Planning for a Pandemic in Long Term Care Facilities: Connecticut Infection Control Nurses

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Planning for a Pandemic in Long Term Care
FacilitiesConnecticut Infection Control Nurses

• Presented by
• Stephanie R. Paulmeno, MS, RN, NHA
• Director, Community Health Planning
• Greenwich Department of Health
• April 20, 2007

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Pandemics A Global Outbreak

• Occurs when a new Influenza A virus or sub-type
  appears or emerges in humans
• Different from seasonal outbreaks which are
  caused by sub-types of already existent virus
• Result in high morbidity, high mortality and
  heavy social and economic costs

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Pandemics Antigenic Shifts

• A sudden major change in an Influenza A virus
  caused by new combinations of proteins on the
  surface of the virus (Antigenic Shift)
• This marks the first step towards a possible
  pandemic
• The CDC and WHO monitor world-wide for this
  potential occurrence

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Anticipated Presentation Impact

• Fever, sore throat, cough, in some fatal
• cases severe respiratory distress related to
• viral pneumonia
• Previously healthy adults children,
• those with chronic illnesses will be affected
• Mortality morbidity will be high rapid

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Goals of Pandemic Planning

• Pre-establish protocols for containment,
  call-down MOU, communication strategies
• Limit morbidity mortality through rapid
  response containment
• Reduce disruption economic loss
• Identify sources of supplies/personnel/partners

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Pre-pandemic planning IssueVaccine

• 6-9 months may be needed to manufacture and
  distribute the new vaccine
• Supplies will be limited
• Use will be targeted to populations at risk for
  complications/death
• State of CT DPH plan 2 vaccines administered
  over a 4 month period

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Appreciate the Historical Perspective As You Plan

• The world vs. your town
• The value of learning with working through
  with others
• Heeding early public alerts
• The value of knowing your facilities strengths,
  weaknesses and specific infrastructure

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Past Pandemics and Pandemic Scares

• 1918 The Spanish Flu (Actual)
• 1957 The Asian Flu (Actual)
• 1968 The Hong Kong Flu (Actual)
• 1976 The Swine Flu (Scare)
• 1977 The Russian Flu (Scare)
• 1997 The Avian Flu (Recurrent current
• occurances)

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The Connecticut Experience 1918 Pandemic

• 1st Case September 11th 1918 - New London
• Within 2 weeks 2,000 cases near New London
• 16 days later 9,000 cases
• 7 days more 18,000 cases
• By the end of October 180,000 cases
• At that point 300 people died in Hartford

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The Greenwich Experience

• The Spanish Flu 1918
• Sept 20, 1918 Public Health Notice of widespread
  outbreak in Greenwich
• First Greenwich case on October 4, 1918
• Within 2 weeks of notice 125 cases within 1
  month 800 cases ultimately 2000 were affected
  and 106 people died by November.

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Maintaining Facility Functions Under Extreme
Duress

• Use an All Hazards approach
• Plan for prolonged staffing shortages
• The need to balance family work
• Potential supply equipment shortages
• Other duties as assigned the value of cross
  training within and beyond your department

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Maintaining Facility Functions Under Extreme
Duress

• Dealing with emotional trauma
• 1. Heavy illness at home work
• 2. High mortality rates
• 3. Reality of more dead bodies than the
• system can manage
• 4. Overwhelming case loads

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Caring for Patients with Avian Flu

• Personal Protective Equipment (PPE)
• Infection control/Heightened awareness
• Staff resident vaccinations
• Staff visitor health surveillance
• Honing respiratory care equipment skills

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Planning for Pandemic Phases

• Pandemic Imminent - Confirmation of the onset of
  a pandemic
• Regional and multi-regional epidemics
• End of the 1st pandemic wave
• Secondary or subsequent waves
• End of the pandemic

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So, How Does Planning Begin?

• Is a planning team/coordinator assigned?
• Is pandemic planning part of your emergency and
  disaster plan?
• Are your contact lists current and complete?
• All key departments Vendors
• Local state contacts Contractors
• Hospital(s)
  Volunteers

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Contingency PlanningAdvance Planning is
Essential

• Contact call-down lists
• Cross training
• What are your essential functions?
• Who performs them?
• Are there clear written protocols?

