Overview to Health Facility Preparedness

and Response to outbreaks and other

Public Health events
Disease Surveillance and Response Unit
Ministry of Health
October, 2018
BE PREPARED!
 Learning Objectives
By the end of this module, participants will be able to:
 Describe the composition of hospital epidemic management
committee (HEMC)
 Describe the role and responsibilities of HEMC
 Outline of a hospital epidemic response plan
 Estimating emergency stocks of essential supplies
 Introduction
 Epidemic preparedness constitute all activities that have to be
undertaken to be ready to respond effectively to outbreaks &
public health events of concern

 Health facilities play a critical role in local and national and

responses to emergencies, such as disease outbreaks

 Most actions required to prepare for epidemics apply to or can be

adapted to manage other emergencies e.g. mass casualties due to
transport crashes, hydro-meteorological, geological or chemical disasters etc.
 Epidemic Cycle
Post-Mortem OR post
Epidemic Evaluation

Response
Forecast

IMPACT

Preparedness

Early Response

Prevention
EWS
 Objectives of Epidemic Preparedness &
Response
1. Anticipation/prediction
 So that epidemics be prevented e.g. meningitis, measles
2. Early detection
 To know when there is a problem e.g. Early Warning Systems
3. Rapid Response
 Guidelines/trained staff/supplies in place before epidemic
4. Effective Response
 Appropriate control methods
 Adequate resources and logistics
 Outbreak Detection and Response
Without Preparedness
First Late Delayed
Case Detection Response
90
80
70
60
CASES
50 Opportunity
40 for control

30
20
10
0
1
3
5
7
9
11

15
17
19

23
25
13

21

27
29
31
33
35
37
39
DAY
 Outbreak Detection and Response
With Preparedness
Early Rapid
Detection Response
90
80
70
60
Potential
CASES Cases Prevented
50
40
30
20
10
0
1
3
5
7
9
11

15
17
19

23
25
13

21

27
29
31
33
35
37
39
DAY
 Components of Epidemic Preparedness
1. Establish Outbreak Management Committee

2. Set priorities

3. Agree epidemic preparedness and response plan

4. Implement surveillance

5. Respond rapidly and effectively

 Epidemic Preparedness and Response
Committee
 Who should be in the committee ?
 What are the tasks of the committee?
• Before the epidemic
• During the epidemic
• After the epidemic
 Hospital Epidemic Management Committee
 Who is in the Hospital Epidemic Management Committee (HEMC)?
 Should include representatives of the
 Chaired by Med Sup/CEO
 Administration: human resource, security, finance,
 Medical and nursing care
 Infection prevention and control
 Surveillance: data management, reporting,
 Stores and supplies services: supplies and commodities
 Laboratory services
 Engineering and maintenance
 Support services: laundry, food services, sanitation
 Communication
 Roles and responsibilities of HEMC
 Conduct an assessment of the risks to which the hospital is
exposed;
 Develop a hospital emergency preparedness and response plan
 Mobilize resources for emergency preparedness and response:
supplies, staff etc.
 Identify weaknesses in the hospital’s emergency preparedness
and mechanisms for remedying them e.g. staff training
 Monitor implementation of outbreak control measures in the
facility
 Roles and responsibilities of HEMC
 Coordination with other players in the health scene, including public
health authorities (SCHMT and CHMT), health-sector agencies
working in the area and neighboring public and private-sector
healthcare facilities;
 Establishment of links with non-health-sector government
authorities, volunteer organizations and other stakeholders
 Coordinate post-epidemic evaluation and use findings to improve
plan and future response
 Responsibilities of the HEMC
 Before an outbreak
 Mobilize material, and financial resources
 Training of personnel
 During an outbreak
 Mobilize human, material, and financial resources
 Coordinate implementation of response plan
 Monitor implementation of outbreak control measures
 After an outbreak
 Conduct epidemic review
 Prepare epidemic report
 Hospital Epidemic Response Plan
 Plan describes the arrangements and activities required to enable
the hospital to function adequately during an outbreak
 Plan covers issues such as:
 Roles and responsibilities of each hospital department in an
outbreak;
 Hospital incident management system and other structures and
mechanisms required to coordinate response to an outbreak;
 Procedures for activating the Hospital Response Plan
 Role of the hospital with respect to the community and health sector
response, including coordination functions and lines of
communication;
 Hospital Epidemic Response Plan
 Standard Operating Procedures
 Setting up of a Hospital Emergency
Coordination Centre, including the
designation of its location;
 Availability of alternative treatment
sites;
 IPC measures; Isolation facility
location/designated space
 Agreed protocols for patient triage
 Measures required to ensure the
safety of hospital staff;
 Continuity of essential routine
procedures and services
 Information and communication
activities;
 Human resource issues;
 Logistic services;
 Pharmacy and laboratory services;
 Essential support services;
 Psychosocial support services.
 Emergency stocks of essential supplies
 Key principle in outbreak response is to avoid any shortage of
supplies
 Buffer stocks: A supply of excess essential supplies or
contingency supplies, (for 10 days) in case of surges of cases or
re-supply issues should be on-site at all times
 Buffer stocks are additional to the supplies needed to meet
normal demands
 Determine a detailed list of supplies per patient load to obtain
estimates for your facility
 Expected number of cases and delays in supply accessibility
should be considered in this estimate
 Management of emergency stocks of essential
supplies
Hospital have identified what should be the amount of buffer
supplies and where they will be kept
Defined process for placing reserve stock in normal delivery
system so that the reserve supplies are not outdated
Define process for reordering reserve supplies to replenish
stock
Hospital know how and where to obtain other logistics
 Resource requirement include the following:

