Pandemic Influenza Policy

Transcription

1 Pandemic Influenza Policy Target Audience Who Should Read This Policy Version 1.1 August 2015

2 Ref. Contents Page 1.0 Introduction Purpose Objectives Process Pandemic Influenza Phases of a Pandemic Incubation Symptoms Transmission of Infection Infection Control Preparing to Respond Declaring a Pandemic and Action Required Recovery Phase Financial Arrangements Communication Procedures connected to this policy Links to Relevant Legislation Links to Relevant National Standards Links to Trust Policy/s References Roles and Responsibilities for this Policy Training Equality Impact Assessment Data Protection Act and Freedom of Information Act Monitoring this Policy is Working in Practice 41 Appendices 1.0 Inpatient/Residential Unit- Situation Report Non-Inpatient Services- Situation Report BCPFT Situation Report (STIREP) Putting on and Removing PPE Poster Pandemic Influenza Action Cards 46 Version 2.0 August

3 Explanation of terms used in this policy Action Cards- Action cards are physical documents containing easy-to-follow instructions on how to execute a key activity Aerosol Generating Procedures (AGP) - A procedure which stimulates coughing and promotes the generation of aerosols e.g. intubation, manual ventilation, CPR, collection of specimens (bronchial and tracheal aspirates), respiratory and airway suctioning (including tracheostomy care) Business Continuity-The creation and validation of a practiced logistical plan for how an organisation will resume and continue delivery (partially or completely) of interrupted critical functions within a predetermined time after a disaster or extended disruption Category 1 Responders- A term defined under the UK s Civil Contingencies Act (CCA) 2004 as a person or body listed in Part 1 of Schedule 1 to the CCA which is required to prepare for emergencies in line with its responsibilities under the Act, which includes assessing local risks, implementing emergency plans and co-operating with other local responders to enhance co-ordination and efficiency. Core responders include: Emergency Services (fire, ambulance, police) Local Authorities Government Agencies (Environment Agency) Health bodies (PCT s, Acute Trusts, Foundation Trusts, Local Health Boards (Wales), Health Protection Agency Category 2 Responders- A term defined under the UK s Civil Contingencies Act (CCA) 2004 as a person or body which has a role in supporting Category 1 responders. Co-operating responders include: Utilities (Gas, water, electric, telephone) Health Bodies (Strategic Health Authorities) Government Agencies (Health and Safety Executive) Transport (network rail, train operating companies, London underground, airport operators, harbour authorities, highways agency) Command and Control-The exercise of authority and direction by a properly trained designated Leader over an assigned and attached team in order to efficiently manage an organisations response to a major incident or emergency. Command and control functions are performed through an arrangement of personnel, equipment, communications, facilities and procedures. They are employed by the Team Leader in planning, directing, co-ordinating and controlling. They are designed to continue delivery of critical services at acceptable levels and affect an orderly return to business as usual operations Epidemic- The occurrence of more cases of a disease than would be expected in a community or region during a given period of time within the country of origin Pandemic- The occurrence of a disease occurring over a wide geographic area affecting an exceptionally high proportion of the population, spreading between countries Personal Protective Equipment (PPE) - Specialized clothing or equipment worn by employees for protection against health and safety hazards. Personal protective equipment is designed to protect many parts of the body, i.e. eyes, head, face, hands, feet, and ears Surge- A transient increase in demand for care or services above usual capacity World Health Organisation (WHO) - Part of the United Nations that is focused on global health issues. The organisation has been working for over sixty years on such issues as smallpox eradication, family planning, childhood immunisations, maternal morbidity rates, polio eradication, and AIDS Version 2.0 August

4 1.0 Introduction Influenza is a virus which affects up to 10% of the population every year. From time to time, a distinctly different strain of influenza virus will emerge that spreads rapidly across the world, causing an influenza pandemic. Pandemic influenza is a global disease outbreak, the virus spreads easily from person to person, causes serious illness and can sweep across the country in which it originates and around the world in a very short time. The World Health Organization (WHO) currently defines a pandemic as the worldwide spread of a new disease. They state that an influenza pandemic occurs when a new influenza virus emerges and spreads around the world and most people do not have immunity. An influenza pandemic is a rare occurrence and occurs one to three times a century but one could start at any time of the year. Historically, pandemics have had a higher clinical attack rate than seasonal influenza (10% - 50% of the population) and higher morbidity rate (0.34% to 2.5%). Previous pandemic virus strains have also targeted the year age range (not usually considered a vulnerable group in terms of seasonal influenza or general physical health). No country can expect to escape the impact of a pandemic entirely and when it arrives most people are likely to be exposed to an increased risk of catching the virus at some point. Influenza pandemics therefore pose a unique international and national challenge. As well as their potential to cause serious harm to human health, they threaten wider social and economic damage and disruption. 2.0 Purpose All NHS Trusts are required to have an operational plan to respond to an outbreak of pandemic influenza, approved by their Boards. This policy details the infection prevention and control measures that must be implemented and complied with in the event of a pandemic affecting the Black Country Partnership NHS Foundation Trust. This policy is based on the Department of Health (DH) current guidance documents and is to be used in conjunction with the Trust s Business Continuity Management Policy to manage the response to any of the following: Escalation of the Pandemic Influenza FluCon Assessment by the DH, which is used as the key indicator of threat Increase in preparedness and case management as directed by the WHO and DH prior to Pandemic FluCon Assessment implementation Reporting of any disruption or impact upon critical services during the period of a pandemic as set out by WHO Phase 6 Invocation of regional and or local Black Country Cluster escalation plans by the Regional Civil Contingencies Committee 3.0 Objectives The principle objectives of this policy are to: Ensure that the Trust is prepared for and can continue to function during an outbreak of pandemic influenza Ensure that the core services are maintained and provided at safe levels Minimise the impact of pandemic influenza on local services Set out procedures for handling infected patients and protecting staff, other patients and visitors Version 2.0 August

5 Identify arrangements for effective communication for patients, staff and visitors Set out the process for recovery from an influenza pandemic in line with the Trust s Business Continuity Management Policy 4.0 Process 4.1 Pandemic Influenza Influenza is a common acute viral infection that can affect all age groups. It is usually a seasonal illness, occurring predominantly in a six to eight week period each winter. With Pandemic Influenza all ages are likely to be affected but those with certain underlying medical conditions, pregnant women, children and otherwise fit younger adults could be at relatively greater risk. Older people usually have some residual immunity from previous exposure to a similar virus earlier in their lifetime. The exact pattern will only become apparent as the pandemic progresses Pandemic Influenza Background A pandemic may occur if an influenza virus undergoes major change (antigenic shift), and a new virus emerges, which is markedly different to recently circulating strains, and to which humans are not immune. A pandemic may occur if the new virus can: Infect people (rather than, or in addition to, animals or birds) Spread from person to person Cause illness in a high proportion of the people infected Spread widely, because most people will have little or no immunity to the new virus and will be susceptible to infection Such an influenza virus can spread rapidly, causing an epidemic within the country of origin and becoming a pandemic when it spreads between countries. A pandemic is a natural phenomenon that has occurred from time to time throughout history. The worst recorded pandemic was in 1918/9, this is also known as the Spanish Flu as Spain was the first country to report openly about the illness affecting its people. It is thought that the impact of World War 1 may have had a direct impact on the mortality figures for this pandemic; however it does not explain the high infection and mortality rate in areas not connected with the War and not in regular contact with other communities, such as Alaska and the Pacific Islands. The scientific research into the causes of the 1918/19 pandemic has led to the development of antiviral medication and the typing of virus strains. The interval between influenza pandemics is variable, ranging from 11 to 39 years during the last century. Although it is highly likely that another influenza pandemic will occur at some time it is impossible to forecast the exact timing or precise nature of its impact. Even if the pandemic originates in Asia, as it seems likely, it will probably reach the UK within 2 to 4 weeks of becoming epidemic in the country of origin and would then only take 1 to 2 weeks to spread to all major population centres here. Version 2.0 August

