Infectious Disease Emergency

Response (IDER) Plan of MOHAP

Hospitals

Prepared By:
Central Infection Prevention Control Committee
Hospitals Department
Version 1.0
2019
 Outline

1. Hospital Incident Command System……………………………………………………3

2. Background………………………………………………………………………….….4
3. Purpose………………………………………………………………………...………..4
4. Base Line Preparedness…………………………………………………………………4
5. Surge capacity…………………………………………………………………………..5
6. Plan Activation………………………………………………………………………….6
7. Roles and Responsibilities (Action Card)……………………………………….……..14
8. Appendix 1: Dealing with influx of patients with communicable diseases……………17
9. Appendix 2: Infectious Disease Response Assessment Checklist……………………..19
10.Appendix 3: Exposed Employee Register Form…………………………...……….….26
11.Appendix 4: Levels of Code Orange Alert…………………………………………….27

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Hospital Incident Command System

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 Background
1. The IDER Plan is intended to be used for any infectious disease emergency that requires a response that exceeds the
Section’s normal disease control capacity. Infectious disease emergencies, such as pandemic influenza, have the
potential to cause widespread illness and death.
2. Infectious disease emergencies range from naturally occurring outbreaks of illness (e.g., measles, pertussis, hepatitis
A, meningococcal disease) to emerging infectious diseases (e.g., SARS, avian influenza). Circumstances of
infectious disease emergencies vary by many factors, including type of agent, scale of exposure, and mode of
transmission. Planning and preparing in advance of an infectious disease emergency is critical for an effective
response.
3. In response to these issues, the Infectious Disease Emergency Response (IDER) Plan was prepared as a framework
with the flexibility to respond to any infectious disease incident (minor or major).
4. Some of MOHAP Hospitals are capable of receiving infectious cases in case of an Epidemic/Outbreak. Accordingly,
this plan was developed with a management process to deal with such situations. Depending on the situation, specific
parts of the plan can be activated and deactivated as necessary.
5. Facilities that are not prepared to receive infectious cases should manage by transforming their facility to an infectious
hospital (as designated by the MOHAP) or transferring patients in appropriate ambulances to designated facilities.
6. The Type of Outbreaks and Risk rating is identified as per infection control annual Risk assessment.

Purpose
1. Provide guidance for containing an outbreak of an infectious disease or a biological toxin or responding to other
infectious disease emergencies.
2. Promote and facilitate preparedness and response plans in dealing with influx of patients with any suspected or
confirmed communicable diseases and implement rapid institution of infection control measures to minimize
potential transmission to staff, patients and visitors.
3. Ensure an effective and coordinated approach is taken in the management of an outbreak from the initial detection
to the formal declaration that the outbreak has ended.
4. Based on infection control annual risk assessment and due to UAE demography certain communicable diseases have
more likelihood to occur:
NB: The below table is an example and each facility has to do its own risk assessment as the numbers are not
reflective of all facilities.

Baseline Preparedness

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1. An Infectious Disease Response Assessment Checklist (Appendix 2) is developed to ensure that infection
control requirements are met in each hospital.
2. To better test the effectiveness of the Plan, an outbreak drill shall be conducted by each MOHAP hospital once
per year.
3. Each hospital shall have a team (task force) to overlook the infectious disease outbreak management plan and
ensure continuous preparedness to manage such occurrence.

The Task Force (team) shall comprise of:

1. Chairperson of Prevention & Control of Infection Committee

2. Disaster Committee coordinator.
3. Head of Accident and Emergency Department
4. Infection Control Practitioner
5. Public Relation Officer on duty (Duty Manager)
6. Nursing Director or Nursing Supervisor on duty
7. Engineering & Maintenance Officer on duty
8. Emergency Department In-Charge or the Designee
9. Medical Wards (Female & Male) In-Charge or the Designee
10. Intensive Care Unit In-Charge or the Designee
11. Medical Store In-Charge
12. Head of Support Services

Surge Capacity

1. Each MOHAP hospital shall define its capacity of isolation in case of an outbreak.
2. Each MOHAP hospital shall establish and improve surge capacity (based on its resources and infrastructure) to
meet the community’s needs during a mass casualty incident.
3. The surge capacity plan shall include:

