Presentation on theme: "Impact of H1N1 on School Facilities: An Outlook for the Future"— Presentation transcript:
1Impact of H1N1 on School Facilities: An Outlook for the Future Daniel LaHart, CIHEnvironmental Issues Program ManagerOperations DivisionAnne Arundel County Public SchoolsEdward L. Van Oeveren, M.D., M.P.H.Health Officer, Anne Arundel County Department of Health
2Outline Novel H1N1 influenza: Background information H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009School response to Novel H1N1 Virus, Fall 2009:CurrentContingency plansPotential school design elements to facilitate response to communicable diseasesSummaryQuestions
4What is influenza?A type of virus that causes respiratory infection with systemic S/STwo types of influenza viruses cause epidemic human disease:Influenza A: Categorized into subtypes on the basis of 2 surface antigens:HemagglutininNeuraminidaseInfluenza B:Two distinct genetic lineages: Yamagata and VictoriaNot categorized into subtypesSeasonal vs. pandemic influenzaSeasonalVirus changes slightly most years (antigenic drift)Season usually October through May~200,000 persons hospitalized~36,000 deathsPandemicInfluenza virus to which most of population lacks immunitySpread to at least two regions in the worldPandemic does not reflect severity of disease—only the spread of the infection geographically.
6What is H1N1 influenza?Antigenically and genetically distinct from other human influenza A (H1N1) viruses in circulation since 1977Inappropriately referred to as “swine” flu because the virus is related to influenza viruses that affect pigs.The most affected group of persons is under age 24 years.Has spread to all regions of theglobe—pandemic declaredin June 2009.
8How is influenza spread? Seasonal and Novel H1N1 Respiratory droplets from an infectious individual— coughing and sneezingCan travel up to 3 feet in the airContaminates another person close byLands on surfaces (fomites), e.g., doorknobs, computer keyboards, faucet handlesInfection begins when the virus is introduced to the nose or mouth (mucous membranes)
9How are people affected? Seasonal and Novel H1N1 Respiratory illness with systemic signs & symptoms:Fever (100°F or greater), cough, sore throatNasal congestion, muscle aches, headache, chills, fatigueDiarrhea, vomiting (seen with novel H1N1)Usually abrupt onsetTypical time to recover is 4 days to one week in healthy people
10Risk Factors for Severe Disease Immune system disordersHIV, transplant, chemotherapy, etc.Elderly, infants, pregnant womenOther medical problems:Lung diseaseDiabetesKidney disease
11Treatment of Infection Seasonal and Novel H1N1 RestDrink plenty of liquidsAvoid drinking alcohol or smokingUse over-the-counter medicationsLabeled “cold and flu” remediesNot aspirinIn some situations, use antiviralsOseltamivir (Tamiflu), zanamivir (Relenza)Prescription medicationsInitiate within 48 to 72 hours of first symptoms for optimal effectiveness
12Preventing the flu Seasonal and Novel H1N1 Clean hands oftenSoap and waterAlcohol-based hand sanitizersCover your cough/sneezeUse a tissue or your sleeveAvoid close contact with sick peoplePractice healthy behaviorsDon’t smoke, eat a healthy diet, exerciseUse antiviral medication if prescribed
15Flu Vaccines Two types Safety (known for seasonal vaccine) Timing Trivalent inactivated influenza vaccine (TIV) (injectable)Live, attenuated influenza vaccine (LAIV) (nasal spray)Safety (known for seasonal vaccine)Shot: arm soreness, redness, swelling, low grade fever, mild muscle aches, fatigueNasal spray: low grade fever, runny nose, headache, sore throat, fatigueDOES NOT CAUSE THE FLU!!TimingProtection takes at least 10 days
16Flu Vaccines Seasonal vaccine Novel H1N1 vaccine Still important this yearAvailable nowNovel H1N1 vaccineFirst shipments anticipated ~mid-OctoberTarget and priority groups initiallyIf available, everyone for whom medically appropriate may be vaccinated over the next 6 monthsNot mandatory
17Who will get the H1N1 vaccine? Target GroupsHigh Priority GroupsPregnant womenHealth care and emergency medical workersPeople who live with or care for children <6 months oldPersons 6 months through 24 yearsAdults 24 through 64 years with high risk health conditionsPregnant womenHealth care workers with direct patient contactPeople who live with or care for children <6 months oldChildren 6 months through 4 yearsPeople 5 through 18 years with high risk health conditionsCDC. MMWR Early Release. 2009;58 (August 21, 2009).
18The Good News…Majority of those affected do not require hospitalization and recover without complications.So far, H1N1 flu appears similar to seasonal flu except for different high-risk groups.Antivirals still generally effective.Vaccine is developed, studies ongoing.Prevention measures work!
19What else can you do? Stay home if you or your children are sick! Do not go to work, school or daycare until 24 hours after the fever has resolvedRecovery takes 3-5 days for most peopleHealthcare workers: Stay home for 7 days after symptom onset or until S/S resolveMake a family planBack-up plans for childcareLook into teleworking with your employerFood & water suppliesBe flexible
20H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009
21Spring 2009: Elementary School – 375 students and staff What occurredWhat’s going on simultaneouslyFamily member ill (flu symptoms)Recently returned from MexicoChildren exposed @ homeChildren come to schoolSchool notified, etcHealth Department directs school system“Pandemic” flu announcedMedia news bites clips focus on people wearing protective masksH1N1Vaccine not ready yetWorst is yet to comeAnxiety - probablyPanic – not yet but….