6 The severity of a pandemic varies but, in the last century, there were three pandemics and one which occurred in 2009: Pandemic Influenza Policy Pandemic Year Deaths worldwide Spanish Influenza 1918 Asian Influenza 1957 Hong Kong Influenza 1968 Swine Flu % (20-50 million) % (1-4 million) % (1-4 million) <0.025% (WHO estimates awaited) Age Groups most affected Young adults Children All age groups Children 5-14 young adults and pregnant women Sub type H1N1 H2N2 H3N2 H1N1 The National Risk Register of Civil Emergencies (2015 edition) highlights pandemic influenza as one of the highest risks: An influenza pandemic can occur either in one or in a series of waves, weeks to months apart. To inform preparedness planning, a temporal profile based on the pandemics that occurred in the last century and current models of disease transmission has been constructed. The profile is intended to show the fastest national progression of a pandemic from the time it becomes the dominant respiratory disease. More locally, epidemics might be over more quickly (6-8 weeks) with a proportionately higher peak. Vaccination or mass treatment with antiviral medicines (assuming their efficacy is similar to that Version 2.0 August

7 against seasonal influenza) can be expected to modify this profile. Pandemic Influenza Policy The Model of single pandemic wave profile showing the proportion of new clinical cases, consultations, hospital admissions or deaths by week in England It is possible that infection may sweep quickly through an in-patient facility, similar to previously recorded occurrences in residential schools and facilities. Infection rates have been recorded at up to 90%. In the event of a high number of patients being ill, all new admissions should be ceased. A high percentage of staff may also become ill during this period and staff from other units or local organisations may be required over a week to two week period to manage the outbreak. The World Health Organisation continues to monitor influenza viruses on a global scale. From 1997, the A/H5N1 virus has caused additional concern as it shares similar characteristics to the 1918/19 virus and has caused severe illness and death in previously healthy young adults. The timing, extent and severity of the next pandemic remains uncertain, as influenza viruses undergo major change at unpredictable intervals. But the circumstances still exist for a new influenza virus with pandemic potential to emerge and spread. New influenza viruses have usually emerged in the Far East and spread along trade and transportation routes. The most likely place for the next pandemic to emerge is China or South East Asia. Spread to the UK through the movement of people is likely to take less than three months. Experience of the dissemination of SARS in 2002 suggests that it may occur more rapidly than this, possibly as little as two to four weeks. The conditions that allow a new virus to develop and spread continue to exist and some features of modern society, such as air travel, could accelerate the rate of spread. Experts therefore agree that there is a high probability of another pandemic occurring, although timing and impact are impossible to predict. 4.2 Phases of a Pandemic The World Health Organisation (WHO) has identified six distinct phases in the progression of an influenza pandemic, from the first emergence of a novel influenza virus to a global pandemic being declared. Version 2.0 August

8 This six phase global classification is based on the overall international situation, and is used internationally for alerting purposes. However, following the 2009/10 swine flu pandemic the revised UK pandemic influenza strategy has moved away from close alignment with these phases and instead is more flexible and proportionate World Health Organisation Pandemic Phases The World Health Organisation (WHO) phases describe the progress of an influenza pandemic: Phase WHO International Phases Overarching Public Health Goals Inter-Pandemic Period 1 No new influenza virus subtypes 2 Animal influenza virus subtype poses substantial risk Pandemic Alert Period Strengthen influenza pandemic preparedness at global, regional, national and sub-national levels Minimise the risk of transmission to humans; detect and report such transmission rapidly if it occurs 3 4 Human infection(s) with a new subtype, but no (or rare) person-toperson spread to a close contact Small cluster(s) with limited personto-person transmission but spread is highly localised, suggesting that the virus is not well adapted to humans Ensure rapid characterisation of the new virus subtype and early detection, notification and response to additional cases Contain new virus or delay its spread to gain time to implement preparedness measures, including vaccine development 5 Large cluster(s) but person-toperson spread still localised, suggesting that the virus is becoming increasingly better adapted to humans Maximise efforts to contain or delay spread, to possibly avert a pandemic and to gain time to implement response measures Pandemic Period 6 Increased and sustained transmission in general population Post Pandemic Period Return to Inter-Pandemic Arrangements Minimise the impact of the pandemic Recovery and preparation for subsequent waves Note: the transition between the WHO phases may be rapid and the distinction blurred Version 2.0 August

9 4.2.2 UK Pandemic Phases UK planning is based around a five phase model: Phase Detect Focus in this Stage Intelligence gathering from countries already affected Enhanced surveillance in this country The development of diagnostics specific to the new virus Information and communications to the public and professionals The indicator for moving to the next stage would be the identification of the new influenza virus in patients in the UK Evaluate This would commence either on the declaration of the current WHO phase 4 or earlier on the basis of reliable intelligence or if an influenzarelated Public Health Emergency of International Concern (PHEIC) is declared by WHO The collection of detailed clinical and epidemiological information on early cases on which to base early estimates of impact and severity in the UK Reducing the spread of the virus within the local community by: actively finding cases, self -isolation of cases and suspected cases, treatment of cases/suspected cases and use of antiviral prophylaxis for close/vulnerable contacts, based on risk assessment of the possible impact of the disease. The indicator for moving from this stage would be evidence of sustained community transmission of the virus, i.e. cases not linked to any known or previously identified cases The above two stages together form the initial response. This may be relatively short and the phases may be combined depending on the speed with which the virus spreads, or the severity with which individuals and communities are affected. It will not be possible to halt the spread of a new pandemic influenza virus and it would be a waste of public health resources and capacity to attempt to do so Treat Treatment of cases Enhancement of the health response to deal with increasing numbers of cases Consider enhancing public health measures to limit transmission of the virus as appropriate, such as localised school closures based on public health risk assessment The indicator to move to the next stage would be when demands for services start to exceed the available capacity. This decision is likely to be made at a regional or local level as not all parts of the UK will be affected at the same time or to the same degree of intensity Arrangements will be activated to ensure that necessary detailed surveillance activity continues in relation to samples of community cases, hospitalised cases and deaths Version 2.0 August

10 Phase Escalate Recover Focus in this Stage Escalation of surge management arrangements in health and other sectors Prioritisation and triage of service delivery Resiliency measure This stage would not necessarily be activated in a mild to moderate pandemic such as that experienced in 2009 Normalisation of services Restoration of business as usual services Evaluation Planning and preparation for a resurgence of activity Targeted vaccination when available The indicator for this phase would be when influenza activity is either significantly reduced compared to the peak or when the activity is considered to be within acceptable parameters. An overview of how service capacities are able to meet demand will also inform this decision 4.3 Incubation The incubation period will be in the range of one to four days (typically 2-3). Flu viruses enter the body via the respiratory airways and multiply in the cells lining the nose, throat and upper respiratory airways affecting mainly the respiratory system. People are most infectious soon after they develop symptoms; adults are infectious for up to a day before the symptoms appear and up to five days from the onset of symptoms. Longer periods have been found, particularly in those who are immunosupressed. Children may be infectious for up to seven days. Some people can be infected, develop immunity and have minimal or no symptoms but still able to pass on the virus. Most people will return to normal activity within 7-10 days. 4.4 Symptoms Influenza is a respiratory illness characterised by sudden onset of: Fever 38 c high temperature, sweating and chills/shivering Headache Extreme physical weakness and fatigue Aching muscles and joints Dry cough Sore throat Runny or stuffy nose Diarrhoea and vomiting There is a wide spectrum of illness, ranging from minor symptoms through to pneumonia and death. Version 2.0 August

11 4.4.1 Predicted Complications Caused by Influenza Pulmonary Cardiac Musculoskeletal Central Nervous System Other Bronchitis Bacterial pneumonia (most common) Combined viral/bacterial pneumonia Pure viral pneumonitis Atrial fibrillation Heart failure Myocarditis Pericarditis Myositis Rhabdomylysis Encephalitis Transverse myelitis Guillain-Barré Syndrome Reye s Syndrome These illnesses may require treatment in hospital and may be life threatening especially in the elderly, asthmatics, those in poor health and pregnant women. During a pandemic influenza they can cause serious illness in young healthy individuals including cyanosis where no clinical intervention may assist the patient s poor prognosis Clinical Risk Groups who Should Receive Influenza Immunisation Clinical risk groups who should receive the influenza immunisation taken from the Green Book: Influenza Chapter 2015: Version 2.0 August

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13 *The list above is not exhaustive and the medical practitioner should apply clinical judgement In addition to the above, immunisation should be provided to healthcare and social care workers in direct contact with patients/clients to protect them and to reduce the transmission of influenza within health and social care premises. It should also be provided to those who are in receipt of a carer s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. 4.5 Transmission of Infection Droplet Transmission Droplets greater than 5 microns in size may be generated from the respiratory tract during coughing, sneezing or talking. If droplets from an infected person come into contact with the mucous membranes (mouth or nose) or surface of the eye of a recipient, they can cause infection. These droplets remain in the air for a short period and travel about one metre, so closeness is required for transmission Direct Contact Transmission Infectious agents are passed directly from an infected person (for example after coughing into their hands) to a recipient who then transfers the organism into their mouth, nose or eyes Indirect Contact Transmission This takes place when a recipient has contact with a contaminated object, such as bedding, furniture or equipment which is usually in the environment of an infected person. Again, the recipient transfers the organisms from the object to their mouth, nose or eyes The Airborne Route During and After Aerosol Generating Procedures (AGPs) AGPs can produce droplets <5 microns in size. These small droplets can remain in the air, travel more than one metre from the source and still be infectious, either by mucous membrane contact or inhalation. Version 2.0 August