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 Bed Number/ Isolation Facility Resources Staffing
Relocation of non-infectious patients from 1. Keep Emergency stock 1. Train all the hospital staff on
areas anticipated to receive incoming with the required supplies. how to respond to the plan.
infectious patients.
2. Responding staff, to the
Discharge stable patients, transfer to other 2. Prepare agreement and
incident, will be determined by
hospitals, and stop elective cases. contract with suppliers the number of patients attending
Emergency Department: A receiving area and companies to supply to the emergency department
shall be allocated to receive the influx of directly in case of extreme and the level of code orange
patients in the A/E. A/E is divided into zones situation and deprived Biological, (CBRN) as decided
for critically ill, seriously ill and minor store. by the Incident Commander.
casualties with color code
3. Backup plan and extra staff are
General Department: specific wards shall 3. Plan Sources and
to be arranged by the
be allocated for receiving the infectious quantities of backup
Management of Incident
cases. if the number exceeds the capacity of equipment and Commander (MIC), in
the allocated wards (medical wards), utilize pharmaceutical supplies coordination with the Hospital
other possible wards (surgical wards). in coordination with Sector and Emergency, Crisis
Critical Care Area: respective medical zone. and Disaster Operation Center/
If the number exceeds the surge capacity of MOHAP.
critical care beds, the High Dependency Unit
(HDU) will be utilized.

Plan Activation
1. MIC (Hospital Director or his deputy) and the Assistant Director for Medical Services are the authorized
personnel to direct the activation/deactivation of the IDER Plan.
2. This plan activation is aligned with Disaster plan activation.
3. The IDER Activation and Notification Protocol should be utilized (Appendix 1):

Prevention and Preparation Phase:

Synopsis of Situation:
No infection disease emergency currently exists.

Strategic Action:
1. Undertake planning for infectious disease emergencies, including staff training and exercising the IDER.
2. Implement routine immunization programs.
3. Conduct the infection control regular surveillance activity.
4. Implement routine infection control practice.
5. Conduct ongoing training and Education on infection control practice.

Stand by Phase:
Synopsis of Situation:
• An infectious disease outbreak has been declared by the WHO and has the potential to enter to the UAE.
• There is a Declaration of outbreak in a neighboring country.
Strategic Action:
1. Define/confirm case definitions and commence case notification.

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2. Educate and train all the staff with hands- on demonstration and re-demonstrations on the proper use of PPE
and the type of precaution needed.
3. Alert the Key stakeholder (Heads of Departments, Head of store, pharmacy, and laboratory).
4. Prepare the required supplies, equipment and staff list.
5. Provide all hospitals’ entrances with (Hand rub, Mask, Tissue).
6. Posters to be displayed to educate patients and other on use of hand rub, mask, tissue and cough etiquette.
7. Prepare the list of possible patients who can be discharged or transferred.

Initial Action Phase:

Synopsis of Situation:
• Receiving cases of infectious disease within the surge capacity.
• An occurrence of a novel infectious disease that has the potential to cause an infectious disease emergency;
OR
• A sustained community transmission in other regions of a novel infectious disease in UAE; OR
• A declaration by World Health Organization (WHO) of a pandemic of a novel infectious disease; AND
• Insufficient information about the infectious disease to move from Standby to Targeted Action.

Strategic Action:
1. Activate the IDER Team.
2. Manage initial cases and contacts and scale up disease surveillance.
3. Activate the notification program and the medical zone emergency plan .
4. Establish a Pre-entry Triage point, near the A/E to sort the patients. All cases will be sorted and directed to
allocated A/E zones based on their complexity (infectious, serious and/ or critical illness).
5. Implement triaging and Isolating/ cohorting of patients and surge management strategies.
6. Separation of infectious patient with symptom from non-infectious patient.
7. Identify and characterize the nature of the disease.
8. Provide the essential supplies and equipment in each zone.
9. Assign specific, well trained staff and physicians to deal with patients.
10. Provide information that support best practice in healthcare services, to be able to reduce the exposure.

