fasld;
Pandemic Influenza
Response Plan
Grampians Region Infection Control Group
November 2008
Table of Contents
References and Resources 1
The Pandemic Influenza Threat 1
Effects of an Influenza Pandemic 1
Local Demographics ,Potential Attack Rates; and Increased Demand on Local Health Agencies 2
Assumptions for Pandemic Influenza Planning 3
Objectives of the Pandemic Influenza Emergency Plan 3
Coordination and Control of the Pandemic Influenza Emergency 3
Current Phase – Early Pandemic Alert (Global 3 Aus 0) 5
Substantial Pandemic Risk – Heightened Pandemic Alert (Aus 4 -5) 10
Pandemic Management – Aus 6a, 6b, 6d 12
Pandemic Emergency Management Structure (Code Brown) 14
Hospital Incident Management Team HIMT Action Card 15
Hospital Incident Commander 15
Scribe 17
OPERATIONS UNIT
Operations Manager (OP) 18
Bed Manager 20
Infection Control 21
Clinical Support Services - Counselling 22
Flu Clinic Manager 23
Medical Records and Surveillance 24
Staff Monitoring and Support 25
Medical Director 26
Nurse Unit Managers 27
Pharmacy Supply – Pharmacist or authorised Officer 28
Staff Supply 24 hour horizon 29
LOGISTICS UNIT
Logistics Manager (LM) 30
Supply and Resources 31
Catering and Domestic Services 32
Security and Facilities Maintenance 33
Transportation 34
Communication and IT 35
PLANNING UNIT
Planning Manager (PM) 36
Incident Planning Officer 37
Staff Supply +24 hour horizon 38
LIAISON UNIT
Liaison Manager (LIM) 39
Media Liaison Officer 40
External Agency Liaison Officer 41
Phone Support – Home care 42
Residential Aged Care Unit 43
Business Continuity Planning 44
Pandemic in Australia – Subsided (Aus 6c) and Recovery Phase 45
APPENDIX LIST
Appendix A – AI Medical Record 46
Appendix B - Requirements for a Flu Clinic 49
Appendix C - Situation Report (SITREP) 51
Appendix D - Hospital Tabard List 52
Appendix E – Incident Management Log 53
Appendix F - Movement of Equipment Log Sheet 54
Appendix G – Staff Record Sheet 55
Appendix H – Fever & Symptom Log 57
Appendix I – Volunteer Listing Form 59
Appendix J – Home Isolation Assessment Tool 60
Appendix K - Flu Clinic Triage Form 63
Appendix L – Reduction of Care to Essentials 64
Appendix M - Antivials 65
ii
References and Resources
The following sources have been used in the preparation of this plan:
· Australian Government and State Government Pandemic Plans (all available at: www.pandemic.net.au, - Key Pandemic Resources, which also contains a large number of Business Continuity Plans and Influenza Pandemic pamphlets and poster resources)
· Toronto Academic Health Sciences Network Pandemic Influenza Planning Guidelines at: www.baycrest.org/Family_Information/Pandemic_Information
· Ontario Health Plan for an Influenza Pandemic at: http://www.health.gov.on.ca/english/providers/program/emu/pan_flu/pan_flu_plan.html
· Canadian Pandemic Influenza Plan at: http://www.phac-aspc.gc.ca/cpip-pclcpi/index-eng.php, and Annexes
The Pandemic Influenza Threat
An influenza pandemic occurs when a new viral strain transmissible between humans appears for which there is little or no immunity in the population.
Influenza viruses that primarily affect birds are called “avian influenza viruses”. There are many such viruses which cause epidemics in birds. Some of these are of low pathogenicity in poultry, causing minor illnesses. Others are of high pathogenicity, causing almost complete “wipe out” of bird populations. The highly-pathogenic form of the H5N1 type A influenza virus which causes avian influenza is transmissible to humans by close contact with infected birds.
Currently the vast proportion of human avian influenza transmission has been by bird to human transmission; however, a few cases of probable human to human spread between close family members have been identified.
Mutation of the highly-pathogenic avian influenza virus with a human influenza virus could allow large-scale transmission between humans by respiratory secretions and fomites. In aerosol form or by hand/fomite transfer the virus can reach the unprotected surfaces in the nose, mouth or eyes.
