Hospital preparedness planning for pandemic influenza (H1N1) 2009 in Austria - a case study...
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Transcript of Hospital preparedness planning for pandemic influenza (H1N1) 2009 in Austria - a case study...
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