Action Phase:
Synopsis of Situation:
• An occurrence of a novel infectious disease in UAE, cases will increase in number and major influx of patient
with the same presentation.
• A sustained community transmission, in other regions, of a novel infectious disease in UAE; OR a Declaration
by World Health Organization (WHO) of a pandemic of a novel infectious disease; And
• Sufficient information about the infectious disease causing the emergency to implement Targeted Action.
• Receiving cases of infectious disease within the surge capacity.

Strategic Action:
1. Inform the Hospital Director (MIC) or his deputy to declare code orange CBRN.
2. Implement and define infection control protocols based on identified disease.
3. Manage bed capacity by discharging, transferring the stable patients, stop the elective cases and outpatient,
redirect the national ambulance in collaboration with Emergency, Crisis and Disaster Operation Center/
MOHAP.
4. Reallocation of patient with immunocompromised condition such as (dialysis, neutropenic ,HIV, etc.)
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5. Put the hospital in lock down situation, Limit the visitors, media reporters and patient relatives.
6. Implement disease-specific immunization programs, if available.
7. Methods of early diagnosis by fast test methods should be used.
8. Daily monitoring of staff exposure; check for any signs and symptoms of infection.
9. Increase the surge capacity by converting nursing units to isolation.
10. Ensure effective notification and communication process with District Preventive Medicine and, Emergency,
Crisis and Disaster Operation Center.

Stand Down Phase:

The infectious disease emergency has abated.
Health service capacity is no longer being exceeded.

Strategic Actions:
1. Health services return to normal activities.
2. Discontinue heightened surveillance activities that are no longer required.
3. Complete the debriefing report.
4. Carry Post incident analysis and identify lessons learned.
5. Conduct Staff training and education on the IDER plan, based on lesson learned.

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Measure Planning Stand by Initial Action Targeted Action Stand Down
Notification • Inform the Head of • The IDER Team will be • Activate code orange • Code orange
emergency, activated. as indicated, and the CBRN will be
• Head of infection control • Notify the preventive level will be deactivated.
determined based on
committee, Assistant medicine and central
the number of
Director of Medical MOHAP disaster infectious patients
Affairs, Assistant Director committee triaged (Appendix 4).
of nursing Affairs,
• Head of the departments,
Head of support services,
and Head of Public
Relations Office to be
stand-by
PPE • Maintain staff • Conduct Demonstration • Monitor Staff practice and
competency about and Re- Demonstration give immediate feedback.
wearing and removal about proper use of PPE.
donning & doffing of • Provide PPE at point of
PPE. care
• Ensure Availability of • Put awareness posters.
required PPE and
backup stock.
Point of Entry • Train all Clerks at the • Alert the Clerk about the • Assign pre- triage area to • Limit the visitors to • Back to normal
point of entry about need and importance of screen patients. close family members stage.
Quick patient quick patient registration • Assign security on all entry only. • Open all entry
registration • Put the hospital on points.
• Post a sign on all points of points to direct patients and
• Post a reminder card lock down stage. • Give feedback to
in all computers. entry to direct patients to limit the visitors.
staff about patient
• Monitor staff designated areas • Post directions arrows to flow and triaging
performance • Place masks and hand rub guide patients to process.
periodically. on all entry points. designated entry points.
• Designated triage point
shall be near the A/E.
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IDER • Prepare the List of • Alert the IDER team to be • The IDER team is • The IDER team is • Debrief the
Members IDER Team Members prepared for the disaster. activated and each member activated and each members with
with their contact • Advise the IDER team to will execute his/ her member will execute feedback about
details. the required activities. their performance.
plan and review their designated activities.
• Train the IDER • Monitor the IDER
members about their assignments and member performance.
roles and responsibilities.
responsibilities in the
disaster and conduct
exercises to prepare
them for a disaster.
Resources • Prepare a list of • Check the available stock • Check the availability of • Consider prioritization • Assess stock pile
Medical required supplies, and backup system. the supplies and usage. of resources. status and replenish
supplies backup supplies, • Confirm readiness of stock • Check the strategic stock • Monitor the health resources as
equipment, and care system capacity. appropriate.
transportation. of MOHAP and possible
pharmaceuticals.
• Keep an emergency • Provide all the Zones with delivery status and timings.
stock in each the essential stock. • Consider the need for
department. additional support from
• Implement measures suppliers of PPE.
to support strong
supply chain.
Resources • Consider the • Consider human resource • Monitor the staff capacity • Surge and adjust • Replenish depleted
HR allocation of staff and availability, particularly in and assess the need for staffing levels in resources, to meet
maintain the ratio of critical, specialized areas additional staff members. accordance with the remaining
skilled, well trained such as emergency • Prepare the backup plan for health service demand.
staff in crucial areas management, infection surge staff. requirements.
such as ICU, A/E, and control, ICU/HDU, ED & • Assign specific staff
Medical Wards. public health. for the isolation
• Keep a list of staff facility.
with • Monitor staff
immunocompromised exposure and replace
conditions. the staff as needed.

