Healthcare Preparedness and Response Issues

1
Healthcare Preparedness and Response Issues

• Patricia M. Simone, M.D.
• Division of Healthcare Quality Promotion
• Centers for Disease Control and Prevention

2
Outline

• Healthcare impact
• Role of healthcare system
• Readiness
• Plans and recommendations
• Division of Healthcare Quality Promotion, CDC
• Key healthcare issues
• Role of NVAC Pandemic Influenza Working Group

3
Estimated Burden in the United States

• Based on past pandemics, 15-35 of U.S.
  population may become clinically ill with
  influenza virus
• 18 to 42 million outpatient visits
• 314,000 to 733,000 hospitalizations
• 89,000 to 207,000 deaths
• Meltzer et al. EID 19995659-71.

4
Healthcare Impact

• High demand for services
• Estimated gt25 increase in demand for inpatient
  beds, ICU beds, and ventilators for a mild
  pandemic
• Staff absenteeism
• 1957/58 (UK) 20 absenteeism rate 1/3 of staff
  in one hospital was ill during peak
• Limited availability of critical resources

5
FluSurge

• Tool to estimate impact of pandemic on community
• Census data
• Hospital data
• Staffed beds, staffed ICU beds, ventilators
• Estimates
• Numbers of hospitalizations and deaths
• Number of beds (ICU and non-ICU) and ventilator
  capacity needed
• Based on
• Duration of pandemic (weeks)
• Gross clinical attack rate (15, 25, or 35)

www.cdc.gov/flu/flusurge.htm
6
Estimates Using FluSurge Software

• Example impact of an 8-week influenza pandemic
  with 25 gross clinical attack rate
• Demand of hospital resources peaked in week 5
• 27 of all hospital beds
• 54 of total ICU capacity
• 29 of all ventilators
• Total burden
• 9,707 hospital admission (ranging from 3,310 to
  12,924)
• 1,741 deaths (ranging from 782 to 3,120)

7
Pandemic Response Components
Pandemic influenza disease
Interventions to prevent disease transmission
Provide quality medical care
Infection control in healthcare settings
Impact
Maintain essential services/ response activities
Antiviral treatment prophylaxis
Vaccination
Time
8
Role of Healthcare System in Pandemic Response

• Provide quality care
• Adequate staffing
• Adequate equipment and supplies
• Prevent transmission to patients and HCWs
• Triage and early detection
• Implementation of infection control measures
• Coordinate with other healthcare settings and
  health department

9
Assessment of Hospital Preparedness for Emerging
Infectious Disease Threats

• 556 hospitals in 47 states and Puerto Rico
  completed a survey on hospital preparedness
• Many hospitals had SARS plans but few had
  coordinated them with other facilities or
  jurisdictions
• Infection control and certain specialty services
  were limited in small and rural hospitals
• The number of negative pressure rooms and other
  medical equipment/supplies may not be adequate
  for a large event

10
Proportion of Hospitals Lacking Infection
Control Workforce by Bedsize

Bed size lt100 100-299 300-499 500 N
224 N-142 N154 N32 Infection Control 44
(20) 7 (5) 3 (2) 0 Practitioner Hospi
tal 215 (96) 114 (80) 109 (71) 11
(34) Epidemiologist ID Physician 186 (83) 79
(56) 45 (29) 0 Occupational Health 180 (80)
91 (64) 83 (54) 6 (19) Physician Occupational
Health 110 (49) 37 (26) 9 (6) 1
(3) Nurse
11
US Hospitals by Bed Size
Source AHA Annual Survey 2002
12
Results of APIC Influenza Survey2003/2004 Season

• Shortages
• Diagnostic kits (50)
• Staffing (35)
• Vaccine (25)
• Beds (28)
• Diversions averaging 6 days in 9 of facilities
• HCW vaccination rate of 50
• Respiratory hygiene program consistent with
  CDC/HICPAC recommendations implemented in 81

13
Field Exercises - Observations

• Lack of adherence to proper infection control
  practices and confusion about PPE use
• Inadequate planning for
• exposure management of healthcare workers
• surge capacity including staff, beds, equipment,
  and laboratory services
• Inadequate healthcare staff with appropriate
  expertise during non-peak hours
• Unclear notification and communication channels
  internally and externally

