Mexico s experience with H1N1 and PPE

Transcription

1 Mexico s experience with H1N1 and PPE Rogelio Perez Padilla National Institute of Respiratory Diseases INER Mexico perezpad@gmail.com

2 Overview About INER Early situation during the outbreak PPE use

3 ABOUT THE NATIONAL INSTITUTE OF RESPIRATORY DISEASES - MEXICO

4 One of the 13 National Institutes of Health, 2000 workers

5 An Evolving Institution 1936 Tuberculosis Sanatorium 1959 Lung diseases 1982 National Institute ~17.3 acres / ~7 hectares

6 The Institution REFERRAL HOSPITAL 180 beds + ICU-ER-POC OUTPATIENT CLINIC RESEARCH Basic and Clinical TEACHING 5 Residency Programs Nursing School Respiratory Care school

7 EARLY SITUATION (APRIL-MAY 2009)

8 March April 2009 On April 5, we identified 3 patients with severe influenza in respiratory failure and mechanical ventilation. Vaccination against seasonal Flu started General precautions recommended by CDC were distributed: Use of masks, gloves, hand cleaning etc.

9 Hospitalization: three peaks Number of patients with confirmed or suspected influenza 2nd outbreak 1st outbreak 3rd outbreak April-May 2009 Sept-Nov 2009 Feb-Apr 2010

10 Emergency Room (ILI): three peaks 1st outbreak 2nd outbreak 3rd outbreak

11 The Result: A diverse response People at a bus stop wearing facemasks. Varied facemask usage was also seen in clinical settings around the country.

12 Training required. Using dustmasks as N95 Double facemask Carrying N95 outside risk area Facemask under N95

13 Workers Demand in early epidemic Low-risk workers demanding N95 respirators Pressure on resources Complicated to control distribution Stocks quickly depleted

14 May 2009 Limited supply of N95 Federal stockpile distributed Donations USA-aid China-aid Unfamiliar item (...?) Without information Downloaded from alibaba.com.cn Instructions in Chiness, unable to descifer

15 PPE Training Interventions 26 Apr 9 May 5 11 Nov

16 THE HUMAN FACTOR

17 Stress management: perception of high risk in personnel new disease H5N1? Young previously healthy individuals dying or in mechanical ventilation Personnel felt threatened/at risk Everybody should be wearing N95 Isolate high-risk workers Hospital reorganization also induces stress Over-reactions: going to Union, and to mass media Absenteeism (holidays)

18 Staff management Repeated on-site training sessions

19 (Used by permission of the author)

20 Use of PPE at the National Institute of Respiratory Diseases of Mexico, 2008 vs 2009 Training must address the needs and requirements of adult education with particular emphasis on reducing noise during stressing events. Substantial increase in 2009

21 Personnel with ILI at the National Institute of Respiratory Diseases of Mexico, Training must address the needs and requirements of adult education with particular emphasis on reducing noise during stressing events. *after the third patient admitted with severe influenza **one year of epidemic, three outbreaks, rate per worker-months much lower

22 Workers demanding N95 Workers demanded N95, for daily change, in clinical areas but also in other hospital areas.

23 Agreement: with the Hospital Union Use of N95 in areas with patients with ILI Use one for 5 working days (except if damaged) Use of surgical masks in the rest of the hospital

24 Conclusions We lack complete evidence-based information comparing N95 vs regular masks to take a rational decision risk reduction, cost-effectiveness, durability etc. Current idea is to use N95 only for high risk procedures Surgical masks for the remaining Emphasis on hand cleaning

25 THANK YOU

26 Institute of Medicine Workshop Current Research Issues Personal Protective Equipment for Healthcare Workers to Prevent Transmission of Pandemic Influenza and Other Viral Respiratory Infections June 3, 2010 Venable Conference Center th Street, NW Capitol Room 8 th Floor Washington, DC Rogelio Perez Padilla National Institute of Respiratory Diseases INER Mexico perezpad@gmail.com