14 It is well established that influenza is transmitted from person-to-person through close contact and is easily passed on by breathing in the tiny droplets from the breath of infected people which are produced when they talk, cough or sneeze. Transmission almost certainly occurs through multiple routes, including droplets and direct and indirect contact. Influenza is highly contagious it may also be spread by hand-to-face contact after a person or surface contaminated with infectious droplets has been touched. Influenza spreads rapidly especially in closed communities e.g. hospitals, residential care homes, secure units etc. The virus can survive outside the body for some time: Hard surfaces-24 to 48 hours Cloths- 8 to12 hours Hands- 5 minutes Hygiene and environmental cleaning is therefore important in helping to control the spread through contact Reducing the Risk of Transmission The following section is adapted from the Department of Health publication Pandemic (H1N1) 2009 Influenza: A summary of guidance for infection control in healthcare settings. Limiting transmission of pandemic influenza in a healthcare setting requires a range of measures. Administrative controls: Timely recognition of influenza cases Maintaining separation in space and/or time between influenza and noninfluenza patients Occupational health arrangements, including immunisation of frontline healthcare workers Educating staff, patients, carers and visitors about infection control for influenza including the importance of good respiratory hygiene Consistently and correctly implementing standard and droplet infection control precautions to limit transmission Restricting access of ill visitors to the building Instructing staff members with symptoms to stay at home and not come into work Planning and implementation of strategies for surge capacity Environmental/engineering controls: Environmental cleaning Adequate ventilation Waste disposal Use of PPE and hand hygiene: Using PPE appropriately according to the risk of exposure to the virus Consistent and correct hand hygiene Version 2.0 August

15 4.6 Infection Control In the event of a Pandemic the Infection Control principles below apply to all Trust staff caring for patients in in-patient settings and those working in the community having direct contact in the patient s own home Standard Infection Control Precautions Standard infection control precautions (also known as standard infection control principles) and droplet precautions must be used for patients with suspected or confirmed pandemic influenza. Standard infection control precautions: Are a set of broad statements of good practice to minimise exposure to and transmission of a wide variety of micro-organisms Should be applied by all healthcare practitioners to the care of all patients all of the time Protect against contact transmission of influenza as they include the use of hand hygiene, gloves and aprons to protect from respiratory secretions and other bodily secretions and excretions Standard infection control precautions include: Hand Hygiene Correct use of Personal Protective Equipment (PPE) Occupational exposure management including Sharps Management of care equipment Safe care of linen including uniforms Control of environment Safe use and disposal of waste and sharps (See Infection Prevention and Control Assurance Policy for further details) Hand Hygiene Good hand hygiene is essential to reduce the transmission of infection in healthcare settings and is a critical element of standard infection control precautions. Hands must be cleaned immediately before every episode of direct care of or contact with patients and after any activity or contact that potentially results in hands becoming contaminated, including the removal of protective clothing (including gloves), cleaning of equipment and handling of waste Hands should be cleaned between caring for different patients and between different care activities for the same patient, even if gloves have been worn Hand hygiene includes hand washing with soap and water and thorough drying, and the use of alcohol-based products (e.g. alcohol hand rub) that do not require the use of water If hands are visibly soiled or contaminated, then they should be washed with soap and water and dried; if not visibly soiled, an alcohol hand rub can be used Hand washing and use of alcohol hand rub to clean hands must be carried out thoroughly and for a time period sufficient to inactivate the virus, i.e. 40 to 60 seconds for hand washing (including thorough drying); 20 to 30 seconds when using alcohol hand rub Touching the face with gloved hands or hands that have not been recently cleaned should be avoided All staff, patients and visitors should clean their hands when entering and leaving areas where care is delivered Version 2.0 August

16 Respiratory Hygiene Catch it, bin it, kill it Patients, staff and visitors should be encouraged to minimise potential influenza transmission through good respiratory hygiene measures: Hands should be kept away from the eyes, mouth and nose Disposable, single-use tissues should be used to cover the nose and mouth when sneezing, coughing or wiping and blowing noses. Used tissues should be disposed of promptly in the nearest waste bin Tissues, waste bins (preferably lined and foot operated) and hand hygiene facilities should be available for patients, visitors and staff Hands should be cleaned (using soap and water if possible, otherwise using alcohol hand rub) after coughing, sneezing, using tissues or after any contact with respiratory secretions and contaminated objects Some patients (e.g. older people and children) may need assistance with containment of respiratory secretions; those who are immobile will need a container (e.g. a plastic bag) readily at hand for immediate disposal of tissues In common waiting areas or during transport, symptomatic patients may wear surgical masks to minimise the dispersal of respiratory secretions and reduce environmental contamination Applying Droplet Precautions for Pandemic Influenza In addition to standard infection control precautions, droplet precautions should be used for a patient known or suspected to be infected with influenza. Droplet precautions should be continued until the resolution of fever and respiratory symptoms Patient Placement Patients with suspected or confirmed influenza should be placed in single rooms. When this is not possible, patients should be cohorted (grouped together with other patients who have influenza or the symptoms of influenza and no other infection) in a segregated area. A distance of at least one metre should be maintained between patients beds; in communal areas where there are no beds, patients should be kept at least one metre apart. Special environmental controls, such as negative pressure rooms, are not necessary to prevent the transmission of influenza either by respiratory droplets or aerosols. Patient s cared for in their own homes should be advised to isolate themselves while symptomatic as far as is possible to reduce the risk of transmission to other family members Fluid Repellent Surgical Masks Fluid repellent surgical masks must be worn when working in close contact (within approximately one metre) of a patient with symptoms. In an area where influenza patients have been cohorted together, it may be more practical for staff to wear a surgical mask at all times, rather than only when in close proximity to or close contact with a patient Patient Transport The movement and transport of patients from their rooms or the cohorted area should be limited to essential purposes only Staff at the destination must be informed that the patient has or is suspected to have influenza If transport or movement is necessary, consider offering the patient a surgical Version 2.0 August

17 mask to be worn during transport until the patient returns to the segregated area, to minimise the dispersal of respiratory droplets. As an alternative, good respiratory hygiene should be encouraged Catch it, bin it, kill it Hand hygiene is important for staff involved in transfers, and hand hygiene facilities should be offered to patients when feasible Aerosol-Generating Procedures It has been suggested that aerosols generated by medical procedures are one route for the transmission of the influenza virus. However, the evidence necessary to establish which aerosol-generating procedures are associated with transmission of influenza or other pathogens is poorly established, with studies being of variable quality and rigour. A WHO review of such studies found that it was not possible to draw recommendations from some of the conclusions due to flaws identified within the methodology. From the available literature and incorporating UK expert opinion, the following procedures are considered likely to generate aerosols capable of transmitting influenza when undertaken on patients with influenza, i.e. are considered to be potentially infectious aerosol-generating procedures: Intubation, extubation and related procedures, e.g. manual ventilation and open suctioning Cardiopulmonary resuscitation Bronchoscopy Surgery and post-mortem procedures in which high-speed devices are used Dental procedures Non-invasive ventilation (NIV), e.g. Bilevel Positive Airway Pressure ventilation (BiPAP) and Continuous Positive Airway Pressure ventilation (CPAP) High-frequency oscillating ventilation (HFOV) Induction of sputum For patients with suspected or confirmed influenza, any of these potentially infectious aerosol-generating procedures should only be carried out when essential. Where possible, these procedures should be carried out in well-ventilated single rooms with the doors shut. Only those healthcare workers who are needed to undertake the procedure should be present. A gown, gloves, eye protection and an FFP3 respirator should be worn by those undertaking these procedures and by those in the same room. In post-mortem examinations where high-speed devices are used, the use of a powered respirator can be considered as an alternative to a FFP3 respirator. The rate of clearance of aerosols in an enclosed space is dependent on the extent of any ventilation the greater the number of air changes per hour (ventilation rate), the sooner any aerosol will be cleared. The time required for clearance of the aerosol, and thus the time after which the room can be entered without a respirator, can be determined following a risk assessment. The risk assessment should take into account the characteristics of the room such as whether it is a room in a theatre suite or a ward side room and, if known, the number of air changes per hour as outlined in WHO guidance. Where feasible, environmental cleaning should be performed when it is considered appropriate to enter without a respirator. Visitors to patients ventilated with NIV or HFOV may be exposed to potentially infectious aerosols. The number of such visitors should be limited where possible. Version 2.0 August