14
Participants

• WHO
• HHS (CDC, HRSA)
• State and local health departments
• Hospitals
• Emergency responders
• Professional organizations
• Providers

15
WHO Plan New Phases

• Interpandemic
• Phase 1 no new subtypes in humans subtype in
  animals with low risk of human infection
• Phase 2 no new subtypes in humans subtype in
  animals with substantial risk of human disease
• Pandemic alert
• Phase 3 human infections with new subtype no
  or rare human-to-human spread
• Phase 4 small clusters of human-to-human
  transmission
• Phase 5 large clusters of human-to-human, but
  localized
• Pandemic period
• Phase 6 sustained transmission
• Postpandemic period

www.who.int/csr/disease/influenza/inforesources/en
/
16
HHS Plan Healthcare and Emergency Response

• Inter-Pandemic Phase (Phase 0, level 1 and 2)
• Assess capacity of healthcare and emergency
  response system to meet needs in a pandemic
  (ASPHEP)
• Inter-Pandemic Phase (Phase 0, level 3)
• Review and revise plans for healthcare delivery
  and community support (HHS, HRSA)
• Assess availability of personnel, supplies and
  materials for infection control and clinical care
  of infected patients should a pandemic occur
  (HRSA)
• Disseminate infection control guidelines to
  hospitals, long-term care facilities, and medical
  care providers (HRSA, CDC)

17
HHS Plan Healthcare and Emergency Response

• Pandemic confirmed (Phase 1)
• Activate state and local plans to coordinate
  healthcare delivery and community response
  (ASPHEP, HRSA)
• Pandemic spreading (Phase 2)
• Establish inpatient medical care in
  non-traditional facilities to provide hospital
  bed surge capacity (HRSA)
• Assess quality of healthcare and emergency
  response (HRSA)
• End of first wave (Phase 3)
• Assess effectiveness of healthcare and service
  delivery during prior phases and revise as needed
  (ASPHEP)

18
HRSA Cooperative AgreementCritical Benchmarks

• Must be achieved by August 31, 2007
• Establish a system for triage, treatment, and
  initial stabilization of 500 adult and pediatric
  patients per 1,000,000 above current capacity
• Ensure all participating hospitals can maintain
  at least one case of a highly infectious disease
  in negative pressure isolation and have at least
  on regional facility that can support the initial
  evaluation and treatment of at least 10 patients
  at a time in negative pressure isolation

19
HRSA Cooperative AgreementCritical Benchmarks

• Establish as system for immediate deployment of
  additional HCWs in support of surge bed capacity
• Develop a system for advance registration and
  credentialing of clinicians needed for surge
  capacity
• Establish regional plans to insure supply of
  prophylaxis meds for 3 days (HCWs and community)
• Ensure adequate PPE for surge capacity staff
• Ensure adequate decontamination systems
• Enhance capacity of care related to behavioral
  health consequences

20
HRSA Cooperative AgreementCritical Benchmarks

• Cross-cutting benchmark Preparedness for
  Pandemic Influenza
• Describe current plan for response
• Provide a complete plan (summer 2005)

21
CDC Division of Healthcare Quality Promotion

• Infection control guidance (HICPAC)
• Evaluation of prevention measures
• Investigation of healthcare-associated outbreaks
• Established networks with hospitals
• Long-standing partnerships (APIC, SHEA, AHA)
• Monitoring adverse events (antivirals with FDA)
• Healthcare and Infection Control supplement for
  CDC plan

22
CDC Plan

• Preparedness Planning for Hospitals
• Disease surveillance
• Hospital communications
• Education and training
• Triage and admissions
• Facility access
• Occupational health
• Vaccine and antiviral use and adminstration
• Surge capacity
• Mortuary issues

23
CDC Plan

• Preparedness planning for non-hospital settings
• Infection control recommendations for hospitals
  and non-hospital settings
• Infection Control Supplement
• Hospital Preparedness Checklist
• Tabletop exercises

24
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25
Issues

• Coordination
• Surge capacity
• Alternative care sites
• Planning and implementation tools
• Mask and respirator recommendations
• Preparing the public (expectations)
• Monitoring progress

26
Coordination

• How to facilitate coordination of planning
  efforts? (consistency of recommendations and
  efficient use of resources)
• At national, state, and local levels?
• Between public health and healthcare systems?
• Among healthcare systems?
• With other planning activities? (SARS)
• What else needs to be done?
• How can it be implemented?

