Impact of H1N1 on School Facilities: An Outlook for the Future
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Impact of H1N1 on School Facilities: An Outlook for the Future. Daniel LaHart, CIH Environmental Issues Program Manager Operations Division Anne Arundel County Public Schools 410-360-0138 Edward L. Van Oeveren, M.D., M.P.H. Health Officer, Anne Arundel County Department of Health. Outline.

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Daniel lahart cih environmental issues program manager operations division

Impact of H1N1 on School Facilities: An Outlook for the Future

Daniel LaHart, CIH

Environmental Issues Program Manager

Operations Division

Anne Arundel County Public Schools

410-360-0138

Edward L. Van Oeveren, M.D., M.P.H.

Health Officer, Anne Arundel County Department of Health


Daniel lahart cih environmental issues program manager operations division

Outline

  • Novel H1N1 influenza: Background information

  • H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009

  • School response to Novel H1N1 Virus, Fall 2009:

    • Current

    • Contingency plans

  • Potential school design elements to facilitate response to communicable diseases

  • Summary

  • Questions


Novel h1n1 influenza background information

Novel H1N1 influenza: Background information


What is influenza

What is influenza?

A type of virus that causes respiratory infection with systemic S/S

Two types of influenza viruses cause epidemic human disease:

Influenza A: Categorized into subtypes on the basis of 2 surface antigens:

Hemagglutinin

Neuraminidase

Influenza B:

Two distinct genetic lineages: Yamagata and Victoria

Not categorized into subtypes

Seasonal vs. pandemic influenza

Seasonal

Virus changes slightly most years (antigenic drift)

Season usually October through May

~200,000 persons hospitalized

~36,000 deaths

Pandemic

Influenza virus to which most of population lacks immunity

Spread to at least two regions in the world


Daniel lahart cih environmental issues program manager operations division

Novel H1N1 influenza: Background information

H

N


What is h1n1 influenza

What is H1N1 influenza?

Antigenically and genetically distinct from other human influenza A (H1N1) viruses in circulation since 1977

Inappropriately referred to as “swine” flu because the virus is related to influenza viruses that affect pigs.

The most affected group of persons is under age 24 years.

Has spread to all regions of the

globe—pandemic declared

in June 2009.


How is influenza spread seasonal and novel h1n1

How is influenza spread?Seasonal and Novel H1N1

Respiratory droplets from an infectious individual—coughing and sneezing

Can travel up to 3 feet in the air

Contaminates another person close by

Lands on surfaces (fomites), e.g., doorknobs, computer keyboards, faucet handles

Infection begins when the virus is introduced to the nose or mouth (mucous membranes)


How are people affected seasonal and novel h1n1

How are people affected?Seasonal and Novel H1N1

Respiratory illness with systemic signs & symptoms:

Fever (100°F or greater), cough, sore throat

Nasal congestion, muscle aches, headache, chills, fatigue

Diarrhea, vomiting (seen with novel H1N1)

Usually abrupt onset

Typical time to recover is 4 days to one week in healthy people


Risk factors for severe disease

Risk Factors for Severe Disease

Immune system disorders

HIV, transplant, chemotherapy, etc.

Elderly, infants, pregnant women

Other medical problems:

Lung disease

Diabetes

Kidney disease


Treatment of infection seasonal and novel h1n1

Treatment of InfectionSeasonal and Novel H1N1

Rest

Drink plenty of liquids

Avoid drinking alcohol or smoking

Use over-the-counter medications

Labeled “cold and flu” remedies

Not aspirin

In some situations, use antivirals

Oseltamivir (Tamiflu), zanamivir (Relenza)

