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Pandemic Influenza Planning for the Long-Term Healthcare Workplace

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Title: Pandemic Influenza Planning for the Long-Term Healthcare Workplace


1
Pandemic Influenza Planning for the Long-Term
Healthcare Workplace
  • Georgia Tech OSHA Consultation Program
  • GHCA Annual Convention
  • June 2008
  • Information Provided under OSHA Susan Harwood
    Grant
  • SH-16620-07-60-F-13

2
Agenda Day 1
  • Definitions
  • Transmission
  • Projections
  • Break
  • Current Status
  • Surveillance Principles ICS NIMS
  • Introduction to Exposure Reduction
  • Part A Workshop and Homework

3
Agenda Day 2
  • Exposure Reduction (continued)
  • Personal Protective Equipment
  • Respiratory Protection
  • Break
  • Development/Implementation of Business Continuity
    and Preparedness Plan
  • Part B Workshop and Game

4
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5
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6
Seasonal Influenza Symptoms
  • Fever (usually high) and chills
  • Body aches
  • Sore throat
  • Non-productive cough (dry)
  • Runny or stuffy nose
  • Headache
  • Extremely tired (fatigue)
  • Diarrhea

Symptomatic 1-4 days (exposure to onset)
average 2 days Infectious 1 day before to 5
days after symptomatic illness Recovery 3-7 days
7
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8
Avian Influenza
  • Birds (wild and domestic poultry) are natural
    reservoirs of all influenza A viruses
  • Rarely infect humans
  • Flu types can be either be of low or high
    pathogenicity (ability to cause disease)
  • Low pathogenic strains wild domestic
    transmission can mutate
  • Highly pathogenic strain high bird death rate
    (example H5N1 virus) with rapid spread among
    domesticated fowl. Bird to human transmission
    possible.

9
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10
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11
Shifting from Avian Flu to Pandemic Flu
  • Expecting H5N1 (or a similar virus) to give rise
    to next Human flu pandemic
  • When the avian flu virus changes its genetic
    structure so that it is capable of infecting
    humans
  • AND
  • It can be easily spread from human to human
  • Pandemic Influenza occurs

12
Pandemic Influenza
  • A disease outbreak that spreads rapidly and
    affects many people world wide.
  • Characteristics
  • New virus that spreads easily as most people are
    susceptible (no natural resistance or immunity)
  • Effective human to human transmission is
    necessary
  • Measured by how fast the virus spreads
  • Wide geographic spread
  • Not predictable
  • Outbreaks lasting 8-12 weeks with 1-3 week wave
    cycles

13
Pandemic Influenza Anticipated Illness
  • A severe form of seasonal flu symptoms
  • H5N1 cases in Asia reported seasonal flu symptoms
    with LOWER respiratory infection (rather than
    traditional UPPER respiratory infections)
  • Shortness of breath, viral pneumonia, abdominal
    pain, diarrhea, and vomiting in higher prevalence
    than seasonal flu

14
Influenza
Photo credit A. Davidhazy 2002
15
Pandemic Influenza Transmission
  • Not yet known which of three routes of
    transmission will be MOST important
  • Possibilities
  • Droplet (large droplets produced during coughs
    and sneezes) (eg seasonal flu)
  • Airborne (very small infectious particles able to
    travel long range distances) (eg TB)
  • Contact (hand to mouth and/or nose contact
    contact with contaminated surfaces)

16
Projections What Lies Ahead
  • What are the projected numbers?
  • What is the projected magnitude of impact?
  • What to expect?