18 Visitors should be made aware of the risks and be offered PPE as recommended for staff. Certain other procedures/equipment may generate an aerosol from material other than patient secretions but are not considered to represent a significant infectious risk. Procedures in this category include: Administration of pressurised humidified oxygen Administration of medication via nebulisation During nebulisation, the aerosol derives from a non-patient source (the fluid in the nebuliser chamber) and does not carry patient-derived viral particles. If a particle in the aerosol coalesces with a contaminated mucous membrane, it will cease to be airborne and therefore will not be part of the aerosol. For such procedures, gloves, an apron and a surgical mask (plus eye protection if there is a risk of splashes to the eyes) are recommended as per standard infection control and droplet precautions Personal Protective Equipment (PPE) PPE is worn to protect staff from contamination with body fluids and to reduce the risk of transmission of influenza between patients and staff and from one patient to another. Appropriate PPE for care of patients with pandemic influenza is summarised in the table below. Standard infection control precautions apply at all times. PPE should comply with the relevant BS EN standards (European technical standards as adopted in the UK) where these apply Personal Protective Equipment for Care of Patients with Pandemic Influenza Entry to cohorted area but no patient contact Close patient contact (within one metre) Aerosolgenerating procedures Hand Hygiene Gloves Plastic Apron Gown Surgical Mask FFP3 Respirator Eye Protection Risk Assessment Eye protection As part of standard precautions, eye protection should be used when there is a risk of contamination of the eyes from splashing, e.g. by secretions (including respiratory secretions), blood, body fluids or excretions An individual risk assessment should be carried out at the time of providing care Disposable, single-use eye protection is recommended Version 2.0 August

19 Eye protection should always be worn by all those present in the room during potentially infectious aerosol-generating procedures Surgical masks Surgical masks are worn to protect the wearer from the transmission of influenza by respiratory droplets. A recent trial suggests that masks and respirators offer a similar level of protection to each other against infection with influenza to healthcare workers during routine patient care (this does not apply to infectious aerosol-generating procedures). Surgical masks should be fluid repellent and should be worn by healthcare workers for any close contact with patients with influenza symptoms (i.e. within approximately one metre). The mask will provide a physical barrier and minimise contamination of the nose and mouth by droplets When pandemic influenza patients are cohorted in one area and several patients must be visited over a short time or in rapid sequence, it may be more practical for staff to put on a surgical mask on entry to the area and to keep it on for the duration of the activity or until the surgical mask requires replacement (i.e. when it becomes wet or damaged) In outpatient settings it may be more practical for staff working in the segregated area for influenza patients to put on a surgical mask on entry to the area and to keep it on for the duration of the activity or until the surgical mask requires replacement Surgical masks should: - cover both nose and mouth - not be allowed to dangle around the neck after or between each use - not be touched once put on - be changed when they become moist or damaged - be worn once and then discarded as clinical waste hand hygiene must be performed after disposal Respirators A disposable respirator providing the highest possible protection factor available (i.e. an EN149:2001 FFP3 disposable respirator) should be worn by healthcare workers when performing procedures that have the potential to generate infectious aerosols.ffp3 support training materials are available on the DH website ( Fitting the respirator correctly is critically important for it to provide proper protection. Every user should be fit tested and trained in the use of the respirator. In addition to the initial fit test carried out by a trained fitter, a fit check should be carried out each time a respirator is worn. A good fit can only be achieved if the area where the respirator seals against the skin is clean shaven. Beards, long moustaches and stubble may cause leaks around the respirator. Other types of respiratory protective equipment (e.g. powered hoods and helmets) are available and should be considered if a good fit cannot be achieved with disposable respirators. A powered respirator might be the only type suitable for some healthcare workers, for example someone who, perhaps for cultural reasons, prefers not to remove their beard. Disposable respirators should be replaced after each use and changed if breathing Version 2.0 August

20 becomes difficult, the respirator is damaged or distorted, the respirator becomes obviously contaminated by respiratory secretions or other body fluids, or if a proper face fit cannot be maintained. Respirators should be disposed of as clinical (also known as infectious) waste Putting on PPE PPE should be put on before entering a side room or cohorted area. If full PPE is required, for example for a potentially infectious aerosol-generating procedure, all staff in the room or entering within one hour of the procedure should wear the following PPE put on in the following order: 1. Gown (or apron if not a potentially infectious aerosol-generating procedure) 2. FFP3 respirator (or surgical mask if not a potentially infectious aerosolgenerating procedure) 3. Eye protection, i.e. goggles or face shield (for a potentially infectious aerosolgenerating procedure and as appropriate after risk assessment) 4. Disposable gloves This order is practical but the order for putting on is less critical than the order of removal given below Removal of PPE PPE should be removed in an order that minimises the potential for crosscontamination. Before leaving the side room or cohorted area, gloves, gown and eye protection should be removed (in that order, where worn) and disposed of as clinical (also known as infectious) waste. After leaving the area, the respirator (or surgical mask) can be removed and disposed of as clinical waste. (See Appendix 2) Gloves: Grasp the outside of the glove with the opposite gloved hand; peel off Hold the removed glove in gloved hand Slide the fingers of the un-gloved hand under the remaining glove at the wrist Peel the second glove off over the first glove and discard appropriately Gown or apron: Unfasten or break ties Pull gown or apron away from the neck and shoulders, touching the inside of the gown only Turn the gown or apron inside out, fold or roll into a bundle and discard Eye protection: To remove, handle by headband or earpieces and discard appropriately. Respirator or surgical mask: Untie or break bottom ties, followed by top ties or elastic, and remove by handling ties only and discard appropriately To minimise cross-contamination, the order outlined above should be applied even if not all items of PPE have been used. Clean hands thoroughly immediately after removing all PPE. Version 2.0 August

21 Visitors During a pandemic visitors to all areas should be kept to a minimum Visitors with influenza symptoms should not enter the clinical area and should be encouraged to return home All visitors entering an affected clinical area must be instructed on hand hygiene practice and the wearing of PPE as appropriate Environmental Cleaning Freshly prepared detergent and warm water should be used for cleaning in clinical areas. Influenza viruses are removed by detergent, so it is not necessary to enhance cleaning with chlorine-based disinfectants Areas used for cohorted patients should be cleaned at least daily Clinical rooms should be cleaned at least daily and after clinical sessions for patients with influenza Frequently touched surfaces such as medical equipment and door handles should be cleaned at least twice daily and when known to be contaminated with secretions, excretions or body fluids Domestic staff should be allocated to specific areas and not moved between influenza and non-influenza areas Domestic staff should be trained in which PPE to use and the correct methods of wearing and removing PPE. In addition to gloves and an apron, a surgical mask should be worn for cleaning in cohorted areas Linen Treat Linen as used infected; bag linen as per Trust policy for handling used infective linen safely Both used and infected linen must be handled, transported and processed in a manner that prevents exposures to skin and mucous membranes of staff, contamination of their clothing and the environment, and infection of other patients. Gloves and an apron should be worn when handling used linen. Hands should be cleaned after removing PPE 4.7 Preparing to Respond The Trust s Emergency Planning Officer with the co-operation and advice from the Infection Prevention and Control Team will advise the Trust Board when it is necessary to activate the Pandemic Influenza Plan and the Major Incident and Business Continuity Plan in order to ensure the Trust is prepared to respond to the potential pandemic. During this phase the Trust will ensure its Business Continuity plans are reviewed and updated and the Pandemic Influenza Planning Group is mobilised. In the absence of early or effective intervention there could be widespread social and economic disruption including: Threats to the continuity of essential services (including fuel) Lower production levels of essential goods (including pharmaceuticals) Travel disruptions causing shortages and distribution difficulties of essential supplies All of the above can be mitigated or the effects minimised with good business continuity management practices. Version 2.0 August