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Infection • Train staff on the • Emphasize Hand hygiene • Assign a trained PCI • Implement and • Educate staff about
Control IDER plan and and general infection personnel in each isolation monitor the infection lesson learned from
Measures conduct frequent control measures. facility to confirm with control prevention the IDER and close
drills. • Provide hands on training responders the application measures (isolation, the Gaps.
• Establish and maintain on PPE donning and
of standard infection Equipment cleaning
infection control doffing; and disease-
practice. specific infection control control practices. PPE, Hand Hygiene).
measures. • Provide education about
disease specific prevention
measures.
• Monitor the
implementation of control
measures and give
immediate feedback.
Surveillance • Establish and maintain Passive Surveillance: • Identify and describe the • Collect core data from • Continue collecting
systems to collect • Maintain case notification epidemiology and clinical established surveillance data
surveillance data on system. features of the disease. surveillance systems and infection
notifiable cases. • Prepare / refine case • Refine case definitions as in order to detect any control risk
• Investigate outbreaks definition. needed. changes in the assessment for
of diseases with • Prepare to investigate • Confirm identification of epidemiology. notifiable diseases.
potential to cause an cases and conduct contact at- risk groups.
infectious disease tracing. • Analyze and report data.
emergency. • Confirm likely at-risk • Maintain case notification
• Identify at-risk for groups. system.
infection groups • Consider the need for
and/or serious enhanced surveillance and
complications of studies to learn about the
infection. disease/evaluate
emergency response.
• Consider sustainability of
surveillance systems.

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Occupational • Staff immunization • Raise staff awareness • Check for • Reallocate • Monitor staff
Health about potential risks, chemoprophylaxis immunosuppressed health and follow
required precaution and availability and stock. staff. up on the exposed
alarming signs to be • Monitor staff daily for • Provide exposed staff staff members.
immediately reported. signs and symptoms of with prophylaxis.
• Reallocate infection and exposure. • Furlough staff with
immunocompromised, symptoms.
• Minimize panic by clearly
pregnant and unvaccinated
staff. explaining risks, offering
careful but rapid medical
evaluation/ treatment, and
avoiding unnecessary
isolation or quarantine.
Clinical and • Undertake routine • Prepare arrangements for • Implement arrangements • Use dedicated • Resume pre-
Patient Care infectious disease reducing non-urgent work for triaging in primary equipment for emergency, triage,
control programs, • Prepare arrangements for care. isolation patients or clinical care and
including outbreak providing • Implement arrangements
additional clean and disinfect public health
management. support to at- risk groups. for cohorting (grouping) shared equipment. management
• Build the capacity in patients. • Educate patient and arrangements for
the health sector to • Implement arrangements family about cases and contacts.
manage infectious for reducing non-urgent precaution measures. • Resume elective
disease outbreaks work. and non-urgent
• Sustain the core • Develop discharge health service
capacities instructions for patients work.
determined to be non-
contagious.
• Provide information
regarding when they
should return for follow up
care, if applicable.
Facility • Provide an adequate • Ensure the Negative • Isolate the patient who • Cohort patients after
Management number of negative pressure rooms are require Airborne Infection consulting infection
pressure isolation functioning properly. Isolation Rooms (AIIR) in control.
Rooms based of the Negative pressure room.

