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Training Workshop for Health Care Workers For the Care and Isolation Unit (CIU) of St. Patrick Hospital Welcome to the George Risi, MD, Msc Infectious.

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Presentation on theme: "Training Workshop for Health Care Workers For the Care and Isolation Unit (CIU) of St. Patrick Hospital Welcome to the George Risi, MD, Msc Infectious."— Presentation transcript:

1 Training Workshop for Health Care Workers For the Care and Isolation Unit (CIU) of St. Patrick Hospital Welcome to the George Risi, MD, Msc Infectious Disease Specialists, PC 614 West Spruce Street Missoula, MT

2 Purpose of This Course To familiarize the Health Care Professional with the fundamental aspects of Biosafety and Biocontainment To introduce the concept of Biosafety Levels To describe the role of the health care community and St. Patrick Hospital in support of research activities at the Rocky Mountain Labs To replace fear of the unknown with respect for the known To establish confidence that the proper use of established methods to prevent transmission of familiar infectious diseases will also protect against infection by exotic or high hazard agents.

3 Lets Do This Right The National Research Council has recently published a comprehensive review of the state of knowledge regarding how people learn Fundamental concepts about how people learn arose from this, along with the realization that many established methods of education are inconsistent with what is now known about effective learning. The fundamental concepts of learning apply to children as well as adults, and are irrespective of ones level of educational achievement From How People Learn, National Research Council, 2000

4 How People Learn Students come to a learning situation with preconceptions about how the world works. If these initial preconceptions, correct or incorrect, are not engaged, the student will either: –Fail to grasp new concepts or –Will learn them just for an exam and then revert to the preconception outside the learning environment To develop competence in an area of inquiry, students must –Have a deep foundation of factual knowledge –Understand facts and ideas in the context of a strong conceptual framework, which allows them to organize information into meaningful patterns Students need to take control of their own learning by defining goals and monitoring their progress in achieving them (metacognition) From How People Learn, National Research Council, 2000

5 Application of Novel Teaching Methods to Medical Education (in a one day workshop..?) What are the preconceived ideas one has when walking into a lecture? What are the essential facts to be conveyed and how to convey them within a frame of reference? How does one determine what the listener is absorbing? Is the listener engaging and self evaluating whether or not they are learning the material?

6 Essentials for Learning Identify the common misconceptions that learners have about this topic and rectify them Provide information that is relevant Engage the learner in the process Query the learner in novel ways to determine their mastery of the material Provide feedback Whats wrong with this picture?

7 Objectives of This Workshop List the essential elements of standard and transmission based isolation guidelines Demonstrate proper technique of donning and doffing personal protective equipment Illustrate proper technique of hand hygiene At the Completion of this Workshop the Health Care Worker Will be Able to:

8 Objectives Contd Apply proper technique for cleanup of infectious body fluids within the CIU Cite which of the Biosafety Level 4 agents have demonstrated person to person transmission in the health care environment Utilize the information in the pathogen specific modules to decide the appropriate type of PPE to don for a disease and the stage of illness

9 Agenda for the Day You have already: –Taken the pretest –Read the Lassa education module –Viewed the videos Introduction to BSL-4 research Techniques for donning and doffing Techniques for spill cleanup Isolation guidelines

10 Agenda Lecture: Viral Hemorrhagic Fevers Interactive sessions. Patient care scenarios utilizing the Lassa module –B. Radley scenario –Ravenwood scenario –Potter scenario Lecture: Hand Hygiene and PPE Lunch- on your own

11 Agenda: II Hospital SOP Jeopardy!!! (with prizes) Break out sessions –Duran learning center Spill cleanup Hand hygiene Blood drawing and use of the I-Stat –CIU if room available Donning and Doffing of PPE Mannequin training Post test and evaluation form Group Discussion on further improvements to the training

12 Feedback Workshops are intentionally being kept small This is a work in progress Your feedback and assistance in improving this course will –Help you –Help your colleagues –Help provide optimal care to an exposed individual

13 What is the Response of the Medical Community when a New Disease Emerges? Bubonic plague, Surat, India 1994 Monkeypox, US, 2003