17
Impact of Pandemic FluUnited States
(ESTIMATES for TODAYS WORLD)
18
Whats this mean for Georgia?
  • How many licensed hospital beds in Georgia?
  • 23,000
  • How many of those beds are staffed?
  • 16,000
  • How many people are anticipated to be sick in
    Georgia?
  • 3 million
  • How many of those sick will need hospitalization?
  • 60,000 to 330,000
  • How many of those hospitalized will need
    ventilators?
  • 4500 to 24,750
  • How many ventilators do we have in Georgia?
  • 1500

Who is operating these ventilators and performing
the work when 40-60 of the workforce is absent?
19
Pandemic Waves
  • Pandemics occur in multiple waves of disease
    outbreaks
  • The first wave in a local area is likely to last
    six to eight weeks
  • The time between pandemic waves varies and can
    not be easily predicted.
  • Anticipate 1-3 waves

20
What to Expect
  • Crisis for extended period of time in multiple
    locations
  • Daily routines will be affected from personal,
    community, and professional changes
  • Isolation/quarantine guidelines or requirements?
  • Cancellation of public events and schools?
  • Non-essential work activities limited?
  • Commerce Patterns changed?
  • Elements of personal action will be required
  • Absenteeism from pandemic flu expected to be
    40-60
  • Lost availability for those who are ill (or
    caring for ill family) is projected at 2-4 weeks

21
Impact on the Health Care System
  • Extreme staffing shortages
  • Shortages of beds, facility space, key supplies
    (ventilators, drugs)
  • Hospital morgues, Medical Examiner and mortuary
    services will be overwhelmed
  • Extreme demands on social and counseling services
  • Long-term demand will outpace supply

22
Specific Risks to Long-Term Health Care Community
  • Potentially already immune-compromised
  • Living in close proximity
  • Visitors from outside
  • Surfaces
  • Activities
  • Employees

23
Is a Vaccine Available?
  • A vaccine to protect people from pandemic flu is
    not available now.
  • A vaccine may not be available at the start of a
    flu pandemic ( 6-8 months after start)
  • The best protection is to practice healthy
    hygiene to stay well now and during a flu
    pandemic.

24
Current Status
  • Where are we now?
  • What preparation has been done so far?
  • Federal level
  • State level
  • What available tools do we need to understand to
    prepare better at the local level?

25
Is there a Pandemic now?
  • As of 3 January 2008
  • Reported to World Health Organization (WHO)
    cumulative total confirmed human cases of Avian
    Influenza A H5N1 virus
  • 348 cases
  • 216 deaths
  • No sustained human to human transmission
    identified
  • currently NO pandemic

26
Risk Classification Structure
  • Whos Who
  • World Health Organization (Phases 1-6)
  • US Government (Stages 1-5)
  • Centers for Disease Controland Prevention
  • CDC (Categories)
  • OSHA Risk Pyramid

27
U.S. Government and WHO A Comparison
28
CDC Severity Index
29
What is surveillance?
  • Ongoing, systematic collection, analysis, and
    interpretation of health-related data essential
    to the planning, implementation, and evaluation
    of public health practice, closely integrated
    with the timely dissemination of these data to
    those responsible for prevention and control.

30
Information Loop of Public Health Surveillance
Source Denise Koo, MD, MPH Epidemiology Program
Office, Centers for Disease Control and Prevention
31
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32
Pandemic Influenza SurveillanceResponsibility at
all levels
  • Globally- World Health Organization
  • WHO Global Influenza Surveillance Network
  • National Influenza Centres (NICs)
  • WHO Collaborating Centres (WHO CCs)
  • Nationally- Health and Human Services
  • National Influenza Surveillance System
  • Influenza Surveillance coordinators
  • State and Local governments
  • Support national and global surveillance systems

33
Surveillance Recommendations for Interpandemic
and Pandemic Alert Periods
  • State and local responsibilities
  • Continue to employ state influenza surveillance
    coordinators to oversee improvements in influenza
    surveillance
  • Conduct influenza surveillance year round, where
    possible.
  • Implement enhanced surveillance for detection of
    the first U.S. cases of novel virus infection.
  • State and large local public health laboratory
    responsibilities
  • Isolate and subtype influenza viruses year round.
  • Improve capacity for rapid identification of
    unusual influenza strains