Prescription medications

Initiate within 48 to 72 hours of first symptoms for optimal effectiveness


Preventing the flu seasonal and novel h1n1

Preventing the flu Seasonal and Novel H1N1

Clean hands often

Soap and water

Alcohol-based hand sanitizers

Cover your cough/sneeze

Use a tissue or your sleeve

Avoid close contact with sick people

Practice healthy behaviors

Don’t smoke, eat a healthy diet, exercise

Use antiviral medication if prescribed


Daniel lahart cih environmental issues program manager operations division

Novel H1N1 influenza: Background information


Preventing the flu influenza vaccine

Preventing the flu Influenza Vaccine


Flu vaccines

Flu Vaccines

Two types

Trivalent inactivated influenza vaccine (TIV) (injectable)

Live, attenuated influenza vaccine (LAIV) (nasal spray)

Safety (known for seasonal vaccine)

Shot: arm soreness, redness, swelling, low grade fever, mild muscle aches, fatigue

Nasal spray: low grade fever, runny nose, headache, sore throat, fatigue

DOES NOT CAUSE THE FLU!!

Timing

Protection takes at least 10 days


Flu vaccines1

Flu Vaccines

Seasonal vaccine

Still important this year

Available now

Novel H1N1 vaccine

First shipments anticipated ~mid-October

Target and priority groups initially

If available, everyone for whom medically appropriate may be vaccinated over the next 6 months

Not mandatory


Who will get the h1n1 vaccine

Who will get the H1N1 vaccine?

Pregnant women

Health care and emergency medical workers

People who live with or care for children <6 months old

Persons 6 months through 24 years

Adults 24 through 64 years with high risk health conditions

Pregnant women

Health care workers with direct patient contact

People who live with or care for children <6 months old

Children 6 months through 4 years

People 5 through 18 years with high risk health conditions

Target Groups

High Priority Groups

CDC. MMWR Early Release. 2009;58 (August 21, 2009).


The good news

The Good News…

Majority of those affected do not require hospitalization and recover without complications.

So far, H1N1 flu appears similar to seasonal flu except for different high-risk groups.

Antivirals still generally effective.

Vaccine is developed, studies ongoing.

Prevention measures work!


What else can you do

What else can you do?

  • Stay home if you or your children are sick!

    • Do not go to work, school or daycare until 24 hours after the fever has resolved

    • Recovery takes 3-5 days for most people

    • Healthcare workers: Stay home for 7 days after symptom onset or until S/S resolve

  • Make a family plan

    • Back-up plans for childcare

    • Look into teleworking with your employer

    • Food & water supplies

  • Be flexible


H1n1 outbreak in anne arundel county public schools spring 2009

H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009


Spring 2009 elementary school 375 students and staff

Spring 2009: Elementary School – 375 students and staff

What occurred

What’s going on simultaneously

Family member ill (flu symptoms)

Recently returned from Mexico

Children exposed @ home

Children come to school

School notified, etc

Health Department directs school system

“Pandemic” flu announced

Media news bites clips focus on people wearing protective masks

H1N1Vaccine not ready yet

Worst is yet to come

Anxiety - probably

Panic – not yet but….


School system response

School System Response

School

With Teachers and Admin.

Facilities

With Custodial Staff

In consultation w/HD who, in turn, are following CDC:

Family children sent home

Meet w/teachers and staff

Explain situation

Advise cleaning protocols

Promote good hygiene in classroom & home

Letter sent home

School will stay open

School custodial staff backed up with extra volunteers to clean & disinfect classroom

Provided training on virus, disinfection cleaning techniques, overview of disinfectant, and MSDS

Provided gloves, masks, rags, spray bottles, pump sprayers

Team cleaning approach

Disinfectant sprayed on

Wipe and rinse


Then what

Then what…..

At school

Facility Management

Parents swamp phone lines

Some kids stay home

Rumors

Many are sick

Another child suspected of H1N1

School to close 5-7 days per H.D.

News helicopters, TV reporters & cameras, etc.

Gear up for full school disinfection; desks, chairs, hallways. Lockers, basically all surfaces, handles, sinks, knobs etc.

TV Crews see inside school to see crews with masks, etc.

National news show same scenario in a NY high school.