The incubation period for the influenza A (H5N1) viral illness is usually 2 to 4 days, but can be up to 7 days (median 3 days). The period of infectivity commences 1 day prior to the start of influenza to 7 days after the onset of illness (maximum of 21 days in children aged 12 years or less).
Clinical features of influenza are those of an acute febrile illness, with fatigue, muscle and joint pains, respiratory symptoms – cough, dyspnoea, pleuritic chest pain, and cyanosis.
Young children, the elderly, pregnant women and the immuno-suppressed may present with atypical clinical features. These may include abdominal pain, diarrhoea/vomiting, or neurological features.
Effects of an Influenza Pandemic
High attack rates of the viral infection (>30 percent of population could become infected) result in mortality, increased need for health care, decreased availability of health care, and severe social dislocation due to deterioration in all essential services. Previous influenza epidemics have come in a series of waves.
Local Demographics, Potential Attack Rates; and Increased Demand on Local Health Agencies
(insert local data here)
Assumptions for Pandemic Influenza Planning
1. Increased Need for Health Care
An influenza attack rate of 30% of the population would place huge pressure on all health care services, both-inpatient and community-based.
2. Decreased Availability of Health Care
A simultaneous major reduction in the availability of Health Care Workers would limit availability of health care.
3. Severe Social Dislocation
In a worst case scenario essential services, supply, and communications, in addition to medical and care services within the community; would be seriously affected by absenteeism.
4. Assumptions Affecting Medical Services and Care Agencies
· The Pandemic will occur in waves over some months
· The existing health care system may be overwhelmed, depending on attack rate, and severity
· The best use of scarce health care resources will be achieved through system-wide prioritization
· There will only be capacity for limited transfer of resources
· Usual supply lines will be disrupted. This will include such items as medical supplies, PPE, clean linen, food
· A Pandemic Influenza Vaccine may be unavailable (at least for some months)
· Anti-influenza drugs will be in short supply, and will be released from Commonwealth Stockpiles according to National Guidelines
· The number of all essential service workers will be reduced
· Limited numbers of medical equipment may require ethical decisions based on Quality of Life/Life Expectancy issues, for example numbers of ventilators available. Similar considerations may influence priority for vaccines, antiviral medications, and antibiotics.
Objectives of the Pandemic Influenza Emergency Plan
1. Reduce the incidence of transmission by effective infection control measures
2. Deliver an effective treatment response for all affected patients
3. Maintain functional ability of the agency during the emergency, probably using reduced human and physical resources
4. Return the agency to normal functioning as soon as the emergency abates.
Coordination and Control of the Pandemic Influenza Emergency
The Department of Human Services is the Controlling Agency for Public Health Threat Incidents in Victoria.
Notification of all suspected cases of Influenza is to the Communicable Diseases Control Unit (DHS Public Health) 13000 651 160
When a substantial pandemic risk is anticipated the Victorian Emergency Response Plan (State Influenza Management Plan) will be activated, and the DHS Emergency Coordination Centre will be operational.
Current Phase – Early Pandemic Alert (Global 3 Aus 0)
Global: Human infection overseas with new subtype but no human to human spread or at most rare instances of spread to a close contact
Aus: No circulating animal influenza subtypes in Australia that have caused human disease
Objective: Containment and Preparedness
Elements:
Border Control
· Screening of in-coming travellers from areas currently affected with Avian Influenza Responsibility: Australian Quarantine and Inspections Service (AQIS) Information on currently affected areas: WHO at http://oie.int/eng/en_index.htm
Australian department of Health and Ageing (DoHA)
· Maintain Australian stockpile of antiviral drugs, and antibiotics
· Maintain contracts for AI vaccine production with laboratories
· Provide advise to states in conjunction with the Communicable Diseases Network Australia (CDNA)
DHS Victoria
· Maintain currency of Victorian Influenza Pandemic Plans and develop public education resources
· Maintain limited stockpile of PPE
· DHS Regions to work to integrate health agency, municipal, and GP Divisions Plans
· Surveillance of Influenza Like Illnesses (ILI) through Victorian Infectious Diseases Reference (VIDRL) and Veterinary Research Laboratory
Healthcare Agencies
General considerations
· Preparation of agency Pandemic Influenza Response Plan
· Preparation /updating of Business Continuity and Surge Capacity Plans
· Prepare plan for the priorities to be followed for the utilization of scarce resources based on ethical considerations, e.g.: antivirals, vaccines
· Integration of Healthcare Agency Plan with other regional plans: municipal, regional, and other agencies
· Practise Healthcare agency and regional plans
· Educate staff in Respiratory Etiquette and Social Distancing , and provide consumables to enable these precautions to become normal practise
· Construction of a Pandemic Volunteers List and provision of education for each role.