34
Recommendations for the Pandemic Period
  • If an influenza pandemic begins in the United
    States or another country
  • State and local responsibilities
  • Implement enhanced surveillance for detection of
    the first cases.
  • Enhance all influenza surveillance components
    (virologic, outpatient, hospitalization, and
    mortality).
  • Communicate to all partners the heightened need
    for timely and complete surveillance data.
  • HHS responsibilities
  • Provide technical support, as requested, to
    ministries of health and WHO to track the
    pandemic virus and gather epidemiologic data on
    risk factors for infection or severe illness.
  • Issue updated case definitions and guidance for
    laboratory testing and enhanced surveillance.
  • Assist state and local health departments, as
    requested.
  • Analyze influenza surveillance data on a regular
    and timely basis.

For more information http//www.hhs.gov/pandemicf
lu/plan/pdf/S01.pdf
35
OSHA Surveillance Recommendations for Healthcare
Providers
  • Keep records of and monitor
  • Who cares for sick patients
  • Which employees
  • Show signs of disease
  • Become ill
  • Recover
  • Absenteeism
  • Encourage self-reporting of symptoms by employees
  • Educate employees about transmission
  • Perform Serologic testing on employees, where
    possible
  • Prioritize employees with serologic evidence of
    pandemic flu for care of patients
  • Remove employees with increased risk of
    complications due to pandemic flu

36
Incident Command Health
Care Workers
  • When pandemic flu arrives starts to manifest
    itself, many original discoverers of infected
    seriously ill people will be public safety first
    responders
  • Public safety, especially fire EMT services,
    work within Incident Command System (ICS) that
    utilizes standardized terminology concepts in
    order to efficiently safely address emergencies
    and other kinds of incidents
  • http//training.fema.gov/EMIWeb/IS/is200HC.asp
  • http//training.fema.gov/EMIWeb/IS/is100HC.asp

37
Incident Command Health Care Workers
  • During a pandemic, private HCWs will not be able
    to work in a vacuum by themselves
  • Will have to coordinate interface with public
    safety
  • Will have to understand the language be able to
    work within the ICS
  • Private entities have compliance responsibilities
    under National Incident Management System (NIMS)

38
  • Through the use of NIMS/ICS, all types of
    response activities, to include in-house
    management of infected people, will be more
    efficient and ultimately safer for all involved

39
National Incident Management System (NIMS) and
Incident Command System (ICS)
  • Incident Command System (ICS)
  • Public safety, especially fire EMT services
  • utilizes standardized terminology concepts in
    order to efficiently safely address emergencies
    and other kinds of incidents
  • National Incident Management System (NIMS)
  • Private entities have compliance responsibilities
    under
  • NIMS is mandated for adoption across all spectra
    of response organizations
  • public private
  • government
  • non-governmental organizations
  • and private businesses

40
Exposure Reduction and General Infection
Control Practices
41
HHS CDC Plan
  • GOAL Slow the spread to reduce incidence of
    illness and death
  • Hospitals/Healthcare System Overloaded
  • Use social distancing, targeted antiviral
    treatment, isolation and quarantine to buy time
    to increase
  • Antiviral supply
  • Vaccine availability

Impact
Unprepared
Prepared
Weeks
42
Hierarchy of Controls
  • Avoid the need
  • Reduce the need
  • Reduce exposure
  • Dilute and Divert
  • Personal barriers
  • Source Substitution
  • Source Reduction
  • Procedures
  • Ventilation
  • Personal Protection

Preference
43
Tiered Readiness Approach
  • Personal Readiness
  • Family and Community Readiness
  • Workplace Readiness
  • INFORMATION POWER
  • Example Personal Readiness planning now to
    care for yourself or loved ones who get the flu
    better equipped to respond in Workplace Readiness
  • Example encourage employees to obtain a seasonal
    flu vaccine (as normal flu will probably continue
    to circulate).

