Module 7. Surveillance, Epidemiology, Reporting, and Emergency Preparedness. Kim Roberts, Quality Improvement Advisor

Transcription

1 Module 7 Surveillance, Epidemiology, Reporting, and Emergency Preparedness Kim Roberts, Quality Improvement Advisor October 2016

2 What is covered in this module: WHAT: Identifying and managing disease outbreaks; public health threats; and preparing for emergencies and disasters WHY: These activities help protect health and appropriately respond to outbreaks and extreme events WHO: Diseases in long-term care facilities can have public health consequences. Long-term care facilities have a key role in their community s ability to prepare, respond, and recover from disasters. HOW: Several key references, tools and resources are provided 2

3 Surveillance Purpose of surveillance Identify outbreaks and prevent the spread of disease Types of surveillance Active Actively contacting people or organizations for information about diseases More expensive and time-consuming, but get complete information Passive CDC and State Department of Health rely on long-term care facilities to report This method can result in under-reporting of diseases Syndromic Based on certain symptoms occurring in a population Example: flu-like illness (fever and sore throat / cough) 3

4 Common Surveillance Targets Flu-like illness, Rash-like illness, drug-resistant organisms Sexually transmitted diseases (STDs) Contaminated medical equipment, devices, or medication Foodborne illness Listeria, E. coli, Salmonella, Hepatitis A, Vibrio, Shigella Bioterrorism Germ warfare (bacteria, viruses, toxins) Intentionally trying to infect people to cause harm Could be through contaminated food, water, air, surfaces, medication, insects, person-to-person contact Look for unusual pattern of illness, unusual # of people getting sick Symptoms of bioterrorism might not seem unusual at first: fever, rash, stomach ache, diarrhea, headache, cough, sore throat, etc. 4

5 What is an Outbreak? A disease outbreak is when there are more cases of disease than normal in a particular area For rare diseases, 1 or 2 cases could be an outbreak To determine whether an outbreak is happening, you have to know how many cases would normally be present How do outbreaks spread? Common source (everybody who got sick was exposed to the same source) Examples: water supply, air, foodborne illness Propagated (the disease spreads from person to person) Examples: influenza, Norovirus, C. difficile, E. coli, Salmonella, scabies, RSV An endemic disease is common to a particular area or group of people An epidemic is when diseases spread to a larger group of people than usual A pandemic is when a disease spreads throughout the world 5

6 Outbreaks in U.S. History Smallpox Yellow Fever Cholera Scarlet Fever (Group A Strep infection) Typhoid Mary ( ) New York Diphtheria ( ) Polio HIV/AIDS (1980s-present) Measles Cryptosporidium from contaminated water (1993) Whooping cough, Pertussis (2010, 2014) Foodborne - many 6 Pandemic Influenza (Flu)

7 Pandemic flu impact on the U.S. An estimated million people died from influenza, called the Spanish flu during the pandemic 675,000 Americans died Pandemic flu ( ) 70,000 deaths in the U.S. Pandemic flu ( ), called the Hong Kong flu 33,000 deaths in the U.S. Pandemic flu (2009), called H1N1 Swine flu From April 12, 2009 April 10, 2010 in the U.S. Approximately 60.8 million cases of influenza in the U.S. 274,304 hospitalizations 12,469 deaths 7 Pandemic Influenza (Flu)

8 8 Pandemic Influenza ( Spanish flu)

9 Outbreaks in Nursing Homes Respiratory (lung) infections Influenza, RSV, Legionella Rhinovirus, Tuberculosis (TB), Pertussis Skin / soft tissue infections MRSA Gastrointestinal (nausea/vomiting/diarrhea) Norovirus Clostridium difficile ( C. diff ) Salmonella Parasite infestations Scabies, bed bugs, fleas Head lice, body lice, kissing bugs 9 Disease Outbreaks in Nursing Homes outbreaks-in-the-nursing-home-responding-responsibly

10 Outbreak A True Story Outbreak experience shared by a Nursing Home administrator Staff asked him what he could to about the roach problem Got pest control to treat for cockroaches in Dietary department Several residents started getting sick with Salmonella Check food prep techniques and kitchen hygiene Looked for possible food sources Asked the staff if they had any pet reptiles Tested the tube-feeding formula The connection = ROACHES Each resident had a water pitcher in his/her room New pitchers were stored in a closet, some not washed before use The roaches had crawled on the pitchers and contaminated them 10 Nursing Home Pro website