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 health service and • Check the isolation • Allocate an area to receive • Keep specific ward to
population served. facilities and provide the all patients with infectious be utilized as a backup
• Ensure that the required supplies. diseases by using portable to increase the number
isolation rooms are HEPA filter. of isolation rooms.
well maintained and • Isolate critically ill patients • Discharge stable
functional. in the designated area . cases.
• Separate symptomatic
from asymptomatic
(quarantine) cases in
designated areas .
• Triage family members
and accommodate them in
designated waiting area.
• Admit patients in the
isolation rooms in the
medical Department.
Morgue • Assign a Designated • Collect data about total • Allocate patient in the • If deaths numbers • Clear all dead
mortuary Fridge for morgue capacity. mortuary Fridge. exceed the morgue bodies and
infectious cases. • Provide enough amount of • Follow standard capacity, allocate the decontaminate the
• Ensure proper packing mortuary bags to precaution with all dead deceased bodies to a mortuary area.
of deceased with no respective Departments. bodies. designated area.
leaking, when
indicated

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 Roles and Responsibilities (Action Card)
A/E Department
No. Action Responsible Person
1. Stay updated with all infection control notifications, Alerts and training. All Healthcare Workers
(HCW)
2. Place alcohol hand rub, PPE and related Posters at all hospital entry points; PCI Team
A/E, OPD, and hospital Main entrance.
3. Pre-Triage: Pre-triage area staff
Assign a pre-triage area to screen all patients.
3.1 Green is for non-infectious cases: patients will follow the normal ESI
triage.
3.2 Yellow for symptomatic patients: when identified, staff will immediately
step back at least 1 m away from the patient, offer patient a surgical mask,
direct patient to the designated triage area near the A/E.
3.3 Contact with positive cases shall be sent to a designated waiting area.
4. A/E Department shall be evacuated; patients shall be as appropriate, Head of A/E
(Discharged/Admitted/Transferred) in order to accommodate infectious cases Department
5. Designated Triage Area: Triage Nurse
4.1 Assess all patients for signs and symptoms (fever, cough, rashes).
4.2 Use surgical mask, gloves and adhere to standard precaution measures.
4.3 Offer surgical mask to patients, ask them to clean their hands with a sanitizer,
and explain to them why you are taking these measures.
4.4 Isolate patients and direct them according to the following categorization
(patients will be given a Hand band according to designated category:
4.4.1 Yellow for Symptomatic infectious cases, to be sent to the yellow
designated area.
4.4.2 Red for critically ill infectious cases, to be shifted to the designated
area.
4.4.3 Contact with a positive case who’s asymptomatic is to be placed in a
designated waiting area.
4.5 Family members will be screened and directed to designated waiting area.
6. Transfer
3 the patient to designated area as per the triaging category detailed. A/E Nurses
7. Any
4 patient who requires airborne precaution will be immediately transferred to Head of A/E
the available negative pressure isolation room, if available, else he/ she will be Department and A/E
transferred to a another hospital with isolation facilities. In-Charge
8. Assign
6 designated physicians and Nurses to patient area, excluding HCWs who Head of A/E
have any immunocompromised condition or pregnant from providing care for Department & Head
such patient. Nurse of A/E
9. Staff
7 movement should be restricted to those who are required to give direct Security Guard
patient care. Put the hospital in lock down state.
10. Patient
8 transport should be limited to movement that is essential to provide A/E nurse
patient care, thus reducing the opportunities for transmission of microorganisms
within healthcare facilities.
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11. Transmission
9 Based Precautions will be followed by all involved staff throughout ALL HCW
the care process based on type of infectious disease, by following the isolation
guide in the transmission based precaution policy (USO/Clin/051).
12. Use
1 single- use dedicated items for patients in isolation, if not possible use A/E nurses
designated items and clean and disinfect between uses.
13. Report
1 any occupational health illness or unprotected exposure immediately to All HCW
the infection control and charge Nurse.

Security
No. Action Responsible Person
1. Control all entry points and quickly screen the patients, if any positive symptoms Security Guard
are observed, offer the patient hand Rub and a surgical mask and direct him/her
to the designated triage area.
2. Limit the visitors to close family members only. Security Guard
3. Lock and monitor all access doors for patients’ waiting and treatment areas. Security Guard

4. Lock one of the elevators (if applicable), to be used for transferring patients with Security Guard
infectious disease only.