Infection control preparedness
· Signage and supplies for respiratory etiquette and social distancing should be pre-advised to the public, and in operation in the ED. Signage requesting patients to put on a surgical mask if they have a respiratory infection should be in place
· Infection control techniques for dealing with respiratory infections should be familiar to staff, and supplies of PPE available in ED (sets of N95/P2 masks, full-surround goggles and disposable gowns, in addition to gloves and the usual hand hygiene supplies)
· If the ED is not equipped with a negative pressure room for patients with respiratory infections a room with separate air handling facility, or good natural ventilation should be designated
· All clinical staff should have annual influenza immunisation, and staff within the age range have pneumococcal vaccine
· A routine system of recording patient arrival and departure times, and staff arrival and departure times within the ED makes contact tracing easier.
Suspect Avian Influenza Patient Presenting to a Healthcare Agency
Case Definition
A current case definition of avian influenza is prominently displayed in the ED for staff, accompanied by the list of geographic areas where avian influenza is active. Changes in geographic distribution will be promulgated to all staff who are likely to attend ED patients.
Provisional clinical Case definition for pandemic phase - Overseas 3(avian influenza affecting humans)
A high index of suspicion should be maintained during assessment of any patient with an acute, febrile, respiratory illness who has recently travelled overseas.
Suspected H5N1 avian influenza:
Fever > 38 degrees Celsius, cough and fatigue of acute onset,
AND
One of the following exposures within seven days of symptom onset:
a. Contact with a confirmed case of H5N1 influenza during the infectious period
OR
b. Visit to a poultry farm or other poultry contact in an area known to have outbreaks of H5N1 influenza
OR
c. Having worked in a laboratory that is processing samples from persons or animals that are suspected to have a H5N1 influenza infection
Latest Case Definition and list of AI-affected countries will be circulated by DHS.
Clinical staff should maintain a high index of suspicion for avian influenza in patients presenting with symptoms of influenza who have recently travelled in affected countries.
Nursing staff covering the ED should make an initial triage of presenting patients as to the likelihood of influenza (of any aetiology) in distinction to the common cold, by familiarity with the following chart:
Medical Record
Use of the Pandemic Influenza Medical Record (Appendix A) is suggested.
A Medical Record for children is located at the following site:
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/ohp-pandemic-ahmppi.htm
Go to Interim National Pandemic Influenza Guidelines
2.5 Draft Forms for Use in Assessment Centres
Control and Communication
The ED medical officer will immediately notify the agency Infection Control Consultant
Phone No. …………………………………………………
As a suspected notifiable infection the Medical Officer will contact the Communicable Diseases Control Unit at the Department of Human Services Phone No. 1300 651 160
CDCU will authorise virology samples to be forwarded to the Victorian Infectious Diseases Reference Laboratory VIDRL.
If diagnosis is positive for AI the patient may be managed at presenting agency if adequate resources are available. If not, CDCU will arrange, in conjunction with Rural Ambulance Victoria to transfer the patient to a Designated Hospital.
Antiviral medication will be commenced as prescribed by a Public Health Infectious diseases Physician or General Practitioner.
Patient should wear long sleeved gown and a surgical mask for inter-agency transfer.
Hospital Executive or Public Relations Officer need to advise staff and community of the confirmed diagnosis, and measures to protect public safety as soon as possible, in order to allay misapprehensions.
Infection Control Measures
Isolate the patient in the best RESPIRATORY PRECAUTIONS environment available within the ED. If no negative pressure room, a room with a strong exhaust system, or openable windows.
· Room door to remain closed
· As few staff should care for the patient as is practicable
· RESPIRATORY PRECAUTIONS ARE MAINTAINED
· Only limited staff enter patient room. All staff are trained in PPE use
· Immediate donning of full PPE for all close patient contact when avian influenza is suspected (refer page 67, Appendix 6, Vic. Health management plan for pandemic influenza)
- P2/N95 particulate respirator mask- correctly applied and fit checked for leaks during test exhalation. If no P2/N95 mask is available use a surgical mask for both patient and staff member