pandemic flu preparedness and update april 30, 2009
TRANSCRIPT
Pandemic Flu Preparedness and Update
April 30, 2009
Today’s Presenters:
Al Cook, CMRP, FAHRMM
Chief Resource Director
The Regional Medical Center
Jeff Wagner, CMRP
Vice President
MidMichigan Health
Pandemic Guidelines
Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels (this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)
Interpandemic Pandemic Alert Pandemic Postpandemic
Impact
Risk of human infection or disease is considered to
be low
human-to-human spread is still localized, suggesting that
the virus is becoming increasingly better adapted to humans but may not yet be
fully transmissible (substantial pandemic risk)
Increased and sustained transmission in the general
population, likely that 30% or more of population infected
Return to Interpandemic stage
Community
Develop direct communication with
disaster or bio-terrorism coordinator in your facility,
county, or region to ensure duplication of activity is limited or
eliminated
Align planning with clinical leaders and disaster
coordinator(s), prepare for support of satellite treatment centers that may be utilized
to keep flu patients away from medical centers if
possible
Full activation of supply acquisition and distribution related to high volume of flu
patients
De-commission of community services, move back to focus
on main activity centers
Pandemic Guidelines
Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels (this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)
Interpandemic Pandemic Alert Pandemic Postpandemic
Supplies (see list below)
Maintain normal supply level, stay in close
contact with distribution channel for planning, obtain a copy of the
distributor's disaster plan to ensure supply lines to
the customers, and please
DO NOT HOARD SUPPLIES
Increase in flu patients will place pressure on supplies
within medical facilities, increase supply quantities accordingly, again, please
DO NOT HOARD SUPPLIES
Continue to increase purchases and frequency to handle the increased volume without hoarding, realize that
this may last 4-8 weeks
Supply levels should taper down with decreased patient
activity
Equipment
Ventilator/Respirators and IV Pumps undergo
preventative maintenance checks. Prepare a list of local
medical equipment rental companies and inquire
on availability of specific equipment such as
ventilators/respirators
All ventilators/respirators and IV Pumps ready for service
All available ventilators/respirators and IV Pumps are in active service; maintaining, cleaning, and
turnaround are critical. Rental equipment ordered and in
use.
Disinfecting, repair and maintenance after high
activity
Pandemic Guidelines
Stages of Preparedness Level for Materials Managers related to Pandemic Flu Levels (this includes the Avian Flu; a.k.a. H5N1, H5, or bird flu)
Interpandemic Pandemic Alert Pandemic Postpandemic
Staffing
Prepare list of alternate workers in the event of
staff shortages in Materials Management.
Consider cross training of staff. Update phone
records and prepare your protocol for calling in
relief workers
Monitor the need for calling on relief workers
Monitor the need for calling on relief workers
Return staff to normal duties
Funding
Check with local, state and governmental
agencies for funding opportunities. This may
fall under the responsibility of your
facility's disaster coordinator
Focus on supply needs Focus on supply needs
Check with local, state and governmental agencies for funding opportunities. This
may fall under the responsibility of your facility's
disaster coordinator
Pandemic GuidelinesSupply List
Gloves Exam Suction Catheters
Gowns Isolation Disposable/re-usable Suction Canisters
Masks N95 Oxygen Masks
Masks Procedure Ventilator Tubing
Masks SurgicalRapid Lab Test Kits
Shields Face Respiratory Etiquette signs
Stethoscopes Disposable/re-usable
Tissues
Goggles Gel Hand Alcohol Based - personal
Blood Pressure Cuffs Disposable/re-usable Wipes Disinfectant for Surfaces
Thermometers Disposable/Re-usable
Vaccines/anti-viral Medications Morgue Packs
IV Supplies
Note that quantities should increase based on patient volume changes in most cases, and not by simply increasing by "weeks" or "months" of supplies. This should be managed via close communication with the distributors.
Medical Materials Coordinating Group(MMCG)
The MMCG is a subgroup of the Healthcare Sector Coordinating Council (HSCC), which itself is comprised of fifteen owner-operators and association members which represent the medical products supply chain – including manufacturers, consolidators, distributors, and maintenance and repair.