Assigned Isolation Ward (Male /Female Medical Ward)

No. Action Responsible Person
1. Male /female Medical Wards shall be evacuated (upon decision of Head Medical director,
of disaster committee) discharge /transfer stable patient to accommodate Prevention and Control of
infectious patients. Infection Committee
(PCIC) Chairperson and
Concerned MRP
2. Staff traffic should be restricted to those who are required to give direct Security Guard
patient care.
3. Staff who is unvaccinated or with immunocompromised condition (on Unit Manager/PCI
high dose of steroid therapy or pregnant, etc…) should be excluded from practitioner
direct patient care.
4. Ensure that high-risk patients (i.e. dialysis, chemotherapy/radiation Unit Manager
patients) are separated from those who may have an infectious disease
(Transferred to other wards).
5. Daily monitoring of negative pressure will be carried out when patients Nursing and Biomedical
with airborne infections are admitted. Departments.

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6. Transmission Based Precautions will be followed, by all involved staff, Unit Manager and PCI
throughout the care process. team
7. Limit the number visitors and the time spent with the patient, after they Nursing, Medical staff
comply with hand hygiene and precautions required. Screen the visitors
for any signs of infection.
8. Use single- use dedicated equipment if available. Appropriate Cleaning Nursing, Medical, CSSD,
and disinfection of reusable Medical Equipment and Environmental Housekeeping and
surfaces will be carried out as specified by the hospital’s policies and Biomedical Departments
guidelines.
9. Daily screen the staff for any signs and symptoms of infection and furlough Nursing, Medical and
staff who are exposed. Keep register for all the exposed HCWs for further Support Services director
follow up
10. Exclude staff from patient care, If hospital personnel present to work with Nursing, Medical and
symptoms of febrile upper respiratory tract infection or Known to have Support Services director
immunocompromised condition

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Appendix 1: Dealing with Influx of Patients with Communicable Diseases (Example 1)

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Appendix 1: Dealing with Influx of Patients with Communicable Diseases (Example 2)

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 Appendix 2: Infectious Disease Response Assessment Checklist

This checklist includes questions to ask to assess risks in your organization’s response to infectious
disease outbreaks. The results can provide a guide to preparation, including education and training on
infectious disease response. Answers to all questions should ideally be Y for Yes (unless they aren’t
applicable).

Organization: _____________________________ Date of Review: ___________________________

Reviewer: ________________________________
No. Criteria Escalation Yes No Partially Comments

Service Standard 1: Assessment of Preparedness for Infectious Disease Disasters

1.1 The facility has on stock an appropriate number of
standard/surgical masks
1.2 The facility has on stock an appropriate number of N95-
equivalent respirators
1.3 The facility has an appropriate number of ICU beds with
mechanical ventilation capacity
1.4 The facility has an appropriate number of isolation rooms
(negative pressure rooms (AIIR) or appropriate single
rooms with anteroom and mobile HEPA filtration units
and/or exhaust air HEPA filtration rooms)
1.5 The facility infection prevention and control program
includes policies and procedures for the management of
influx of patients during infectious disease disasters
Service Standard 2: Planning for Infectious Disease Disasters: Awareness/Education Program
3.1 The facility has in place an awareness/educational
program for healthcare personnel, patients and visitors,
specific for the management of influx of patients during
infectious disease disasters
3.2 The awareness/education program includes:
• Information letters
• Electronic communication (E-mail, intranet)
• Signs
• Poster
• Flyers/leaflets
• Brochures
• Staff meetings
• Staff training sessions
• Other: Demonstration on appropriate use of PPE and
other precautions

