Hurricane Ike

1. Hurricane Ike Virginia Kennedy, RN, MS, CIC Infection Prevention & Management Associates

3. Pre-event

4. Pre-event Communication to receiving facility regarding isolation patients Plans for sterile supplies Temperature and humidity issues Transportation of sets and supplies CSPD OR Cardiac lab Labor and Delivery Facility Expectations of Infection Prevention Communications

5. Pre-event From All Nurses…. Going to the lock down at the hospital I had all my essentials: air mattress & pump, battery operated tv (although after Feb it won't work anymore), toiletries, enough clothes and scrubs for three days

6. Pre-event Facility expectations A team to be present in facility for event B team to provide immediate relief or C team for clean up and recovery Communications Cell phone – numbers, chargers, hand crank charges Text messaging

7. Pre-event Know facility water source City Dependent on electric pump? Well Meets potable water standards? Pump? Determine if water will need to be tested Have contract service on standby Alternative source Implications for ice machines

8. Pre-event Water supplies Drinking/cooking Toileting (fill bathtubs) Hand hygiene EVS additional supplies Linen Sharps containers Ensure supplies for isolation Gowns Gloves

9. Pre-event Sterile supplies Storage in controlled temperature/humidity Instrument processing Additional high level disinfectant? Sufficient disposable sterile supplies Contract for dehumidifiers and wet vacs Contract construction workers on hand to build emergency containments Establish childcare and pet care guidelines Vaccine storage (occupational health) General work areas should have a temperature controlled between 68?F and 73?F (20?C and 23?C).  The decontamination area should have a temperature controlled between 60?F and 65?F (16?C and 18?C).  The temperature in sterilization equipment access rooms should be controlled between 75?F and 85?F (24?C and 29?C) or as recommended by the equipment manufacturer.  The temperature in sterile storage and personnel support areas (e.g., toilets, showers, locker rooms) may be as high as 75?F (24?C). Independent monitors should be located in each of the areas where temperature should be controlled; temperature should be recorded daily.  Processing personnel in each work area are responsible for monitoring and recording the temperature to ensure that the correct temperature is being achieved.General work areas should have a temperature controlled between 68?F and 73?F (20?C and 23?C).  The decontamination area should have a temperature controlled between 60?F and 65?F (16?C and 18?C).  The temperature in sterilization equipment access rooms should be controlled between 75?F and 85?F (24?C and 29?C) or as recommended by the equipment manufacturer.  The temperature in sterile storage and personnel support areas (e.g., toilets, showers, locker rooms) may be as high as 75?F (24?C). Independent monitors should be located in each of the areas where temperature should be controlled; temperature should be recorded daily.  Processing personnel in each work area are responsible for monitoring and recording the temperature to ensure that the correct temperature is being achieved.

11. During Observe floors for condensation (slippery) Round on bathroom facilities (for families and others) to ensure cleanliness Observe for floods and damage (ceiling/windows etc) Complete all risk assessments for containment Potentially implement alternative high level disinfection Review food preparation

13. After 30 inches of water in the building after Ike struck ………. Sept. 13.

14. Water damage Inventory all water damaged areas, building materials and furnishings. Special attention should be given to identify carpet under cabinets, furnishings Use moisture meter to identify extent of water damage to drywall Cut 12 inches above Remove wet walls and insulation within 24 hours If >24 hours, or previous water damage has caused microbial/fungal growth Extensive controls Ceiling tiles Remove wet tiles within 24-48 hours

15. Major storms or other natural disasters sometimes cause major outages - affecting a large number of customers over an extended period of time.

16. After Boil water ban Alternative sources Have testing completed asap Ice machines Sterilizers Steris 1 Conflicting statements given to various hospitals Issues with water Sterile supplies When operating rooms would be opened Key learning: Infection Preventionists should be part of decision making group

17. After-CSPD Autoclaves inspected, cleaned and re-commissioned? Does steam system meet AAMI standards? Sterile supplies compromised? Reprocessed Replaced Steris I filter replaced?

18. After - Laboratory Emergency power available ? Has essential equipment, including biological safety cabinents, been inspected, cleaned and disinfected? Have damaged or contaminated reagents and supplies been replaced?

19. After – Operating Room Any damage to sealed flooring and ceilings? Do sterile supplies need reprocessing? Autoclaves inspected? Have System 1 machines had a couple of loads run (if under boil water order) then filler changed before running BI loads? Evaluation for electrical hazards? Scrub sinks functioning properly? Enough air exchanges per hour? Particle counts or cultures been performed and results acceptable? Air filters changed?

20. After-Pharmacy Have damaged or contaminated meds/solutions been replaced? Refrigerators at proper temperature? Clean and disinfected? Had admixture room hood been recertified and filters changed? Has the medication compounding area been thoroughly disinfected?

21. After – Food Service Has stored food been inspected for damage and discarded if unsafe? Ice-machines and refrigerators cleaned and sanitized? All food contact surfaces cleaned and sanitized? Pest control systems been restored? Does Health department need to inspect?

22. After- All Patient Care Porous furniture and mattresses that were wet been discarded? Linens laundered? All patient care surfaces cleaned and disinfected? Medications and supplies that were damaged or contaminated discarded? Ice machines flushed, cleaned and disinfected?

23. Patient Education

24. Critical Resources CDC Natural Disasters Remediation and Infection Control Considerations for Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage Disaster Safety – Patient Education AAMI ST79 University of Minnesota Fungal abatement HVAC System Decontamination Managing Water Infiltration APIC

25. Chance favors only the prepared  Louis Pasteur