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© 2008 Professional Disposables International, Inc.04/10/23
Pandemic Preparedness
© 2008 Professional Disposables International, Inc.
Objectives of ProgramAt end of this program, the learner will be able to:• Define Pandemic
• State Stages in WHO Pandemic Outbreak Scale
• Describe Populations at Risk and Stats on Transmission
• Discuss Strategies for Prevention of Pandemic (H1N1) 2009 influenza
• List Preparedness Measures for Healthcare Settings
© 2008 Professional Disposables International, Inc.
Pandemic is Declared!!
June 11, 2009 WHO declares Pandemic of
Pandemic (H1N1) 2009 influenza
© 2008 Professional Disposables International, Inc.
What is a Pandemic??
• WHO definition: a pandemic can start when three conditions have been met:1. emergence of a disease new to a population;2. agents infect humans, causing serious illness; and3. agents spread easily and sustainably among
humans.
Source: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Examples of PandemicsRecent Pandemics
• Pandemic (H1N1) 2009 Influenza -30,000 confirmed cases worldwide from April- June 11th 2009
• AIDS and HIV- 1969 to present; projected deaths by 2025– Africa 90-100 million– India 31 million– China 18 million
Historical Pandemics
• Influenza- last pandemic “Hong Kong” 1968-1969
• Cholera- 7th pandemic 1962-1966
• Smallpox- 50 million cases in 1950’s; eradicated in 1979 only ID to be eradicated
• Typhus, tuberculosis, etc.
© 2008 Professional Disposables International, Inc.
Pandemic Phases
Source: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Interpandemic Period
WHO Phase 1.• No new influenza virus subtypes have been detected
in humans. • An influenza virus subtype that has caused human
infection or disease may or may not be present in animals.
• If present in animals, the risk of human infection or disease is considered to be low.
WHO Phase 2.• No new influenza virus subtypes have been detected
in humans. • However, a circulating animal influenza virus subtype
poses a substantial risk of human diseaseSource: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Alert Period
WHO Phase 3: • Human infection(s) with a new subtype but no human-to-
human spread, or at most rare instances of spread to a close contact.
WHO Phase 4: • Small cluster(s) with limited human-to-human
transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.
WHO Phase 5:• Larger cluster(s) but human-to-human spread still
localized, virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).
Source: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Period
WHO Phase 6:
Pandemic: increased and sustained transmission in
general population.
© 2008 Professional Disposables International, Inc.
Post Peak Period
Post-peak period• Pandemic disease levels in most countries
with adequate surveillance will have dropped below peak observed levels
• The post-peak period signifies that pandemic activity appears to be decreasing
• It is uncertain if additional waves will occur and countries will need to be prepared for a second wave.
Source: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Post Pandemic Period
Post-pandemic period • Influenza disease activity will have returned to
levels normally seen for seasonal influenza
• It is expected that the pandemic virus will behave as a seasonal influenza A virus
• It is important to maintain surveillance and update pandemic preparedness and response plans accordingly
• An intensive phase of recovery and evaluation may be required. Source: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza Stats….Did You Know?
• Typical incubation period (interval between infection and onset of symptoms) for influenza is approximately 2 days
• Persons who become ill may shed virus and can transmit infection for up to one day before the onset of illness until 5-7 days later
• Viral shedding and the risk of transmission will be greatest during the first 2 days of illness.
• Children usually shed the greatest amount of virus and therefore are likely to post the greatest risk for transmission.
© 2008 Professional Disposables International, Inc.
And more……..• Clinical disease attack rate will likely be 30% or
higher in the overall population
• Illness rates will be highest among school-aged children (about 40%) and decline with age
• Among working adults, an average of 20% will become ill during a community outbreak.
• In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40% during the peak weeks of a community outbreak
© 2008 Professional Disposables International, Inc.
More Stats…….
• Of those who become ill with influenza, 50% will seek outpatient medical care (w/antiviral drugs available may be higher)
• Number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios
• Risk groups for severe and fatal infection are likely to include infants, the elderly, pregnant women, and persons with chronic medical conditions
© 2008 Professional Disposables International, Inc.
And lastly…………….
• On average, infected persons will transmit infection to approximately two other people
• In an affected community, a pandemic outbreak will last about 6 to 8 weeks
• Multiple waves (periods during which community outbreaks occur across the country) of illness could occur with each wave lasting 2-3 months
What do these stats mean to you?
© 2008 Professional Disposables International, Inc.
Preparedness
• Pandemics affect everyone:– Healthcare Professionals– Public Services– Communities– Schools– Families– Workplaces– Government
• Pandemic planning requires that people and entities not accustomed to responding to health crises understand the actions and priorities required to prepare for and respond to these potential risks.
© 2008 Professional Disposables International, Inc.
Basic Infection Prevention Preparedness
• Regardless of your environment or occupation, there are general infection prevention guidelines to prevent transmission of H1N1:– Hand Hygiene– Respiratory Etiquette and other Personal
Protective Equipment (PPE)– Environmental Surface Disinfection– Isolation Practices– Education of Healthcare Providers, Patients,
and Visitors
© 2008 Professional Disposables International, Inc.