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Service Standard 3: Identification of an Infectious Diseases Disaster
3.1 The facility has a mechanism of getting alerts from
international agencies when infectious disease disasters
occur globally.
Facility task force members are registered with
CDC/WHO
3.2 The facility has a mechanism of communication with
relevant authorities such as the preventive medicine
department and central disaster committee to be notified
when there is an infectious disease disaster
3.3 The facility reports suspected and confirmed cases to the
appropriate authority during a disaster
Service Standard 4: Early Recognition of an Infectious Disease Disaster: Patient Screening
4.1 The facility implements all measures to ensure the early
recognition of potential cases and initiation of all
precautionary measures to prevent transmission of the
infectious disease.
4.2 Quick screening:
• The facility implements a system to inform potential
patients about alerting the healthcare workers/ staff
(such as the security or the reception staff) about their
condition at the first point of contact as they enter the
facility.
• For example, The facility has posted signs to direct
patients presenting to A/E with signs and symptoms of
an acute respiratory infection about necessary measures
like self-reporting, asking for a mask, keeping a safe 1
meter distance from others, coughing etiquette and to
waiting in a separate waiting area/room, if available
4.3 The facility implements a screening program, either
passive or active, (syndromic surveillance) as per
MOHAP algorithm to identify potential cases during an
infectious disease disaster
4.4 The facility identifies a triage area for initial
screening/syndromic surveillance of potential cases

Service Standard 5: Infection Prevention and Control Measures

5.1 Standard Precautions
5.1.1 The facility develops and implements a mechanism for
immediate isolation of potential cases during an infectious

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 disease disaster, based on the initial screening/syndromic
surveillance
5.1.2 Standard infection prevention and control precautions are
implemented:
• Hand hygiene
• Safe waste management
• Cleaning, disinfection and sterilization of patient-care
equipment and linen
• Cleaning and disinfection of the environment
5.2 Patient Assessment
5.2.1 The facility has to work on creating separate waiting
areas/rooms for patients with suspected/confirmed
infectious diseases
5.2.2 The facility has a written procedure to assess patients with
suspected or confirmed infectious diseases, with high
priority and in a timely manner
5.3 Assigning Staff Roles and Responsibilities
The facility develops and implements a staffing plan with
specific roles and responsibilities during an infectious
disease disaster
5.4 Isolation Precautions
5.4.1 The facility has a written procedure to place patients with
suspected or confirmed infectious diseases under specific
isolation/transmission based precautions
5.4.2 The facility has the capacity to isolate patients with
probable or confirmed airborne infectious diseases, under
AIIR or appropriate single rooms with anteroom and
mobile HEPA filtration units and/or exhaust air HEPA
filtration
5.4.3 Facility has written procedures in place and adheres to
inter-hospital and intra-hospital transfer of patients with
communicable diseases
5.4.4 Patients with suspected or confirmed infectious diseases
are restricted from group activities until they are no longer
considered infectious
5.4.5 Visitors in contact with patients with airborne/droplet
infectious diseases should wear a mask and perform hand
hygiene
5.4.6 Signs are placed at the entrance of the patient isolation
room indicating contact, droplet or airborne infection (as
applicable)

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5.4.7 Staffing policies are in place to minimize the number of
personnel who should enter the room
5.5 Staff compliance with infection control practice
5.5.1 Staff comply with all infection control procedures
• Hand Hygiene
• PPE is worn by all healthcare personnel according to the
patient isolation status (contact, droplet, airborne):
Gloves
Gowns
Eye protection (goggles or face shield)
Respirator (N95 or equivalent),
• PPE is worn by HCP upon entry into patient rooms or
care areas
• Upon exit from the patient room or care area, PPE is
removed and either discarded or, for re-usable PPE,
cleaned and disinfected according to the manufacturers’
reprocessing instructions
5.5.2 Records are maintained of all staff involved in the
management of confirmed cases of communicable
diseases ( confirmed cases during an outbreak) to facilitate
contact tracking and surveillance
5.5.3 Record sheets are placed at the door and all staff entering
are completing it
5.6 Personal Protective Equipment (PPE)
5.6.1 Personal protective equipment are available and
accessible for use by patients, visitors and staff
5.6.2 PPE are worn by all healthcare personnel according to the
patient isolation status (contact, droplet, airborne):
• Gloves
• Gowns
• Eye protection (goggles or face shield)
• Respirator (N95 or equivalent)

5.7 Additional Precautions for aerosol-generating procedures for patients with droplet or airborne infectious
diseases
5.7.1 Aerosol-generating procedure is performed only when
medically necessary
5.7.2 Procedure is performed in airborne infection isolation
rooms (AIIR), whenever feasible
5.7.3 A limited number of HCPs is present during the procedure
5.7.4 Respirators or facial/eye protection are available and are
used by all HCPs in the room
5.8 Appropriate Clinical Management of Patients: Anti-infective Therapy