Multiple Level Impact requires Multiple Level
Planning
44
Variable Guidance Depending on Risk
Classification Level
  • Lower Exposure Risk
  • Medium Exposure Risk
  • High Exposure Risk
  • OSHA Guidance on Preparing Workplaces for an
    Influenza Pandemic (OSHA 3327-02N 2007)

Expect majority of American workforce will be in
these 2 categories
45
Healthcare employees performing
aerosol-generating procedures on known or
suspected patients
Healthcare delivery support staff entering
known or suspected patient rooms
46
Stratifying Risk How Likely Will I Be Infected?
  • In Healthcare settings
  • Aerosol generating procedures performed on
    influenza patients
  • Resuscitation of a patient with influenza
  • (i.e., emergency intubation, CPR, etc.)
  • / Direct patient care for a symptomatic
    (ill) patient suspected to have influenza
  • Direct routine patient care for all other
    patients
  • Home care for a family member ill with
    influenza
  • Non-patient-care activities in a healthcare
    setting
  •  

47
Workplace Readiness
  • Surface Cleaning, Facility Hygiene and other
    Environmental Measures
  • Cough Etiquette
  • Hand Hygiene
  • Social Distancing
  • Limiting Face-to-Face Meetings
  • Employee and/or visitor screening
  • Personal Barriers
  • Contingency Planning/Business Continuity

48
Potential for Contact Transmission and Surface
Cleaning
  • Influenza virus can survive on surfaces at room
    temperature and moderate humidity
  • Steel and plastic 24-48 hours
  • Cloth and tissues 8-12 hours
  • Surfaces can include items such as
  • Tabletops
  • Doorknobs
  • Tools
  • Computer keyboards and Telephone handsets
  • Cloth, tissues, paper or currency infected with
    the virus
  • Faucets, toilet flushers

49
Potential for Contact Transmission
  • Effectively inactivated by
  • Detergents
  • Alcohol-based products (hand gels)
  • Bleach solutions
  • Household disinfectants (virucides)

50
Facility Hygiene
  • Practices and Policies

51
Facility Hygiene Supplies and Equipment
  • Dishes and Eating Utensils Handled by Pandemic
    Influenza Patients
  • Wear gloves
  • Wash reusable items in dishwater
  • Consult local health codes for water temperature
  • Disposable dishes and utensils may be discarded
    in general waste
  • Linens and Laundry potentially contaminated with
    pandemic influenza
  • Wear gloves
  • Place linens in laundry bag
  • Contain bag to prevent opening during transport
  • Do not shake or handle linen or laundry to
    promote disease transmission
  • Wash and dry in accordance with infection control
    standards

Always practice hand hygiene after removal of
gloves
52
Facility Hygiene Patient Care Equipment
  • Standard practices for handling and reprocessing
    used patient care equipment, including medical
    devices, should be followed
  • Wear gloves
  • Wipe heavily soiled equipment with registered
    disinfectant before removal from patients room
  • Clean, disinfect, and sterilize according to
    procedures
  • Wipe external surfaces of portable equipment with
    registered disinfectant

Always practice hand hygiene after removal of
gloves
53
Facility Hygiene Cleaning and Disinfection
  • PPE Required
  • Gloves that are chemically resistant to the
    disinfectant being used
  • Typically wear a surgical mask
  • Gowns not routinely necessary
  • Wear face and eye protection if lt3 ft from
    patient
  • Store supplies and equipment gt3 ft from patient
  • Use only registered disinfectant
  • Focus on frequently touched surfaces
  • Bedrails, bedside or over-bed tables, TV
    controls, call buttons, telephones,
    safety/pull-up bars, doorknobs, lavatory
    surfaces, ventilator surfaces, etc.
  • After patient is discharged or transferred
  • Clean and disinfect all surfaces
  • Follow standard post-discharge cleaning or
    isolation room

Always practice hand hygiene after removal of
gloves
54
Facility Hygiene Disposal of Solid Waste
  • Wear gloves
  • Discard non-contaminated supplies in routine
    waste
  • Contaminated medical waste must be disposed of in
    accordance with
  • Facility procedures
  • State and local regulations
  • And in compliance with OSHAs Bloodborne
    Pathogens standard