27
Surge Capacity

• What is the true capacity for increasing the
  number of available HCWs? (e.g., available number
  of administrators with clinical competence,
  volunteers)
• What are the barriers using volunteers? How can
  they be addressed?
• Should the focus be on efficient use of current
  resources?

28
Alternative Care Sites

• What federal sites are available nationwide?
• How well are states doing in assessing
  availability of other sites?
• What tools are available for assessing
  requirements?

29
Tools

• What tools are available to assist healthcare
  facilities and health departments in planning and
  implementation?
• Use existing tools (e.g., FluSurge, guideines)
• Identify other tools that can be adapted
• Which ones are priority for development?

30
Examples of Tools

• Tracking systems (staffing, beds, flow of care,
  supplies, etc.)
• Triage algorithms
• Hotline templates
• System for detecting transmission in the hospital
• Public education tools
• Templates for daily reports and other
  communication tools
• Emergency training materials for volunteers
• Protocols to prioritize procedures, limit
  elective admissions
• Staffing priority groups
• Consumable resource needs
• Vaccine and antiviral distribution models
• Description of field hospital requirements

31
WHO Plan Measures to Reduce Risk of Transmission

• Confinement
• plan for large numbers
• type not specified
• Face masks
• Symptomatic persons surgical mask
• Exposed persons
• Consider use and type based on risk assessment
• N95 for HCWs
• Public places permitted but not encouraged

32
Respirators and Masks

• Influenza recommendations
• Standard and droplet precautions
• Surgical mask for HCWs
• Private room
• Avian influenza recommendations
• Airborne isolation
• N95 for healthcare workers
• Airborne isolation room (negative pressure)
• Pandemic influenza
• WHO plan implies N95 for HCWs
• Graded response? (maximum precautions early for
  containment but not feasible later)
• Use in public places (permit but not encourage?)

33
Preparing the Public

• How do we best prepare the public?
• Stay home when sick
• Respiratory hygiene and cough etiquette
• Telephone triage

34
Monitoring Progress

• How to prioritize preparedness activities
  (limited resources)?
• How to monitor progress toward readiness?
• Benchmarks
• Timelines
• Testing
• Coordination

35
NVAC Pandemic Preparedness Work Group

• Facilitate coordination
• Review and provide input on guidance
• Unresolved issues
• Surge capacity
• Alternative care sites
• Assess barriers to implementation
• Identify existing tools and other resources
• Prioritize needs
• Monitor progress

36
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37
Healthcare Preparedness for Pandemic

• Impact of previous pandemics
• Inter-pandemic preparedness planning
• Surveillance
• Capacity and supplies
• Communication and Education
• Lessons learned from SARS

38
Timeline of Emergence of Influenza Viruses
in Humans
Avian Influenza
H7
H9
Pandemic vaccines
H5
H5
B
Russian Influenza
H1
Asian Influenza
Regular vaccines
H3
Spanish Influenza
H2
Hong Kong Influenza
H1
1998/9
1918
1957
1968
1977
1997
2003
39
Pandemic Spread

• Spread of pandemic
• Months to reach U.S. of prior pandemic strains
  1918- 0 1957 2-3 1968 2-3 1977 3-4
• International travel---Globalization

40
Impact of Previous Pandemics

• Spanish flu 1918-19 killed 20-40 million people,
  675,000 in the United States.
• Asian flu (57-58) and Hong Kong flu (68-69)
  killed a total of 103,600 people in the United
  States.
• Annual influenza epidemics cause 36,000 deaths
  and 226,000 hospitalizations in the United
  States.

41
Previous Pandemics

• Besides the elderly, excess of mortality is also
  likely in younger adults and children
• 1918/19 higher mortality in younger adults and
  children
• 1957 higher mortality in older adults
• 1968/69 higher mortality in children and older
  adults
• In planning, consider several scenarios based on
  clinical attack rates, case fatality rate etc.

