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Pandemic Influenza From a healthcare perspective

Pandemic Influenza From a healthcare perspective. Your Facility Spring 2006. Overview. Seasonal influenza Avian influenza Pandemic influenza Preparedness – Government, partners, individuals. Influenza. Influenza. Respiratory infection Spread through coughing, sneezing

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Pandemic Influenza From a healthcare perspective

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  1. Pandemic Influenza From a healthcare perspective Your Facility Spring 2006

  2. Overview • Seasonal influenza • Avian influenza • Pandemic influenza • Preparedness – Government, partners, individuals

  3. Influenza

  4. Influenza • Respiratory infection • Spread through coughing, sneezing • 1 to 5 days from exposure to onset of symptoms • Spread 1 day before illness up to 7 days after • Seasonal influenza traditionally occurs October through April

  5. Influenza Symptoms • Rapid onset of: • Fever • Chills • Body aches • Sore throat • Non-productive cough • Runny nose • Headache

  6. Seasonal Influenza • 36,000 deaths nationally every year; 800-1000 in MN • Vaccine available • High risk for complications include: • Very young • Very old • Fragile immune systems • Pregnant women

  7. AVIAN INFLUENZA

  8. Avian Influenza (“Bird Flu”) • Birds of all species thought to be susceptible • Two forms • Mild • Severe • Signs and symptoms • Mild: ruffled feathers, reduced egg production; significant to poultry producers • Severe: extremely contagious between birds, rapidly fatal, about 100% of infected birds die

  9. Avian Influenza - H5N1 Infection in Humans • Virus remains an avian flu strain • Human infection – has occurred when living quarters were close to animals • Transmission • Contact with manure • Handling chickens • Eating sick, undercooked chickens

  10. Avian Influenza - H5N1Why do we care? • Spreading among birds quickly and across countries • Jumping hosts (across animal groups) • Large percentage of deaths in those infected (184 documented cases, 103 deaths) as of March 21, 2006 • Has potential to mutate into a human strain

  11. Pandemic • Epidemic • More than the expected number of cases within a certain period of time • Pandemic - Geographically widespread epidemic of disease

  12. Influenza Virus Attaining Pandemic Status • Must be a “new” virus transmitted to humans (no immunity within the community) • Must be able to cause illness in humans • Must be able to pass easily from human to human

  13. Influenza Pandemic of 1918-1919 • 20% of the world’s population infected • 20-40 million people died from influenza • Highest mortality in people ages 20-40 yrs • 675,000 Americans died of influenza • 43,000 U.S. serviceman died of influenza

  14. Could H5N1 Spark the Next Flu Pandemic? • Possibly… but so far the virus cannot pass easily from human to human

  15. World Health Organization Influenza Pandemic Phases

  16. Local Impact • Planning assumptions of CDC - Over 1 million sick in Minnesota - 15,000 to 172,000 hospitalized - 3,600 to 32,900 deaths • Insert local numbers on this slide

  17. Emergency Planning Across Levels of Government General All Hazards Planning Natural Disasters Pandemic Flu Federal State Local

  18. Protective Actions • Governor is state decision maker about • Closing schools • Canceling large gatherings • Encouraging people to limit exposure to others • Assuring continuation of infrastructure • Using limited resources

  19. Goals of Pandemic Response • Maintain community infrastructure • Minimize social disruption • Reduce morbidity/mortality

  20. Regional and Local Planning Considerations • Integrate non-health entities in planning • Establish community stockpiles (e.g. of vaccine and antivirals) & distribution systems • Identify spokespersons • Provide effective public education

  21. Partnerships • Homeland Security and Emergency Management • County and city emergency managers • Schools • Law enforcement/military • Voluntary organizations • Local public health • Clinics • Emergency Medical Services • Media

  22. Health & Medical Planning • __ County, tribal and city public health agencies • ___hospitals ___ clinics • Emergency management • Emergency Medical Services • Other community partners Insert your regional map

  23. MODERATE PANDEMIC SEVERE PANDEMIC Illness (30% of population) 90 million 90 million Outpatient Care (50% of ill) 45 million 45 million Hospitalizations (1% to 11% of ill) 865,000 9,900,000 ICU Care (15% of hospitalized) 128,750 1,485,000 Ventilators (50% of ICU) 64,875 742,500 Deaths (0.2% to 2% of ill) 209,000 1,903,000 Projected Pandemic Impact Based on 2004 U.S. Population Estimate of 294 Million(0.05% of World Population)

  24. MODERATE PANDEMIC SEVERE PANDEMIC Illness (30% of population) 1,544,000 1,544,000 Outpatient Care (50% of ill) 772,000 772,000 Hospitalizations (1% to 11% of ill) 15,000 172,000 ICU Care (15% of hospitalized) 2,250 25,700 Ventilators (50% of ICU) 1,120 12,900 Deaths (0.2% to 2% of ill) 3,600 32,900 Projected Pandemic Impact Based on 2004 Minnesota Population Estimate of 5.1 Million (1.75% of U.S. Population)

  25. MODERATE PANDEMIC SEVERE PANDEMIC Illness (30% of population) 831,000 831,000 Outpatient Care (50% of ill) 416,000 416,000 Hospitalizations (1% to 11% of ill) 8,100 92,000 ICU Care (15% of hospitalized) 1,200 13,900 Ventilators (50% of ICU) 610 6,930 Deaths (0.2% to 2% of ill) 1,940 17,700 Projected Pandemic Impact Based on 2004 Metro Region Population Estimate of 2.8 Million (53.8% of Minnesota Population)

