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Why Plan for a Pandemic?. December 2007 Wisconsin Veterans Home at King Compiled by: Gail Boushon, Risk Management Officer 715-256-3230/ gail.boushon@dva.state.wi.us From: PowerPoint presentations from the WI Dept of Health and Family Services

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Why Plan for a Pandemic?

December 2007

Wisconsin Veterans Home at King

Compiled by:

Gail Boushon, Risk Management Officer

715-256-3230/ gail.boushon@dva.state.wi.us

From:

PowerPoint presentations from the WI Dept of Health and Family Services

OSHA’s “Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers”


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What Is Seasonal Influenza?

  • A respiratory disease caused by influenza virus.

  • Abrupt onset of fever, cough, sore throat, chills, body aches.

  • Not typically associated with vomiting or diarrhea.

  • Typical incubation period

  • 1–5 days (usually 1-3 days).


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Avian Influenza - Highly Pathogenic H5N1 Outbreaks in Asia

  • Incubation period of up to 10 days

  • Primarily affected children & young adults (good immune systems)

  • Initially developed typical seasonal influenza symptoms – high fever/cough

  • But...lower respiratory tract symptoms (rather than upper) – shortness of breath and viral pneumonia

  • Diarrhea, abdominal pain, vomiting also frequently reported


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Avian Influenza (H5N1)

  • Of the human cases, most had direct contact with infected domestic poultry

  • Several isolated cases are suspected to be spread from human to human

  • Lack of upper respiratory involvement appears to limit ability to cough up virus for easy human to human infection


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Avian Flu has affected humans:

  • Azerbaijan – 8 cases/5 deaths

  • Cambodia – 7 cases/7 deaths

  • China – 25 cases/16 deaths

  • Djibouti – 1 case/0 deaths

  • Egypt – 38 cases/15 deaths

  • Indonesia – 113 cases/91 deaths

  • Iraq – 3 cases/2 deaths

  • Lao People’s– 2 cases/2 deaths

  • Nigeria – 1 case/1 death

  • Thailand – 25 cases/17 deaths

  • Turkey – 12 cases/4 deaths

  • Viet Nam – 100 cases/46 deaths

    Total – 335 cases/206 deaths – 61% death rate



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For Avian Influenza To Become Pandemic, It Must:

Be able to consistently spread from human-to-human


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Possible Transmission Methods

  • 1957 – one study indicated person-to-person not consistent with airborne but another showed airborne based on reduction in illness rate from 19% to 2% in wards with UV ceiling lights

  • 2003 – conjunctivitis suggests transmission of H7N7 via the mucous members of the eye

  • Detection of infectious virus & ribonucleic acid in blood, cerebrospinal fluid & feces of one child raises potential for transmission by contact with these fluids, as well as respiratory secretions


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Pandemic Influenza

“An influenza pandemic is unlike any other public health emergency or disaster”


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Seasonal Versus Pandemic Influenza

In an affected community, a pandemic outbreak will last 6-8 weeks, with at least 2 pandemic disease waves.


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1999

1997

2000

2001

1998


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1999

1997

2000

2001

1998



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Influenza: Seasonal Impact

WISCONSIN Population ~5.4 million

Outpatient Care

120,000-240,000

~5%-20% Infected (270,000-1.1 million)

Deaths

~600-1000

Hospitalized

3,500-7,000


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Influenza: Pandemic Impact

WISCONSIN Population ~5.4 million

Outpatient Care

1.4 Million

~35% Infected

1.9 million

Deaths

~8500

Hospitalized

27,400


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What We Know And Don’t Know

  • An influenza pandemic is likely to occur at some time in our life

  • An influenza pandemic is not imminent

  • An influenza pandemic will affect everyone!!!

  • We do not know when it will occur

  • Need to prepare for increased absenteeism

  • Need to prepare now!!


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Why Plan For A Pandemic?

  • The Pandemic will be so widespread, that we cannot count on the government to take care of us.

  • Resources – both people and supplies – will be in short supply at some point during the Pandemic.

  • There will be great need for health care.

  • We will not want to walk away from our residents, as was done in Hurricane Katrina.


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Why plan?

  • On average, how many employees do you allow on pre-approved leave?

  • How many call in sick?

