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Pandemic Influenza Policy
Pandemic Influenza Policy
Target Audience
Who Should Read This Policy
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Version 1.1 August 2015
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Pandemic Influenza Policy
Ref.
Contents
Page
1.0
Introduction
4
2.0
Purpose
4
3.0
Objectives
4
4.0
Process
5
4.1
Pandemic Influenza
5
4.2
Phases of a Pandemic
7
4.3
Incubation
10
4.4
Symptoms
10
4.5
Transmission of Infection
13
4.6
Infection Control
15
4.7
Preparing to Respond
21
4.8
Declaring a Pandemic and Action Required
23
4.9
Recovery Phase
32
4.10
Financial Arrangements
32
4.11
Communication
32
5.0
Procedures connected to this policy
32
6.0
Links to Relevant Legislation
32
6.1
Links to Relevant National Standards
33
6.2
Links to Trust Policy/s
34
6.3
References
34
7.0
Roles and Responsibilities for this Policy
36
8.0
Training
40
9.0
Equality Impact Assessment
40
10.0
Data Protection Act and Freedom of Information Act
40
11.0
Monitoring this Policy is Working in Practice
41
Appendices
1.0
Inpatient/Residential Unit- Situation Report
42
1.1
Non-Inpatient Services- Situation Report
43
1.2
BCPFT Situation Report (STIREP)
44
2.0
Putting on and Removing PPE Poster
45
3.0
Pandemic Influenza Action Cards
46
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Explanation of terms used in this policy
Action Cards- Action cards are physical documents containing easy-to-follow instructions on how to
execute a key activity
Aerosol Generating Procedures (AGP) - A procedure which stimulates coughing and promotes
the generation of aerosols e.g. intubation, manual ventilation, CPR, collection of specimens (bronchial
and tracheal aspirates), respiratory and airway suctioning (including tracheostomy care)
Business Continuity-The creation and validation of a practiced logistical plan for how an
organisation will resume and continue delivery (partially or completely) of interrupted critical functions
within a predetermined time after a disaster or extended disruption
Category 1 Responders- A term defined under the UK’s Civil Contingencies Act (CCA) 2004 as a
person or body listed in Part 1 of Schedule 1 to the CCA which is required to prepare for emergencies
in line with its responsibilities under the Act, which includes assessing local risks, implementing
emergency plans and co-operating with other local responders to enhance co-ordination and
efficiency. Core responders include:
Emergency Services (fire, ambulance, police)
Local Authorities
Government Agencies (Environment Agency)
Health bodies (PCT’s, Acute Trusts, Foundation Trusts, Local Health Boards (Wales), Health
Protection Agency
Category 2 Responders- A term defined under the UK’s Civil Contingencies Act (CCA) 2004 as a
person or body which has a role in supporting Category 1 responders. Co-operating responders
include:
Utilities (Gas, water, electric, telephone)
Health Bodies (Strategic Health Authorities)
Government Agencies (Health and Safety Executive)
Transport (network rail, train operating companies, London underground, airport operators,
harbour authorities, highways agency)
Command and Control-The exercise of authority and direction by a properly trained designated
Leader over an assigned and attached team in order to efficiently manage an organisations response
to a major incident or emergency.
Command and control functions are performed through an arrangement of personnel, equipment,
communications, facilities and procedures. They are employed by the Team Leader in planning,
directing, co-ordinating and controlling. They are designed to continue delivery of critical services at
acceptable levels and affect an orderly return to ‘business as usual’ operations
Epidemic- The occurrence of more cases of a disease than would be expected in a community or
region during a given period of time within the country of origin
Pandemic- The occurrence of a disease occurring over a wide geographic area affecting an
exceptionally high proportion of the population, spreading between countries
Personal Protective Equipment (PPE) - Specialized clothing or equipment worn by employees for
protection against health and safety hazards. Personal protective equipment is designed to protect
many parts of the body, i.e. eyes, head, face, hands, feet, and ears
Surge- A transient increase in demand for care or services above usual capacity
World Health Organisation (WHO) - Part of the United Nations that is focused on global health
issues. The organisation has been working for over sixty years on such issues as smallpox eradication,
family planning, childhood immunisations, maternal morbidity rates, polio eradication, and AIDS
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1.0 Introduction
Influenza is a virus which affects up to 10% of the population every year. From time
to time, a distinctly different strain of influenza virus will emerge that spreads rapidly
across the world, causing an influenza pandemic.
