Disaster Management "Covering all the Bases"

1. Disaster Management"Covering all the Bases" CHANGES IN APPROACHES TO PANDEMIC PLANNING – AN ALL HAZARDS APPROACH

2. Introduction • Current Position • Biopreparedness Officer Hunter New England Local Health District (Inc.in Disaster Mgt Unit :HSFAC) • Registered General Nurse • Emergency Department • Cardiothoracic • Operating Suite (Scrub & Recovery) • Intensive Care • High Dependency • IT systems trainer in PAS (IPm software)

3. Concepts /Understandings • Hazard: A hazard is a situation that poses a level of threat to life, health, property, or environment. Most hazards are dormant or potential, with only a theoretical risk of harm; however, once a hazard becomes "active", it can create an emergency situation. Hazard and vulnerability interact together to create risk. • Threat: An indication or warning of probable trouble: • Potential Threat: One Capable of being but not yet in existence; latent: remaining in an inactive or hidden phase ;dormant • Biopreparedness: A state of readiness that attempts to enable a facility or institution to manage /control a situation in order to maintain Business Continuity and minimise the Threat to individuals within.

4. Biopreparedness roles in Health • Develop an understanding and situational awareness within the health and broader community • Partnership with Public Health practioners at LHD and State/Federal levels • Create or establish links with Geo Health and community groups. • Planning for the future: existing, new, known risks and emerging threats • CBR risks to Health facilities (generally not ACFs) • Education of LHD staff/broader Health communities • Assist in evaluation and recommendations for future planning and management of Pandemic like outbreaks.

5. Biopreparedness roles in Health • Develop and undertake exercises to enhance facility/LHD response capacity to threats to their Business Continuity. • Support Infection Control Practioners in Pandemic and disease outbreak management (primarily with a significant threat) • Co ordinate and facilitate management of identified threats in conjunction with the Disaster Management unit (HNEH) under the control of the HSFAC. • Assumes role/roles under ICS structure within the HNEH team . • Establish reporting mechanisms and intelligence gathering to enable a situation awareness and understating of the threat or risk to facilities / population

6. Biopreparedness roles in Health • Advocate /encourage Immunisation outside the legislated vaccination schedule for Health workers • Negotiate at LHD/Management level for appropriate funding • Facilitate opportunistic vaccination of at risk individuals within the hospital system: Outpatients/inpatients (adult and paed) • Originally this position was created to develop an understanding and awareness of the threat of Viral respiratory outbreaks that were being identified in Asia :Western world

7. History of recent “pandemic” threats • SARS coronavirus (China 2002 /2003) 8273 cases and 775 Deaths (HCW transmission in Canada) likely remains in animal hosts • Bird Flu (H5N1) Emerged in 1997 : 2003 became more prominent. Cases 1130, deaths 662 (2003-2011:19/08/2011) • A new deadly mutant strain of H5N1 virus (the dreaded Bird Flu virus) is threatening to enter India after its appearance in China and Vietnam, in what could be the third and the deadliest Bird Flu epidemic wave. • Swine Flu H1N109 Cases 1549364: Deaths 25174 • World Wide : 1. 62% Death rate • USA (115341 Cases :10837Deaths) 9.3% Death rate • Australia 37642 Cases 1910 Deaths . 0.51% Death rate(bottom 20 OECD) • Influenza A (H3N2) Prevalent in current season+(H1N109)

8. Outbreak Management • Infectious outbreaks in long term care facilities (LTCFs) or Nursing homes are likely to have a significant impact on infection rates and mortality rates on residents • It is estimated that several thousand outbreaks at LTCFs in the USA each year. Respiratory and Gastro intestinal infections are the most common causes of these outbreaks • Review of US data has found that HCWs are at an increased risk of infection in a facility outbreak, this is due to HCWs working with highly vulnerable elderly residents as they are potentially exposed to more outbreak pathogens than HCW in Acute care settings • Infection control programs have historically been inadequate and infection control personnel tend to be under educated. Thankfully this trend has changed in recent times.

