Policy Template for Communicable Diseases of Public Health Importance Spread via the Airborne and Droplet Routes

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Policy Templatefor Communicable Diseases of
Public Health Importance Spread via the Airborne
and Droplet Routes

• Marion A. Kainer MD, MPH
• Tennessee Department of Health
• marion.kainer_at_state.tn.us

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Triage Protocol

• Prompt recognition and isolation of a patient
  presenting to the Emergency Department (ED) or
  Clinic
• Fever/rash or fever/respiratory illness
• ? Communicable disease of public health concern
  (e.g., measles, meningococcal disease, SARS,
  avian influenza, smallpox, or plague)

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Emergency Departments and Clinics

• Important and vulnerable points of entry into a
  hospital
• Effective strategies for triage applied in these
  settings will have great impact on minimizing
  nosocomial transmission within and beyond the ED
  and clinics.

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TB Example
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TB Case Example

• 25 Year old Black Man
• HIV
• 12/29/2005 PPD placed in medical correctional
  facility. Reading of 16mm.
• 12/30/2005 Abnormal Chest X-Ray in same facility

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TB Continued

• 4/14/2006 Admitted to ER
• Presented with
• Sore throat
• Cough
• Thick Yellow Sputum
• Fever
• Discharged that day.
• Told to See PCP or return to ER if worsens or
  does not improve within 24 hours.
• Diagnosed with Bronchitis and told to take OTC
  medicine.

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TB Continued

• 5/13/2006 Admitted to ER of same hospital early
  in morning
• Presented with
• Fever
• Chills
• Weight loss
• Malaise
• Nose bleed
• Chest pain
• Hemoptosis (SP)
• Cough
• Smears ordered
• Patient moved to ICU (Isolation unknown)

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TB Continued

• 5/14/2006 Patient died later in the evening.
• Mycobacterium tuberculosis complex cultured
• Autopsy revealed massive bleeding in chest,
  massive hemoptysis, necrosis of pulmonary vein,
  right lung, with alveolar hemorrhage.

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Guidance Document

• To assist hospitals in developing or updating
  their protocols for screening and isolation for
  potentially communicable diseases of public
  health concern (i.e., diseases with greater
  likelihood of spread to others, and with higher
  likelihoods of more severe morbidity or mortality

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Objectives

• Enhance early recognition of a patient who may
  have a communicable disease of public health
  concern upon arrival at the hospital ED or clinic
  
• Prompt the rapid institution of infection control
  measures to minimize potential transmission to
  staff, patients and visitors.
• Provide a template from which hospitals may
  operationalize their plans

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Sections

• (1) Initial Patient Encounter
• (2) Infection Control Measures on Arrival
• (3) Notification
• (4) Identification and Management of
  Exposed Persons in ED/Clinics

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Training and Drills

• Essential to ensure compliance with these
  measures
• Frontline staff (triage, reception, security as
  well as nursing and medical staff)
• Measures outlined in this protocol, including
  notification procedures

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Training and Drills

• Expect staff from county/regional health
  departments to take part in assessment in local
  hospitals
• Check-list of actions taken for the fake
  patient, including notification of ICP and PH
• Measure time taken to complete all of these
• Provide feedback to local hospital

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OMS Update

• Version 1.5 to be released early December
• Training will be held
• January 30, 31 February 1 at MCRO
• Scenario
• (a) Shigella in a daycare
• (b) Hepatitis A
• Need input in designing the package
• Laptops loaded with MS SQL, SAS, OMS v 1.5