Readiness Guideline for Epidemic Respiratory Infection in Long Term Care Facilities

1. Readiness Guidelinefor Epidemic Respiratory Infection in Long Term Care Facilities Rachel N. Plotinsky MD Epidemic Intelligence Service Officer, NH Centers for Disease Control and Prevention NH Department of Health and Human Services Division of Public Health Services

2. Epidemic Respiratory Illness (ERI) Planning

3. Background • Modeled on hospital ERI plan, originally created by DHMC Readiness Committee, and being modified by other NH hospitals • Outlines plan for responding to various levels of threat posed by ERI • To serve as a guideline for LTCFs • Will be adapted to specific needs/abilities of each facility • Still in draft form

4. ERI Plan Features • Matrix based on transmission risk • Alert levels “Ready”, Green,Yellow,Orange, Red modeled on federal • 5 Considerations at each level • Access control • Surveillance, screening and triage • Infection control precautions • Communication and education • Additional preparedness activities • Emphasis on achieving goals of Ready

5. Alert Matrix

6. WHO PANDEMIC PHASES Interpandemic period Phase 1. Present in animals, low risk to humans Phase 2. Present in animals, higher risk of human disease Pandemic alert period Phase 3. Human infection present, but no or very limited human-to-human spread  Phase 4. Evidence of increased human- to-human transmission, but still limited Phase 5. Evidence of significant human-to-human transmission (substantial pandemic risk).b Pandemic period Phase 6. Evidence of sustained transmission in general population. Postpandemic Period

8. Current State of Affairs: Global

9. 5 Considerations: Level Ready • Access control • Security, plan to control access, IDs • Surveillance, screening and triage • Screening residents for new cough • Infection control precautions • Use of droplet precautions for all residents with new cough • Communication and education • Form Readiness Committee • Develop plan for communicating internally • Additional preparedness activities • Influenza vaccination for residents, staff • “Ask for a mask,” cough etiquette signs for visitors, volunteers

12. Staff Illness and Protection • Staff, volunteers with fever and cough should: • Alert ICP • Practice hand hygiene after touching face • Wear surgical mask or use tissue to cover nose and mouth • Stay out of work while ill • Clinicians should: • Manage residents with cough using droplet precautions until cause of respiratory illness is determined • Staff should be fit-tested for N-95 masks

13. Level Green Efficient human-to-human transmission of potentially ERI • None at LTCF • None in US or bordering countries

14. 5 Considerations Level Green • Access control • Required IDs • Surveillance, screening and triage • “Ask for a Mask” campaign • Screen for new cough expanded by • Relevant risk factors (e.g. travel) • New admissions with suspect diagnosis of ERI • Infection control precautions expand to airborne and contact for suspect ERI • Communication and education • Additional preparedness activities prn

15. Level Yellow Efficient human-to-human transmission of potentially ERI • None at LTCF • Confirmed in US or bordering countries

16. 5 Considerations Level Yellow • Access control: all wearing IDs • Surveillance, screening and triage • Expanded • Infection control precautions • No change • Communication and education • No change • Additional preparedness activities • Weekly meeting of Readiness Committee

17. Level Orange • Recognized nosocomial transmission at LTCF OR • Local human-to-human transmission

18. 5 Considerations Level Orange (1) • Access control • One entrance with security posted • Restrict volunteers, visitors • Most activities suspended • Surveillance, screening and triage • Mandatory screening • All entering facilities • Registration of exposed staff; daily screening • Isolation and quarantine?

19. 5 Considerations Level Orange (2) • Infection control precautions • N-95s • Daily communication and education internally and with families of residents, as applicable • Additional preparedness activities • Twice daily meetings of Readiness Committee • Redeployment of staff from other areas of LTCF

20. Level: Red • Uncontrolled nosocomial transmission of ERI OR • Widespread local human-to-human transmission

21. 5 Considerations Level Red • Access control • Only essential employees can enter • Surveillance, screening and triage • Daily (no change) • Infection control precautions • All staff surgical masks at least, hand hygiene • Communication and education • Additional preparedness activities

22. Appendix • Criteria for hospital transfer • Only if clinically indicated • Protective equipment • Room setup • Staffing • Dedicated staff to ERI patients • Employee surveillance • Keep track of those interacting with ERI patients • Cohorting residents, staff • Review/acceptance sign off sheet

23. Questions? NH Department of Health and Human Services Division of Public Health Services