• Who knows locations of keys, codes, essential
  items documents?
• How long can you be self sufficient?
• Who are your partners?
• Recovery planning

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Components of your LTC Plan Structure

• Person assigned to monitor health alerts when
  H5N1 hits the U.S.
• A protocol addresses monitoring flu-like
  symptoms in residents, staff, volunteers
• A protocol exists for evaluating and diagnosing
  residents staff who show symptoms of pandemic
  flu

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Components of your LTC Plan Structure (continued)

• Identify the strengths and weaknesses of your
  system
• Identify your pandemic planning resources
• Pre-identify hospitals who you many need to send
  people to, and those who may need you to take
  their patients (MOUs)
• Formalize your planner working with other
  planning groups

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Components of your LTC PlanDeveloping a written
plan

• Do your best-practices research (Review the CDC,
  HHS, www.pandemicflu.gov)
• Establish a formal review process to assure that
  you have covered all essential components
  (Checklist provided)
• The plan needs to provide implementation
  authority to a designated person.

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Components of your LTC PlanEssential Plan
Elements

1. Specific people are assigned specific roles and
   the authority and budget to comply
2. Daily/weekly flu symptom monitoring plan
3. Protocol for assessment is written approved for
   staff and residents
4. Admissions/other policies address appropriate
   placement surveillance of people with flu-like
   symptoms

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Components of your LTC PlanCommunication Plan

• Local hospitals, health State Health Department
  contacts (name/title/contact info)
• The facility person designated to speak with
  public health authorities, staff, families,
  residents the media (public Information
  officer-The facility speaks with one voice)
• Describe the use of phone trees, call-down lists
  each form of communication form included in the
  plan back-ups to the systems
• Keep all resident contact info constantly current

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Components of your LTC Plan Personnel, Residents
family Education

• Designees name contact information
• Duties Include
• Maintain training/trainingneeds records
  
• Cover traditional specific infection
  control info
• Have an approved plan for expediting
  credentialing
• training of non-facility staff in a
  crisis
• Maintain culturally appropriate reading/
  age-level info

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Components of your LTC Plan Infection Control
-Visitors/Staff

1. Policies require the use of Standard Droplet
   Precautions with symptomatic residents
2. Respiratory Cough Etiquette is policy enforced
3. Cohorting strategies are defined Staff working
   in restricted areas do not work elsewhere by
   policy
4. Plans for closing units /or the facility exist
5. Policies and criteria for limiting visitors
   canceling group activities exist

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Components of your LTC Plan Occupational Health

• Presenteeism is not allowed by policy
• Non-punitive sick leaves must be supported
  Those becoming ill at work
  Those who have recovered
  from a pandemic Those with ill
  family members
• Those with symptoms but able to work
• Process for self-assessment prior to work
• Counseling/faith-based resources available
• Vaccination monitoring system
• Work at home options for high risk others

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Components of your LTC Plan Vaccine Anti
-Viral Use

1. Policy revisions based on most current
   recommendations
2. Estimate identify the categories number of
   personnel /residents to be targeted as 1st 2nd
   vaccine/antiviral priorities
3. Plan for rapid delivery/administration of meds
4. Consider that protecting staffs families may be
   a way of improving your staffs presence at work

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Components of your LTC Plan Surge Capacity

1. A contingency staffing plan identifies minimal
   staffing needs prioritizes services for every
   department (who does what/who can cover role)
2. Every essential task needs a written procedure
3. Cross train people to do multiple roles
4. Assign a designated party to assess daily staffing

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Components of your LTC Plan Surge Capacity
(continued)

• Address anticipated shortages of supplies,
  equipment beds, morgues, staff, vendors, services
  
• (Plan for 6 weeks)
• Your surge capacity plan needs to include
  exceeding your bed limits as well as your ability
  to assist hospitals with their overflow . (MOU)
• Identify space on your site that could be
  converted to emergency beds/morgue

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Plan For Recovery

• Monitor for additional waves
• Post-traumatic Stress/Mental health debriefings
  and counseling
• Assess staffing replacement
• Assess tally up your financial losses
• Address neglected areas
• Environmental cleaning
• Evaluate your performance
• Thank the staff

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Resources

• www.pandemicflu.gov www.cdc.gov
• www.who.int
  www.redcross.org
• www.dph.state.ct.us www.aarc.org
• www.businessfairfield.com www.hhs.gov
• CDC 1-800-CDC-INFO
• WHO 202-974-3787