The HSCC and MMCG are recognized by the Department of Homeland Security and other federal agencies as the initial point of contact within healthcare’s private industry for critical infrastructure protection, preparedness, and response purposes.
Healthcare and Public Health Sector Government Coordinating Council (GCC)
Healthcare Personnel
Includes:
Doctors, nurses, pharmacists, dentists, emergency medicine and other clinicians and practitioners with direct involvement in healthcare delivery
Insurers, Payers, HMOs
Includes:
Representatives of third-party payers for medical treatment and healthcare delivery including insurance companies, HMOs and others
Information Technology
Includes:
All IT systems, capabilities and networks supporting delivery of healthcare services
Laboratories and Blood
Includes:
Laboratories and lab support services separate from medical treatment facilities, and companies and associations from the blood, tissue and organ industry
Mass Fatality Mgt Services
Includes:
Medical examiners, coroners, funeral directors, cremationists, cemeterians, clergy, and manufacturers and distributors of funeral, memorial, and cremation supplies
Each sub-council is responsible for organizing itself
Sample Priority Issues for Sub-Councils: Emergency Preparedness, Emergency Response; Vulnerability Assessment / Prioritization; Communication & Information Sharing among members, with HHS and DHS, and with other sectors
Medical Materials
CoordinatingIncludes:
Manufacturers, suppliers, and distributors of medical supplies and equipment, as well as health care materials managers
Medical Treatment
Includes:
Hospitals, clinics, and other organizations/entities that deliver medical treatment
Occupational Health
Includes:
Occupational health physicians and nurses, industrial hygienists, and other occupational health professionals
Pharma and Biotech
Includes:
Manufacturers, suppliers and distributors of generic and branded pharmaceuticals and biological equipment
Cross-cutting Work Groups will be established to address priority issues that cut across sub-councils
Healthcare Sector Coordinating Council (HSCC)
The HSCC is comprised of representatives and alternates from each sub-council. Issue will be identified by Subcouncils. Coordination across Subcouncils and with the GCC will be organized through the HSCC.
AHRQ CMS FDA HRSA IHS/TRIBAL NIH SAMHSA DOD VA STATE/LOCAL CDC
Manage the Hype
Update | 1:09 p.m. | C.D.C. Briefing Dr. Richard Besser, the Acting Director of the C.D.C. said that the
declaration of a public health emergency in the United States on Sunday "streamlines the process by which the government works." He adds that the government will be giving people coming to the U.S. information on how to avoid getting sick and "out of an abundance of caution" is advising people to forgo any non-essential travel to Mexico at this time.
Manage the Hype Update | 1:16 p.m. | C.D.C. Briefing
Dr. Besser says that, for people who run businesses or schools, it is "time to think about" how they might adapt if an outbreak happens on a large scale and they have to make things work with people working or studying from home. He also says that 11 million doses of anti-viral drugs from a government stockpile have been sent to states with cases of the swine flu, including California, Texas and New York.
Update | 1:19 p.m. | C.D.C. Briefing In response to a question from a reporter, Dr. Besser says that wearing masks is generally not as useful as doing things to prevent disease transmission, like washing your hands and forgoing "that little kiss of greeting" between people. Dr. Besser makes the point that the flu is not transmitted by eating pork.
Update | 1:21 p.m. | C.D.C. Briefing A reporter for the Wall Street Journal asks if not having a director of Health and Human Services at the moment has hurt the government's response to this crisis. Dr. Besser says that it has not. He does say that a lack of funds for the public health system, due to cuts in state budgets, could cause problems in the future. He says that "investments in preparedness" is what led to this outbreak being identified in the United States as quickly as it was.
Manage the Hype
Update | 1:28 p.m. | C.D.C. BriefingDr. Besser clarifies that the government has only released 25% of the stockpile of anti-viral drugs so far.
Update | 1:35 p.m. | C.D.C. BriefingDr. Besser says, in response to a question, that the decision of the European Union to place a travel restriction on people coming to the United States is "premature," given that "we only know of 20 cases" and just one person has been hospitalized in the U.S. so far.