22 Since the potential impact of a pandemic is determined by many factors leading to uncertainties surrounding the potential severity of any future pandemic, the UK has the following preparedness arrangements: UK wide stockpiles and distribution arrangements of antiviral medicines and antibiotics sufficient for a widespread severe pandemic Health service preparation for up to 30% of symptomatic patients requiring assessment and treatment in usual primary care pathways through surge planning Health service preparation for between 1 and 4% of symptomatic patients requiring hospital care through surge planning Multi-agency planning to cope locally with up to 200,000 additional deaths across the UK over a 15 week period through excess death planning (this is a precautionary measure as less widespread and lower impact pandemic the deaths would be lower) Staff Absence The difficulties in maintaining essential services detailed above could be exacerbated within the Trust further by high levels of staff absence with over 50% of all staff possibly requiring time off at some stage over the pandemic period through: Sickness or fear of infection Care providing responsibilities (especially if schools are closed) Stress Bereavement (or other psychological impacts) Transport disruptions It is likely that staff absences will be higher and more pronounced in the Trust s smaller teams where staff work in close proximity Workforce Management Staff will follow the business continuity procedures in a pandemic with low and moderate impacts. However in a high impact event the Trust is likely to activate its major incidents procedures and activate this policy Pandemic Influenza Planning Group Pandemic influenza planning group should meet routinely 2-3 times per year in order to review this policy and undertake exercises to test the Trusts emergency response. The group will develop an action list to progress the planning process, this includes roles and responsibilities for areas including all clinical services, antiviral distribution, staff welfare and infection control. In developing this plan, the group will consult widely with subcontracted services and neighbouring organisations on specific issues. In the event of a Pandemic the group will meet at least once each day to review developing and predicted contingencies and to ensure plans are in place to respond to them. The following roles make up the core group: Pandemic Influenza Lead (responsible person TBC) Emergency Planning Officer Chief Operating Officer Version 2.0 August

23 Infection Prevention and Control Team Medical Director Director of Resources (includes Communications and IT) Chief Pharmacist Director of Workforce and Learning Staff-side / Union representative Communications Lead Service Directors for those parts of the organisation affected Estates and Facilities Pandemic Influenza Policy Terms of reference of this group are to: Provide leadership and co-ordination in planning and dealing with the potential implications of an Influenza pandemic (or similar highly infectious disease) Monitor identified actions and report progress at each meeting Co-ordinate the work of subgroups Discuss and agree the decision making process for the deployment of local resources, including restricting, withdrawal and cancellation of services Identify and develop strategies for the maintenance of essential services Interpret and implement local, national and international guidance on potential pandemics Develop communication material for service users in line with national guidance and local responding organisations Develop business continuity strategies and co-ordinate post-pandemic return to normality Prepare reports on progress or planning issues Work with the Infection Prevention and Control Team to effectively manage influenza outbreaks Co-ordinate bed management including ward/departmental closures Review effectiveness of this policy in light of lessons learnt from exercises or incidents. Utilize the Action Cards in Appendix 3 Maintain the incident record log 4.8 Declaring a Pandemic and Action Required WHO will announce the phases when they are confirmed, indicating the level of preparedness expected. National authorities are expected to activate their contingency plans immediately following announcement of WHO Phase 5 (see 4.2.1) The Secretary of State will inform all health and social care organisations of any change to the World Health Organisation pandemic alert phases, or UK alert levels, via the Chief Medical Officers link with Public Health England. Directors of Public Health within the local authority will ensure a co-ordinated approach from all organisations involved in the response. In addition the national communication strategy will ensure information is cascaded in a timely manner. At this point the Trusts Business Continuity Management Policy will be used in addition to the local group plans to ensure the pandemic influenza response is coordinated in a timely manner. Version 2.0 August

24 4.8.1 Trust Actions Required During the Phases of the Pandemic Named Indicator Actions / Focus for the Trust Phase Detection Locally, this phase would start if the World Health Organisation phase 4 was declared or if there was reliable intelligence or if an influenza-related Public Health Emergency of International Concern was declared by the WHO If there was identification of the novel influenza virus in patients in the UK then this would be an indicator to move to the next stage Summary of key National healthcare response Initiate the Pandemic Influenza Planning Group (book rooms etc.) Initiate urgent review of Trust current response plans, business continuity arrangements and surge arrangements and any findings from the Local Resilience Forum Review current response strategies in respect of any past experiences Accelerate, consolidate and test all Trust wide and local pandemic preparedness efforts Ensure subcontractors and commissioned services have adequate response plans in place Increase awareness of the signs, symptoms and epidemiology of pandemic influenza as well as infection control measures, including posters, intranet and newsletters - training Review use of infection control procedures and use of personal protective equipment within services Check stock availability of PPE, antiviral medication, antibiotics etc. and introduce stringent stock control measures Implement record keeping and surveillance measures for suspected or confirmed cases of Pandemic influenza to the Public Health services Trust representation at relevant local committees as part of the joint management approach Continue business as normal Public Health England response supported by primary care Detection and diagnosis of early cases through testing and contact tracing Influenza information line may be activated Local areas to start initial preparations for activation of Antiviral Collection Points (ACPs) Preparations to use the National Pandemic Flu Service (NPFS) when required Version 2.0 August

25 Named Phase Assessment Indicator Progression on to the next stage would occur if there was evidence that cases were not linked to any known/ previously identified cases Pandemic Influenza Policy Actions / Focus for the Trust Ensure continued Trust representation at relevant local committees as part of the joint management approach Set up the Situation Reports (SITREP) see Appendix 1.1 and 1.2 to enhance surveillance and data collection to reflect Public Health Services data requests Review staff sickness levels and implement Business Continuity measures if required, communicating and changes to services to staff and patients Increase Infection Prevention and Control Procedures and distribute personal protective equipment as required Liaise with Public Health teams locally regarding additional service requirements e.g. antiviral collection points, vaccination requirements etc. Liaise with local acute trusts regarding any changes to admission/discharge criteria Ensure subcontractors and commissioned services are putting their response plans in place (if required) Implement any Pandemic Influenza training as required (i.e. use of FFP3 mask fitting, basic medical care and infection control precautions) Review staff skills including volunteers and recently retired staff lists and their training requirements Continue business as usual Summary of key National healthcare response Influenza information line function activated ACPs established in hotspots only Use of existing legislation to allow the supply of antiviral medicines at premises that are not a registered pharmacy Detection and assessment collectively form the initial response. The length of this phrase will depend on the severity and speed by which the virus spreads. These two initial stages may be combined Version 2.0 August

26 Named Phase Treatment Indicator During a pandemic, the need for services may exceed the service s available capacity. At this point a decision would most likely be made locally or nationally to decide what additional measures are required Pandemic Influenza Policy Actions / Focus for the Trust Work in conjunction with the CCG to agree establishment of any additional services i.e. anti-viral distribution points or vaccination centres Complete pre-pandemic or seasonal flu vaccination of staff if available and advised by Public Health Review SITREP reports including number of infected patients and staff implement workforce management measures as needed Monitor the provision of services and implement Business Continuity measures if trigger points are reached, communicating any changes to service delivery to patients and staff Review current cases and advise changes to admission criteria if necessary (taking into account the impact on vulnerable service users) Review use of infection control procedures and personal protective equipment within services and stock control provisions against current guidance, implementing any changes and ordering additional stock if required Review use of PPE and masks Set up a staff welfare team and agree any measures which may be introduced to assist staff i.e. provision of transport Review Trust plans in light of current information and public reaction Summary of key National healthcare response Influenza information line function active NPFS activated as required Local areas establish ACPs as required Contingency plans for supporting care at home and respite care On-going monitoring of the nature and scale of illness locally and nationally and its effect on healthcare delivery These two stages together form the treatment phase. In mild pandemics it may not be necessary to activate the escalation stage but it would be preferential to start preparing at the start of the Treatment phase Version 2.0 August

27 Named Phase Indicator Actions / Focus Escalate The start of this phase would be indicated when influenza activity has dramatically increased with widespread disease in the UK with most age groups affected and/or severe debilitating illness with or without severe or frequent complications Pandemic Influenza Policy Continue with or start to moderate actions Activate major incident command and control procedures if trigger point is met Regularly report situation to the Pandemic Influenza Planning Group Establish daily briefing bulletin including number of cases and mortality rate Review data collection and surveillance requirements during peak period Review staff absence rates and ability to resource essential services Review staff welfare arrangements and enable well staff to work Review implications of change in duties for redeployed staff Review use of personal protective equipment (if available) and stock control provisions (record level of use during peak weeks for use during next wave) Review antiviral medication stocks and availability for re-ordering Communicate latest medical and selfcare information for staff and patients Agree admission and discharge protocols for local hospitals during peak weeks Determine level of care to be provided in the community for service users in relation to staffing and resource availability Implement alternative mortality arrangements (if necessary) Ensure regular communication updates are issued and Trust messages are being added to local communication bulletins Implement any reduced service policies agreed with subcontractors Review policy on visitors to in-patient facilities during peak of pandemic Assess availability of medicines and essential resources Ensure deputies are appointed to all key roles in case of illness or absence Summary of key National healthcare response (escalate phase) Emphasis on maintaining supplies and staffing Possible implementation of national legislative changes to facilitate changes in working practice (e.g. death certification, drivers hours, sickness selfcertification requirements, Mental Health Act, benefits payments) On-going monitoring of the nature and scale of illness locally and nationally and its effect on healthcare delivery Version 2.0 August

