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Pandemic Influenza Planning for the Long-Term Healthcare Workplace. Georgia Tech OSHA Consultation Program GHCA Annual Convention June 2008 Information Provided under OSHA Susan Harwood Grant #SH-16620-07-60-F-13. Agenda Day 1. Definitions Transmission Projections Break

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pandemic influenza planning for the long term healthcare workplace

Pandemic Influenza Planning for the Long-Term Healthcare Workplace

Georgia Tech OSHA Consultation Program

GHCA Annual Convention

June 2008

Information Provided under OSHA Susan Harwood Grant


agenda day 1
Agenda Day 1
  • Definitions
  • Transmission
  • Projections
  • Break
  • Current Status
  • Surveillance Principles; ICS & NIMS
  • Introduction to Exposure Reduction
  • Part A Workshop and Homework
agenda day 2
Agenda Day 2
  • Exposure Reduction (continued)
    • Personal Protective Equipment
    • Respiratory Protection
  • Break
  • Development/Implementation of Business Continuity and Preparedness Plan
  • Part B Workshop and Game
seasonal influenza symptoms
Seasonal Influenza Symptoms
  • Fever (usually high) and chills
  • Body aches
  • Sore throat
  • Non-productive cough (dry)
  • Runny or stuffy nose
  • Headache
  • Extremely tired (fatigue)
  • Diarrhea


1-4 days (exposure to onset); average = 2 days


1 day before to 5 days after symptomatic illness

Recovery: 3-7 days

avian influenza
Avian Influenza
  • Birds (wild and domestic poultry) are natural reservoirs of all influenza A viruses
  • Rarely infect humans
  • Flu types can be either be of low or high pathogenicity (ability to cause disease)
  • Low pathogenic strains: wild domestic transmission; can mutate
  • Highly pathogenic strain: high bird death rate (example H5N1 virus) with rapid spread among domesticated fowl. Bird to human transmission possible.
shifting from avian flu to pandemic flu
Shifting from Avian Flu to Pandemic Flu
  • Expecting H5N1 (or a similar virus) to give rise to next Human flu pandemic
  • When the avian flu virus changes its genetic structure so that it is capable of infecting humans


  • It can be easily spread from human to human:

Pandemic Influenza occurs

pandemic influenza
Pandemic Influenza
  • A disease outbreak that spreads rapidly and affects many people world wide.
  • Characteristics
    • New virus that spreads easily as most people are susceptible (no natural resistance or immunity)
    • Effective human to human transmission is necessary
    • Measured by how fast the virus spreads
    • Wide geographic spread
  • Not predictable
  • Outbreaks lasting 8-12 weeks with 1-3 week wave cycles
pandemic influenza anticipated illness
Pandemic Influenza Anticipated Illness
  • A severe form of seasonal flu symptoms
  • H5N1 cases in Asia reported seasonal flu symptoms with LOWER respiratory infection (rather than traditional UPPER respiratory infections)
  • Shortness of breath, viral pneumonia, abdominal pain, diarrhea, and vomiting in higher prevalence than seasonal flu

Photo credit: A. Davidhazy 2002

pandemic influenza transmission
Pandemic Influenza Transmission
  • Not yet known which of three routes of transmission will be MOST important
  • Possibilities
    • Droplet (large droplets produced during coughs and sneezes) (eg seasonal flu)
    • Airborne (very small infectious particles able to travel long range distances) (eg TB)
    • Contact (hand to mouth and/or nose contact; contact with contaminated surfaces)
projections what lies ahead
Projections: What Lies Ahead
  • What are the projected numbers?
  • What is the projected magnitude of impact?
  • What to expect?
impact of pandemic flu united states







90 million (30%)

90 million (30%)

Outpatient medical care

45 million (50%)

45 million (50%)





ICU care



Mechanical ventilation






Impact of Pandemic FluUnited States


what s this mean for georgia
What’s this mean for Georgia?
  • How many licensed hospital beds in Georgia?
    • 23,000
  • How many of those beds are staffed?
    • 16,000
  • How many people are anticipated to be sick in Georgia?
    • 3 million
  • How many of those sick will need hospitalization?
    • 60,000 to 330,000
  • How many of those hospitalized will need ventilators?
    • 4500 to 24,750
  • How many ventilators do we have in Georgia?
    • 1500