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 The facility ensures that patients with suspected or
confirmed infectious diseases are appropriately managed,
including early diagnosis and initiation of appropriate
treatment to prevent / reduce further complications/
morbidity and mortality and reduce the transmission of
disease
5.9 Prophylaxis and Vaccination
The facility develops and implements an appropriate plan
for identification of potential candidates to receive
preventive measures such as vaccination,
chemoprophylaxis and post exposure prophylaxis for staff
and families of affected patients, in liaison with authorities
such as the preventive medicine department
5.10 Quarantine
The facility develops and implements a plan to quarantine,
when indicated, those who had unprotected exposure to
infectious patients or those with mild clinical illness that
can be transmitted
5.11 Food Safety and Water Safety
During infectious diseases disasters such as cholera or
other common vehicle transmitted diseases, the facility
ensures safety of potable water and food supplied within
the facility
5.12 Post Mortem Care
The facility has a written procedure for handling dead
bodies, with communicable diseases
Service Standard 6: Laboratory Testing and Diagnostic Procedures
7.1 The facility has written procedures for indications, for
laboratory testing, for patients with infectious diseases (or
equivalent, e.g. ARDS, SARI, CAP)
7.2 The facility has written procedures and adheres to them
for preferred specimens, specimen collection, storage, and
shipment, specific to infectious diseases during a disaster
(or equivalent, e.g. ARDS, SARI, CAP)
Service Standard 7: Environmental and Engineering Infection Control
7.1 Environmental Cleaning and Disinfection Plan
7.1.1 The facility has an approved environmental cleaning and
disinfection plan
7.1.2 The facilities’ environmental cleaning and disinfection
plan addresses environmental surfaces, medical devices

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 and equipment, textiles and laundry, food utensils and
dishware
7.1.3 Hospitals grade cleaning and disinfection agents (high
level disinfectants) sufficient for inactivating infectious
agents during a specific disaster
7.1.4 Cleaning and housekeeping personnel are instructed to
also follow droplet/airborne infection isolation
precautions as applicable
7.2 Engineering controls
7.2.1 Technical specifications of airborne infection isolation
rooms (AIIR) (if available) are in line with international
best practice guidelines (i.e. CDC Guidelines for
Environmental Infection Control)
7.2.2 If an AIIR is not available, an appropriate number of
single rooms with anteroom and mobile HEPA filtration
units and/or exhaust air HEPA filtration is available
7.2.3 AIIR and/or single rooms for patients with infectious
diseases must be fitted, if feasible, with private toilets, and
must have:
• Designated patient sinks
• Wall-mounted liquid soap dispenser
• Wall-mounted tissue paper dispensers
• Medical waste container with foot control
7.2.4 Designated staff hand washing sinks are available
7.2.5 Alcohol-based hand rub is made available for use
throughout clinical areas
7.3 Pest Control
The facility ensures that appropriate pest control
measures are undertaken to prevent spread of zoonotic
diseases, during disasters such as viral hemorrhagic fever
outbreaks
7.4 Exercise and Drills
7.4.1 The facility conducts annual drills to enable staff to be
familiarized with the process of dealing with an influx of
patients with infectious diseases.
7.4.2 The facility conducts a post-drill briefing and develops
action plan on any significant findings during the drill

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 Appendix 3: Exposed Employee Register Form

No. Staff Name Bayanati Department Designation Activities Performed with the Use of PPE Length of
No. patient exposure
Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Date: _______________
Unit Manager Signature: ______________________

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 Appendix 4: Levels of Code Orange Alert

Hospital has been notified that a disaster has occurred in the community ( NO CASUALTIES are arriving yet).
Level I: The hospital is receiving up to 3 casualties.
Level II: The hospital is receiving ≥ 4 major casualties and/or the number of victims/severity of injuries will
require additional staff and resources.
Level III: The hospital is receiving more than 3 major casualties and/or the number of victims/severity of
injuries will require additional staff and resources AND normal hospital routines will be disrupted.

NB: The above levels are an example that hospitals can utilize or modify based on their capacity of
receiving patients during an emergency infectious disaster.

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