Pandemic influenza is a global disease outbreak, the virus spreads easily from
person to person, causes serious illness and can sweep across the country in which
it originates and around the world in a very short time. The World Health
Organization (WHO) currently defines a pandemic as ‘the worldwide spread of a new
disease.’ They state that an influenza pandemic occurs when a new influenza virus
emerges and spreads around the world and most people do not have immunity.
An influenza pandemic is a rare occurrence and occurs one to three times a century
but one could start at any time of the year. Historically, pandemics have had a higher
clinical attack rate than seasonal influenza (10% - 50% of the population) and higher
morbidity rate (0.34% to 2.5%). Previous pandemic virus strains have also targeted
the 20 – 45 year age range (not usually considered a vulnerable group in terms of
seasonal influenza or general physical health).
No country can expect to escape the impact of a pandemic entirely and when it
arrives most people are likely to be exposed to an increased risk of catching the virus
at some point. Influenza pandemics therefore pose a unique international and
national challenge. As well as their potential to cause serious harm to human health,
they threaten wider social and economic damage and disruption.
2.0 Purpose
All NHS Trusts are required to have an operational plan to respond to an outbreak of
pandemic influenza, approved by their Boards. This policy details the infection
prevention and control measures that must be implemented and complied with in the
event of a pandemic affecting the Black Country Partnership NHS Foundation Trust.
This policy is based on the Department of Health (DH) current guidance documents
and is to be used in conjunction with the Trust’s Business Continuity Management
Policy to manage the response to any of the following:
Escalation of the Pandemic Influenza FluCon Assessment by the DH, which is
used as the key indicator of threat
Increase in preparedness and case management as directed by the WHO and
DH prior to Pandemic FluCon Assessment implementation
Reporting of any disruption or impact upon critical services during the period of
a pandemic as set out by WHO Phase 6
Invocation of regional and or local Black Country Cluster escalation plans by the
Regional Civil Contingencies Committee
3.0 Objectives
The principle objectives of this policy are to:
Ensure that the Trust is prepared for and can continue to function during an
outbreak of pandemic influenza
Ensure that the core services are maintained and provided at safe levels
Minimise the impact of pandemic influenza on local services
Set out procedures for handling infected patients and protecting staff, other
patients and visitors
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Identify arrangements for effective communication for patients, staff and visitors
Set out the process for recovery from an influenza pandemic in line with the
Trust’s Business Continuity Management Policy
4.0 Process
4.1 Pandemic Influenza
Influenza is a common acute viral infection that can affect all age groups. It is usually
a seasonal illness, occurring predominantly in a six to eight week period each winter.
With Pandemic Influenza all ages are likely to be affected but those with certain
underlying medical conditions, pregnant women, children and otherwise fit younger
adults could be at relatively greater risk. Older people usually have some residual
immunity from previous exposure to a similar virus earlier in their lifetime. The exact
pattern will only become apparent as the pandemic progresses.
