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

Austria  Nine federal states  Total population: 8.3 million  Life expectancy at birth: 79.5 years  people work in the health sector  (5.6% of total employees)  Resources: 271 hospitals

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 17Austria 361 cases No deaths All EU/ EFTA countries 52,710 cases 157 deaths Oct 15Austria No deaths All EU/ EFTA countries 208 deaths

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 Provincial 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 stocks  Antiviral drugs  Considerable stocks of suitable FFP1-, FFP2- or FFP3-masks  Vaccines

Population:1.2 M inhabitants Capital (Graz) inhabitants Styria 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 authorities  Leader ship  Health sector  Non - health sector  Armed forces, fire brigade, police forces  Basic service providers (telecommunication, electrical and water)  Private businesses  Communities, families and individuals  Civil society organizations

1 University hospital beds 1 Major referral hospital 230 beds 2 Minor referral hospitals 128 beds 1 Military hospital 60 beds _______________________________________ Total beds 20 district hospitals beds 60 pediatricians 30 pulmonologists 200 physicians GP´s Health care facilities and hospitals

CalculationNo. Patients who will require a bed for 10 – 12 days at the peak of the pandemic Expected impact No. No. of beds available in Graz and surrounding areas No. of additional beds needed  Inclusion of private hospitals and district hospitals  Inter - facility transfer  Inclusion of general practitioners  Include in triage system

Preparedness on a hospital level Medical University Hospital Graz Medical University Hospital Graz beds 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 system 2. Communication 3. Infrastructure & Infection control 4. Surveillance 5. Case management 6. Human resources 7. 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 centre  Command group  Medical Director  Representatives from  Nursing Staff, Pharmacy, Institute of Hygiene, Laboratory, Human resources, Pharmacy services  Representatives from certain units  Internal medicine, Pediatrics, ICU, Accident & Emergency, Infectious Diseases  Security engineer and public information spokesman

2. Communication (internal)  Information management team  Update information  disseminated via to a group of key persons (doctors, head nurses, hospital managers etc.)  further disseminated by key persons  via  during 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 group  Co ordinates public/media communication strategies with health authorities  Consensus 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 identified  Units are provided with adequate equipment (masks, gowns, gloves etc.)  Instructional materials for affected patients and their relatives  Brochures and posters  Information on relevant hospital policies

3. Infrastructure & Infection control  Regular personnel education and training  Long-distance influenza training programs  Educational website and update on the “intranet” (local hospital server)  Specimen protocol  Specimen clearly identified  Send with biohazard precautions  Special dispose protocol for disposable items

4. Surveillance  Case definition  Close link to the Austrian surveillance system  Surveillance system has been tested during the regular influenza season  Written protocol for monitoring and reporting influenza

 Admission criteria  Triage criteria  Method 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 Plan  Plan 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 illness  Staff might also use telephone triage system 6. Human resources *

7. Logistics Management  Estimation of quantities of essential patient care  Materials and equipment  Estimates are shared with the provincial health authorities and regional hospitals  Stockpiling agreements  Contingency plan for an increased need for post mortem care  Involvement of local morticians

Conclusion  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