Swine flu spreads across d c region

SwineFlu Spreads Across D.C. Region

Washington Post

Washington Post

A federal agent who traveled to Mexico with President Obama this month probably contracted swine flu and infected several members of his family in Anne Arundel County, prompting assurances yesterday from the White House that the President was safe.

Parents and government officials are debating whether to close schools where suspected cases of swine flu have been discovered. What should officials do?

Keep schools open. Schools should be cleaned and sick children kept home, but closings go too far.39%

Close schools. School officials should take every step possible to protect children from the flu.57%

Other solution. Write your answer in the comments below.2%

Total Votes: 2,648


Community parents alarm

Community/parents alarm

  • Folger McKinsey Elementary School in Anne Arundel County has a student that has been tested for the swine flu. The results have not come back yet. School and county officials were on hand for the opening of school Thursday morning.


Parents debate sending children to school as officials urge caution

Parents Debate Sending Children to School as Officials Urge Caution

School

National

The word came so late in the school day yesterday that officials couldn't send a letter to parents, so they resorted to e-mails and phone calls: A student at Folger McKinsey Elementary School in Severna Park was one of six probable cases of swine flu in Maryland.

At a news conference last night, President Obama recommended that schools with suspected cases of swine flu strongly consider closing. But a spokesman for Gov. O'Malley said afterward that Maryland schools would remain open. "At this point it doesn't appear that it's necessary given the probable cases in Maryland," spokesman Shaun Adamec said.


Cdc guidance

CDC Guidance

CDC

School & Health Department

On a national conference call, CDC states that any school with even a single case of H1N1 influenza should close for 5-7 days (possibly as long as 14 days).

In conformity with CDC guidance, School and Health Department close school.


Outcomes

Outcomes

School

Facilities

Reopened in 3-4 days

No outbreak

School returns to routine

Vast expenditure of manpower and equipment

Lots of overtime


Lessons learned from spring 2009

Lessons Learned from Spring 2009

  • Use of Incident Command System (ICS)

  • Consistent, uniform messages from key leaders:

    • Joint Information Center (JIC)

    • Joint Press Conference

    • Manage expectations; pro-actively stress need for flexibility in response to a dynamic situation.

  • Frequent updates in understandable language:

    • Public/parents/children:

      • Phone bank

      • Automated phone call-out system

      • Websites

      • Written materials (letters home, posters in schools)

    • Staff (Schools, Health Department)

  • Collaboration between Schools and Health Department:

    • Planning (Schools/Health Department MOU; exercises)

    • Implementation

    • Communications

(Continued)


Lessons learned from spring 2009 continued

Lessons Learned from Spring 2009(continued)

  • After-action analysis/assessment and follow-up action

  • Needs identified:

    • Formal school-based surveillance system

    • School attendance policies

    • Staff sick leave policies

    • Identification of personnel and equipment shared between schools (e.g., buses and bus drivers, itinerant staff)

    • Identification of, and planning for, “higher-order effects” of closure (e.g., free/subsidized meals, after-school activities, athletics)

    • Tracking costs/expenditures

    • Personal Protective Equipment (supplies, fit testing)

    • Isolation rooms

    • Handwashing stations


School response to novel h1n1 virus fall 2009

School response to Novel H1N1 Virus, Fall 2009


School response to novel h1n1 virus fall 2009 cdc guidance philosophy

School response to Novel H1N1 Virus, Fall 2009: CDC Guidance--Philosophy

Decision to dismiss students should:

Be made locally

Balance the goals of:

Morbidity and mortality from influenza with

Minimizing social disruption and safety risks to children sometimes associated with school dismissal.