4.1.1 Pandemic Influenza Background
A pandemic may occur if an influenza virus undergoes major change (antigenic shift),
and a new virus emerges, which is markedly different to recently circulating strains,
and to which humans are not immune. A pandemic may occur if the new virus can:
Infect people (rather than, or in addition to, animals or birds)
Spread from person to person
Cause illness in a high proportion of the people infected
Spread widely, because most people will have little or no immunity to the new
virus and will be susceptible to infection
Such an influenza virus can spread rapidly, causing an epidemic within the country of
origin and becoming a pandemic when it spreads between countries. A pandemic is
a natural phenomenon that has occurred from time to time throughout history. The
worst recorded pandemic was in 1918/9, this is also known as the Spanish Flu as
Spain was the first country to report openly about the illness affecting its people. It is
thought that the impact of World War 1 may have had a direct impact on the mortality
figures for this pandemic; however it does not explain the high infection and mortality
rate in areas not connected with the War and not in regular contact with other
communities, such as Alaska and the Pacific Islands. The scientific research into the
causes of the 1918/19 pandemic has led to the development of antiviral medication
and the typing of virus strains.
The interval between influenza pandemics is variable, ranging from 11 to 39 years
during the last century. Although it is highly likely that another influenza pandemic will
occur at some time it is impossible to forecast the exact timing or precise nature of its
impact. Even if the pandemic originates in Asia, as it seems likely, it will probably
reach the UK within 2 to 4 weeks of becoming epidemic in the country of origin and
would then only take 1 to 2 weeks to spread to all major population centres here.
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The severity of a pandemic varies but, in the last century, there were three
pandemics and one which occurred in 2009:
Pandemic
Year
Spanish Influenza
1918
Asian Influenza
1957
Hong Kong
Influenza
1968
Swine Flu
2009-10
Deaths worldwide
2-3%
(20-50 million)
0.1-0.2%
(1-4 million)
0.2-0.4%
(1-4 million)
<0.025%
(WHO estimates
awaited)
Age Groups
most affected
Sub type
Young adults
H1N1
Children
H2N2
All age groups
H3N2
Children 5-14
young adults
and pregnant
women
H1N1
The National Risk Register of Civil Emergencies (2015 edition) highlights pandemic
influenza as one of the highest risks:
An influenza pandemic can occur either in one or in a series of ‘waves’, weeks to
months apart. To inform preparedness planning, a temporal profile based on the
pandemics that occurred in the last century and current models of disease
transmission has been constructed.
The profile is intended to show the fastest national progression of a pandemic from
the time it becomes the dominant respiratory disease. More locally, epidemics might
be over more quickly (6-8 weeks) with a proportionately higher peak. Vaccination or
mass treatment with antiviral medicines (assuming their efficacy is similar to that
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against seasonal influenza) can be expected to modify this profile.
The Model of single pandemic wave profile showing the proportion of new
clinical cases, consultations, hospital admissions or deaths by week in
England
It is possible that infection may sweep quickly through an in-patient facility, similar to
previously recorded occurrences in residential schools and facilities. Infection rates
have been recorded at up to 90%. In the event of a high number of patients being ill,
all new admissions should be ceased. A high percentage of staff may also become ill
during this period and staff from other units or local organisations may be required
over a week to two week period to manage the outbreak.
The World Health Organisation continues to monitor influenza viruses on a global
scale. From 1997, the A/H5N1 virus has caused additional concern as it shares
similar characteristics to the 1918/19 virus and has caused severe illness and death
in previously healthy young adults. The timing, extent and severity of the next
pandemic remains uncertain, as influenza viruses undergo major change at
unpredictable intervals. But the circumstances still exist for a new influenza virus with
pandemic potential to emerge and spread.
New influenza viruses have usually emerged in the Far East and spread along trade
and transportation routes. The most likely place for the next pandemic to emerge is
China or South East Asia. Spread to the UK through the movement of people is likely
to take less than three months. Experience of the dissemination of SARS in 2002
suggests that it may occur more rapidly than this, possibly as little as two to four
weeks. The conditions that allow a new virus to develop and spread continue to exist
and some features of modern society, such as air travel, could accelerate the rate of
spread. Experts therefore agree that there is a high probability of another pandemic
occurring, although timing and impact are impossible to predict.
4.2 Phases of a Pandemic
The World Health Organisation (WHO) has identified six distinct phases in the
progression of an influenza pandemic, from the first emergence of a novel influenza
virus to a global pandemic being declared.