14 Surat, India State of Gujarat, NE India September 1993 earthquake strikes a nearby region known to be endemic for plague 10,000 deaths, 10 6 homes destroyed. Survivors evacuate but store grain before leaving Stored grain results in an explosion of rats and fleas By mid September, 1994 at least 35 residents of the village of Mamala had developed bubonic plague

15 Bubonic Plague: Surat, India, 1994 A farmer whose bubonic plague had progressed to pneumonia travels to Surat to attend the festival of Ganesh on 9/18/03, unknowingly transmits disease to others On 9/21 there are 7 cases of pneumonic plague, 6 more the next day On 9/22 the BBC reports an outbreak resulting in panic and mass exodus Within 12 hours 100,000 had fled, 300,000 more the next day By 9/24 600,000 or half the population of Surat had fled

16 The Worlds Reaction 9/28 the Gulf states ban all flights, goods and citizens from India Pakistan and Sri Lanka follow the next day, then China, Russia, Egypt, Malaysia, Bangladesh North Korea denies docking privileges to all ships of any nationality that had previously been in Indian waters The U.S. attempts to screen all arriving passengers from India Stock Market in Bombay crashes Estimated loss from trade and tourism: $1.3 billion

17 Actual Toll of Cases 6300 reported, only a few confirmed and using invalidated techniques Total deaths 56 No convincing transmission outside of Surat No tourists contracted plague No patients with plague are known to have actually left India during the outbreak

18 And the Medical Response? On the one hand… –Ministry of health seems to lack good information. Recommendations were late –Of 137 private physicians, 80% fled the city, closing their clinics and abandoning their patients On the other hand… –Hundreds of physicians and nurses in the community and at the Civil Hospital stayed on the job and cared for hundreds of patients

19 The Gambian Giant Pouch Rat Up to 32 inches long Up to 2 ½ pounds

20 Monkeypox, US Midwest, 2003 April 9, 2003 a Texas animal importer received a shipment of 800 small mammals from Ghana, West Africa with 6 different genera of rodents including Gambian giant rats. The rats were sold to an Iowa vendor who then sold them to a vendor in Chicago, Illinois. The Chicago vendor housed the rats in a cage near a cage of domestic prairie dogs. Prairie dogs from the Illinois vendor were sold or traded at swap meets to persons from Illinois, Ohio, Wisconsin and Indiana. Many of the prairie dogs became ill and died from what was later recognized as monkeypox. 72 cases of monkeypox were reported to CDC from Wisconsin, Illinois, Indiana, Ohio, Kansas and Missouri.

21 HCW Response In Rockford, Illinois a 10 year old girl is admitted with fever and rash, suspected diagnosis of monkeypox All but one physician and 4 nurses refused to provide care for the patient. Over 4 days they worked in shifts Marshfield Clinic, Wisconsin. Similar case, but no HCW reluctance. No occupational transmission

22 Rockford Explanation Globalization has resulted in the recognition of several serious emerging infectious agents in the US during the past year, including SARS, WNV, and monkeypox. The tempo of this infectious disease assault combined with the lack of time for the professional health care community to acquire knowledge and come to terms with the handling of these frightening diseases has uncovered an apparent change in the traditional professional values of some medical practitioners. Anderson MG, Ped. Infect Diseases 2003;22:1093

23 Lessons Learned: Why SOME HCW are Reluctant and How to Address Has there been a change in the medical culture ? –HCW have always had differing responses to a disease outbreak A recent survey of US physicians revealed that 80% would continue to care for patients in the event of an outbreak of an unknown but potentially deadly illness, but that only 21% felt prepared for doing so. Issues raised –Ignorance of the disease and methods of avoidance –Fear, for themselves and for their loved ones

24 What Do HCWs Need? Sense that risks are shared equally. Lead from the front Ready access to information For RML, knowledge of what agents are being studied in advance A well engineered healthcare facility that enhances safety Detailed knowledge of and confidence in transmission based isolation guidelines and their correct application Reliable PPE and knowledge of proper use The confidence that is instilled by frequent testing and drilling


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