Update | 1:38 p.m. | C.D.C. BriefingA CNN reporter asks if Dr. Besser's advice to not kiss people as a token of greeting only applies to people in areas where the virus has been identified. He says that the C.D.C. is not calling for "a ban on affection," but suggests people in areas where the virus has been identified should probably pass on kissing each other hello or goodbye for now.
Manage the Hype
Update | 1:47 p.m. C.D.C. BriefingDr. Besser's briefing is over, but a good resource is the C.D.C.'s Swine Influenza page on its Web site, which has a lot of information about how to spot the infection, how to avoid getting it, and information on where the 40 confirmed cases in the U.S. have been identified. The C.D.C. site was updated within the last hour to show that cases have been confirmed in the following states: California (7 cases); Kansas (2 cases); New York City (28 cases); Ohio (1 case); Texas (2 cases).
Pandemic Influenza Phases
In nature, influenza viruses circulate continuously among animals, especially birds. Even though such viruses might theoretically develop into pandemic viruses, in Phase 1 no viruses circulating among animals have been reported to cause infections in humans. In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission under such restricted circumstances does not indicate that the virus has gained the level of transmissibility among humans necessary to cause a pandemic.
Pandemic Influenza Phases
Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.
Pandemic Influenza Phases
Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.
Pandemic Influenza Phases
During the 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; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate “at-ease” signal may be premature. In the 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. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required.
Calculating demand in a pandemic
OSHA estimates that for healthcare workers, masks will be changed four times per 12 hour shift for direct patient care givers. Most healthcare workers think this is well underestimated.
OSHA also indicates that in Emergency Rooms, direct care givers may use as many as one mask between each patient and that each person visiting the ER should be issued an n-95 to prevent transmission.
The number is staggering and might indicate that in some cases, Materials Managers might be better served to seek reusable alternatives.
Considerations for meeting demand for PPE
Initial volume will not be 100% occupancy but will start with a significant surge in daily use and crescendo at full census.
Heightened awareness should be made for the potential of sensitive medical PPE departing with the workforce.
At the onset, estimates of daily use should be calculated and the initial 96 hours of use should be brought on site.
Work with established suppliers and with the work force to establish potential alternatives to disposable N-95 face masks. OSHA site offers several alternative devices.
Assure that the correct type of mask or respirator is used in the most appropriate instance, e.g.: surgical masks used where appropriate and disposable N-95s only used where essential.
Resources
http://www.cdc.gov/swineflu/http://www.cdc.gov/swineflu/recommendations.htm
http://www.cdc.gov/swineflu/masks.htm
http://www.chcoc.gov/Transmittals/TransmittalDetails.aspx?TransmittalID
=2227
http://www.osha.gov/Publications/3328-05-2007-English.html#RespiratoryProtectionforPandemicInfluenza
Additional Resource
AHRMM’s Disaster Preparedness Manual for Materials Management Professionals is carried in the online AHRMM Book Store
AHRMM’s Disaster Preparedness Manual
This book offers sound advice in planning and preparing for disaster preparedness. This is the time to engage with local, regional, state and even federal agencies regarding the plans and resources that will be made available to the hospital as a result of those plans. No hospital will stand alone in any disaster response but will stand as a focal point with other local and regional agencies to deliver health and public health services to their respective communities in the most efficient and effective manner.
Now is the time for understanding these resources and how they will all come together to serve the health needs of their communities. Preparation and understanding of these integrated response efforts will be key elements of hospitals’ disaster response plans.
Late Breaking News
Current level of influenza pandemic alert raised from phase 4 to 5
Based on assessment of all available information and following several expert consultations, Dr Margaret Chan, WHO's Director-General raised the current level of influenza pandemic alert from phase 4 to 5. She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.
Questions
Speaker Contact Information
Al Cook, CMRP, FAHRMM
Chief Resource Director
The Regional Medical Center
Orangeburg, SC
803 395 2651
Jeffrey J. Wagner, CMRP
Vice President
MidMichigan Health
Midland, MI
989-839-3821