Who is operating these ventilators and performing the work when 40-60% of the workforce is absent?

pandemic waves
Pandemic Waves
  • Pandemics occur in multiple waves of disease outbreaks
  • The first wave in a local area is likely to last six to eight weeks
  • The time between pandemic waves varies and can not be easily predicted.
  • Anticipate 1-3 waves
what to expect
What to Expect
  • Crisis for extended period of time in multiple locations
  • Daily routines will be affected from personal, community, and professional changes
    • Isolation/quarantine guidelines or requirements?
    • Cancellation of public events and schools?
    • Non-essential work activities limited?
    • Commerce Patterns changed?
  • Elements of personal action will be required
  • Absenteeism from pandemic flu expected to be 40-60%
  • Lost availability for those who are ill (or caring for ill family) is projected at 2-4 weeks
impact on the health care system
Impact on the Health Care System
  • Extreme staffing shortages
  • Shortages of beds, facility space, key supplies (ventilators, drugs)
  • Hospital morgues, Medical Examiner and mortuary services will be overwhelmed
  • Extreme demands on social and counseling services
  • Long-term: demand will outpace supply
specific risks to long term health care community
Specific Risks to Long-Term Health Care Community
  • Potentially already immune-compromised
  • Living in close proximity
  • Visitors from outside
  • Surfaces
  • Activities
  • Employees
is a vaccine available
Is a Vaccine Available?
  • A vaccine to protect people from pandemic flu is not available now.
  • A vaccine may not be available at the start of a flu pandemic (~ 6-8 months after start)
  • The best protection is to practice healthy hygiene to stay well now and during a flu pandemic.
current status
Current Status
  • Where are we now?
  • What preparation has been done so far?
    • Federal level
    • State level
  • What available tools do we need to understand to prepare better at the local level?
is there a pandemic now
Is there a Pandemic now?
  • As of 3 January 2008:
    • Reported to World Health Organization (WHO); cumulative total confirmed human cases of Avian Influenza A H5N1 virus:
      • 348 cases
      • 216 deaths
  • No sustained human to human transmission identified

= currently NO pandemic

risk classification structure
Risk Classification Structure

Who’s Who:

World Health Organization (Phases 1-6)

US Government (Stages 1-5)

Centers for Disease Controland Prevention —

CDC (Categories)

OSHA Risk Pyramid

what is surveillance
What is surveillance?
  • Ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.



Health CareProviders




Information Loop of Public Health Surveillance

Source: Denise Koo, MD, MPHEpidemiology Program Office, Centers for Disease Control and Prevention

pandemic influenza surveillance responsibility at all levels
Pandemic Influenza SurveillanceResponsibility at all levels:
  • Globally- World Health Organization
    • WHO Global Influenza Surveillance Network
      • National Influenza Centres (NICs)
      • WHO Collaborating Centres (WHO CCs)
  • Nationally- Health and Human Services
    • National Influenza Surveillance System
    • Influenza Surveillance coordinators
  • State and Local governments
    • Support national and global surveillance systems
surveillance recommendations for interpandemic and pandemic alert periods
Surveillance Recommendations for Interpandemic and Pandemic Alert Periods
  • State and local responsibilities:
    • Continue to employ state influenza surveillance coordinators to oversee improvements in influenza surveillance
    • Conduct influenza surveillance year round, where possible.
    • Implement enhanced surveillance for detection of the first U.S. cases of novel virus infection.
  • State and large local public health laboratory responsibilities:
    • Isolate and subtype influenza viruses year round.
    • Improve capacity for rapid identification of unusual influenza strains
recommendations for the pandemic period
Recommendations for the Pandemic Period

If an influenza pandemic begins in the United States or another country:

  • State and local responsibilities:
    • Implement enhanced surveillance for detection of the first cases.
    • Enhance all influenza surveillance components (virologic, outpatient, hospitalization, and mortality).
    • Communicate to all partners the heightened need for timely and complete surveillance data.
  • HHS responsibilities:
    • Provide technical support, as requested, to ministries of health and WHO to track the pandemic virus and gather epidemiologic data on risk factors for infection or severe illness.
    • Issue updated case definitions and guidance for laboratory testing and enhanced surveillance.
    • Assist state and local health departments, as requested.
    • Analyze influenza surveillance data on a regular and timely basis.