22School System Response With Teachers and Admin.FacilitiesWith Custodial StaffIn consultation w/HD who, in turn, are following CDC:Family children sent homeMeet w/teachers and staffExplain situationAdvise cleaning protocolsPromote good hygiene in classroom & homeLetter sent homeSchool will stay openSchool custodial staff backed up with extra volunteers to clean & disinfect classroomProvided training on virus, disinfection cleaning techniques, overview of disinfectant, and MSDSProvided gloves, masks, rags, spray bottles, pump sprayersTeam cleaning approachDisinfectant sprayed onWipe and rinse
23Then what….. At school Facility Management Gear up for full school disinfection; desks, chairs, hallways. Lockers, basically all surfaces, handles, sinks, knobs etc.TV Crews see inside school to see crews with masks, etc.National news show same scenario in a NY high school.Parents swamp phone linesSome kids stay homeRumorsMany are sickAnother child suspected of H1N1School to close 5-7 days per H.D.News helicopters, TV reporters & cameras, etc.
24Swine Flu Spreads Across D.C. Region Washington PostWashington PostParents and government officials are debating whether to close schools where suspected cases of swine flu have been discovered. What should officials do?Keep schools open. Schools should be cleaned and sick children kept home, but closings go too far. 39%Close schools. School officials should take every step possible to protect children from the flu. 57%Other solution. Write your answer in the comments below. 2%Total Votes: 2,648A federal agent who traveled to Mexico with President Obama this month probably contracted swine flu and infected several members of his family in Anne Arundel County, prompting assurances yesterday from the White House that the President was safe.
25Community/parents alarm Folger McKinsey Elementary School in Anne Arundel County has a student that has been tested for the swine flu. The results have not come back yet. School and county officials were on hand for the opening of school Thursday morning.
27Parents Debate Sending Children to School as Officials Urge Caution NationalSchoolAt a news conference last night, President Obama recommended that schools with suspected cases of swine flu strongly consider closing. But a spokesman for Gov. O'Malley said afterward that Maryland schools would remain open. "At this point it doesn't appear that it's necessary given the probable cases in Maryland," spokesman Shaun Adamec said.The word came so late in the school day yesterday that officials couldn't send a letter to parents, so they resorted to s and phone calls: A student at Folger McKinsey Elementary School in Severna Park was one of six probable cases of swine flu in Maryland.
28CDC Guidance School & Health Department CDC In conformity with CDC guidance, School and Health Department close school.On a national conference call, CDC states that any school with even a single case of H1N1 influenza should close for 5-7 days (possibly as long as 14 days).
29Outcomes School Facilities Reopened in 3-4 days No outbreak School returns to routineVast expenditure of manpower and equipmentLots of overtime
30Lessons Learned from Spring 2009 Use of Incident Command System (ICS)Consistent, uniform messages from key leaders:Joint Information Center (JIC)Joint Press ConferenceManage expectations; pro-actively stress need for flexibility in response to a dynamic situation.Frequent updates in understandable language:Public/parents/children:Phone bankAutomated phone call-out systemWebsitesWritten materials (letters home, posters in schools)Staff (Schools, Health Department)Collaboration between Schools and Health Department:Planning (Schools/Health Department MOU; exercises)ImplementationCommunications(Continued)
31Lessons Learned from Spring 2009 (continued) After-action analysis/assessment and follow-up actionNeeds identified:Formal school-based surveillance systemSchool attendance policiesStaff sick leave policiesIdentification of personnel and equipment shared between schools (e.g., buses and bus drivers, itinerant staff)Identification of, and planning for, “higher-order effects” of closure (e.g., free/subsidized meals, after-school activities, athletics)Tracking costs/expendituresPersonal Protective Equipment (supplies, fit testing)Isolation roomsHandwashing stations
33School response to Novel H1N1 Virus, Fall 2009: CDC Guidance--Philosophy Decision to dismiss students should:Be made locallyBalance the goals of:Morbidity and mortality from influenza withMinimizing social disruption and safety risks to children sometimes associated with school dismissal.Based on the experience and knowledge gained in jurisdictions that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students are often outweighed by negative consequences, including:Students being left home aloneHealth workers missing shifts when they must stay home with their childrenStudents missing meals, andInterruption of students’ education.
