Bioterrorism in the Long Term Care Facility

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Bioterrorism in the Long Term Care Facility
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Acknowledgements

• South Carolina Area Health Education Consortium
  (AHEC)
• Funded by the Health Resources and Services
  Administration.
• Grant number 1T01HP01418-01-00
• P.I. David Garr, MD, Executive Director AHEC
• BT Project Director Beth Kennedy, Associate
  Program Director AHEC
• Core Team
• BT Co-director Ralph Shealy, MD
• BT Project Manager Deborah Stier Carson, PharmD
• BT CME Director William Simpson, MD
• IT Coordinator Liz Riccardone, MHS
• Web Master Mary Mauldin, PhD
• P.R Coordinator Nicole Brundage, MHA
• Financial Director Donald Tyner, MBA

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Acknowledgment

• This material has been prepared for SC AHEC
  Bioterrorism Training Networkby
• Kimberly E. Fine, RN, BSN, CLNC
• Pee Dee AHEC Bioterrorism Education Coordinator
• SC AHEC Bioterrorism Training Network
• Owner, Coastal Medical Consulting, Inc.

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Objectives

• At the end of the session, participants should be
  able to
• Recognize Infection Control issues within a Long
  Term Care Facility
• Discuss Personal Protective Equipment available
  in a Long Term Care setting
• Identify the role of the Pharmacist as an
  Educator in a Long Term Care Facility in the
  event of a terrorism incident

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There was a time when it was easy for you to know
who your enemies were.
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There was a time when it was easy to know you
were under attack.
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Most forms of terrorism are obvious.
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Mindset
Why learn about this? There will never be a
Terrorist Attack in a Long Term Care Setting.
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What you learn about terrorism applies to any
man-made or natural disaster!
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Long Term Care Facility

• Homelike environment
• Living room
• Dining room
• Activity room

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Infection Control Issues

• Semi-private rooms
• Sharing of restrooms
• Sharing of Bathtubs and Showers
• Sharing of Laundry Facilities

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Infection Control Issues

• Linen carts
• Trash carts
• Soiled Linen rooms

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Infection Control Issues

• Agents that can be transmitted through
  contaminated clothing
• Variola major (smallpox)
• Bacillus athracis (anthrax)
• Coxiella burnetti (Q-fever)
• Yersinia pesitis (plague)

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Infection Control Issues

• Common ventilation system
• Isolation rooms are limited
• Negative pressure rooms limited

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Linking the Issues Together

• Symptoms mimic the flu
• Immune Systems are Compromised
• Lag time between infection and symptoms
• Long Term Care Physical Setting

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What To Look For

• Increasing number of residents on antibiotics
• Increasing number of medications used for
  flu-like symptoms
• Flu-like symptoms out of season
• Increasing number of ointments used for rashes
• Increasing number of dressing supplies for wound
  care

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Infection Control Issues Involving Chemical Agents

• Chemical agents can contaminate our water supply.
• Run off from decontamination site can contaminate
  our water supply.

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Infection Control Issues involving Chemical Agents

• Contaminated Water Supply
• Alcohol Hand Gel
• Back up water supply - 25 gallons/day/resident
• Boil water 5-10 minutes
• 10 drops of bleach per gallon
• Website cdc.gov

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Diligent application of normal infection control
practices will protect us from patients who are
victims of a bioterrorism attack.
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Personal Protective Equipment

• Scrub suits
• Head covering
• Masks
• Gown
• Outer garments impervious to fluids
• Gloves
• Shoe covers
• High top rubber overboots
• Eye protection
• Gas Mask

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Personal Protective Equipment

• Gloves
• Gowns
• Masks
• Eye Protection

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Emergency Equipment

• Eyewash station
• Emergency Shower
• Extra scrubs

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Eyewash

• Rinse eyes with plain water for 5-10 minutes.

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Emergency Shower

• Wash with soap and water to remove chemical
  agents from your skin.

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Extra Scrubs

• It is always a good idea to have extra scrubs on
  hand in case workers become contaminated in their
  daily work routine.
• Opaque Trash Bags work well for temporary
  clothing.

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Personal Protective Equipment
The following slides show equipment that most
likely would not be found in a Long Term Care
Facility.
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Particulate Respirator
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Powered Air-Purifying Respirator (PAPR)
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Self-Contained Breathing Apparatus (SCBA)
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Gas Mask
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Role of the Pharmacist

• Educate the staff
• Educate the residents
• Educate family members

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Questions They May Ask

• What medications do we need?
• How much?
• What are the side effects?
• What are the contraindications?
• What if we become resistant to the medication?
• What if we run out of medication?

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Strategic National Stockpile

• Repository of
• Antibiotics
• Vaccines
• Immunoglobulins
• Chemical antidotes
• Antitoxins
• Life-support medications
• IV administration
• Airway maintenance supplies
• Medical/surgical items

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SNS Push Packages

• Strategically located throughout US
• Supplement and re-supply state and local public
  health agencies in the event of a national
  emergency
• When Anywhere and Anytime
• Where Within the U.S. or its territories

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SNS Fast and Flexible

• First line Push Packages
• Caches of pharmaceuticals, antidotes, and medical
  supplies
• Designed to provide rapid delivery of a broad
  spectrum of assets for an ill defined threat in
  the early hours of an event.
• Positioned in strategically located, secure
  warehouses
• Ready for immediate deployment to a designated
  site within the state.

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SNS ProgramDelivery and Transport

• Push packages can be delivered within 12 hours of
  a federal decision to deploy.
• Authority for material will transfer upon arrival
• Once package is on the tarmac, responsibility
  shifts from federal to local authorities
• SNS technical advisory response unit (TARU) staff
  will arrive and remain
• Coordinate with state and local officials for
  efficient delivery and distribution

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SNS Follow up

• Vendor managed inventory (VMI) supplies
• Shipped to arrive within 24 to 36 hours.
• Can be tailored to the suspected or confirmed
  agent(s).
• Could act as the first option for immediate
  response from the SNS if agent is known.

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Push Package Delivery Administration

• State and local authorities will provide security
  and transport to local distribution sites
• Local pharmacists will prepare dispense the
  drugs at public distribution sites according to
  state regulations
• Security will be a major concern

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Must be in a position to

• Advise public health officials on appropriate
  messages to convey to the public about the use of
  essential pharmaceuticals after an attack
• Adverse effects
• Contraindications
• Effectiveness of alternatives
• Potential for development of drug resistance

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The Pharmacistas Counterterrorist

• Easily accessible source of  information in the
  pre-event phase.
• Can provide appropriate reassurance or accurate
  information should a disaster or emergency occur.
• SC Pharmacy Association Pharmalert Network"
• Participating pharmacies are hooked into the DHEC
  "health alert network". 

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Our Job As Healthcare Providers

• Our job is not to determine that an act of
  terrorism has occurred, but that we recognize
  things that are out of the ordinary and report
  those finding to DHEC.

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FBI Regional WMD Coordinators

• Midlands Coordinator
• SA Roger Stanton
• [phone]
• Horry/Georgetown Coordinator
• SA Jeff Long
• [phone]

• Low Country Coordinator
• SA Lance Coble
• [phone] 
• Upstate Coordinator
• SA Tony Garcia
• [phone] 
• Pee Dee Coordinator
• SA Jackie Hamelryck
• [phone]

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