For more information:

osha surveillance recommendations for healthcare providers
Keep records of and monitor:

Who cares for sick patients

Which employees

Show signs of disease

Become ill



Encourage self-reporting of symptoms by employees

Educate employees about transmission

Perform Serologic testing on employees, where possible

Prioritize employees with serologic evidence of pandemic flu for care of patients

Remove employees with increased risk of complications due to pandemic flu

OSHA Surveillance Recommendations for Healthcare Providers
incident command health care workers
Incident Command &Health Care Workers
  • When pandemic flu arrives & starts to manifest itself, many original discoverers of infected & seriously ill people will be public safety first responders
  • Public safety, especially fire & EMT services, work within Incident Command System (ICS) that utilizes standardized terminology & concepts in order to efficiently & safely address emergencies and other kinds of incidents
incident command health care workers1
Incident Command &Health Care Workers
  • During a pandemic, private HCWs will not be able to work in a vacuum by themselves
    • Will have to coordinate & interface with public safety
    • Will have to understand the language & be able to work within the ICS
  • Private entities have compliance responsibilities under National Incident Management System (NIMS)
Through the use of NIMS/ICS, all types of response activities, to include in-house management of infected people, will be more efficient and ultimately safer for all involved
national incident management system nims and incident command system ics
National Incident Management System (NIMS) and Incident Command System (ICS)
  • Incident Command System (ICS)
    • Public safety, especially fire & EMT services
    • utilizes standardized terminology & concepts in order to efficiently & safely address emergencies and other kinds of incidents
  • National Incident Management System (NIMS)
    • Private entities have compliance responsibilities under
    • NIMS is mandated for adoption across all spectra of response organizations
      • public & private;
      • government;
      • non-governmental organizations;
      • and private businesses
hhs cdc plan
HHS & CDC Plan
  • GOAL: Slow the spread to reduce incidence of illness and death
  • Hospitals/Healthcare System Overloaded
  • Use social distancing, targeted antiviral treatment, isolation and quarantine to buy time to increase:
    • Antiviral supply
    • Vaccine availability





hierarchy of controls
Source Substitution

Source Reduction



Personal Protection

Avoid the need

Reduce the need

Reduce exposure

Dilute and Divert

Personal barriers

Hierarchy of Controls


tiered readiness approach
Tiered Readiness Approach
  • Personal Readiness
  • Family and Community Readiness
  • Workplace Readiness


  • Example: Personal Readiness – planning now to care for yourself or loved ones who get the flu = better equipped to respond in Workplace Readiness
  • Example: encourage employees to obtain a seasonal flu vaccine (as normal flu will probably continue to circulate).

Multiple Level Impact requires Multiple Level Planning

variable guidance depending on risk classification level
Variable Guidance Depending on Risk Classification Level
  • Lower Exposure Risk
  • Medium Exposure Risk
  • High Exposure Risk
  • OSHA Guidance on Preparing Workplaces for an Influenza Pandemic (OSHA 3327-02N 2007)

Expect majority of American workforce will be in these 2 categories


Healthcare employees performing aerosol-generating procedures on known or suspected patients

Healthcare delivery & support staff entering known or suspected patient rooms

stratifying risk how likely will i be infected
Stratifying Risk: How Likely Will I Be Infected?

In Healthcare settings:

++++ Aerosol generating procedures performed on influenza patients

++++ Resuscitation of a patient with influenza

(i.e., emergency intubation, CPR, etc.)

