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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……. Seek expert advice as soon as possible!. Overt Release .

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What to Do

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  1. 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

  2. If faced with suspect cases…… • Seek expert advice as soon as possible!

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Viral infection: Smallpox VHF Others: Botulism Protection of healthcare workersProphylaxis if dealing with infected cases • “Prophylaxis”: • Vaccinate within 2 (- 4) days all hospital employees • None • None required

  10. 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

  11. Protection of healthcare workersPatient Isolation/ precautions • Anthrax • Side room NOT required • Standard precautions • gloves • plastic aprons • hand-washing (especially for skin lesions)

  12. 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

  13. Protection of healthcare workersPatient Isolation / precautions • Botulism • Isolation NOT required • Hand-washing

  14. 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)

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. What to do with possible cases[2] • Consider empirical addition of fluoroquinolone to standard regimens • Nurse in standard isolation • Minimise contacts and maintain list

  21. Are you (we) ready? • Awareness • Surveillance • Planning • Stockpiles e.g. antibiotics • Training • Protective equipment • Vaccination • “Don’t panic?” • Coping with victims

  22. 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

  23. 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

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