9. Measures to improve outbreak Management • HCW (in Nursing homes) have historically been under educated about infection prevention and control methods and practices • Education surrounding reinforcing transmission– based precautions and hand hygiene would reduce respiratory and GI tract infections amongst health care Workers • Improve Workforce knowledge base on infection control practices and understanding • Medical practioners: Educated surrounding hand hygiene and transmission based precautions whist visiting patients in facilities • HCW families are also at risk of secondary infections, mostly in Norovirus outbreaks • It is essential that infection control manuals are inclusive of prevention strategies to minimise secondary infections.

10. Existing Threats • Influenza A • Seasonal strains H1N1 09 • Noro Virus (Norwalk) • NHAP (Nursing Home Acquired Pneumonia) • C- Pneumoniae • Clostridium difficile • Legionella • Re emergence of Bird Flu • RSV • Zoonosis • Hendra Virus (Flying foxes (bats):Horses) • Equine Flu: Equine Herpes (USA)

11. New Threats!!!!

12. Infectious Disease threats to LTCFs • Single Pathogen Outbreaks (Viral) • Influenza virus predominantly major contributor • Noroviruses • Group A Streptococci • Salmonella • RSV • Bacterial Infections • Scabies (Sarcoptes_scabiei) • Staph, Pseudomonas • Clostridium _Difficile • Mycobacterium Tuberculosis

13. Understanding Outbreak mechanisms • Source of Infection/routes • Norovirus has been identified in outbreaks transferred for one facility to another. • HCW’s highly likely vectors (could include transfer to / from family members or alternate places of work) • Patient transfers from acute facilities into LTCF’s with pre existing illness (undetected) • Patients are being transferred earlier than previously due to Acute Occupancy pressures in Tertiary Health facilities • Insitu devices such as IDC/SPC and Peg/Enteral tubes for feeding (long term) • Intravenous devices: IVC/SC/PICC lines fluids or medications • Increase in Dementia patients, decreased cognitive function • Decreased levels of Immunity.

14. Mechanisms of management • Management/prevention of Outbreaks • Early recognition of disease occurrence in resident populations • Screening of patients admitted to facilities(determination of Health status prior to transfer) • Determination of vaccination status of resident population and new clients • Accurate medical history e.g. Varicella exposure ,existing Pressure areas • Isolation of individuals with known MROs. • Cohorting in areas whilst maintaining individual isolation status. • Immunisation if not contraindicated on a just in time basis(Specialist advice)

15. Mechanisms of management • Minimise transfer of individuals from facility to facility in times of outbreak(+/-lockdown) as this is shown to spread MROs, MRSA and VRE in both settings. • Reporting of suspected outbreaks • Parent body/affiliated organisations • GPs responsible for medical management of patients in facility • Private Infection control practioners (industry groups) • Notifications along State Guidelines/pathways • Public Health Units • HSFAC reporting through to LHD (establish triggers for this)

16. Communications • HCW’swith advice relevant to management/ protection of self and family • Relatives of patients • Ancillary and domestic staff • Contractors: advise of lockdown procedures if placed insitu • Public advice through Communications units / media

17. Mechanisms of Protection • Staff Immunisation according to legislation PD2011_005 • Encourage Non Mandatory immunisation (Seasonal Influenza) • Restriction of work placement due to immune status • Mandated use of appropriate PPE for situations • Self triage of staff who are unwell (in times of Outbreaks and Pandemic) • Encourage if not mandate reporting of illness in all staff (in particular Gastro and ILI) • Enforce stay away protocols and policy for those who have Gastro /ILI symptoms • PPE Donning and Doffing skills

18. Pandemic Planning • Plans need to be able to accessible by all staff and able to read in a short period of time • Defined communication pathways are paramount to enable a clear understanding of reporting and documentation • Infection control component is a vital and should align with State Infection control policies , this enables for example the use of PPE that may be stored in Pandemic stockpiles .Staff will be familiar with product and use in accordance with established protocols • Methods of decontamination and cleaning are standardised so that procedural confusion is minimised in the event of additional staff being required • Workforce; Planning must involve contingencies surrounding the need to replace or reassign staff to different roles within organisations. This may include MOUs with workplace (Unions ).

19. Questions