++/+++ Direct patient care for a symptomatic (ill) patient suspected to have influenza

++ Direct routine patient care for all other patients

++ Home care for a family member ill with influenza

++ Non-patient-care activities in a healthcare setting

workplace readiness
Workplace Readiness
  • Surface Cleaning, Facility Hygiene and other Environmental Measures
  • Cough Etiquette
  • Hand Hygiene
  • Social Distancing
    • Limiting Face-to-Face Meetings
    • Employee and/or visitor screening
  • Personal Barriers
  • Contingency Planning/Business Continuity
potential for contact transmission and surface cleaning
Influenza virus can survive on surfaces at room temperature and moderate humidity:

Steel and plastic: 24-48 hours

Cloth and tissues: 8-12 hours

Surfaces can include items such as:




Computer keyboards and Telephone handsets

Cloth, tissues, paper or currency infected with the virus

Faucets, toilet flushers

Potential for Contact Transmission and Surface Cleaning
potential for contact transmission
Potential for Contact Transmission

Effectively inactivated by:

  • Detergents
  • Alcohol-based products (hand gels)
  • Bleach solutions
  • Household disinfectants (virucides)
facility hygiene

Facility Hygiene

Practices and Policies

facility hygiene supplies and equipment
Dishes and Eating Utensils Handled by Pandemic Influenza Patients

Wear gloves

Wash reusable items in dishwater

Consult local health codes for water temperature

Disposable dishes and utensils may be discarded in general waste

Linens and Laundry potentially contaminated with pandemic influenza

Wear gloves

Place linens in laundry bag

Contain bag to prevent opening during transport

Do not shake or handle linen or laundry to promote disease transmission

Wash and dry in accordance with infection control standards

Facility Hygiene: Supplies and Equipment

***Always practice hand hygiene after removal of gloves***

facility hygiene patient care equipment
Facility Hygiene: Patient Care Equipment
  • Standard practices for handling and reprocessing used patient care equipment, including medical devices, should be followed:
    • Wear gloves
    • Wipe heavily soiled equipment with registered disinfectant before removal from patients room
      • Clean, disinfect, and sterilize according to procedures
    • Wipe external surfaces of portable equipment with registered disinfectant

***Always practice hand hygiene after removal of gloves***

facility hygiene cleaning and disinfection
PPE Required:

Gloves that are chemically resistant to the disinfectant being used

Typically wear a surgical mask

Gowns not routinely necessary

Wear face and eye protection if <3 ft from patient

Store supplies and equipment >3 ft from patient

Use only registered disinfectant

Focus on frequently touched surfaces:

Bedrails, bedside or over-bed tables, TV controls, call buttons, telephones, safety/pull-up bars, doorknobs, lavatory surfaces, ventilator surfaces, etc.

After patient is discharged or transferred:

Clean and disinfect all surfaces

Follow standard post-discharge cleaning or isolation room

Facility Hygiene: Cleaning and Disinfection

***Always practice hand hygiene after removal of gloves***

facility hygiene disposal of solid waste
Facility Hygiene: Disposal of Solid Waste
  • Wear gloves
  • Discard non-contaminated supplies in routine waste
  • Contaminated medical waste must be disposed of in accordance with:
    • Facility procedures
    • State and local regulations
    • And in compliance with OSHA’s Bloodborne Pathogens standard

***Always practice hand hygiene after removal of gloves***

additional resources
Additional Resources
  • Guidelines for Environment Control in Health-Care Facilities:
  • EPA registered disinfectants:
  • Department of Health and Human Services: Supplement 4-
hand hygiene
Hand Hygiene
  • Provide resources and work environment that promote personal hygiene.
    • Tissues; no-touch trashcans, sinks, towel dispensers; hand soap; hand sanitizer; disinfectants for work surfaces
  • Train on the expectation that employees will follow these guidelines
  • Make it a habit NOW
  • Make it an institutional priority NOW
social distancing
Social Distancing
  • Encourage sick employees to stay home
  • Avoid close contact with coworkers and customers (>6 ft apart)
  • Avoid shaking hands (and wash after)
  • Discourage sharing of phones, desks, offices, work tools and equipment
  • Minimize face-to-face meetings. Utilize email, telephone, texting capabilities
  • Reduce or eliminate unnecessary social interactions (including others coming onsite)
patient isolation
Patient Isolation
  • Dependent on transmission route
  • Single-patient room or designated room/area for cohorting patients with confirmed pandemic influenza
    • Con-current circulation of other respiratory illnesses
    • Separate suspected and confirmed cases
    • Avoid staff-floating
    • Limit # of entrants into “restricted area”
    • Limit patient transport
  • Use airborne isolation room during aerosol-generating procedures
personal protective equipment

