Dr Gail Thomson Biorisk reduction for Dangerous Pathogens (BDP) Department of Epidemic and Pandemic Alert and Response (EPR) Biological risks in health service: The WHO experience

WHO WHO’s objective, as set out in its constitution is: The attainment by all peoples of the highest possible level of health A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity Protect the public & the patients from disease; There is also a need to protect the health care workers

WHO Network WHO HQ PAHO COs AFRO COs EURO COs EMRO COs SEARO COs WPRO COs 192 MEMBER STATES Needs Global challenges

n HQ, Geneva Regional offices: n AFRO, Brazzaville Harare n PAHO, Washington n EMRO, Cairo n EURO, Copenhague n SEARO, Delhi n WPRO, Manilla n 141 country offices WHO regions

Listen to and address the fears & needs of our HCWs l Global Health workforce is estimated > 100 million people l There is a recognised need to strengthen health care systems l “such systems are impossible without health workers who are the ultimate resource of health systems” Joint Learning Initiative l HCWs: more than a resource l Listen to & address their fears and needs: – “ We are afraid. We question our safety. But we are obliged to our patients.” (Congolese nurse, Ebola outbreak, Hewlett 2005)

12 th session of the Joint ILO WHO Committee on Occupational health in 1995 adopted a new definition of occupational health l aiming at the promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations

Healthcare Worker safety l Occupational and Environmental Health Programme l Injection Safety & Related Infection Control Safe Injection Global Network (SIGN) Secretariat l Department of EPR: Healthcare-Associated Infections Prevention and Control focal point Deployment of field teams with Personal Protective Equipment (PPE) Training materials/ Outbreak Response Leadership Course

The Department of EPR assists with the control of outbreaks. This may be done through triggering the GOARN Network.

GOARN Global Outbreak Alert & Response Network l GOARN is an independent network of institutions l The GOARN Project Manager and Secretariat sit inside the Department of EPR, WHO Geneva l WHO has mounted 30 missions since 1 Jan 2006: Revolved around Avian Influenza Human or animal epidemiologists Case management & infection control Logistics Social mobilisation Laboratory experts

Outbreak coordination slide

Outbreaks show where the strengths and weaknesses are in a system l Find the weak link/s & strengthen it/them l Preferably before an outbreak Disrupt the interaction between man, agent & environment

Where in the patient’s journey through the health care facility is there a risk of nosocomial amplification? Identify at risk personnel & activities Manage the risk

Trying to create a safety culture & climate at an outbreak l Senior management support for the safety of personnel l Appropriate administrative and engineering controls in place l Hazard identification and risk assessment l Buddy system; can provide informal feedback l Adequate & accessible supplies of PPE l Consistent use of PPE l Review of work processes to ensure that the risk of exposure is eliminated or minimised l Try to identify job hindrances and remove them

Able to smile behind their masks

In certain situations the usual controls may be absent

Scenario - Outbreak investigation Non hospital setting l You are asked as part of a GOARN response to go to a village and investigate an outbreak. This will include taking samples from a sick patient who has a fever, has been vomiting blood and who is unable to leave his/her house because he/she is so weak. In such a situation it is important to be well prepared and to be aware of the emotions and beliefs of the community For example: establishing good links with community leaders, ensuring you have all necessary material with you & decide where to put on and take off PPE

In certain situations the usual controls may be absent STOP: Stop, Think, Observe and Plan what to do next l Hazard identification l Risk management l Appropriate precautions Aiming for SOS: Safety of Staff & Others resulting in Safe patient care

Community support

In summary An outbreak response requires: l Prompt initiation l Strong coordination l Clear lines of communication l Community support l Adequate & appropriate staff who have their needs addressed

Thank you