Always practice hand hygiene after removal of
gloves
55
Additional Resources
  • Guidelines for Environment Control in Health-Care
    Facilities
  • http//www.cdc.gov/ncidod/dhqp/pdf/guidelines/Envi
    ro_guide_03.pdf
  • EPA registered disinfectants
  • http//www.epa.gov/oppad001/chemregindex.htm
  • Department of Health and Human Services
    Supplement 4-
  • http//www.hhs.gov/pandemicflu/plan/sup4.html

56
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57
Hand Hygiene
  • Provide resources and work environment that
    promote personal hygiene.
  • Tissues no-touch trashcans, sinks, towel
    dispensers hand soap hand sanitizer
    disinfectants for work surfaces
  • Train on the expectation that
    employees will follow these
    guidelines
  • Make it a habit NOW
  • Make it an institutional priority NOW

58
Social Distancing
  • Encourage sick employees to stay home
  • Avoid close contact with coworkers and customers
    (gt6 ft apart)
  • Avoid shaking hands (and wash after)
  • Discourage sharing of phones, desks, offices,
    work tools and equipment
  • Minimize face-to-face meetings. Utilize email,
    telephone, texting capabilities
  • Reduce or eliminate unnecessary social
    interactions (including others coming onsite)

59
Patient Isolation
  • Dependent on transmission route
  • Single-patient room or designated room/area for
    cohorting patients with confirmed pandemic
    influenza
  • Con-current circulation of other respiratory
    illnesses
  • Separate suspected and confirmed cases
  • Avoid staff-floating
  • Limit of entrants into restricted area
  • Limit patient transport
  • Use airborne isolation room during
    aerosol-generating procedures

60
Personal BarriersPersonal Protective Equipment
andRespiratory Protection
61
Personal Protective Equipment
  • For Long Term Health Care Facility Workers
  • During a Pandemic Influenza

62
Personal Protective Equipment (PPE)
  • Designed to provide a barrier to microbial
    transfer
  • Involves
  • respiratory protection (respirators)
  • dermal protection (gloves, gowns)
  • protection of mucous membranes (face shield, eye
    protection)

63
Barriers to PPE Use
  • Barriers in Industry
  • Communication interference
  • Physical discomfort
  • Additional Barriers in Healthcare
  • Patient interactions (e.g. Split-second actions)
  • Patient needs come first

64
Hindering Protectiveness
  • Scarce data on the transmission of influenza
  • Impossible to definitively inform HCW about
  • What PPE is critical
  • What level of protection the equipment will
    provide in a pandemic
  • Challenges in training and equipping HCW with
    effective PPE

65
Importance of PPE Use
  • Surge capacity cannot be met if
  • HCW are ill
  • HCW are absent due to concerns about PPE efficacy
  • PPE will save lives, just as other critical
    medical devices do!

66
Gloves
  • Should be latex, vinyl, nitrile, or other
    synthetic
  • Use when there is contact with blood or other
    bodily fluids, including respiratory secretions
  • Recommendations
  • If use latex, use powder free and low protein to
    reduce risk of latex sensitization
  • No need to double glove
  • Do not touch face or eyes while wearing
  • gloves
  • Remove and discard after patient care
  • Gloves should not be washed or reused
  • Hand hygiene should be done after glove
  • removal

67
  • Proper Glove Removal

68
Gloves, cont
  • Glove supplies my be limited in event of pandemic
    influenza.
  • Other barriers should be used when there is
    limited contact with respiratory secretions.
  • Ex. use disposable paper towels when handling
    used facial tissues.
  • Practice hand hygiene consistently in this
    situation.

69
Gowns
  • Isolation gowns
  • Can be disposable and made of synthetic material
  • Can be reusable and made of washable cloth
  • Should be the appropriate size to fully cover the
    areas requiring protection
  • Most routine pandemic influenza patient
    encounters do not necessitate gown use.