Personal Protective Equipment

For Long Term Health Care Facility Workers

During a Pandemic Influenza

personal protective equipment ppe
Personal Protective Equipment (PPE)
  • Designed to provide a barrier to microbial transfer
  • Involves
    • respiratory protection (respirators)
    • dermal protection (gloves, gowns)
    • protection of mucous membranes (face shield, eye protection)
barriers to ppe use
Barriers to PPE Use
  • Barriers in Industry
    • Communication interference
    • Physical discomfort
  • Additional Barriers in Healthcare
    • Patient interactions (e.g. Split-second actions)
    • Patient needs come first
hindering protectiveness
Hindering Protectiveness
  • Scarce data on the transmission of influenza
    • Impossible to definitively inform HCW about:
      • What PPE is critical
      • What level of protection the equipment will provide in a pandemic
  • Challenges in training and equipping HCW with effective PPE
importance of ppe use
Importance of PPE Use
  • Surge capacity cannot be met if
      • HCW are ill
      • HCW are absent due to concerns about PPE efficacy
  • PPE will save lives, just as other critical medical devices do!
  • Should be latex, vinyl, nitrile, or other synthetic
  • Use when there is contact with blood or other bodily fluids, including respiratory secretions
  • Recommendations
    • If use latex, use powder free and low protein to reduce risk of latex sensitization
    • No need to double glove
    • Do not touch face or eyes while wearing


    • Remove and discard after patient care
    • Gloves should not be washed or reused
    • Hand hygiene should be done after glove


gloves cont
Gloves, cont…
  • Glove supplies my be limited in event of pandemic influenza.
  • Other barriers should be used when there is limited contact with respiratory secretions.
    • Ex. use disposable paper towels when handling used facial tissues.
    • Practice hand hygiene consistently in this situation.
  • Isolation gowns:
    • Can be disposable and made of synthetic material
    • Can be reusable and made of washable cloth
    • Should be the appropriate size to fully cover the areas requiring protection
  • Most routine pandemic influenza patient encounters do not necessitate gown use.
gowns cont
Gowns, cont…
  • Isolation gowns are needed:
    • When it is anticipated that soiling of clothes with blood or other bodily fluids may occur.
    • Ex. Procedures such as intubation or when closely holding a pediatric patient.
  • After patient care is performed, remove gown and place in laundry or waste.
  • Hand hygiene should follow.
goggles face shield
HHS Pandemic Influenza Plan does not recommend the use of goggles or face shield for routine contact with patients with pandemic influenza.

However, if sprays or splatters of infectious material are likely, goggles or face shield should be worn

Ex. If a pandemic influenza patient is coughing, any healthcare worker needing to be w/in 3 feet of the infected patient is likely to encounter sprays of infections material.

Goggles / Face Shield
goggles face shields cont
Goggles / Face Shields cont…
  • Selection
    • Depends on circumstances of exposure, other PPE used, and personal vision needs.
    • Must be comfortable, allow for sufficient peripheral vision, and be adjustable to ensure a secure fit.
    • May be necessary to provide several
    • different types, styles and sizes.
  • Most reliable & practical for protection from splashes, sprays, and respiratory droplets:
    • Indirectly-vented goggles
    • Anti-fog coating
    • Fit snugly, particularly from the corners of the eye across the brow
  • Some goggles seem to fit adequately over prescription glasses with minimal gaps, but are not efficacious.
  • While highly effective as eye protection, goggles do not provide splash or spray protection to other parts of the face.
face shields
Face Shields
  • Used as an alternative to goggles
    • Provides protection to other facial areas.
    • May be more comfortable than goggles when used in combination with respiratory protection.
  • For optimum protection:
    • Should have crown and

chin protection

    • Should wrap around the face

to the point of the ear

  • Sub-optimum protection:
    • Disposable face shields made of film that are attached to surgical mask or fit loosely
ppe for aerosol generating procedures
PPE for Aerosol-Generating Procedures

Examples of aerosol-generating procedures:

  • Endotracheal intubation
  • Aerosolized or nebulized medication administration
  • Airway suctioning
  • Diagnostic sputum induction
  • Bronchoscopy
  • Positive pressure ventilation via face mask (e.g., BiPAP and CPAP)