28 Named Phase Indicator Actions / Focus Recovery Recovery (continued) The start of this phase would be indicated when influenza activity has dramatically reduced in comparison to the peak or when activity is within acceptable parameters Pandemic Influenza Policy Continue with or start to moderate actions Reduce the frequency of briefing bulletins as appropriate Review availability of services and implement recovery strategy, recovering services back to how they were before or developing a new outlook of what is normal for a service Return to business as usual with the aim of catching up on activity which was scaled down due to the pandemic. For example re-scheduling cancelled appointments Address issues relating to staff fatigue, review absence levels, and allocate additional or compassionate leave where appropriate Reduce rotas and duties (where necessary) for seconded / volunteer staff Review surveillance and data collection methods Review availability of subcontracted services and suppliers Ensure PPE (if available) is used to minimise the risk of infection (virus will still be circulating although number of cases reducing) Review antiviral medication use and stock availability Review effectiveness of local communication methods and information for patients and staff Review admission protocols for local hospitals and reintroduction of services Agree stand down of control team Review level of care provided in the community and transfer individuals to appropriate inpatient care as required (where available) Assess case loads and redeploy Version 2.0 August

29 staff and resources where necessary to relieve short term pressures Ensure regular communication updates are issued regarding changes to services, postpandemic vaccination availability etc. Review mortality arrangements Conducting a review post pandemic of what went well, what could have gone better and any lessons learnt Prepare a debrief report for the Trust Board Prepare for the influenza virus remerging Prepare post pandemic vaccination strategy and allocate resources Prepare for post pandemic seasonal influenza Summary of key National healthcare response Emphasis on maintaining supplies and staffing Provision of psychological counselling for both staff and public will be required Preparation for 2 nd and future waves Business Continuity Management For guidance on business continuity management please refer to the detailed plans described in the Business Continuity Management Policy. Business Continuity Management (BCM) is a process that helps manage risks to the smooth running of our organisation or delivery of our services, ensuring continuity of critical functions in the event of a disruption, and effective recovery afterwards. Business Continuity Management (BCM) is facilitated through the production of Business Continuity Plans (BCPs) which, as well describing the steps that need to be followed to maintain or recover the delivery of services, will also cover incident management such as the initial impact of an event e.g. evacuation of patients and staff, media response, etc. Each major site of the Black Country Partnership NHS Foundation Trust should have a Business Continuity Plan (BCP) that is specific to that site/service. The major site plan may well be made up of individual unit/service plans dependant on the sites requirements Unit/service BCPs will be available from the service manager in each building whereas the overall site plan may only be available on the intranet or in a senior managers office Business Continuity Plans cover all elements of our services and in addition this Pandemic Flu Plan contains information specific to BCM during a flu pandemic. The Civil Contingencies Act requires that all Black Country Partnership NHS Foundation Trust services: Version 2.0 August

30 Have robust and tested business continuity plans in place which cover arrangements for dealing with pandemic influenza (see Business Continuity Management Policy) Encourage organizations on which they will rely during a pandemic do the same (i.e., have business continuity plans in place which cover arrangements for dealing with pandemic influenza) Guidance for business continuity planning (including a pandemic influenza checklist for businesses) can be found on the UK Resilience website at: /060516flubcpchecklist.pdf Ensure that their business continuity plans have the flexibility to accommodate the range of predicted staff absences Situation Reporting During the pandemic the Trust will be required to collect the following information as a minimum and this will be reported through the command and control structures: Staff availability sickness rates in staff and volunteers Number and rates of patient admissions and discharges Case demographics and other underlying disease profiles Assessment level of admitted patients Bed capacity and occupancy General responses to treatment of pandemic influenza cases Deaths Status of core facilities and utilities Financial impact Each unit/department will be required to provide a situation report identifying the current situation and measuring the impact of the pandemic against a number of identified standards. The frequency of reporting will be determined by the Major Incident Management Group (MIMG). It is anticipated that as a minimum such reports will need to be produced and submitted on a daily basis to the Emergency Planning Officer who will collate the figures and send to the identified point for the MIMG (see Appendix 1.1 and 1.2) Impact on Workforce It is estimated that up to 50% of the workforce may require time off at some stage over the entire period of the pandemic, with individuals likely to be absent for a period of seven to ten working days. Absenteeism should follow the pandemic profile, with an expectation that it will build to a peak lasting for two to three weeks, when between 15% and 20% of staff from the workforce may be absent, and then decline. However as the rate of infection in in-patient facilities may be higher over a short period, higher levels of absence must be planned for. Additional staff absences are likely to result from other illnesses, taking time off to provide care for dependants, family bereavement, other psychosocial impacts, fear of infection or practical difficulties in getting to work. The Government may advise schools and early years/childcare settings to close in order to reduce the spread of infection amongst children. This advice will be provided only if closure is anticipated to produce significant health benefits. Closures will be area specific (whilst the virus is circulating in the locality) and are likely to be for two to three weeks, although they may be extended if the pandemic remains in the area. Version 2.0 August

31 A further 5 6% of staff could be absent as a result of school closures, though this is based on an analysis of informal childcare being available for parents Workforce Profile The workforce profile for the Trust (March 2013) is very diverse in terms of ethnicity. The majority age group is which may increase the risk of absence and severe illness in staff during a pandemic. The majority of mental health nursing staff will not have any clinical qualification and will require training in basic health needs, influenza assessment and treatment, for use during a pandemic. The Trust sub-contracts some of its services including maintenance and security. Staff absences in support services will have a direct impact on the Trust s ability to provide safe working environments for its own staff during a pandemic Staff Welfare Planning People are the most valuable resource and the most vulnerable during a pandemic. As part of the planning process, the Human Resources Department will develop plans to: Ensure contact details and skills of the available workforce are captured so that they can be easily contacted in the event of a pandemic Work with the Group Directors to identify possible risk in service delivery and find solutions where possible Identify staff with personal caring responsibilities that may impact upon their ability to attend work during normal hours and develop plans to support them with alternative work options Liaise with the Learning and Development team to develop education and training that builds capacity into the existing workforce through teaching new skills, updating existing skills. This may allow staff to take on additional duties as required Facilitate arrangements for joint working and buddying up of community teams or specialist services to provide cross boundary cover within the Trust 4.9 Recovery Phase UK will move into recovery phase as the pandemic phase subsides and there is no threat of further waves occurring in the UK. The phase will follow guidance in the recovery phase of a major incident as per emergency planning. The Black Country Partnership NHS Foundation Trust will need to: Consider available workforce, both clinical and non-clinical Consider provision of psychological support to staff (this needs to be in operation during pandemic as well as recovery stages) Refer staff to the staff support service and bereavement services as required, the Spiritual Care Team may be able to offer help and support Ensure that buildings are adequately cleaned sanitised and otherwise made ready for resumption of normal service 4.10 Financial Arrangements The financial arrangements for pandemic influenza planning including stockpiling of PPE, training and development costs will be agreed with the Director of Finance and reported to the Board through the Associate Chief Operating Officer. Version 2.0 August

