Pandemic Preparedness -Risk assessment and infection control in health care settings-

1. Pandemic Preparedness -Risk assessment and infection control in health care settings- Elisaveta Stikova, Ronald LaPorte, Faina Linkov, Margaret Potter, David Piposzar, Sam Stebbins

2. Learning objectives • To introduce student with five components of pandemic preparedness and response and whole society approach • To enlighten the differences between WHO’s 2005 and 2008 pandemic phases • To add more information about risk assessment, use of risk assessment matrix and risk classification of the • workers • To bring forward to the development of the one peak-week scenarios for needs assessment • To set up hierarchy of control measures for workers’ protection during the pandemic

3. SEE Public Health Preparedness Supercourse Network Elisaveta Stikova • Present position • 1991-Present, Professor, University “Ss. Cyril and Methodius”, Medical faculty, Skopje, Macedonia (courses taught: Occupational Health, Public Health, Medical Ecology, Hygiene • 1994 – Present, Director and Advisor, National Public Health Institute, Skopje, Macedonia • 2009 – Fulbright Visiting Scholar, Pittsburg University, Graduate School of Public Health – New Educational Pathway for Global Public Heath Security

4. SEE Public Health Preparedness Supercourse Network Co-Authors and collaborators: • Ronald E. LaPorte, PhD, UPGSPH, Director, Disease Monitoring and Telecommunication, WHO Collaborating Center • Faina Linkov, PhD, Assistant Professor, Cancer Institute • Margaret Potter, JD, MS, Associate Dean and Director, UPGSPH, Center for Public Health Practice • David Piposzar, MPH, UPGSPH, PPLI Co-director • Sam Stebbins, MD, MPH, UPCPHP Principal Investigator/Director, Center for Public Health Preparedness

5. What is pandemic ? • Public health emergency that rapidly takes on significant political, social an economic dimension • Influenza Pandemic would be: • extended event • multiple waves (2-3) • each waves will last • 6-8 weeks

6. Five components of pandemic preparedness and response • Planning and coordination • Communication • Situation monitoring and risk assessment (likelihood and severity) • Reducing the spread – infection control • Striving to ensure continuity of health care provision and businesses

7. A whole of society approach to pandemic preparedness and response WHOLE OF SOCIETY INDIVIDUALS FAMILIES AND COMMUNITIES HEALTH SECTOR NON HEALTH SECTOR • Provide leadership and guidance • Take actions to reduce health consequences • Raise awareness about risk and potential consequences. • Develop guidance and implement actions needed to minimize the effects of a pandemic on non health sectors. • Take actions needed to minimize the effects of a pandemic on families and individuals PLANNING AND COORDINATION COMMUNICATION

8. WHO Guidance, core documents Supporting Technical Documents Disease Control Measures For Pandemic Influenza Outbreak Communicat ions Global Pandemic Influenza Surveillance Laboratory Preparedness For Pandemic Influenza Surge Capacity in Health Care Facilities Non- Health Sector Preparedness Tools Self- Assessment Checklist for Preparedness Planning and Executing a Preparedness Exercise Training CD-ROMs For Trainers Rapid Containment Training Package Handbook For the Public Sample Preparedness Plans

10. Comparison of the 2005 and 2008 WHO pandemic phases 2005 Phases 2008 Phases Structure & Pandemic Disease “Risk” Structure & Pandemic Disease “Risk” Geographic spread Pandemic Predominantly animal Post Pandemic Infections; 5 - 6 Phase 6 Limited Peak Alert transmissibility Post Inter pandemic Post among people Sustained 4 Phases 3-5 Pandemic Pandem H-2-H Period transmission 1 - 3 Phases 1-2 Time Time

11. Risk assessment The risk assessment analyzes: • Threat (probability of occurrence) • Consequences of the occurrence • Vulnerability

12. Risk analysis circles RISK RISK ASSESSMENT MANAGEMENT Dose n o assessment Decision control i t a z i k r s e i Hazard t R c a Acceptable risk identification r a level definition h c Exposure Mitigation assessment measures Feedback RISK COMMUNICATION

13. Risk assessment The risk assessment process involves the following tasks: ❍ Preparing the risk assessment matrices ❍ Determining the risk ratings ❍ Prioritizing observations

14. Likelihood and severity of damage, 3x3 matrix S e v e r t y Likelihood

15. Classifying workers exposure to pandemic influenza at work Occupational Risk Pyramid

16. Critical infrastructure and key resources workers

17. First line responders • Health care workers with direct patient contacts • Workers engaged in health care supporting services • Public health emergency respond workers • Public safety workers (police, firefighters, dispatchers…) • Utility service workers • Transportation workers • Mortuary services’ workers

