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What to Do. Part 10 of 13 Comments and contributions are encouraged: please e-mail DRcomments@hpa.org.uk. HPA Centre for Infections. Reviewed April 2009. If faced with suspect cases……. Seek expert advice as soon as possible!. Overt Release .

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what to do

What to Do

Part 10 of 13

Comments and contributions are encouraged:

please e-mail DRcomments@hpa.org.uk

HPA Centre for Infections

Reviewed April 2009

if faced with suspect cases
If faced with suspect cases……
  • Seek expert advice as soon as possible!
overt release
Overt Release
  • Guidance re-issued August 2002 (first issued March 2000)
      • Police lead
      • Chief Constable advised by Joint Health Advisory Cell
      • Cabinet Office will coordinate centrally
      • Agent-specific information
  • Report threats/ suspicion
  • Available on DH website
suspect packages and materials biological chemical threats by post
Suspect Packages and MaterialsBiological / Chemical threats by post
  • General handling of mail and identification of suspect material
      • Open all mail with a letter opener or other method that is least likely to disturb contents, and with minimum of movement
      • Do not blow into envelopes
      • Do not shake or pour out contents
      • Keep hands away from nose and mouth while opening mail
      • Wash hands after handling mail
suspect packages and materials types of letters and packages
Suspect Packages and MaterialsTypes of letters and packages
  • Those with suspicious/ threatening messages
  • Letters with oily stains
  • Envelopes that are lopsided, rigid, bulky, discoloured, have an obvious strange odour or feel like they contain powder
  • No postage stamp, no franking, no cancelling of the postage stamp
  • Improper spelling of common names, places or titles
  • Hand written envelopes/packages from an unknown source particularly if addressed to an individual and marked personal or addressee only
suspect packages and materials what to do
Suspect Packages and MaterialsWhat to do
  • Do not open
  • If already opened, do not touch or clean up
  • Keep exposed persons separate from other staff
  • CALL POLICE - they are responsible for the risk assessment
  • If credible:
        • define potentially exposed persons
        • decontamination by emergency services
        • chemoprophylaxis may be required, depending on nature of suspect material
suspect packages and materials further information
Suspect Packages and MaterialsFurther information
  • The updated guidance document is available from:
  • http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1194947391200
  • Health and Safety Executive guidance 2001 is available from:
  • http://www.ukresilience.info/package.htm
protection of healthcare workers prophylaxis
Protection of healthcare workersProphylaxis
  • Bacterial infection:
      • Anthrax
      • Plague (pneumonic)
      • Tularemia
      • Brucellosis
      • Glanders/melioidosis
      • Q fever
      • Enteric organisms
  • Antibiotic:
  • Antibiotics and Particulate Facemasks
  • Cipro - for 7 days after last known “exposure”
  • None required
  • None required
  • None required
  • None required
  • None required
protection of healthcare workers prophylaxis if dealing with infected cases
Viral infection:





Protection of healthcare workersProphylaxis if dealing with infected cases
  • “Prophylaxis”:
  • Vaccinate within 2 (- 4) days all hospital employees
  • None
  • None required
protection of healthcare workers patient isolation precautions
Protection of healthcare workersPatient isolation/ precautions

Pneumonic Plague

  • Side room required if few patients, or cohort nurse
    • possibly whole ward(s)
    • isolate for first 72 hr treatment
  • Standard precautions
    • gloves, gowns, hand-washing
  • Respiratory precautions
    • particulate face masks (highest efficiency available), eye protection
protection of healthcare workers patient isolation precautions1
Protection of healthcare workersPatient Isolation/ precautions
  • Anthrax
      • Side room NOT required
      • Standard precautions
        • gloves
        • plastic aprons
        • hand-washing (especially for skin lesions)
protection of healthcare workers patient isolation precautions2
Protection of healthcare workersPatient Isolation/ precautions
  • Tularemia, Glanders, Q Fever, Melioidosis, Brucellosis
  • Generally side room NOT required (except for Tularemia)
  • Standard precautions
    • gloves
    • gowns
    • hand-washing (especially for skin lesions)
    • wearing of face masks in case of Tularemia
protection of healthcare workers patient isolation precautions3
Protection of healthcare workersPatient Isolation / precautions
  • Botulism
      • Isolation NOT required
      • Hand-washing
protection of healthcare workers patient isolation precautions4
Protection of healthcare workersPatient Isolation/ precautions
  • Smallpox and VHF
      • Strict isolation in Designated Centre
      • Otherwise
        • Side room ESSENTIAL(negative pressure ventilation)
        • Standard precautions(gloves, fluid repellent gowns, eye protection and hand-washing)
        • Respiratory precautions(high-efficiency FFP3 face masks)
protection of healthcare workers investigations
Protection of healthcare workersInvestigations
  • Keep to minimum necessary
    • especially after initial patients diagnosed
  • Individual packaging
    • High risk labels
  • Do not use vacuum-tube system
    • Transport by hand, in sealable container
  • Keep lab staff informed
concern about deliberate release hysteria 1
Concern about deliberate release – hysteria [1]
  • Definition
      • Symptoms occurring among a group of persons with shared beliefs regarding those symptoms
      • Suggestive of organic illness but no identifiable environmental cause and little clinical or laboratory evidence of illness
      • Essentially a diagnosis of exclusion but prompt identification of the outbreak is important to limit cases
concern about deliberate release hysteria 2
Concern about deliberate release – hysteria [2]
  • Symptoms

The range of symptoms is wide and inconsistent:

      • Commonly includes nausea, vomiting and/or dizziness
      • Relapses can occur in the same person over multiple days of theoutbreak
      • Occurs in adolescents or children, groups under stress and females disproportionately more than males
how real is the threat
How real is the threat?
  • Who knows?
  • No current ‘credible threat’ to UK
  • Public/ media response in US compared to number of cases
  • Large scale release technically very difficult
what to do with possible cases 1
What to do with possible cases [1]
  • Contact CCDC, microbiologist, infectious diseases consultant, HPA CfI for advice
  • Investigations
      • Culture blood, sputum, skin lesions, nose swabs etc
      • Acute serum
      • Label as ‘Infection risk’
      • ‘Chain of evidence’
      • Do not use vacuum tube system
what to do with possible cases 2
What to do with possible cases[2]
  • Consider empirical addition of fluoroquinolone to standard regimens
  • Nurse in standard isolation
  • Minimise contacts and maintain list
are you we ready
Are you (we) ready?
  • Awareness
  • Surveillance
  • Planning
    • Stockpiles e.g. antibiotics
    • Training
    • Protective equipment
    • Vaccination
  • “Don’t panic?”
  • Coping with victims
preparedness 1
Preparedness [1]
  • Be aware (risks low)
  • Review CMO letters and HPA CfI website regularly
  • Discuss planning with local colleagues
  • Keep list of key numbers to call if concerned including people to inform if event – ensure is up to date
  • Think laterally
preparedness 2
Preparedness [2]
  • Avoid overuse of antibiotics, vaccines, gas masks, survival gear
  • Involve public health early, develop and use standard protocols
  • Be aware of local incidents plans, relevant emergency planning documents etc
  • Best to get to know key players in your area before any possible event