Overview

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Overview

• The avian flu situation
• The UN plan
• The OPCW, and its plan
• Thoughts on
• Communication
• Prevention
• Business continuity planning
• Medical and protective interventions
• Conclusions

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Terminology

• Avian flu
• Seasonal flu
• Pandemic flu

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Confirmed avian cases since 2003
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Confirmed avian cases since 2006
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Confirmed human cases since 2003
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Confirmed human cases since 2003(WHO 21/04/06)
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How real / large is the risk?

• The only thing more difficult than planning for a
  crisis is explaining why you didnt

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Pandemic flu concerns

• Health and wellbeing of staff and families
• at home (The Hague)
• while travelling (typical inspector travels 130
  days / year)
• Impact on activities
• Reduced manpower due to illness / absence
• Reduced travel availability
• Increased infection risk if travel is available
  (?)
• International movement restrictions

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OPCW Planning Principles

• We will take the threat seriously, and prepare
  actively
• Pandemic flu will not be treated as something
  different
• Planning will be based on WHO and UN guidance
• Crucial decisions will be anticipated, and
  exercised
• Medical planning will be tightly integrated with
  local plans, and focused on occupational
  responsibilities (travel health)
• We will supplement local health services if
  access / supply difficulties arise

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Preparedness elements

• Communication
• Internal
• External
• Prevention
• Personal hygiene
• Social distancing
• Business Continuity Planning
• Medical and protective interventions
• Vaccinations
• Consultation
• Anti-viral medications
• Personal protective equipment

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Internal Communication

• Planning group
• Regular Management Board briefings
• Provision of information to staff
• Intranet web-site
• E-mail
• Briefings
• Direct contacts (HSB staff)

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Internal message

• We are aware, and keeping up to date
• We are doing something
• Here is some practical advice
• Here is where you can find more information
• We will keep you informed

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External Communication

• Formal through UN regional co-ordinator
• Informal working group with medical units of
  other international organisations
• Information sharing
• Resource sharing
• Local health authority (GHOR / GGD)
• We have met, and obtained their plan
• We are in the communication loop
• International
• UN HQ (New York)
• WHO (Geneva)

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Key findings in The Hague

• Extensive preparation underway
• National Tamiflu stockpile 3 million doses in
  stock now (18 of resident population). 3
  million more to be obtained by mid 2007 (36)
• No Tamiflu will be available for prophylaxis
• Huisarts (GPs) will be the primary service
  providers
• 3 referral / treatment / dispensing centres
  designated

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Prevention

• Personal hygiene
• Social distancing

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Minimise contact

• Reduce numbers essential staff
• Shelter at home, work at home
• Minimise shift contact
• Reduce sharing of equipment and facilities
• Increased cleaning of potential contact surfaces

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Business Continuity Planning OPCW status

• Manager identified and active
• Representatives nominated from each unit
• BCP team identified and assembled
• Briefings of all conducted
• First tasks completed
• Key activities identified
• Supporting personnel identified
• Critical assets identified
• Key dependencies identified (internal / external)
• All documented, and collective file assembled
• First table top exercise completed

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Key activities

• Critical
• Core to the mission and reputation of the OPCW.
  Must continue even during crises
• Essential
• Important, but could cease for up to one month
  before mission or reputation is harmed
• Non-essential
• Could cease for longer than one month before
  mission or reputation is harmed

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Business Continuity Planning Next steps

• Filtration of the unit level activity planning
• (what is really critical or essential)
• Follow up of dependencies
• Second table top exercise
• HR and administrative issues being addressed

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Medical and Protective Interventions

• 2005 seasonal flu vaccination campaign completed
  
• (100 increase in uptake over 2004)
• Stockpile of medications and protective equipment
  obtained
• 1000 doses Tamiflu in stock, 500 on order
• Stock of goggles, caps, masks, overshoes, gloves.
• Physical access plans for consultation developed
• Close monitoring of developments that would
  affect planning or protocols

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Direct costs of implementing the UN plan at the
OPCW(581 staff, 996 dependants)

• Tamiflu treatment
• 30 staff dependants
• Tamiflu prophylaxis
• 10 of staff 6 weeks
• 2500 travel days
• Vaccinations (seasonal)
• Surgical masks
• Medical staff PPE
• Total

• 9,000 (18 per course)
• 9,000
• 2,800 (internal)
• 6,000
• 5,000
• 31,800

external add 13,000
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Conclusions (internal)

• Current risk of infection for staff is negligible
• Should the risk increase, OPCW is already well
  placed to implement the WHO / UN recommended
  actions
• Regular contact with local and international
  sources of expertise
• Keep personnel informed

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Conclusions (organisational)

• The time to act is now
• Preparedness goes well beyond Tamiflu
• A lot can be done without major expense
• Preparedness for a pandemic will be equally
  relevant for seasonal flu, and for all other
  crises threatening business continuity

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Conclusions (CBMTS)

• Organisational preparedness could make a major
  contribution to National / International efforts
• Preparedness for natural disease also creates
  capabilities for responding to deliberate release

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SARS
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Planning Goal

• Protect the healthcare community from SARS
• Patients
• Healthcare Workers (HCWs)
• Visitors

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SARS Preparedness Planning

• Preparedness Plan Elements
• Organizational infrastructure
• Logistics of patient care
• Staffing
• Durable and consumable resources
• Exposure management
• Patient focused pre-event planning
• Lessons learned
• Fix the weaknesses in the system

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SARS 2 - NYGH
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What have we learned?