Hand Hygiene…
• Wash your hands often with soap and water, especially after you cough or sneeze
• Alcohol-based hand cleaners such as alcohol impregnated wipes are also effective if soap/water is not available
• Hand sanitizers with 60-95% alcohol are preferredSource: Guideline for Hand Hygiene in Healthcare Settings, Centers for Disease Control and Prevention,
2002.
© 2008 Professional Disposables International, Inc.
Respiratory Etiquette
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Hand sanitize.
• Cough/sneeze into your arm/shoulder if tissues are not available
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people or put on a mask if you are sick and sneezing/coughing
© 2008 Professional Disposables International, Inc.
Surface Disinfection….
• Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.
• To prevent the spread of influenza virus it is important to keep surfaces (especially high touch surfaces) clean by wiping them down with a disinfectant according to directions on the product label.
• Influenza virus is destroyed by heat (167-212°F [75-100°C]) several chemical germicides, including chlorine, hydrogen peroxide, quat/alcohol and alcohols are effective if used in proper concentration for a sufficient length of timeSource: Guideline for Disinfection and Sterilization in Healthcare Settings, Centers for Disease Control and
Prevention, 2008.
© 2008 Professional Disposables International, Inc.
Isolation Practices…..
• If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people
• CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities.
• This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings (no Swine Flu parties!)
Source: Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Centers for Disease Control and Prevention, 2007.
© 2008 Professional Disposables International, Inc.
Education…Spread the Word, not the Flu!!
• Educate yourself, family members, co-workers, friends, students on prevention measures and vaccination for the flu
• Spread the word, not the Flu!!
• Use resources found on CDC and WHO websites– www.cdc.gov– www.who.int
© 2008 Professional Disposables International, Inc.
Where Do YOU Fit in??
Steps to take during Pandemic Period in U.S.
• Maintain close contact with key public health, healthcare, and community partners
• Implement hospital surveillance for pandemic influenza in incoming patients and previously admitted patients
• Implement a system for early detection/treatment of healthcare personnel who might be infected with the pandemic strain of influenza
• Reinforce infection control procedures to prevent the spread of influenza
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Preparedness Plan• Accelerate staff training in accordance with the facility’s
pandemic influenza education and training plan
• Implement activities to increase capacity, supplement staff, and provide supplies and equipment
• Post signs for respiratory hygiene/cough etiquette.
• Maintain high index of suspicion that patients presenting with influenza-like illness could be infected with pandemic strain
• If pandemic strain is detected in local patient, community transmission can be assumed; hospital would move to next level of response
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza in local areaEmergency department (ED)• Establish segregated waiting areas for persons with symptoms
of influenza.
• Implement phone triage to discourage unnecessary ED/outpatient department visits
• Enforce respiratory hygiene/cough etiquette
Access controls• Limit number of visitors to those essential for patient support
• Screen all visitors at point of entry to facility for signs and symptoms of influenza
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza in local area
• Limit points of entry to facility; assign clinical staff to entry screening
Hospital admissions• Defer elective admissions and procedures until local
epidemic wanes
• Discharge patients as soon as possible
• Cohort patients admitted with influenza
• Monitor for nosocomial transmission
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza in local areaStaffing practices• Consider furlough or reassignment of pregnant staff and
other staff at high risk for complications of influenza.
• Consider re-assigning non-essential staff to support critical hospital services or placing them on administrative leave; cohort staff caring for influenza patients
• Consider assigning staff recovering from influenza to care for influenza patients
• Implement system for detecting and reporting signs and symptoms of influenza in staff reporting for duty; provide staff with antiviral prophylaxis, according to HHS guide
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza in local area
Nosocomial transmission• Close units where there has been nosocomial
transmission.
• Cohort staff and patients.
• Restrict new admissions (except for other pandemic influenza patients) to affected units.
• Restrict visitors to the affected units to those who are essential for patient care and support.
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza in local area
Widespread transmission in community/hospital• Redirect personnel resources to support patient care (e.g.,
administrative clinical staff, clinical staff working in departments that have been closed)
• Recruit community volunteers (e.g., retired nurses and physicians, clinical staff working in outpatient settings).
• Consider placing on administrative leave all non-essential personnel who cannot be reassigned to support critical hospital services.
• Close units where there has been nosocomial transmission.
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
Pandemic Influenza in local area
Widespread transmission in community/hospital• Cohort staff and patients
• Restrict new admissions (except for other pandemic influenza patients) to affected units
• Restrict visitors to the affected units to those who are essential for patient care and support
For more information on healthcare and other preparedness plans, visit the CDC website:
www.cdc.gov or www.hhs.gov.pandemicflu
Source: Department of Health and Human Services Pandemic Influenza Plan, 2009.
© 2008 Professional Disposables International, Inc.
In Summary………
• Pandemic H1N1 is here
• Everyone is at risk of infection and can be source of transmission
• Infection prevention practices are key to minimizing virus transmission
© 2008 Professional Disposables International, Inc.
In Summary…….
• Healthcare providers should be leaders in Pandemic Preparedness Plans
• Knowing the measures to take and when to implement is a key component to being prepared
ARE YOU PREPARED???