Pandemic Preparedness
3/22/2016
© 2008 Professional Disposables International, Inc.
Objectives of Program
At 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; and
3. agents spread easily and sustainably among
humans.
Source: World Health Organization, 2009.
© 2008 Professional Disposables International, Inc.
Examples of Pandemics
Recent Pandemics
Historical Pandemics
• Pandemic (H1N1) 2009
Influenza -30,000
confirmed cases
worldwide from AprilJune 11th 2009
• Influenza- last pandemic
“Hong Kong” 1968-1969
• AIDS and HIV- 1969 to
present; projected deaths
by 2025
• Smallpox- 50 million cases
in 1950’s; eradicated in
1979 only ID to be
eradicated
– Africa 90-100 million
– India 31 million
– China 18 million
• Cholera- 7th pandemic
1962-1966
• 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 disease
Source: 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
preferred
Source: 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 time
Source: 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 area
Emergency 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 area
Staffing 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???
© 2008 Professional Disposables International, Inc.