34School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses Conditions with similar severity as in Spring 2009:Recommendation:Stay home when sickSeparate ill students and staffHand hygiene and respiratory etiquetteFacilities Issues:Location for screening upon returnInstruction (study or teaching)while at homeIsolation rooms (students, staff)StaffingStorage of masks (surgical masks for ill; N- 95’s for healthcare personnel)Soap & towels, hand sanitizer, tissues:SuppliesLocations, dispensersRefill, maintenance, securityWaste receptacles(Continued)
35School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses Conditions with similar severity as in Spring 2009:(continued)Recommendation:Routine cleaningEarly treatment of high-risk students and staffConsideration of selective school dismissalFacilities Issues:Supplies & equipment (gloves, masks, pump and hand sprayers)*StaffingCompliance with medication regimenDispensing and storage of anti-viral Rx’sCo-location of high-risk andnormal-risk facilities*American Academy of Pediatrics’ Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition (2009) for guidance on cleaning and sanitizing in schools. (http://aapredbook.aappublications.org/resources/midsheets.dtl )The EPA provides a list of EPA-registered products effective against flu:
36School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses Conditions of increased severity compared with Spring 2009:Facilities Issues:Location for screeningEquipment/supplies (e.g., thermometers)StaffingIdentification of high-risk persons:StaffLocationCommunication with high-risk personsStudy/work from home:Equipment, suppliesSame as above for affected studentsRecommendation:Active screeningHigh-risk students and staff members stay homeStudents with ill household members stay home(Continued)
37School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses Conditions of increased severity compared with Spring 2009:(continued)Recommendation:Increase distance between people at schoolsExtend the period for ill persons to stay homeSchool dismissalsFacilities Issues:Space limitationsSchedulingLonger duration of above issuesIdentification of appropriate schoolsImpact on co-located facilities (e.g., schools, libraries, recreation centers)Instructional staff facilities & resourcesSecurity
38Potential School Design Elements to Facilitate Response to Communicable Diseases
39Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 1 of 9) Generally:Collaboration with School Health staff during design phaseHealth Room:LocationSizeEquipmentCommunications/support systems (intranet, internet, phone, fax)SuppliesStorageStaffingNational Clearinghouse for Educational Facilities (National Institute of Building Sciences), Resource List for School-Based Health Facilities--http://www.edfacilities.org/rl/health_centers.cfmThe Center for Health and Health Care in Schools--http://www.healthinschools.org/static/states/MD-guidelines.aspx
40Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 2 of 9) Screening Points:Potential uses:Active screeningReturn from illnessConsiderations:Traffic flowLocation:Ingress/egress to exterior of buildingProximity to:Health RoomIsolation facilitiesStaffing/monitoringFurnishingsEquipmentSupport systems (intranet, internet, telephone, fax)
41Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 3 of 9) Isolation capability:“Isolation” vs. “quarantine”Considerations:CapacityLocation:Proximity to:Health RoomScreening PointsIngress/egress to exterior of buildingStaffing/monitoringFurnishingsEquipmentSupport systems (intranet, internet, telephone, fax)
42Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 4 of 9) Potential for fomite transmission:Factors affecting infection potentialEnvironmental surfaces:FloorsHandles/knobsWallsFurnishings (e.g., desks, counters)Equipment (e.g., keyboards [membrane covers?])Considerations:Infection potentialCleanability/potential to disinfectCosts (total lifetime cost):InitialMaintenanceReplacementDurabilityEstheticsSpecial characteristics (e.g., non-slip flooring)
43Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 5 of 9) Hygiene resources/facilities:Rest Rooms:SoapTowelsSupply storageWaste/refuse disposalFomite infection risk:Environmental surfacesFaucet handlesMaintenanceHand hygiene:Free-standing hand-washing stationsHand sanitizer stations:LocationsRefilling & MaintenanceSafety & Security
44Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 6 of 9) Environmental Control Systems:TemperatureHumidityParticulates (especially allergens)Gases and vaporsAir exchangeDesign easy to change and readily accessible air filtersDesign for adequate ventilation: Solution to Pollution is DilutionDesign schools with systems that require no-touch to operate via sensorsRoom lightingDrinking fountainsToiletsHand sinks
45Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 7 of 9 ) Storage:Cleaning & maintenance supplies (e.g., disinfectant)Equipment (e.g., sprayers)Health Room:EquipmentSupplies (e.g., masks, gloves, thermometer covers)Refrigerated storage:CapacityTemperature Tolerance45
46Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 8 of 9) Alternate uses of facility:Use:Alternate Care Site (e.g., for local hospital during disaster)Mass immunization sitePoint-of-distribution (POD) for medicationsFacilities issues:Location/Proximity to “index”facilityIngress/EgressBuilding systems (HVAC, electrical, IT)Location/Proximity to PopulationTraffic FlowStorage (e.g., refrigeration)Same
47Potential School Design Elements to Facilitate Response to Communicable Diseases (Slide 9 of 9) Co-located facilities:Examples:Other schools (e.g., pod of high school, middle school, and elementary school)LibraryRecreation/Community/Social CenterPotential issues:Infection/cross-contamination (directly, or by shared/common population)Facility closure (does closure of one necessitate closure of all)Futility of selective/partial closureShared infrastructure/building systems:Possible or cost-effective to partially shut down)Effects on health risks/environmental control/comfort (e.g., HVAC)
48Summary Novel H1N1 influenza: Information relevant to educational facility plannersH1N1 outbreak in Anne Arundel County Public Schools, Spring 2009:Lessons learnedSchool response to Novel H1N1 Virus, Fall 2009:CurrentContingency plansPotential school design elements to facilitate response to communicable diseases