During these procedures, personnel should wear:

  • Face/eye protection
    • Respiratory protection

(N95 or better)

  • Gloves
  • Gowns
ppe use in infection control precautions
PPE Use in Infection Control Precautions
  • Tier 1: Standard Precautions
    • Primary strategy for preventing transmission of infectious agents among patients and healthcare personnel
  • Tier 2: Transmission-Based Precautions
    • Intended to be combined for protection from diseases with multiple modes of transmission
      • Contact precautions
      • Droplet precautions
      • Airborne Precautions

Tier 2

Tier 1

all tiers involve
All Tiers Involve:

It is the circumstances of the disease that dictate how/when to use them.

tier 1 standard precautions
Tier 1: Standard Precautions
  • Gloves:
    • Wear when touching blood or Other Potentially Infected Materials (OPIM)
    • Remove immediately after use and practice hand hygiene
  • Mask / Eye protection / Face Shield:
    • Wear during activities likely to generate splashes or sprays of blood or OPIM
tier 1 standard precautions1
Tier 1: Standard Precautions
  • Gown:
    • Wear to protect skin and avoid soiling clothing when contact with blood or OPIM is anticipated.
    • Remove gown and perform hand hygiene before leaving the patient’s environment.
  • Other:
    • Practice standard procedures in regards to hand hygiene, cleaning patient equipment, care and disposal of soiled linens, protections regarding Blood Borne Pathogens, and patient placement.
tier 2 contact precautions
Tier 2: Contact Precautions
  • Intended to prevent transmission of infectious agent spread by direct or indirect contact with the patient or the patient’s environment.
tier 2 contact precautions1
Tier 2: Contact Precautions
  • Gloves:
    • Wear whenever touching the patient’s intact skin or items in close proximity to the patient.
    • Don gloves upon entry into the room.
  • Gown:
    • Wear whenever anticipating that clothing will have direct contact with the patient or items in close proximity.
    • Don upon entry into the room.
    • Remove gown and observe hand hygiene before leaving the patient-care environment.
tier 2 droplet precautions
Tier 2: Droplet Precautions
  • Intended to prevent transmission of infectious agent spread through close respiratory or mucous membrane contact with respiratory secretions.
  • In addition to Standard Precautions, droplet precautions require:
    • Mask:
      • Don upon entry into the patient room

or cubicle.

tier 2 airborne precautions
Tier 2: Airborne Precautions
  • Intended to prevent transmission of infectious agents that remain infectious over long distances when suspended in the air.
  • In addition to standard precautions,

airborne precautions require:

    • Respiratory Protection:
      • Wear a fit-tested NIOSH-approved N95 or

higher level respirator when entering the

room or home of a patient who is

suspected or confirmed to have an

airborne infectious disease.

prepared not scared

Prepared, Not Scared

Creating Your Workplace Pandemic Influenza Response Plan

expect to be asked
Expect to be Asked:

“Does MY employer have a plan”:

  • for employees who get sick during a pandemic and need to stay home?
  • to keep the business functioning if key staff can’t come to work?
  • for sick leave, benefits and wages when employees are asked to remain at home?
top 10 errors in workplace planning
Lack of Upper-Management support

No employee buy-in

Poor or no planning

Limited training/practice

No designated leader

Communication failure

Exclusion of OSHA regulations

Contingency plan for facility equipment

No roles and responsibilities

Pandemic Specific: non-occupational exposure risk

Top 10 Errors in Workplace Planning
approaching the planning process
Define the community

Identify a plan

Determine risks and hazards

Set goals for planning

Determine current capacities and capabilities

Develop plan

Include: communication planning

Mental health planning

Vulnerable populations


Training, exercises


Approaching the Planning Process
planning team example
Human Resources









3rd Parties

Vaccine/antiviral distributors

State and local health depts.