Based on the experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students are often outweighed by negative consequences, including:

Students being left home alone

Health workers missing shifts when they must stay home with their children

Students missing meals, and

Interruption of students’ education.

http://pandemicflu.gov/professional/school/


School response to novel h1n1 virus fall 2009 cdc guidance scalable responses

School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses

  • Conditions with similar severity as in Spring 2009:

  • Facilities Issues:

    • Location for screening upon return

    • Instruction (study or teaching)while at home

    • Isolation rooms (students, staff)

    • Staffing

    • Storage of masks (surgical masks for ill; N-95’s for healthcare personnel)

    • Soap & towels, hand sanitizer, tissues:

      • Supplies

      • Locations, dispensers

      • Refill, maintenance, security

      • Waste receptacles

Recommendation:

  • Stay home when sick

  • Separate ill students and staff

  • Hand hygiene and respiratory etiquette

(Continued)


School response to novel h1n1 virus fall 2009 cdc guidance scalable responses1

School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses

  • Conditions with similar severity as in Spring 2009:

  • (continued)

  • Facilities Issues:

    • Supplies & equipment (gloves, masks, pump and hand sprayers)*

    • Staffing

    • Compliance with medication regimen

    • Dispensing and storage of anti-viral Rx’s

    • Co-location of high-risk and

      normal-risk facilities

*American Academy of Pediatrics’ Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition (2009) for guidance on cleaning and sanitizing in schools. (http://aapredbook.aappublications.org/resources/midsheets.dtl)

The EPA provides a list of EPA-registered products effective against flu: http://www.epa.gov/oppad001/influenza-disinfectants.html

Recommendation:

  • Routine cleaning

  • Early treatment of high-risk students and staff

  • Consideration of selective school dismissal


School response to novel h1n1 virus fall 2009 cdc guidance scalable responses2

School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses

  • Conditions of increased severity compared with Spring 2009:

  • Facilities Issues:

    • Location for screening

    • Equipment/supplies (e.g., thermometers)

    • Staffing

    • Identification of high-risk persons:

      • Staff

      • Location

    • Communication with high-risk persons

    • Study/work from home:

      • Equipment, supplies

      • Staff

    • Same as above for affected students

Recommendation:

  • Active screening

  • High-risk students and staff members stay home

  • Students with ill household members stay home

(Continued)


School response to novel h1n1 virus fall 2009 cdc guidance scalable responses3

School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses

  • Conditions of increased severity compared with Spring 2009:

  • (continued)

  • Facilities Issues:

    • Space limitations

    • Scheduling

    • Longer duration of above issues

    • Identification of appropriate schools

    • Impact on co-located facilities (e.g., schools, libraries, recreation centers)

    • Instructional staff facilities & resources

    • Security

Recommendation:

  • Increase distance between people at schools

  • Extend the period for ill persons to stay home

  • School dismissals


Potential school design elements to facilitate response to communicable diseases

Potential School Design Elements to Facilitate Response to Communicable Diseases


Potential school design elements to facilitate response to communicable diseases slide 1 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 1 of 9)

National Clearinghouse for Educational Facilities (National Institute of Building Sciences), Resource List for School-Based Health Facilities--http://www.edfacilities.org/rl/health_centers.cfm

The Center for Health and Health Care in Schools--http://www.healthinschools.org/static/states/MD-guidelines.aspx

http://www.maclearinghouse.com/schoolhealthmanual/PDF/Chapters/Chapter02_D.pdf

  • Generally:

    • Collaboration with School Health staff during design phase

  • Health Room:

    • Location

    • Size

    • Equipment

    • Communications/support systems (intranet, internet, phone, fax)

    • Supplies

    • Storage

    • Staffing


Potential school design elements to facilitate response to communicable diseases slide 2 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 2 of 9)

  • Screening Points:

    • Potential uses:

      • Active screening

      • Return from illness

    • Considerations:

      • Traffic flow

      • Location:

        • Ingress/egress to exterior of building

        • Proximity to:

          • Health Room

          • Isolation facilities

      • Staffing/monitoring

      • Furnishings

      • Equipment

      • Support systems (intranet, internet, telephone, fax)


Potential school design elements to facilitate response to communicable diseases slide 3 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 3 of 9)

  • Isolation capability:

    • “Isolation” vs. “quarantine”

    • Considerations:

      • Capacity

      • Location:

        • Proximity to:

          • Health Room

          • Screening Points

        • Ingress/egress to exterior of building

      • Staffing/monitoring

      • Furnishings

      • Equipment

      • Support systems (intranet, internet, telephone, fax)


Potential school design elements to facilitate response to communicable diseases slide 4 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 4 of 9)

  • Potential for fomite transmission:

    • Factors affecting infection potential

    • Environmental surfaces:

      • Floors

      • Handles/knobs

      • Walls

      • Furnishings (e.g., desks, counters)

      • Equipment (e.g., keyboards [membrane covers?])

      • Considerations:

        • Infection potential

        • Cleanability/potential to disinfect

        • Costs (total lifetime cost):

          • Initial

          • Maintenance

          • Replacement

        • Durability

        • Esthetics

        • Special characteristics (e.g., non-slip flooring)


Potential school design elements to facilitate response to communicable diseases slide 5 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 5 of 9)

  • Hygiene resources/facilities:

    • Rest Rooms:

      • Soap

      • Towels

      • Supply storage

      • Waste/refuse disposal

      • Fomite infection risk:

        • Environmental surfaces

        • Faucet handles

      • Maintenance

    • Hand hygiene:

      • Free-standing hand-washing stations

      • Hand sanitizer stations:

        • Locations

        • Refilling & Maintenance

        • Safety & Security


Potential school design elements to facilitate response to communicable diseases slide 6 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 6 of 9)

  • Environmental Control Systems:

    • Temperature

    • Humidity

    • Particulates (especially allergens)

    • Gases and vapors

    • Air exchange

    • Design easy to change and readily accessible air filters

    • Design for adequate ventilation: Solution to Pollution is Dilution

    • Design schools with systems that require no-touch to operate via sensors

      • Room lighting

      • Drinking fountains

      • Toilets

      • Hand sinks


Potential school design elements to facilitate response to communicable diseases slide 7 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 7 of 9 )

  • Storage:

    • Cleaning & maintenance supplies (e.g., disinfectant)

    • Equipment (e.g., sprayers)

    • Health Room:

      • Equipment

      • Supplies (e.g., masks, gloves, thermometer covers)

      • Refrigerated storage:

        • Capacity

        • Temperature Tolerance

45


Potential school design elements to facilitate response to communicable diseases slide 8 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 8 of 9)

  • Alternate uses of facility:

Facilities issues:

  • Location/Proximity to “index”

    facility

  • Ingress/Egress

  • Building systems (HVAC, electrical, IT)

  • Location/Proximity to Population

  • Ingress/Egress

  • Traffic Flow

  • Building systems (HVAC, electrical, IT)

  • Storage (e.g., refrigeration)

  • Same

Use:

  • Alternate Care Site (e.g., for local hospital during disaster)

  • Mass immunization site

  • Point-of-distribution (POD) for medications


Potential school design elements to facilitate response to communicable diseases slide 9 of 9

Potential School Design Elements to Facilitate Response to Communicable Diseases(Slide 9 of 9)

  • Co-located facilities:

    • Examples:

      • Other schools (e.g., pod of high school, middle school, and elementary school)

      • Library

      • Recreation/Community/Social Center

    • Potential issues:

      • Infection/cross-contamination (directly, or by shared/common population)

      • Facility closure (does closure of one necessitate closure of all)

      • Futility of selective/partial closure

      • Shared infrastructure/building systems:

        • Possible or cost-effective to partially shut down)

        • Effects on health risks/environmental control/comfort (e.g., HVAC)


Summary

Summary

  • Novel H1N1 influenza:

    • Information relevant to educational facility planners

  • H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009:

    • Lessons learned

  • School response to Novel H1N1 Virus, Fall 2009:

    • Current

    • Contingency plans

  • Potential school design elements to facilitate response to communicable diseases


Questions

Questions?


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