Hospital preparedness planning for Hospital preparedness planning for pandemic influenza (H1N1) 2009 pandemic influenza (H1N1) 2009

in Austria - a case studyin Austria - a case study

Willibald ZeckWillibald Zeck

Even in a disaster situation hospitals have to..

Ensure continuity of essential services Manage an extra-load of patients Organize the response Protect the facility and its services (staff

&patients) from harm Provide specific services for the pre-

hospital phase

General Principles

A hospital plan is a functional plan if....

It is developed through a true emergency planning process The plan must not be copied The process is as important as the document The process is an interactive process

It meets the national planning criteria

It is tested, validated, regularly exercised and revised

All key staff are familiar with the details of the plan

Exercise and training

Additional key principles

Remember: a pandemic will NOT stop other diseases or disasters

An ALL HAZARD APPROACH IS NEEDED!

The preparedness plan has to be an integrated process

Additional key elements

A contingency plan should be complementary to the generic plan

Resources should be used– F.e. do not create a new telephone line in a

pandemic when it already exists– F.e. if an Incident Command System already

exists for an earthquake, make use of it in a pandemic

– F.e. learn from seasonal flu for H1N1

AustriaAustria

Nine federal states Total population: 8.3 million Life expectancy at birth: 79.5 years 171.972 people work in the health sector

(5.6% of total employees) Resources: 271 hospitals

H1N1 Chronology - Austria 2009

H1N1 Chronology - Austria 2009

Source: ECDC 2009

April 29 Nation's first case reported A 28-year-old woman after returning from a trip to Mexico

Sept 17 Austria 361 cases No deaths

All EU/ EFTA countries 52,710 cases 157 deaths

Oct 15 Austria No deaths

All EU/ EFTA countries 208 deaths

Preparedness on a national level

Preparedness on a national level

“Influenza Pandemic Plan – Strategy for Austria”

2005 Based on government decision Basic framework which contains the essentials of operative plans

Pandemic crisis committee

Core team

Expanded crisis committee

National level National level Provincial levelProvincial level

Crisis committee members are on 24 -

hour standby from Phase 5 onwards

Activation system via mobile phones tested regulary guarantees that the committee can

meet within two hours

Procuring stocks

Austria acquired country stocksAntiviral drugsConsiderable stocks of suitable

FFP1-, FFP2- or FFP3-masksVaccines

Population: 1.2 M inhabitants

Capital (Graz) 255.354 inhabitants

StyriaGraz ●Graz ●

Vienna

Influenza Pandemic Plan

for the province of Styria Developed in 2005

Based on the Austrian national pandemic plan

Tailored to the local context

A whole of society approach

Provincial health authoritiesLeader ship

Health sectorNon - health sector

Armed forces, fire brigade, police forcesBasic service providers

(telecommunication, electrical and water)Private businesses

Communities, families and individualsCivil society organizations

1 University hospital 1.500 beds 1 Major referral hospital 230 beds2 Minor referral hospitals 128 beds 1 Military hospital 60 beds_______________________________________Total 1.918 beds

20 district hospitals 4.300 beds

60 pediatricians 30 pulmonologists 200 physicians1.000 GP´s

Health care facilities and hospitalsHealth care facilities and hospitalsHealth care facilities and hospitalsHealth care facilities and hospitals

Calculation No.

Patients who will require a bed for 10 – 12 days at the peak of the pandemic

3.000

Expected impact

No.

No. of beds available in Graz and surrounding areas

1.918

No. of additional beds needed 1.082

Inclusion of private hospitals and district hospitalsInter - facility transfer

Inclusion of general practitionersInclude in triage system

Preparedness on a hospital level

Medical University Hospital Medical University Hospital GrazGraz - 1.500 beds - 6.420 employees

A local Crisis preparedness plan was developed Based on

WHO documents, national and provincial Influenza Pandemic Plan

In collaboration with other hospitals

1. Incident command system2. Communication3. Infrastructure & Infection

control4. Surveillance5. Case management6. Human resources7. Logistics Management

Hospital preparedness

*Hospital Preparedness Checklist for Pandemic Influenza, WHO 2009, currently being developed

WHO Hospital Preparedness Checklist for Pandemic

Influenza Hospital Checklist

– Currently being developed– Useful tool – Formed the basis for 3 workshops

on „Hospital Emergency Preparedness“ organized by WHO in September/ October 2009 in

• Albania• Moldava• Kyrgyzstan

1. Incident command system

Incident command centreCommand group

Medical DirectorMedical DirectorRepresentatives fromRepresentatives from

Nursing Staff, Pharmacy, Institute of Hygiene, Laboratory, Human resources, Pharmacy services

Representatives from certain unitsRepresentatives from certain unitsInternal medicine, Pediatrics, ICU, Accident

& Emergency, Infectious DiseasesSecurity engineer and public Security engineer and public

information spokesman information spokesman

2. Communication (internal)

Information management team Update information

disseminated via email to a group of key persons (doctors, head nurses, hospital managers etc.)

further disseminated by key persons via emailduring regular meetings

Update information is shared by key persons in team meetings

Hard copies are pinned in meeting rooms

2. Communication

Public information spokesman Part of the Command groupCo ordinates public/media communication

strategies with health authoritiesConsensus with health authorities on

information to the public

Translation services/ interpreters for patients and relatives with limited German proficiency

Inter – facility communication

3. Infrastructure & Infection control

Two units designated for case patient care

Rooms at the admission unit assigned for triage Short distance to designated wards Transport to the wards distant from

patient main stream

3. Infrastructure & Infection control

Rooms are clearly identifiedUnits are provided with adequate

equipment (masks, gowns, gloves etc.)

Instructional materials for affected patients and their relativesBrochures and postersInformation on relevant hospital

policies

3. Infrastructure & Infection control

Regular personnel education and trainingLong-distance influenza training

programs Educational website and update on the

“intranet” (local hospital server)Specimen protocol

Specimen clearly identifiedSend with biohazard precautions

Special dispose protocol for disposable items

4. Surveillance

Case definitionClose link to the Austrian

surveillance systemSurveillance system has been

tested during the regular influenza season

Written protocol for monitoring and reporting influenza

Admission criteriaTriage criteriaMethod to specifically track

admission and discharges of influenza patients

“Medocs” Computer System

Telephone hotline established

5. Case management

Facts on staff absenteeism 12% of work force will be absent during the peak

weeks (UK Planning Assumptions 2009)

Surge Capacity PlanPlan for mobilization of second-line human

resources (Red cross, health profession students, armed forces, civil servants)Staff list updated regularly

Encourage staff to stay at home when ill or when symptomatic with influenza-like

illnessStaff might also use telephone triage system

6. Human resources

*

7. Logistics Management

Estimation of quantities of essential patient careMaterials and equipment

Estimates are shared with the provincial health authorities and regional hospitals

Stockpiling agreements

Contingency plan for an increased need for post mortem careInvolvement of local morticians

ConclusionConclusion

The preparedness planning process is as important as the document

An all hazard approach is needed

Strengthening working relationships between health and other sectors

Inter - facility coordination and communication