42
Estimated Number of Cases by Outcome, Attack
Rate of 15, Canada
Source Canadian Pandemic Influenza Plan
43
Healthcare Preparedness for Pandemic

• Impact of previous pandemics
• Inter-pandemic preparedness planning
• Surveillance
• Capacity and supplies
• Communication and Education
• Lessons learned from SARS

44
Inter-Pandemic Preparedness for Hospitals

• Objective develop planning and decision-making
  structures for responding effectively to pandemic
  influenza
• Create and test a plan that provides efficient
  and effective healthcare to influenza-infected
  patients and minimizes the disruption of other
  healthcare delivery
• Build partnerships with state and local health
  departments, local and/or regional healthcare
  facilities

45
Inter-Pandemic Planning

• Facilitate awareness of the potential impact of a
  pandemic on the healthcare system
• Prepare resources and guidelines that may be
  adapted during pandemic (clinicians, patients,
  and family members)
• Educate and train healthcare personnel to detect
  patients with influenza, support surveillance
  systems, and manage and treat patients

46
Disease Surveillance

• Establish a system to detect cases and relay
  information to local and/or state health
  departments
• Surveillance for ILI in ER and outpatient
  settings
• System for internal review of pandemic influenza
  activity in patients to the emergency department
• Laboratory surveillance for unusual isolates
• System to detect transmission in the institution
• Test plan using non-pandemic influenza as a
  surrogate agent

47
Assess Your Capacity

• Assess bed and ventilator capacity
• Assess supply needs for consumable resources
  (e.g., PPE)
• Assess morgue capacity
• Prepare for airborne isolation
• Mobilize required resources (e.g., medical,
  emergency response) within respective jurisdiction

48
Prioritize Beds

• Spectrum of illness is broad, ranging from
  asymptomatic infections to death -- Be prepared
  for complications
• Develop criteria and plans for limiting access to
  the healthcare facility during a pandemic
• Prioritize elective medical and surgical
  admissions
• Develop policies and procedures for expediting
  discharge of patients who do not require
  inpatient care

49
Community Coordination

• Coordinate and develop agreements with other
  facilities in the community/ region
• Health departments
• Home health care
• Long term care
• Primary care

50
Emergency Services and Triage

• Emergency services
• Encourage collaboration between emergency service
  personnel and public health authorities
• Facilitate continuous state of readiness through
  ongoing educations, testing, revision of plans
• Triage and clinical evaluation of patients
• Develop and test options for triage during peak
  of pandemic

51
Respiratory Hygiene/Cough Etiquette

• Universal strategy for patients with symptoms of
  respiratory infection at initial point of contact
  with healthcare system
• Visual alerts
• Tissues or surgical masks for patients
• Hand hygiene materials in waiting areas
• Physical separation of patients with febrile
  respiratory illnesses
• Masks for healthcare workers caring for febrile
  respiratory patients and use Droplet precautions

52
Staffing Issues

• Plan on what to do when the healthcare system is
  overwhelmed and care must be provided by persons
  doing work which is normally not part of their
  daily activities
• Develop strategies to meet the range of staffing
  needs (e.g., recruit retired healthcare
  personnel)
• Engage clinicians in flu-related activities
  (e.g., provide data from ILI surveillance)
• Psychological support to healthcare workers

53
Education

• Clinicians and other healthcare professionals
• diagnosis and treatment
• prevention of transmission
• Patients and family members
• respiratory hygiene
• when to go to the hospital

54
Communication Plan

• Establish rapid and ongoing communication with
• public health officials
• other healthcare facilities,
• lay public and press
• public officials
• Ensure that a system is in place for timely
  communication about pandemic influenza within the
  healthcare facility
• Develop and test a plan to communicate/educate
  patients and visitors to avoid the hospital

55
Vaccination and Antiviral Use

• Plan to use (and distribute) antiviral agents for
  prophylaxis and treatment
• Healthcare personnel
• Patients and family members
• Plan to prioritize the use of vaccines
• Develop a system to monitor
• Work with local and state health department
• Promote vaccination during inter-pandemic period

56
Test the System
57
Healthcare Preparedness for Pandemic

• Impact of previous pandemics
• Inter-pandemic preparedness planning
• Surveillance
• Capacity and supplies
• Communication and Education
• Lessons learned from SARS

58
Lessons from SARS

• Early detection is vital
• Healthcare personnel resources can be affected by
  illness, fatigue, and fear
• Infection control also requires attention to
  visitors and family members
• Education and training with regular updates are
  necessary
• Clear chains of decision making and communication
  are needed