• SARS transmission
• Primarily through close contact with infected
  persons
• Droplet spread most likely
• Cannot rule out fomites and possibility of
  airborne spread
• Intensity of exposure during aerosol-generating
  procedures may increase transmission risks

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What have we learned?

• SARS transmission risks are primarily from
• Unprotected exposures to unrecognized cases in
  both inpatient and outpatient settings.
• We must look beyond the patient contacts may be
  infectious too.
• Prevention begins when a patient or visitor walks
  through the door of an Emergency Department or
  outpatient office.

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SARS Preparedness PlanningAreas of Overlap with
Disaster, Bioterrorism and Pandemic Influenza
Planning

• Preparedness Plan Elements
• Organizational infrastructure
• Logistics of patient care
• Staffing
• Durable and consumable resources
• Exposure management

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Creating the Organizational Infrastructure

• Multi-disciplinary team
• Scientific leadership healthcare
  epidemiology/infection control
• Administrative leadership
• Clinical representation
• Engineering/Environmental Services
• Communications/public relations
• Safety/security
• Other

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Creating the Organizational Infrastructure

• Collaboration with community and public health
  planning groups
• State and local health department
• Disaster preparedness planning groups
• Healthcare facility planning groups

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Creating the Organizational Infrastructure

• Creation of internal and external communication
  channelssolidify these NOW!!
• Health department contacts
• Chain of internal communication
• Responsibility for media communications
• Scientific spokesperson

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Patient Admission Planning

• Identify areas that will be used for the care of
  SARS patients
• Decide how patients will be cohorted
• Consider the need to segregate suspect from
  probable cases
• Exposed asymptomatic patients
• Involve engineering personnel in determining
  optimal locations for cohorting

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Evaluate Existing Facility Design and Functioning

• Identify all airborne isolation rooms in facility
  - ensure proper functioning
• Identify area(s) that can be converted for
  airborne isolationshould be able to
• Seal off from other patient areas
• Establish negative pressure relative to
  surrounding areas
• Exhaust directly outside (gt25 ft from intake) or
  pass through HEPA filter
• Supplement with portable HEPA or UV

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Patient Admission PlanningConfiguration of SARS
Units

• Designate locations for
• PPE and other isolation supplies
• Waste and linen receptacles
• Soiled equipment/PPE receptacles
• Assign responsibility for restocking isolation
  units and removing waste/ linen
• Assign responsibility for reprocessing reusable
  PPE (e.g., goggles)

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Patient Admission PlanningConfiguration of SARS
Units

• Determine how to restrict traffic flow
• Consider placing physical barriers and visual
  alerts
• Establish designated work patterns when moving
  within unit to limit contamination
• Train personnel on these procedures!

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Environmental Cleaning and Disinfection

• Assess staffing needs to meet requirements for
  daily and terminal cleaning of SARS patient rooms
  or units
• Consider dedicating specially trained staff for
  this assignment
• Review current room cleaning protocols

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Develop Plans for Educating and Training
Healthcare Personnel

• SARS 101 for clinical and support staff
• Training on Isolation practices
• PPE use -demonstration of competency?
• Isolation practices in a SARS unit
• Plan for caring for SARS patients
• Specialized training?
• Designated SARS care teams
• Aerosol-generating procedures teams
• Designated environmental services personnel
• Respirator fit-testing and training

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Provide Informational and Instructional Materials

• Posters on PPE use and Hand Hygiene
• Patient and visitor information

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Surveillance Planning

• Develop systems for
• Monitoring patient contacts
• Surveillance for transmission to patients and
  personnel
• Exposure reporting
• HCW exposure management
• Symptom monitoring
• Work furlough

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Planning for Surge CapacityWhat is Surge
Capacity for SARS?
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Surge Capacity Planning

• Assessment of human resource needs
• Assessment of durable and consumable resource
  needs
• Logistics of patient triage, evaluation,
  admission, discharge, transfer
• Control of traffic into and out of facility
• Ramp up of education and training

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Summary

• Finally!!!

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Principal Pillars to Combat WMD (HSPD 4)
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Strategic Program Development
Decision Processing
Situation Assessment
Project Initiation
Monitor Progress
Problem Anticipation
Exercise Plans
Build Plans
Problem Analysis
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Strategic Program Development Tools
HSPDs 4,7
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Plan Development Process
Final Product
Response Plan
Final Document
Validation Audit
Validate
Verify
Quality Assurance
Write / Analyze
Resources Communications
Response Teams
Plan Development
Risk/Threat Analysis
Impact Analysis
Preparedness Strategies
Roles Responsibilities
Develop Requirements
Regulations
Policies
Scope
Mission
Assumptions
Internal Factors
External Factors
Objectives
Critical Key Element
Senior Management Buy-in
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• Build Plans
• Strategic Plan(s) - Why
• Lay out scope of whole program
• Establish basis for location, size, organization,
  etc.
• Functional Plans - Who
• For specific tasks
• Codify interagency agreements
• Tactical Plans - How
• For specific tasks
• Event sequencing
• Exercise Plans