11 Reportable Diseases & Conditions Kentucky Kentucky Department for Public Health Reportable Disease Desk Reference is currently being updated B163-8E61A24A62D8/0/KYEPID200A.pdf Mississippi Mississippi State Department of Health (MSDH) List of Reportable Diseases and Conditions 11

12 National Notifiable Diseases 12

13 Emergency Preparedness CMS rule posted in September 2016 Requirements for health care providers participating in Medicare and Medicaid: Emergency plan based on a risk assessment Policies and procedures based on the emergency plan and risk assessment Coordinate with federal, state, tribal, regional, and local emergency preparedness systems. Develop and maintain a communication plan. Training and testing program. Conduct drills and exercises to test your plan. Install and maintain emergency and standby power systems 13

14 Core EP Rule Elements Risk Assessment and Emergency Planning Identify likely hazards in the area Care-related emergencies Assess the chance of equipment or power failures Consider the impact of an interruption in communications (including cyber attacks) What if you lost all/part of your facility What if you lost of all/part of your supplies Review and update the plan at least annually 14

15 Emergency Support Functions (ESF) Emergency Support Functions group capabilities into an organizational structure to provide support, resources, program implementation, and services that are most likely needed to save lives, protect property and the environment, restore essential services and critical infrastructure, and help victims and communities return to normal following domestic incidents. Long-term care facilities pay a role in helping to prevent, detect, and respond to emerging outbreaks and public health threats ESF 8 15

16 15 Emergency Support Functions ESF 1 Transportation ESF 2 Communications ESF 3 Public Works and Engineering ESF 4 Firefighting ESF 5 Emergency Management ESF 6 Mass Care, Housing, and Human Services ESF 7 Resources Support ESF 8 Public Health and Medical Services ESF 9 Urban Search and Rescue ESF 10 Oil and Hazardous Materials Response ESF 11 Agriculture and Natural Resources ESF 12 Energy ESF 13 Public Safety and Security ESF 14 Long-term Community Recovery and Mitigation ESF 15 External Affairs 16 List of the Emergency Support Functions

17 All-Hazards Approach Infectious diseases Outbreaks and epidemics Natural disasters Earthquake, tornado, flood, wildfire, hurricane, ice storm, blizzard Accidental chemical, biological, radiological, and nuclear threats Industrial accidents, transportation accidents Intentional chemical, biological, radiological, and nuclear threats Effective public health emergency response depends on maintaining and constantly improving the preparedness capabilities of public health departments and healthcare facilities at a state and local level. 17 FY 2017 Budget U.S. Department of Health & Human Services

18 Kentucky Department for Public Health Lead agency for Emergency Support Function #8-Public Health and Medical Services (ESF 8) 18 Kentucky Public Health Preparedness website

19 Emergency Preparedness in KY 19 %2008%20Public%20Health%20and%20Medical%20Services%20Oct % pdf

20 Emergency Preparedness in MS 20

21 Resources to Help with Preparedness 21 CMS Requirements page on TRACIE website

22 Incident Command System (ICS) A standardized approach to the command, control, and coordination of emergency response providing a common hierarchy within which responders from multiple agencies can be effective 22

23 Basic ICS Training IS-100.HCB Introduction to the Incident Command System (ICS 100) for Healthcare/ Hospitals IS-200.HCa Applying ICS to Healthcare Organizations IS-700.A National Incident Management System (NIMS) An Introduction FEMA online training courses 23

24 Center for Domestic Preparedness Center for Domestic Preparedness (Anniston, Alabama) 24

25 Center for Rad/Nuc Training 25 Center for Radiological Nuclear Training (Mercury, Nevada)

26 Checklist Emergency Preparedness checklist for health care facility planning (6 pages) 26 Certification/SurveyCertEmergPrep/Downloads/ SandC_EPChecklist_Provider.pdf

27 Planning Guide Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies (Published by the CDC) 27 Planning Guide

28 Guide Emergency Preparedness Planning for Nursing Homes and Residential Care Settings (Sample guide from Vermont) 28

29 Tools and Resources Hand Hygiene in Healthcare Settings Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings Using personal protective equipment the right way National Notifiable Diseases Surveillance System (NNDSS) CMS Emergency Preparedness Requirements for Healthcare Kentucky s Emergency Support Function (ESF) 8 Annex %20Medical%20Services%20Oct% pdf Mississippi State Department of Health Emergency Preparedness Overview 29