  26. Why must we work together? “If a hospital becomes stressed, it might close its doors to protect itself. This becomes a huge public health problem.” Robert Wise, MD, JCAHO

  27. Surge Capacity vs. Surge Capability • Surge Capacity – ‘the ability to manage increased patient care volume that otherwise would severely challenge or exceed the existing medical infrastructure’(Barbera and Macintyre) • Surge Capability – ‘the ability to manage patients requiring unusual or very specialized medical evaluation and intervention, often for uncommon medical conditions’(Barbera and Macintyre)

  28. What Is Patient Care Coordination? • Patient Care Coordination(PCC) – the ability to triage, transport, and treat extraordinary numbers of patients using a systematically integrated continuum of services that is tiered, scalable, and flexible and provides care in the most appropriate setting(Tommet)

  29. Continuum of Patient Care

  30. Tiers of Response: Patient Care Federal Regional & National Assets Interstate & Intrastate Coordination State Units of Capability Hospital & Clinic Compacts Regional Hospitals Multi-Agency Coordination (MAC) Entity Regional Local Hospitals Clinics Off-site Care EMS PH / EM / Public Safety Local Hospitals Clinics Off-site Care EMS PH/EM/Public Safety Local Day to Day Patient Capacity Time

  31. Regional Healthcare Preparedness • Convene emergency preparedness workgroup • Conduct/upgrade needs assessment, e.g., equipment, supplies, training • Develop clinic emergency response plans • Determine roles and responsibilities • Planning • Response • Evaluate need for mutual aid agreement or compact • Develop communication plan in collaboration with hospitals and public health

  32. Healthcare Pandemic Influenza Planning • Create a planning team and develop a written plan. • Establish a decision-making and coordinating structure. • Collaborate with LPH and hospitals to determine how surveillance will be conducted. • Develop policies and procedure for managing pandemic influenza in patients and staff. • Educate and train healthcare personnel.

  33. Healthcare Pandemic Influenza Planning(continued) • Develop communication plan, e.g., with healthcare partners, public health. • Determine how the facility will communicate with patients and help educate the public regarding prevention and control measures. • Develop a plan for procuring the supplies (e.g., PPE) needed to manage influenza patients. • Determine how the facility will participate in the community plan for distributing vaccine and/or antiviral drugs.

  34. Hospital Bed Capacity • Internal facility capacity - Convert single to double rooms - Convert procedure rooms to patient rooms - Accommodate ventilators on patient care units - Discharge or transfer patients - Cancel elective procedures - Create additional isolation capacity - Adjust staffing needs - Utilize LTC facilities - Other

  35. Off-Site Care Facilities(Adjusted Standard of Care) • Bed capacity and spatial separation of patients • Hand hygiene supplies • Lavatory and shower capacity for large numbers of patients • Food services (refrigeration, food handling, and preparation) • Medical services • Staffing for patient care and support services • PPE supplies • Cleaning/disinfection supplies • Environmental services (linen, laundry, waste) • Safety and security • Heating, ventilation, and air conditioning (HVAC) systems

  36. Who Will Pay for This? • HRSA: hospital preparedness • CDC: pandemic influenza - Spring 2006: $1.7 million - Fall 2006: $5.4 million • State: pandemic influenza

  37. Working with Community Partners to Address • Disease surveillance • Clinical issues • Laboratory • Infection control • Healthcare planning • Vaccine and antiviral agents

  38. Working with Community Partners to Address (cont) • Community disease control and prevention • Communications • Animal health collaboration • Care of the deceased • Legal issues • Ethical issues

  39. Localize this slide • Of the following series of slides (41-53) we suggest you select 2-3 that are relevant to your regional and/or local planning efforts, and are reflected in your previous slide.

  40. Disease Surveillance • Tracking influenza disease on ongoing basis • Maintain high alert for H5N1 • Monitor activity in other countries

  41. Clinical Issues • Clinicians will question travel history and poultry exposure in influenza-like cases • Clinicians will report critical influenza in young, healthy individuals • Treatment and care protocols will be developed

  42. Laboratory • Developing capacity for rapid testing andconfirmation • Maintaining a statewide network ofclinical laboratories • Monitoring agriculturaltesting • Sharing informationquickly • Keeping a strong Connection to CDC

  43. Infection Control • What are the recommendations? - Maintaining stockpiles of supplies - Reusing, disposing - Air handling - Hand washing!!

  44. HealthCare Planning • Working together with hospitals, clinics, EMS, and long term care facilities in 8 regions • Predicting and managingsurge in demand • Protecting workers andpatients • Managing off-site care facilities • Providing home care • Using Minnesota Responds, Medical Reserve Corps

  45. Vaccine, Antiviral Agents, and Supplies • Strategic National Stockpile (SNS) system • Vaccine for prevention • Antivirals potentially for prevention and treatment • Get needed material/supplies delivered to the public quickly

  46. Community Disease Control and Prevention • Respiratory hygiene • Business continuation • School closing • Limited interaction of people • Home care • Isolation and quarantine

  47. Communications • Need many ways to reach people • Consistent, understandable, complete messages • Reaching non-English speakers • Hotlines, web, TV, community organizations and many other means

  48. Animal Health Collaboration • Animal health leaders and industry are planning for bird outbreak • Protecting poultry workers • Disposal of birds • Economic impact

  49. Care of the Deceased • Infection Control • Manage death certificates • Mortician collaboration • Cremations and burials • Safe, compassionate • Limit interaction

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