18. Very high exposure risk occupations • Healthcare workers performing aerosol-generating procedures on known or suspected pandemic patients • Healthcare or laboratory personnel collecting or handling specimens from known or suspected pandemic patients

19. High exposure risk • Health care delivery and support staff exposed to known or suspected pandemic patients • Medical transport of known or suspected pandemic patients in enclosed vehicles • Performing autopsies on known or suspected pandemic patients

20. Medium exposure risk • Workers with high-frequency contact with the general population

21. Lower exposure risk (caution) • Workers who have minimal occupational contacts with general public and other co-workers

22. What an influenza pandemic might look like

23. One waves – peak week scenario severity and extend

24. How pandemic influenza could affect our business? • Absenteeism • Change in patterns of commerce • Interruption of supply/delivery

25. Key responsibilities of every organization • Estimate the level of staff absence • Estimate potential impact on its own activities • Estimate potential impact of its resources to the community

26. Impact on the workforce • Up to 50% of the workforce may require time off at some stage over the entire period of the pandemic • 15% and 20% of staff may be absent during the peak lasting • Up to 30–35% absenteeism for small organisations/units/teams (5 to 15 staff) • 5–6% of staff could be absent as a result of school closures or other restriction

27. Protection in an occupational settingemployers duty: • Provide safe place of work • Require to maintain safe working systems • Implement protective measures based on local risk assessments • Implement appropriate infection control measures • Provide physical barriers o stop transmission • Working procedure adjust to needed social distances • Enhance cleaning regime • Provide appropriate PPE

28. Business continuity plan-BCP • Plan for the impact of a pandemic on business • Plan for the impact of a pandemic on employees and customers • Establishment of appropriate working policies during a pandemic • Allocation of resources to protect employees and customers during a pandemic • Communication to and educate employees • Coordination with external organizations

29. How to reduce the risk of workplace exposure during pandemic influenza “Hierarchy of controls” – workplace risk assessment matrix • Work Practice and Engineering Control • Administrative Controls • Personal Protective Equipment (PPE) • Vaccination

30. Infection control precautions - Key points • Standard infection control • Hand hygiene among staff and patients • Droplet precautions • Respiratory hygiene - managing coughing and sneezing • Use of PPE proportionately to the risk • Placement of patients within the facility • Single room • “Cochorted” patients (epidemiological and clinical data) • Duration of isolation precautions • Vaccination

31. Infection control - Supplementary guidance • Primary health care clinics • General practice premises • Primary care teams making home visits • Allied health professionals (AHP) • Transfer and transport of patients • Centres for mental health • Elderly people care • Dental practices

32. Infection control - Supplementary guidance Guidance for non-healthcare settings and personnel, including: • Prisons • Fire and rescue service • Police service • Universities and schools • Funeral workers

33. General practices – Infection control • Key points • non-essential clinics should be cancelled • staff should be allocated to either influenza or non-influenza patients • a separate waiting area should be set aside for influenza patients • hand hygiene facilities and paper tissues should be made available • the environment should be cleaned frequently with neutral detergent • Organisation of work flow and appointments • Telephone triage • Segregation

34. Checklist for pandemic infection control in GP practices(1) • Layout and configuration of the practice • separate waiting areas for influenza and non-influenza patients. • designate particular clinical rooms or doctors’ offices for * influenza patients * non-influenza patients • remove extraneous items (toys, soft furnishings, magazines) from waiting areas. • mortuary issues • Organisation of work flow and appointments • telephone triage • entry points procedure

35. Checklist for pandemic infection control in GP practices(2) • Staffing • assign GPs for influenza or non-influenza patients • Infection control • Availability of hand hygiene facilities for staff and patients (sinks, soap, alcohol hand rub, paper towels) • Personal protective equipment • supplies of PPE appropriate for needs • perform risk assessment for aerosol-generating procedure

36. Checklist for pandemic infection control in GP practices(3) • Education and training • Provide training in pandemic influenza infection control procedures • Tested FFP3 and training for proper use • Record keeping • Track and document staff sickness and absence • Track and document staff assignments • Patient information • Display posters • provide information sheets, pamphlets…

37. Personal protective equipment

38. Vaccine Priority Group Recommendation

39. Checklist for pandemic infection control in GP practices Environmental infection control: • Clinical and non-clinical waste • Linen and laundry • Staff uniforms • Environmental cleaning and disinfection • Patient care equipment • Furnishings

40. Pandemic Business Continuity of Operations Planning BCOP-Essential • Preparedness 2. Response 3. Recovery BCOP-E Planning

41. Business continuity plan-BCP

42. KEY ACTIVITIES • PLANNING • TRAINING AND EDUCATION