59
Assessment of Hospital Preparedness for Emerging
Infectious Disease Threats

• 556 hospitals in 47 states and Puerto Rico
  completed a survey on hospital preparedness
• Many hospitals have SARS plans but few have
  coordinated them with other facilities or
  jurisdictions
• Infection control and certain specialty services
  are limited in small and rural hospitals
• The number of negative pressure rooms and other
  medical equipment/supplies may not be adequate
  for a large event

60
Proportion of Hospitals Lacking Infection
Control Workforce by Bedsize

Bed size lt100 100-299 300-499 500 N
224 N-142 N154 N32 Infection Control 44
(20) 7 (5) 3 (2) 0 Practitioner Hospi
tal 215 (96) 114 (80) 109 (71) 11
(34) Epidemiologist ID Physician 186 (83) 79
(56) 45 (29) 0 Occupational Health 180 (80)
91 (64) 83 (54) 6 (19) Physician Occupational
Health 110 (49) 37 (26) 9 (6) 1
(3) Nurse
61
US Hospitals by Bed Size
Source AHA Annual Survey 2002
62
Smallpox and SARS Field Exercises

• Purpose to identify operational, logistical,
  communication, and administrative needs to
  prepare and manage BT or epidemic events
• Participants
• Airlines
• Local law enforcement, EMS, emergency planners
• Local and state public health departments
• Local healthcare facilities
• Custom and Border Patrol, Port Authority, TSA,
  DHS, and CDC

63
Field Exercises - Observations

• Lack of adherence to proper infection control
  practices and confusion about PPE use
• Inadequate planning for
• exposure management of healthcare workers
• surge capacity including staff, beds, equipment,
  and laboratory services
• Inadequate healthcare staff with appropriate
  expertise during non-peak hours
• Unclear notification and communication channels
  internally and externally

64
Conclusion

• Several actions can be taken to better prepare
  for pandemic influenza
• We need to use lessons learned from SARS response
  and examples from previous pandemics to improve
  preparedness for pandemic influenza
• Test the system individual and regional will
  help to identify gaps that can be addressed in
  the inter-pandemic period

65
Hurry Up and Get Ready!!!
66
PREVENTION IS PRIMARY!
Protect patientsprotect healthcare
personnel promote quality healthcare! Division
of Healthcare Quality Promotion
67
Distribution of Respondents, Hospital Preparedness
Assessment, N556
31 21-30 11-20 1-10 0
68
Healthcare Planning and Preparedness Needs

• Surge capacity staff, beds, supplies, equipment
• Regional coordination/collaboration
• Triage
• Infection control
• Delivery of interventions to staff and patients

69
Marburg Virus Hemorrhagic Fever

• Angola, October 2004- April 5th, 2005
• Total of 163 cases, 150 fatal
• 75 of reported cases in children aged lt5 years
• Healthcare workers
• Predominant symptoms fever, hemorrhage,
  maculopapular rash, vomiting, cough, diarrhea,
  and jaundice

70
Act Now!Address Prevention Planning Priorities
in Emergency Departments, Outpatient Offices, and
Inpatient Units
71
Pandemic Period New Virus Transmitted
Person-to-Person Abroad

• Objective Heighten institutional surveillance
  for influenza and prepare to activate
  institutional pandemic influenza plans
• Collaborate with key partners on planning
  preparations
• Heighten surveillance
• Reinforce basic infection control measures to
  prevent spread of influenza
• Accelerate training

72
Pandemic Period Virus Transmitted
Person-to-Person in United States

• Objective Maintain integrity of healthcare
  delivery services while responding to the
  communitys need for quality care
• Rapidly identify, isolate, and treat all patients
  with potential pandemic influenza
• Continue to provide healthcare by implementing
  system to increase capacities
• Maintain rapid and frequent communication within
  and among healthcare facilities and with state
  and local health departments to optimize response
  and control efforts.

73
Influenza vs. SARS
74
Lessons Learned

• Communication
• Compliance with basic infection control
• Leadership support
• Clinicians engagement
• Collaboration with community and public health
  planning groups
• Globalization

75
Surveillance Plan during pandemic

• Monitor morbidity and mortality associated with
  pandemic
• Determining if transmission is occurring in the
  facility potential breaches of infection
  control

76
Infection control is EVERYONEs responsibility!
77
Lessons Learned from SARS (1)

• 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.