70
Gowns, cont
  • Isolation gowns are needed
  • When it is anticipated that soiling of clothes
    with blood or other bodily fluids may occur.
  • Ex. Procedures such as intubation or when closely
    holding a pediatric patient.
  • After patient care is performed, remove gown and
    place in laundry or waste.
  • Hand hygiene should follow.

71
Goggles / Face Shield
  • However, if sprays or splatters of infectious
    material are likely, goggles or face shield
    should be worn
  • Ex. If a pandemic influenza patient is coughing,
    any healthcare worker needing to be w/in 3 feet
    of the infected patient is likely to encounter
    sprays of infections material.
  • HHS Pandemic Influenza Plan does not recommend
    the use of goggles or face shield for routine
    contact with patients with pandemic influenza.

72
Goggles / Face Shields cont
  • Selection
  • Depends on circumstances of exposure, other PPE
    used, and personal vision needs.
  • Must be comfortable, allow for sufficient
    peripheral vision, and be adjustable to ensure a
    secure fit.
  • May be necessary to provide several
  • different types, styles and sizes.

73
Goggles
  • Most reliable practical for protection from
    splashes, sprays, and respiratory droplets
  • Indirectly-vented goggles
  • Anti-fog coating
  • Fit snugly, particularly from the corners of the
    eye across the brow
  • Some goggles seem to fit adequately over
    prescription glasses with minimal gaps, but are
    not efficacious.
  • While highly effective as eye protection, goggles
    do not provide splash or spray protection to
    other parts of the face.

74
Face Shields
  • Used as an alternative to goggles
  • Provides protection to other facial areas.
  • May be more comfortable than goggles when used in
    combination with respiratory protection.
  • For optimum protection
  • Should have crown and
  • chin protection
  • Should wrap around the face
  • to the point of the ear
  • Sub-optimum protection
  • Disposable face shields made of film that are
    attached to surgical mask or fit loosely

75
PPE for Aerosol-Generating Procedures
Examples of aerosol-generating procedures
  • Endotracheal intubation
  • Aerosolized or nebulized medication
    administration
  • Airway suctioning
  • Diagnostic sputum induction
  • Bronchoscopy
  • Positive pressure ventilation via face mask
    (e.g., BiPAP and CPAP)
  • During these procedures, personnel should wear
  • Face/eye protection
  • Respiratory protection
  • (N95 or better)
  • Gloves
  • Gowns

76
PPE Use in Infection Control Precautions
  • Tier 1 Standard Precautions
  • Primary strategy for preventing transmission of
    infectious agents among patients and healthcare
    personnel
  • Tier 2 Transmission-Based Precautions
  • USE IN ADDITION TO STANDARD PRECAUTIONS
  • Intended to be combined for protection from
    diseases with multiple modes of transmission
  • Contact precautions
  • Droplet precautions
  • Airborne Precautions

Tier 2
Tier 1
77
All Tiers Involve
It is the circumstances of the disease that
dictate how/when to use them.
78
Tier 1 Standard Precautions
  • Gloves
  • Wear when touching blood or Other Potentially
    Infected Materials (OPIM)
  • Remove immediately after use and practice hand
    hygiene
  • Mask / Eye protection / Face Shield
  • Wear during activities likely to generate
    splashes or sprays of blood or OPIM

79
Tier 1 Standard Precautions
  • Gown
  • Wear to protect skin and avoid soiling clothing
    when contact with blood or OPIM is anticipated.
  • Remove gown and perform hand hygiene before
    leaving the patients environment.
  • Other
  • Practice standard procedures in regards to hand
    hygiene, cleaning patient equipment, care and
    disposal of soiled linens, protections regarding
    Blood Borne Pathogens, and patient placement.

80
Tier 2 Contact Precautions
  • Intended to prevent transmission of infectious
    agent spread by direct or indirect contact with
    the patient or the patients environment.