  • How many call in sick during “cold and flu season”?


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Department of Homeland Security Pandemic COOP Planning Scenarios

  • Scenario 1

    • 30 – 40% absenteeism

    • Commodity availability sustained – some reduction food


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Department of Homeland Security Pandemic COOP Planning Scenarios

  • Scenario 2

    • 40% absenteeism, including many key senior & line management & technical staff

    • Commodity availability sustained – considerable reduction food & fuel – localized disruptions of electrical supply & potable water


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Department of Homeland Security Pandemic COOP Planning Scenarios

  • Scenario 3

    • 50% absenteeism, including most key senior, management, & technical staff

    • Extensive & extended local & regional disruptions in availability of food, fuel, potable water, communications & power


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Why plan?

Think about . . .

How are you going to operate if absenteeism is 30%, 40% or more for 3 weeks to 3 months?


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Why plan?

Oh, and by the way….

  • Your suppliers & vendors may not be able to deliver

  • There may be increased demand for your services

  • Some key employees will never return

    • Some will quit, some retire, some die

  • Hiring replacements may be difficult

  • Quarantine/social distancing limits movement


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Begin Planning

  • By reviewing your services and tasks:

    • By priority

    • By when it needs to be done/how long it can be postponed

  • Assume no regulations apply; do the best you can with what you have


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State Enterprise Priority Levels

Enterprise Priority Level I

A business service whose activities cannot be interrupted for any period of time.

Examples:

  • State level executive, health and military command and control and supporting communications infrastructure,

  • Essential law enforcement activities including law enforcement communications infrastructure,

  • State provided custodial care such as hospitals, nursing homes and prisons, and

  • Agency command, control and communications for agency with Enterprise Priority Level I services.


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State Enterprise Priority Levels

Enterprise Priority Level II

A business service whose activities could be interrupted temporarily, but for no more than one week.

Examples:

  • Benefits payments to individuals, and

  • State and agency payroll


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State Enterprise Priority Levels

Enterprise Priority Level III

A business service whose activities could be interrupted temporarily, but for no more than one month.

Examples:

  • Payments to vendors and businesses,

  • Payments to governmental entities, and

  • Quarterly business processes


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State Enterprise Priority Levels

Enterprise Priority Level IV

All other business services that could be interrupted for from six weeks to three months, the likely duration of a pandemic wave.

Examples:

  • Program planning (other than for the present emergency),

  • IT application enhancement or development (other than that directly supporting the present emergency),

  • Training, Licensing,

  • Most regulatory activities (not directly supporting the present emergency), and

  • Budgeting, accounting and reporting.


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Create Your Plan – Expand on Your Coop

  • Communications

  • Supplies

  • Utilities

  • Security

  • Staffing


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What’s Not in Your COOP Plan

  • Protection of your workforce

  • Wide-spread supply chain disruptions

  • Possible increased need for your services

  • Security procedures for quarantine and potential black-market thefts


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PBX

Home

Fax

Office

Cell

Satellite

PBX

..

..

..

Mobile Switch

..

..

Local Switch

Problem: Communications During an Emergency, Mass Calling Causes Network Congestion

Congestion at many points!

Public

Network


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Problem: Supplies

  • Just-in-time purchasing doesn’t work in an emergency - need to be self-sufficient

  • Disruptions to the supply chain can be expected to become extreme as a world-wide Pandemic results in world-wide shortages

    • Cannot count on the government to provide

    • Need critical supplies for an 8-week peak Pandemic activity period


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Problem: Utilities

  • Interruptions to utility services are anticipated and usually addressed in COOP by use of emergency generators

  • Once interruptions are encountered during a Pandemic, might not be remedied until the Pandemic ends

  • How do you run a generator without fuel? Obtain water when bottled water is not available? Heat?