78
Lessons Learned form SARS (2)

• Use of PPE prevents transmissionhowever,
• Healthcare personnel need instruction on how to
  don, use and remove PPE
• Wearing PPE for extended periods of time is a
  burden and can lead to breaches in technique

79
Education and Training Plan

• Clinical personnel should be educated about
  influenza disease, diagnosis and management
• Highlight the importance of vaccination
• Educate all facility and patients, family members
  and visitors about the prevention and control
• Triage and clinical evaluation of patients

80
When in North America?

• Canada within 3 months after it emerges in
  another part of the world
• Spreads in 2 or more waves 3-9 months of
  initial outbreak

81
Is a Pandemic Imminent?

• New influenza A virus arising from a major
  genetic change
• Susceptible population with little or no immunity
• Virus transmitted efficiently from
  person-to-person
• Virulent virus with capacity to cause serious
  illness and death

82
Factors Increasing Concern

• H5N1 has infected mammals (humans, cats, and
  pigs)
• The influenza season (H3N2) in northern Vietnam
  is ongoing concurrent with avian influenza
• Endemic H5N1 in ducks and wild birds makes
  eradication of this strain unlikely
• Antigenic change continues to occur

83
Assessment of Hospital Preparedness for Emerging
Infectious Disease Threats

• GAO survey suggested urban hospitals are ill
  prepared for a major biologic event
• SARS pandemic highlighted
• Importance of infection control programs and
  workforce
• Need for adequate equipment and supplies

84
Preparedness Planning Healthcare

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

85
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

86
Respiratory Hygiene/Cough Etiquette

• Universal strategy for patients with symptoms of
  respiratory infection at initial point of contact
  with healthcare system
• Visual alerts
• Tissues or surgical masks for patients
• Hand hygiene materials in waiting areas
• Physical separation of patients with febrile
  respiratory illnesses
• Masks for healthcare workers caring for febrile
  respiratory patients and use Droplet precautions

87
APIC Influenza Survey

• Assess the impact of the 2003/2004 influenza
  season on healthcare facility resources
• Assess adoption of respiratory hygiene programs

88
Availability of Preparedness Plans

• N ()
• Written SARS plan 320 (58)
• Coordination of plan with
• local heath department 247 (77)
• healthcare facilities 175 (55)
• municipalities 85 (27)

89
Workforce Resources
Total Urban Rural p-value () () () Microbiol
ogist 65 78 41 lt.0001 Pulmonologist 65 84 30 lt.00
01 Mental Health 61 71 42 lt.0001 Counselor Healt
h Communicator 77 87 60 lt.0001 Bioterrorism 76 77
72 .1 Coordinator
90
Proportion of Hospitals Lacking Infection Control
Workforce by Bedsize

Bed size lt100 100-299 300-499 500 N
224 N-142 N154 N32 Infection Control 44
(20) 7 (5) 3 (2) 0 Practitioner Hospi
tal 215 (96) 114 (80) 109 (71) 11
(34) Epidemiologist ID Physician 186 (83) 79
(56) 45 (29) 0 Occupational Health 180 (80)
91 (64) 83 (54) 6 (19) Physician Occupational
Health 110 (49) 37 (26) 9 (6) 1
(3) Nurse
91
Equipment Resources
Total Urban Rural p-value () () () 1
NPR on wards 86 92 75 lt.0001 1 NPR in
ICU 64 79 38 lt.0001 1 NPR in ER 57 72 33
lt.0001 ability to create NPR 34 37 28 .03 1
mechanical ventilator 91 95 84 .0003 1
portable HEPA filter 51 55 45 .02 1 portable
x-ray machine 97 98 98 .5 NPR negative
pressure room
92
Workforce Resources
Occupation None Median FTE Range Infection
Control 12 1 0 - 10 Practitioner Hospital 81
0.0 0 5 Epidemiologist ID Physician 56 0.0
0 17 Occupational Health 65 0.0 0
5 Physician Occupational Health 29 1 0
15 Nurse
93
Other Healthcare Settings

• Criteria for readmission
• Of one case, assume all are exposed
• Cancel or postpone procedures
• Coughing residents stay in their rooms

94
Smallpox and SARS Field Exercises

• Purpose to identify operational, logistical,
  communication, and administrative needs to
  prepare and manage BT or epidemic events
• Participants
• Airlines
• Local law enforcement, EMS, emergency planners
• Local and state public health departments
• Local healthcare facilities
• Custom and Border Patrol, Port Authority, TSA,
  DHS, and CDC