81
Tier 2 Contact Precautions
  • Gloves
  • Wear whenever touching the patients intact skin
    or items in close proximity to the patient.
  • Don gloves upon entry into the room.
  • Gown
  • Wear whenever anticipating that clothing will
    have direct contact with the patient or items in
    close proximity.
  • Don upon entry into the room.
  • Remove gown and observe hand hygiene before
    leaving the patient-care environment.

82
Tier 2 Droplet Precautions
  • Intended to prevent transmission of infectious
    agent spread through close respiratory or mucous
    membrane contact with respiratory secretions.
  • In addition to Standard Precautions, droplet
    precautions require
  • Mask
  • Don upon entry into the patient room
  • or cubicle.

83
Tier 2 Airborne Precautions
  • Intended to prevent transmission of infectious
    agents that remain infectious over long distances
    when suspended in the air.
  • In addition to standard precautions,
  • airborne precautions require
  • Respiratory Protection
  • Wear a fit-tested NIOSH-approved N95 or
  • higher level respirator when entering the
  • room or home of a patient who is
  • suspected or confirmed to have an
  • airborne infectious disease.

84
Respiratory Protection
85
Prepared, Not Scared
  • Creating Your Workplace Pandemic Influenza
    Response Plan

86
Expect to be Asked
  • Does MY employer have a plan
  • for employees who get sick during a pandemic and
    need to stay home?
  • to keep the business functioning if key staff
    cant come to work?
  • for sick leave, benefits and wages when employees
    are asked to remain at home?

87
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88
Top 10 Errors in Workplace Planning
  • Lack of Upper-Management support
  • No employee buy-in
  • Poor or no planning
  • Limited training/practice
  • No designated leader
  • Communication failure
  • Exclusion of OSHA regulations
  • Contingency plan for facility equipment
  • No roles and responsibilities
  • Pandemic Specific non-occupational exposure risk

89
Approaching the Planning Process
  • Define the community
  • Identify a plan
  • Determine risks and hazards
  • Set goals for planning
  • Determine current capacities and capabilities
  • Develop plan
  • Include communication planning
  • Mental health planning
  • Vulnerable populations
  • Funding
  • Training, exercises
  • Improve

90
Planning Team (example)
  • Human Resources
  • Safety
  • IT
  • Security
  • Sourcing/Purchasing
  • Facilities
  • Legal
  • Communications
  • Operations
  • 3rd Parties
  • Vaccine/antiviral distributors
  • State and local health depts.

91
Example Plan Overview
  • Organizational Structure
  • Assumptions
  • Business Continuity
  • Employee Health
  • Management of Ill Staff
  • Attendance and Leave policies
  • Payroll Administration
  • Training
  • Employee Services
  • Workplace Practices
  • Recovery

92
Plans should address
  • Disease surveillance
  • Isolation quarantine
  • Communication
  • Education
  • Triage
  • Clinical evaluation diagnosis
  • Security
  • Facility access and infrastructure
  • Occupational health for employees
  • Surge capacity
  • Access and use of antivirals and vaccines
  • Supply chains
  • Access to critical inventory supplies
  • Mortuary services demand

93
Planning for Protection of Human Capital
  • Emergency staffing plans
  • Continued delivery of essential services
  • Auxiliary support to Primary Healthcare
  • Maintaining Essential Business Activities
  • Who are the core employees?
  • What are their skills?
  • Planning for absence
  • Prioritizing services

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Planning for Protection of Human Capital (cont)
  • Resident Population Needs
  • Communication altered mental status dementia
  • Basic Personal Care Functions feeding
    hydration medication hygiene needs
  • Behavioral Patterns disorientation

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Decision Logic http//www.opm.gov/pandemic/agency
/decisionchart.asp
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http//www.opm.gov/pandemic/agency/planning.asp
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http//www.opm.gov/pandemic/agency/index.asp
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http//www.opm.gov/pandemic/agency/agency.asp
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Business/Infrastructure Continuity Planning
  • Communication
  • Maintaining Essential Business Activities
  • Who are the core employees?
  • What are their skills?
  • Planning for absence
  • Prioritizing services
  • Human Resource Issues
  • Workplace open or closed? Why? How Long?
  • Risks to employees and others reasonable?
  • Short and Long-Term Planning
  • Influenza Management Team
  • Who?
  • Activation of plan?
  • Infection Control residents, staff, visitors,
    volunteers