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This six phase global classification is based on the overall international situation, and
is used internationally for alerting purposes. However, following the 2009/10 swine flu
pandemic the revised UK pandemic influenza strategy has moved away from close
alignment with these phases and instead is more flexible and proportionate.
4.2.1 World Health Organisation Pandemic Phases
The World Health Organisation (WHO) phases describe the progress of an influenza
pandemic:
Phase
WHO International Phases
Overarching Public Health Goals
Inter-Pandemic Period
1
No new influenza virus subtypes
2
Animal influenza virus subtype
poses substantial risk
Strengthen influenza pandemic
preparedness at global, regional,
national and sub-national levels
Minimise the risk of transmission to
humans; detect and report such
transmission rapidly if it occurs
Pandemic Alert Period
3
Human infection(s) with a new
subtype, but no (or rare) person-toperson spread to a close contact
Ensure rapid characterisation of the
new virus subtype and early
detection, notification and response
to additional cases
4
Small cluster(s) with limited personto-person transmission but spread is
highly localised, suggesting that the
virus is not well adapted to humans
Contain new virus or delay its
spread to gain time to implement
preparedness measures, including
vaccine development
5
Large cluster(s) but person-toperson spread still localised,
suggesting that the virus is
becoming increasingly better
adapted to humans
Maximise efforts to contain or delay
spread, to possibly avert a pandemic
and to gain time to implement
response measures
Pandemic Period
6
Increased and sustained
transmission in general population
Minimise the impact of the pandemic
Recovery and preparation for
subsequent waves
Post Pandemic Period
Return to Inter-Pandemic Arrangements
Note: the transition between the WHO phases may be rapid and the distinction
blurred
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4.2.2 UK Pandemic Phases
UK planning is based around a five phase model:
Phase
Detect
Focus in this Stage
Intelligence gathering from countries already affected
Enhanced surveillance in this country
The development of diagnostics specific to the new virus
Information and communications to the public and professionals
The indicator for moving to the next stage would be the
identification of the new influenza virus in patients in the UK
This would commence either on the declaration of the current WHO
phase 4 or earlier on the basis of reliable intelligence or if an influenzarelated Public Health Emergency of International Concern (PHEIC) is
declared by WHO
The collection of detailed clinical and epidemiological information
on early cases on which to base early estimates of impact and
severity in the UK
Reducing the spread of the virus within the local community by:
actively finding cases, self -isolation of cases and suspected
Evaluate
cases, treatment of cases/suspected cases and use of antiviral
prophylaxis for close/vulnerable contacts, based on risk
assessment of the possible impact of the disease.
The indicator for moving from this stage would be evidence of
sustained community transmission of the virus, i.e. cases not
linked to any known or previously identified cases
The above two stages together form the initial response. This may be relatively short
and the phases may be combined depending on the speed with which the virus
spreads, or the severity with which individuals and communities are affected. It will
not be possible to halt the spread of a new pandemic influenza virus and it would be
a waste of public health resources and capacity to attempt to do so
Treatment of cases
Enhancement of the health response to deal with increasing
numbers of cases
Consider enhancing public health measures to limit transmission
of the virus as appropriate, such as localised school closures
based on public health risk assessment
The
indicator to move to the next stage would be when demands
Treat
for services start to exceed the available capacity. This decision is
likely to be made at a regional or local level as not all parts of the
UK will be affected at the same time or to the same degree of
intensity
Arrangements will be activated to ensure that necessary detailed
surveillance activity continues in relation to samples of community cases,
hospitalised cases and deaths
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Phase
Escalate
Recover
Focus in this Stage
Escalation of surge management arrangements in health and
other sectors
Prioritisation and triage of service delivery
Resiliency measure
This stage would not necessarily be activated in a mild to moderate
pandemic such as that experienced in 2009
Normalisation of services
Restoration of business as usual services
Evaluation
Planning and preparation for a resurgence of activity
Targeted vaccination when available
The indicator for this phase would be when influenza activity is either
significantly reduced compared to the peak or when the activity is
considered to be within acceptable parameters. An overview of how
service capacities are able to meet demand will also inform this
decision
4.3 Incubation
The incubation period will be in the range of one to four days (typically 2-3). Flu
viruses enter the body via the respiratory airways and multiply in the cells lining the
nose, throat and upper respiratory airways affecting mainly the respiratory system.