32 Funding for the response to a potential pandemic has been agreed at Board level including provision of PPE stockpiling, antiviral medication and workforce requirements including volunteer expenses etc. It is envisaged that the CCG s will suspend most targets and regulatory requirements once a pandemic has been declared, however the Trust will need to maintain services under the Mental Health legislation which may incur costs including the employment of private professional staff Communication All official communications within the organisation will be cascaded through formal senior management structures. The MIMG will oversee the co-ordination and dissemination of all information released to staff throughout the Trust. All Service and Team Managers/Leaders are kept fully informed and briefed at all times. It is the responsibility of all Group Heads and all Service/Team Managers/Leaders to ensure all their staff receive and have timely access to all appropriate information. The communication team will publish articles and information for staff and service users in all phases of the pandemic phase to maintain staff awareness of the pandemic threat and the plans developed by the trust. 5.0 Procedures connected to this Policy There are no procedures connected to this policy. 6.0 Links to Relevant Legislation Civil Contingencies Act 2004 The Civil Contingencies Act delivers a single framework for civil protection in the UK. The Act is separated into 2 substantive parts: local arrangements for civil protection (Part 1); and emergency powers (Part 2). Part 1 of the Act and supporting Regulations and statutory guidance Emergency preparedness establish a clear set of roles and responsibilities for those involved in emergency preparation and response at the local level. The Act divides local responders into 2 categories, imposing a different set of duties on each. Those in Category 1 are organisations at the core of the response to most emergencies (the emergency services, local authorities, NHS bodies). Category 1 responders are subject to the full set of civil protection duties. They will be required to: Assess the risk of emergencies occurring and use this to inform contingency planning Put in place emergency plans Put in place business continuity management arrangements Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency Share information with other local responders to enhance co-ordination Co-operate with other local responders to enhance co-ordination and efficiency Version 2.0 August

33 Provide advice and assistance to businesses and voluntary organisations about business continuity management (local authorities only) Health and Social Care Act 2008 The Health and Social Care Act 2008 sets out the code of practice for the prevention and control of infections. Good Infection prevention, cleanliness and prudent antimicrobial is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention of infection and cleanliness must be part of everyday practice and be applied consistently by everyone. Good management and organisational processes are crucial to make sure that high standards of infection prevention and cleanliness are set up and maintained. As the regulator of health and adult social care in England, the Care Quality Commission (CQC) will provide assurance that the care people receive, meets the fundamental standards of quality and safety. This Act outlines what registered providers in England, should do to ensure compliance with registration requirement12 (2) (h) providers must assess the risk of, and prevent, detect and control the spread of, infections, including those that are health care associated. It also sets out the10 compliance criteria against which registered providers will be judged. 6.1 Links to Relevant National Standards CQC Fundamental Standards- Regulation 12: Safe Care and Treatment The intention of this regulation is to prevent service users from receiving unsafe care and treatment, in order to prevent any avoidable harm or risk of harm. To meet the requirement of this regulation, the provider must take appropriate steps to assure itself that the care and treatment it delivers is safe for all service users. This includes assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are health care associated. Health and Social Care Influenza Pandemic Preparedness and Response (DH 2012) The document outlines the key areas where public, independent and voluntary sector health and social care organisations should work together to maintain and improve integrated operational arrangements for planning and response in order to deliver the best outcomes possible during an influenza pandemic. It reflects the structures and roles of the NHS and public health organisations in England during the transition period. UK Influenza Pandemic Preparedness Strategy 2011 (DH 2011) This document describes proposals for a UK-wide strategic approach to planning for and responding to the demands of an influenza pandemic. It builds on, but supersedes, the approach set out in the 2007 National framework for responding to an influenza pandemic, taking account of the experience and lessons learned in the H1N1 (2009) influenza pandemic and the latest scientific evidence. This strategy is intended to inform the development of updated operational plans by local organisations and emergency planners. Version 2.0 August

34 6.2 Links to Trust policy/s Business Continuity Management Policy Although the Trust is classed as a category 1 responder under the Civil Contingencies Act 2004, this is by definition due to its attainment of Foundation Trust status. Thus, within major incident planning and response arrangements the Trust is not expected to play a major role within a traditional major incident scenario. The focus for the Trust should therefore be on developing and embedding appropriate business continuity arrangements to ensure it can effectively meet the challenges of incidents that can disrupt the continuity of its critical and essential services under the NHS England Emergency Preparedness Framework The aim of this policy is to provide an effective business continuity framework which will allow the Trust to meet its regulatory obligations. Infection, Prevention and Control Assurance Policy The aim of the policy is to: Ensure that robust arrangements for the prevention and control of infection are in place within the Trust Ensure that infection prevention and control is embedded at all levels of the organisation from the Board to the Ward To provide Standard operating procedures for effective infection prevention and control 6.3 References DH (2012).Health and Social Care Influenza Pandemic Preparedness and Response. London: Crown Copyright DH (2011). UK Influenza Pandemic Preparedness Strategy. London: Crown Copyright Health Protection Agency (2012). Infection Control Precautions to Minimise Transmission of Respiratory Tract Infections (RTIs) in the Healthcare Setting: Version 1 DH (2007). Pandemic Influenza, Guidance for Infection Control in Hospitals and Primary Care Settings. London: Crown Copyright DH (2011). Pandemic Influenza and the Mental Health Act London: Crown Copyright DH (2008). Pandemic Influenza: Guidance on Preparing Mental Health Services in England. London: Crown Copyright Version 2.0 August

35 7.0 Roles and Responsibilities for this Policy Title Role Responsibilities Chief Executive Accountable - Overall responsibility for all matters relating to Pandemic Influenza Executive Director of Nursing, AHPs and Governance Trust Board Quality and Safety Committee Quality and Safety Steering Group Infection Prevention and Control Committee Major Incident Management Group (MIMG) Executive Lead Strategic Monitoring Scrutiny and Performance Responsible Co-Ordinate Response - Responsible for ensuring this policy is updated, that it represents best practice and includes current evidence based information and national guidance - Ensure that the daily SITREP response is collated and information is shared with other local, regional and national agencies as required (see Appendix 1, 1.1 and 1.2) - Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on - Strategic overview and final responsibility for setting the direction for Pandemic Influenza within the Trust - Oversee the pandemic influenza planning process - Ensure they are represented at the Trust s Business Continuity and Emergency Preparedness Group at Director level by the Associate Chief Operating Officer - Monitor and review performance in connection with this policy and receive exception and progress reports - Scrutinise the implementation of a systematic and consistent approach to Pandemic Influenza and provide exception and progress reports to the Quality and Safety Committee - Oversee the implementation of a systematic and consistent approach to this policy - Approve all policies and procedures that relate to their subject matter or area of practice - Provide exception and progress reports to the Trust Board - Members of the committee are responsible for ensuring this policy is accurate and up to date - Coordinate the Trusts response to an influenza pandemic - Identify critical services and resources - Arrange meetings of the Influenza Pandemic Planning Group and notify members of date/time and venue for meetings - Meet regularly from the onset of an influenza pandemic to oversee the Trusts preparedness, response and business continuity arrangements - Make arrangements for taking minutes of meetings, log decisions taken - Arrange internal debrief sessions - Co-ordinate external debrief attendances as required - Produce hand-outs as required - Ensure the Trusts emergency preparedness is regularly reviewed through regular training, testing and exercises - Make arrangements to develop appropriate tests/exercises with the support of the Emergency Planning and Business Continuity Officer Version 2.0 August

36 Title Role Responsibilities Human Resources Infection Prevention and Control Team (IPCT) Chief Pharmacist/ Pharmacy Team Learning and Development Team Management and Redeployment of Staff Expert advice and support Expert advice and Support Training Pandemic Influenza Policy - Assist with roster management and redeployment of staff with essential skills to maintain core services - Support the segregation of staff so that healthcare staff who are assigned to care for patients with influenza or work in an area that has been segregated to care for patients with influenza are not assigned to care for non-influenza patients or work in non-affected areas. For example one Doctor and Senior Nurse and HCSW could be designated to see all the patients with symptoms of influenza per shift - Prioritise staff who have recovered from influenza or have received a full course of vaccination against the pandemic strain to care for patients with influenza as they are considered unlikely to develop of transmit influenza - Ensure staff welfare throughout the pandemic is considered and support is provided - Ensure daily SITREP report is maintained (Appendix 1.1 and 1.2) - Escalate the notification of the threat of an emerging Pandemic to the DIPC and EPO in order to initiate the Trusts preparedness response and activation of this policy - Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on - Assist with ensuring this policy is updated in line with any new legislation or best practice guidance - Provide expert advice in the planning for and in dealing with an influenza pandemic with the aim to prevent and control infection particularly within the in-patient service areas - Declare an outbreak and inform the Major Incident Management Group (MIMG) and Chief Executive - Attend MIMG group meetings as required - Head and co-ordinate the epidemiological investigation - Collate infection control surveillance data - Provide infection prevention and control advice to other healthcare professionals in the organisation - Provide resources e.g. patient information leaflets and posters - Brief Lead Nurses and Matrons who will cascade information to clinical services - Provide information leaflets for patients, staff and visitors - Be a member of local health economy pandemic flu planning groups - Provide training on infection prevention and control precautions in relation to pandemic influenza - Advise on use of antiviral medication in line with national guidance - Secure supplies of antiviral, vaccines and antibiotics and ensure distribution to wards and departments as required - Liaise with suppliers to ensure adequate and timely supplies - Prepare information on indications, contraindications and adverse reactions of drugs to be used - Ensure administration of pharmaceutical preparations is undertaken in accordance with group directives - Ensure group directives are updated and approved by the Medicines Management Committee - Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on - Facilitate training requirements at the earliest opportunity when the possibility of a pandemic is predicted, in liaison with the Director of Nursing, Medical Director and the Infection Prevention and Control Team to identify the key training requirements - Ensure infection control and basic physical care skills training is provided Version 2.0 August