Planning Team (example)
example plan overview
Organizational Structure


Business Continuity

Employee Health

Management of Ill Staff

Attendance and Leave policies

Payroll Administration


Employee Services

Workplace Practices


Example Plan Overview
plans should address
Disease surveillance

Isolation & quarantine




Clinical evaluation & diagnosis


Facility access and infrastructure

Occupational health for employees

Surge capacity

Access and use of antivirals and vaccines

Supply chains

Access to critical inventory supplies

Mortuary services & demand

Plans should address…
planning for protection of human capital
Planning for Protection of Human Capital
  • Emergency staffing plans

Continued delivery of essential services

Auxiliary support to Primary Healthcare

  • Maintaining Essential Business Activities
    • Who are the core employees?
    • What are their skills?
    • Planning for absence
    • Prioritizing services
planning for protection of human capital con t
Planning for Protection of Human Capital (con’t)
  • Resident Population Needs
    • Communication: altered mental status; dementia
    • Basic Personal Care Functions: feeding; hydration; medication; hygiene needs
    • Behavioral Patterns: disorientation

Decision Logic:

business infrastructure continuity planning
Human Resource Issues:

Workplace open or closed? Why? How Long?

Risks to employees and others reasonable?

Short and Long-Term Planning

Influenza Management Team


Activation of plan?

Infection Control: residents, staff, visitors, volunteers


Maintaining Essential Business Activities

Who are the core employees?

What are their skills?

Planning for absence

Prioritizing services

Business/Infrastructure Continuity Planning
business infrastructure continuity planning1
Business/Infrastructure Continuity Planning
  • What affect of shortages of supplies/raw materials/personnel have on operations? Interrupted supply/delivery?
  • How will staff and visitors be protected?
    • Restricted entry?
    • Personal hygiene (handwashing)?
    • Workplace cleaning?
    • Ventilation system (HVAC)?
    • Social distancing?
  • Becoming ill at work?
  • Deceased care?
  • Personal Protective Equipment?
If we are pandemic prepared…

then we are prepared for anything.

risk communication
Risk Communication
  • Start with knowing your audience
  • Develop FAQ list (example: Pre-Event Pandemic Message Maps)
  • Communicate policies: Staff, residents, families
    • Policies will be easier to accept if justification and rationale are explained BEFORE a crisis


  • Staff that are trained and comfortable with policies and expectations will be more likely to experience reduced stress and provide quality care during a crisis event
training example
Training - Example
  • Hand Hygiene
    • Step 1: Know your audience and key message
    • Step 2: Brainstorm barriers or hurdles
      • Poor adherence with hand hygiene:
        • Handwashing agents cause irritation and dryness
        • Too busy/insufficient time
        • Patient needs take priority
        • Lack of knowledge about guidelines/protocols
        • No role model from colleagues or superiors
        • Skepticism regarding value of hand hygiene
training example con t
Training – Example (Con’t)
  • Step 3: Develop training (and provide resources) to address identified hurdles
    • Handwashing agents cause irritation and dryness
      • Methods to maintain hand skin health
      • Change hand hygiene agent
    • Lack of knowledge about guidelines/protocols
      • Reminders in the workplace
      • Routine observation and feedback
      • Administrative sanction/rewarding
who to train what to train
Staff (Patient-care providers)


Volunteers/back-up staff

Food services



Human Resources

Families of employees


Families of residents

Infection Control

PPE use

Respirator usage and requirements

Occupational safety and health protocols

Risk levels

Facility policies

Facility expectations

Who to Train…What to Train
psychological and behavioral health support
Psychological and Behavioral Health Support
  • What’s the need?
    • Conflicting messages
    • Conflicting actions: community vs work-related
    • Ethical dilemmas
    • Overwork and extra work vs. restricted work
    • Stigma

  • Using HSC National Strategy for Pandemic Influenza Implementation Plan (HSC Stage 0,1)
    • Develop planning and decision-making strategies for response: define roles
    • Understand how to access state and federal information and supplies
    • Set-up communication pathways
    • Identify supply chain issues
      • Calculate needs
key resources
Key Resources
contact information
Contact Information

Hilarie Schubert Warren, MPH

Industrial Hygienist

Health Sciences Branch

Georgia Tech Research Institute

430 10th St NW, North Building

Atlanta, GA 30332-0837

PHONE (404) 407-6255

FAX (404) 407-9256



Information Provided under OSHA Susan Harwood Grant