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Business/Infrastructure Continuity Planning
  • What affect of shortages of supplies/raw
    materials/personnel have on operations?
    Interrupted supply/delivery?
  • How will staff and visitors be protected?
  • Restricted entry?
  • Personal hygiene (handwashing)?
  • Workplace cleaning?
  • Ventilation system (HVAC)?
  • Social distancing?
  • Becoming ill at work?
  • Deceased care?
  • Personal Protective Equipment?

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  • If we are pandemic prepared
  • then we are prepared for anything.

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www.cdc.gov/flu/flusurge.htm
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Risk Communication
  • Start with knowing your audience
  • Develop FAQ list (example Pre-Event Pandemic
    Message Maps)
  • Communicate policies Staff, residents, families
  • Policies will be easier to accept if
    justification and rationale are explained BEFORE
    a crisis

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Training
  • Fact
  • Staff that are trained and comfortable with
    policies and expectations will be more likely to
    experience reduced stress and provide quality
    care during a crisis event

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Training - Example
  • Hand Hygiene
  • Step 1 Know your audience and key message
  • Step 2 Brainstorm barriers or hurdles
  • Poor adherence with hand hygiene
  • Handwashing agents cause irritation and dryness
  • Too busy/insufficient time
  • Patient needs take priority
  • Lack of knowledge about guidelines/protocols
  • No role model from colleagues or superiors
  • Skepticism regarding value of hand hygiene

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Training Example (Cont)
  • Step 3 Develop training (and provide resources)
    to address identified hurdles
  • Handwashing agents cause irritation and dryness
  • Methods to maintain hand skin health
  • Change hand hygiene agent
  • Lack of knowledge about guidelines/protocols
  • Reminders in the workplace
  • Routine observation and feedback
  • Administrative sanction/rewarding

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Who to TrainWhat to Train
  • Staff (Patient-care providers)
  • Cross-train
  • Volunteers/back-up staff
  • Food services
  • Facilities
  • Housekeeping
  • Human Resources
  • Families of employees
  • Residents
  • Families of residents
  • Infection Control
  • PPE use
  • Respirator usage and requirements
  • Occupational safety and health protocols
  • Risk levels
  • Facility policies
  • Facility expectations

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Psychological and Behavioral Health Support
  • Whats the need?
  • Conflicting messages
  • Conflicting actions community vs work-related
  • Ethical dilemmas
  • Overwork and extra work vs. restricted work
  • Stigma
  • www.hhs.gov/pandemicflu/plan/sup11.htm/
  • www.usuhs.mil/psy/CSTSPandemicAvianInfluenza/pdf

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WORKSHOP
  • Using HSC National Strategy for Pandemic
    Influenza Implementation Plan (HSC Stage 0,1)
  • Develop planning and decision-making strategies
    for response define roles
  • Understand how to access state and federal
    information and supplies
  • Set-up communication pathways
  • Identify supply chain issues
  • Calculate needs

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Key Resources
  • www.pandemicflu.gov
  • http//www.o
    sha.gov/Publications/OSHA3327pandemic.pdf
  • http//www.pandemicflu.gov/plan/pdf/businesscheckl
    ist.pdf
  • http//training.fema.gov/IS/NIMS.asp

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Contact Information
Hilarie Schubert Warren, MPH Industrial
Hygienist Health Sciences Branch Georgia Tech
Research Institute 430 10th St NW, North
Building Atlanta, GA 30332-0837 PHONE (404)
407-6255 FAX (404) 407-9256 email
hilarie_at_gatech.edu website www.oshainfo.gatech.ed
u Information Provided under OSHA Susan Harwood
Grant SH-16620-07-60-F-13
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