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Security

  • Need to keep infected people away from non-infected people

    • Checkpoints and screening

    • Locked buildings/units

  • Need to keep staff, visitors, patients from removing valuable supplies


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Problem: Staffing

  • Pandemic staffing levels as low as 50%

  • Requires prioritization of tasks and re-allocation of available staff

  • Staff need to be cross-trained, with at least 3 people for key tasks

  • Detailed manuals/training videos needed to assist untrained staff

  • Staff need to be protected from infection



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Occupational Surveillance

  • Track workers assigned to care for patients with pandemic influenza

  • Track workers who have recovered from pandemic influenza

  • Track reasons for absenteeism

  • Screen workers for symptoms before each shift – exclude from duty

  • Test symptomatic/exposed workers


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Infection Control

  • Standard Precautions

  • Droplet Precautions

  • Airborne Precautions

  • Contact Precautions


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Possible Transmission Methods

  • 1957 – one study indicated person-to-person not consistent with airborne but another showed airborne based on reduction in illness rate from 19% to 2% in wards with UV ceiling lights

  • 2003 – conjunctivitis suggests transmission of H7N7 via the mucous members of the eye

  • Detection of infectious virus & ribonucleic acid in blood, cerebrospinal fluid & feces of one child raises potential for transmission by contact with these fluids, as well as respiratory secretions


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Infection Control

  • Standard Precautions

    • Gloves and nose, mouth & eye protection

    • Hand hygiene

    • SOP for handling/disinfecting


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Infection Control

  • Droplet Precautions

    • 3 feet of separation

    • Surgical mask within 3 feet of coughing/sneezing person

    • Standard cough etiquette

    • Consider cohorting patients

  • Does not protect from aerosol transmission, including aerosol-generating activities as sputum induction or bronchoscopy


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Infection Control

  • Airborne Precautions

    • NIOSH-certified N95 particulate respirator or better for caregivers

    • Negative pressure room/area

      • Alternatives: single room or cohorting

      • Keep door closed

      • Provide own hand washing sink, toilet, bathing

    • Separate from high risk patients

    • Limit access/# of persons entering


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Infection Control

  • Contact Precautions

    During aerosol-generating procedures and when contact with infectious fluids is anticipated and if diarrhea is associated with the Pandemic

    • PPE - including gown

    • Dedicated patient care equipment

    • Limiting patient movement

    • Private room or consider cohorting

    • Frequent cleaning of all “touchable” surfaces


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Infection Control

  • Other –

    • Social distancing

    • If sick, stay home

    • Limit transport/movement

      • If transport necessary, maximize vehicle ventilation (do not use recirculating mode)

      • Mask patient or wear N95 respirator

      • Use vehicle with separate driver compartment when possible


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Social Distancing

  • Consider how to limit contact

    • 3-6 feet between people

    • Limited/no sharing of equipment

    • Workspace/Workstations

    • Meetings/Conference Rooms

    • Cafeterias/Dining Rooms

    • Work at home – business functions such as payroll/billing

    • Reduce meetings, travel


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Treatment and Prevention

  • Vaccinations – including seasonal flu and pneumococcal polysaccharide

  • Use of antivirals – oseltamivir as prophylaxis of healthcare workers or within 48 hours for treatment

  • Limited availability of monovalent vaccine expected 4-6 months after identification of specific pandemic virus strain


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Personal Protective Equipment

  • Gloves – latex, vinyl, nitrile, or other synthetic materials - with no need to double glove

  • Gowns – not recommended for routine use, but when soiling anticipated

  • Goggles/face shields – not recommended for routine use, but within 3 feet and as needed to protect against likely sprays/splatters


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Personal Protective Equipment

  • Respiratory Protection

    • N95 air-purifying respirators filter particulate hazards

    • All elastomeric and same filtering facepiece respirators have exhalation valves that reduce excessive dampness & warmth from exhaled breath but cannot be worn by infected person

    • Surgical mask prevents contamination of the environment by trapping bacteria & secretions expelled by wearer and protects wearer from splashes of blood & bodily fluids but does not filter small particles unless it is a surgical N95

    • Wearing multiple surgical masks will not provide same protection as N95 respirator


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Respirators

  • Need to be fit-tested

  • Considered contaminated after worn in presence of infectious patient; avoid touching exterior

  • World-wide shortage probable; may need to reuse

    • Not obviously soiled or damaged (creased/torn) and functions correctly

    • Limit to single wearer (label prior to use)

    • Consider wearing faceshield that does not interfere with fit or seal (remove upon leaving room, clean/disinfect)

    • Hang respirator in designated area/place in bag

    • Use care when placing used respirator on face