People are most infectious soon after they develop symptoms; adults are infectious
for up to a day before the symptoms appear and up to five days from the onset of
symptoms. Longer periods have been found, particularly in those who are immunosupressed. Children may be infectious for up to seven days. Some people can be
infected, develop immunity and have minimal or no symptoms but still able to pass
on the virus. Most people will return to normal activity within 7-10 days.
4.4 Symptoms
Influenza is a respiratory illness characterised by sudden onset of:
Fever ≥ 38°c – high temperature, sweating and chills/shivering
Headache
Extreme physical weakness and fatigue
Aching muscles and joints
Dry cough
Sore throat
Runny or stuffy nose
Diarrhoea and vomiting
There is a wide spectrum of illness, ranging from minor symptoms through to
pneumonia and death.
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4.4.1 Predicted Complications Caused by Influenza
Bronchitis
Pulmonary
Bacterial pneumonia (most common)
Combined viral/bacterial pneumonia
Pure viral pneumonitis
Atrial fibrillation
Cardiac
Heart failure
Myocarditis
Pericarditis
Musculoskeletal
Myositis
Rhabdomylysis
Encephalitis
Central Nervous System
Transverse myelitis
Guillain-Barré Syndrome
Other
Reye’s Syndrome
These illnesses may require treatment in hospital and may be life threatening
especially in the elderly, asthmatics, those in poor health and pregnant women.
During a pandemic influenza they can cause serious illness in young healthy
individuals including cyanosis where no clinical intervention may assist the patient’s
poor prognosis.
4.4.2 Clinical Risk Groups who Should Receive Influenza Immunisation
Clinical risk groups who should receive the influenza immunisation taken from the
Green Book: Influenza Chapter 2015:
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*The list above is not exhaustive and the medical practitioner should apply clinical
judgement
In addition to the above, immunisation should be provided to healthcare and social
care workers in direct contact with patients/clients to protect them and to reduce the
transmission of influenza within health and social care premises. It should also be
provided to those who are in receipt of a carer’s allowance, or those who are the
main carer of an elderly or disabled person whose welfare may be at risk if the carer
falls ill.
4.5 Transmission of Infection
4.5.1 Droplet Transmission
Droplets greater than 5 microns in size may be generated from the respiratory tract
during coughing, sneezing or talking. If droplets from an infected person come into
contact with the mucous membranes (mouth or nose) or surface of the eye of a
recipient, they can cause infection. These droplets remain in the air for a short period
and travel about one metre, so closeness is required for transmission.
4.5.2 Direct Contact Transmission
Infectious agents are passed directly from an infected person (for example after
coughing into their hands) to a recipient who then transfers the organism into their
mouth, nose or eyes.
4.5.3 Indirect Contact Transmission
This takes place when a recipient has contact with a contaminated object, such as
bedding, furniture or equipment which is usually in the environment of an infected
person. Again, the recipient transfers the organisms from the object to their mouth,
nose or eyes.
4.5.4 The Airborne Route During and After Aerosol Generating Procedures
(AGPs)
AGPs can produce droplets <5 microns in size. These small droplets can remain in
the air, travel more than one metre from the source and still be infectious, either by
mucous membrane contact or inhalation.
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It is well established that influenza is transmitted from person-to-person through
close contact and is easily passed on by breathing in the tiny droplets from the breath
of infected people which are produced when they talk, cough or sneeze.