 Drugs and materials

 Non pharmaceuticals: Syringes, needles, fluid giving sets, IV
branulars
 Lab supplies and commodities
 Linen
 Personnel requirements
 Transport
 Health education materials
 Current Status of stocks and materials
 Do an inventory to determine the current level of stocks
 Identify the gaps
 Estimating resource requirements: Example 1.
Cholera
 Determine the number of people likely to be affected
 How?
 Use figures from previous outbreaks
 Use WHO attack rates estimates for different diseases
and settings
 Formula for number of cases of cholera:
 No of cases of cholera = district population x 0.2% (attack rate)
 In a district with a population of 50 000,
 No of cholera cases = 50 000 x 0.002 = 100
 Estimate minimum requirements for 100 persons
with cholera

 Selection of antimicrobials should be based on susceptibility

testing
 Assumptions
 20 cases – severe dehydration – IV fluids + ORS
 80 cases – only ORS
 Adult – severe dehydration – 3 caps Doxycycline (100mg) or 24 caps
Tetracycline (250mg)
 Child – severe dehydration – 15 tabs TMP20-SMX 100
 Resource requirements for 100 persons with
cholera
 Drugs  Other supplies
 Doxycycline 100mg cap - 60caps  2 large water dispensers with tap (marked
 Tetracycline, 250mg cap – 480caps at 5- and 10-litre levels) for making ORS
solution in bulk
 Child: TMP 20 +SMX 100mg – 300tabs  20 bottles (1 litre) for oral rehydration
solution (e.g. empty IV bottles)
 Materials and supplies
 20 bottles (0,5 litre) for oral rehydration
 ORS - 1 litre each – 650pkts solution
 Ringers lactate – bags - 120  40 tumblers, 200 ml
 Adult IV giving set – 120  20 teaspoons
 Scalp vein sets – 10  5 kg cotton wool
 NG tube for adults – 3  3 reels adhesive tape
 NG tubes for children – 3
 Response to outbreak
Steps to take (may be going on simultaneously)
1. Activate response plan
2. Convene hospital epidemic management committee
 Assign clear responsibilities to individuals for specific
response activities
3. Mobilize response teams for immediate action
4. Develop an incident action plan
 Tailored to circumstances of the ongoing emergency and is
revised as the emergency and its parameters evolve
 Response to outbreak
5. Implement response activities
 Case management
 Strengthen surveillance
 Strengthen IPC
6. Regularly review the situation: Provide situation reports on the
outbreak response
7. Document the response: Report
8. Post outbreak evaluation
 What went well
 What did not go so well
 What can be improved in future responses
 Be

Prepared !
FIN
 Five components of pandemic
preparedness and response
 Planning and coordination
 Communication
 Situation monitoring and risk assessment (likelihood and
severity)
 Reducing the spread – infection control
 Striving to ensure continuity of health care provision and
businesses