37 Title Role Responsibilities Communications Team Occupational Health Provider Directors Emergency Planning Officer (EPO) Managers (including those with on-call) Communication Advice Implementation Operational Lead Operational Pandemic Influenza Policy - Implement the communications strategy, specifically for patients, staff, visitors and contractors - Issue internal media bulletins - Deal with press enquiries and produce media statements based on the advice of the BCEP - Assist with coordination of internal debrief - Meet all the communication requirements detailed in the Major Incident and Business Continuity Plan - Prompt recognition of cases of influenza among healthcare workers is essential to limit the spread of the pandemic - Advise managers on safe return to work of healthcare workers who have been affected - Advise managers if a healthcare worker is at high risk of complications from influenza to ensure vulnerable staff do not provide direct care to symptomatic patients - Facilitate staff access to antiviral treatment where necessary and implement the vaccination of the healthcare workforce when required - Attend influenza pandemic planning meetings as required - Ensure they are familiar with this document and the Major Incident and Business Continuity Plan and have alerted staff of their role in planning for and managing an influenza pandemic - Ensure at least two other appropriate individuals are familiar with their action card (Appendix 4) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on - Responsible for preparing, maintaining, and testing the Trust s Business Continuity Management Policy including Pandemic Influenza and associated training - In the event of the major incident plan being implemented the EPO will also be responsible for undertaking a formal review of the effectiveness of the plan and implementing any need for improvement/amendment identified - Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on - Keep a list of completed exercises and lessons learned from the exercises - Make the plan available on the Trusts intranet for use by all staff following approval from the CEO - Nominate key personnel to collate the SITREP data (see Appendix 1, 1.1 and 1.2) - Ensure they are familiar with this document and the Major Incident and Business Continuity Plan and have alerted staff of their role in planning for and managing an influenza pandemic - Ensure at least two other appropriate individuals are familiar with their action card (Appendix 4) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on - Ensure daily SITREP report is maintained for the wards/departments for which they are responsible (Appendix 1 and 1.1) - Ensure that staff attend infection control training as/when required - Ensure an adequate number of staff receive training on administration of vaccines in liaison with Learning and Development Team - Ensure access to training and Fit-Testing for any staff who are required to wear respirator FFP3 face masks in liaison with the IPCT - Ensure contact details and skills of the available workforce are captured so that they can be easily contacted in the event of a pandemic - Ensure healthcare workers who are at high risk of complications of influenza (e.g. pregnant women and immunecompromised workers) are considered for alternative work assignments. Away from the direct care of patients, for the duration of the pandemic or until they have been vaccinated (if it is clinically appropriate) Version 2.0 August

38 Title Role Responsibilities All Employees Bank and Agency Staff Adherence Adherence Pandemic Influenza Policy - Adhere to the principles detailed within this document - Comply with infection prevention and control procedures detailed within this document to protect themselves and others from the risks of infection - Report promptly to the Infection Prevention and Control Team all cases (patients or staff) suspected to have the illness - Attend Pandemic Influenza training sessions as requested - Refrain from work if symptomatic with the virus - Assist the Trust as far as possible to maintain essential services as requested by the HR Department - Ensure they do not work across different clinical environments which may increase the risks of transmission - Follow the same deployment advice as permanent staff Version 2.0 August

39 8.0 Training What aspect(s) of this policy will require staff training? Specific training based on updated national guidelines which will be made widely available by the DH Which staff groups require this training? Is this training covered in the Trust s Mandatory and Risk Management Training Needs Analysis document? If no, how will the training be delivered? Who will deliver the training? All clinical staff No Internally Infection Prevention and Control Team How often will staff require training Only during planning phase of any future pandemics Who will ensure and monitor that staff have this training? Learning and Development Team 9.0 Equality Impact Assessment Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext or EqualityImpact.assessment@bcpft.nhs.uk 10.0 Data Protection and Freedom of Information This statement reflects legal requirements incorporated within the Data Protection Act and Freedom of Information Act that apply to staff who work within the public sector. All staff have a responsibility to ensure that they do not disclose information about the Trust s activities in respect of service users in its care to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies. Version 2.0 August

40 11.0 Monitoring this Policy is working in Practice As this policy will not be regularly required as influenza pandemics occur infrequently, compliance will be monitored as part of the planning exercises undertaken and post pandemic de-brief. What key elements will be monitored? (measurable policy objectives) Where described in policy? How will they be monitored? (method + sample size) Who will undertake this monitoring? How Frequently? Group/Committee that will receive and review results Group/Committee to ensure actions are completed Evidence this has happened Business Continuity Plans Workforce and staffing to take into account reduced staffing levels and the need to redeploy to other areas Communications with all staff throughout all phases of preparation and planning for pandemic influenza management Availability of personal protective equipment Pandemic Influenza Planning Group Business Continuity Management Staff Welfare Planning 7.0 Roles and Responsibilities for this Policy Trust Actions Required During the Phases of the Pandemic Trust Actions Required During the Phases of the Pandemic Each group to provide assurance that plans have been reviewed and updated Staff data base including skills regularly updated Core briefings to be produced by the communications teams based on the advice provided by the Infection Prevention and Control team Each group to assess their requirements and procure sufficient supplies. Availability of suitable equipment will be reviewed as part of the annual PPE infection control audits Groups Annually Pandemic Influenza Planning Group Human Resources Communications Teams Groups As and when required As and when required As and when required (otherwise annually) Pandemic Influenza Planning Group Pandemic Influenza Planning Group Infection Prevention and Control Committee Major Incident Management Group (MIMG) Pandemic Influenza Planning Group Pandemic Influenza Planning Group Pandemic Influenza Planning Group Completed action plan signed off / minutes of meeting Completed action plan signed off / minutes of meeting Completed action plan signed off / minutes of meeting Completed action plan signed off / minutes of meeting Version 2.0 August

41 Appendix 1 Inpatient/Residential Unit - Situation Report UNIT NAME: Main contact details: Date: No. of beds: No. of flu cases: No. of deaths: Tel: Time: No of beds in use: No. of recovered cases: No. of non-infected: No. of staff symptomatic off sick No. & type of beds available for new admissions Daily Situation Report No. of staff required (state grade/role or duties) Staff available for re-deployment (state grade/role or duties) Estates issues No. staff recovered & returned to work Resources required Communication messages Information required Other Signed (print name) DAILY as instructed (no later than 10 a.m.) Version 2.0 August

42 Appendix 1.1 UNIT/DEPARTMENT NAME: Non-Inpatient services - Situation Report Main contact details: Date: Tel: Time: No. of staff symptomatic off sick Changes to services: No. staff recovered & returned to work No. of staff required (state grade/role or duties) Staff available for re-deployment (state grade/role or duties) Estates issues Daily Situation Report Resources required Communication messages Information required Other Signed (print name) DAILY as instructed (no later than 10 a.m.) Version 2.0 August

43 Appendix 1.2 Black Country Partnership NHS Foundation Trust Situation Report (SITREP) The situation report will provide the Black Country Partnership and other providers of Health and Social Care both locally and wider through effective links with Public Health England with a robust reporting pathway to provide decision makers with the information they need to perform their roles effectively. Here is the overall Daily Situation Report from the Black Country Partnership NHS Foundation Trust Date: Male Female Time: Male Female No. of beds: PICU No of beds Older adult in use: No. of flu cases: No. of deaths: No. of staff symptomatic off sick Adult Learning Disabilities No. & type of beds available for new admissions: Male No. of recovered cases: No. of noninfected: No. staff recovered & returned to work PICU Older adult Adult Learning Disabilities Female PICU Older adult Adult Learning Disabilities Detail re staffing or resource issues: Information to be collated by 12 noon daily Version 2.0 August

44 Appendix 2 Putting on and Removing PPE Poster Version 2.0 August