Transmission almost certainly occurs through multiple routes, including droplets and
direct and indirect contact. Influenza is highly contagious it may also be spread by
hand-to-face contact after a person or surface contaminated with infectious droplets
has been touched. Influenza spreads rapidly especially in closed communities e.g.
hospitals, residential care homes, secure units etc.
The virus can survive outside the body for some time:
Hard surfaces-24 to 48 hours
Cloths- 8 to12 hours
Hands- 5 minutes
Hygiene and environmental cleaning is therefore important in helping to control the
spread through contact.
4.5.5 Reducing the Risk of Transmission
The following section is adapted from the Department of Health publication Pandemic
(H1N1) 2009 Influenza: A summary of guidance for infection control in healthcare
settings.
Limiting transmission of pandemic influenza in a healthcare setting requires a range
of measures.
Administrative controls:
Timely recognition of influenza cases
Maintaining separation in space and/or time between influenza and noninfluenza patients
Occupational health arrangements, including immunisation of frontline
healthcare workers
Educating staff, patients, carers and visitors about infection control for influenza
including the importance of good respiratory hygiene
Consistently and correctly implementing standard and droplet infection control
precautions to limit transmission
Restricting access of ill visitors to the building
Instructing staff members with symptoms to stay at home and not come into
work
Planning and implementation of strategies for surge capacity
Environmental/engineering controls:
Environmental cleaning
Adequate ventilation
Waste disposal
Use of PPE and hand hygiene:
Using PPE appropriately according to the risk of exposure to the virus
Consistent and correct hand hygiene
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4.6 Infection Control
In the event of a Pandemic the Infection Control principles below apply to all Trust
staff caring for patients in in-patient settings and those working in the community
having direct contact in the patient’s own home.
4.6.1 Standard Infection Control Precautions
Standard infection control precautions (also known as standard infection control
principles) and droplet precautions must be used for patients with suspected or
confirmed pandemic influenza. Standard infection control precautions:
Are a set of broad statements of good practice to minimise exposure to and
transmission of a wide variety of micro-organisms
Should be applied by all healthcare practitioners to the care of all patients all of
the time
Protect against contact transmission of influenza as they include the use of
hand hygiene, gloves and aprons to protect from respiratory secretions and
other bodily secretions and excretions
Standard infection control precautions include:
Hand Hygiene
Correct use of Personal Protective Equipment (PPE)
Occupational exposure management including Sharps
Management of care equipment
Safe care of linen including uniforms
Control of environment
Safe use and disposal of waste and sharps
(See Infection Prevention and Control Assurance Policy for further details)
4.6.1.1 Hand Hygiene
Good hand hygiene is essential to reduce the transmission of infection in healthcare
settings and is a critical element of standard infection control precautions.
Hands must be cleaned immediately before every episode of direct care of or
contact with patients and after any activity or contact that potentially results in
hands becoming contaminated, including the removal of protective clothing
(including gloves), cleaning of equipment and handling of waste
Hands should be cleaned between caring for different patients and between
different care activities for the same patient, even if gloves have been worn
Hand hygiene includes hand washing with soap and water and thorough drying,
and the use of alcohol-based products (e.g. alcohol hand rub) that do not
require the use of water
If hands are visibly soiled or contaminated, then they should be washed with
soap and water and dried; if not visibly soiled, an alcohol hand rub can be used
Hand washing and use of alcohol hand rub to clean hands must be carried out
thoroughly and for a time period sufficient to inactivate the virus, i.e. 40 to 60
seconds for hand washing (including thorough drying); 20 to 30 seconds when
using alcohol hand rub
Touching the face with gloved hands or hands that have not been recently
cleaned should be avoided
All staff, patients and visitors should clean their hands when entering and
leaving areas where care is delivered
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4.6.1.2 Respiratory Hygiene – ‘Catch it, bin it, kill it’
Patients, staff and visitors should be encouraged to minimise potential influenza
transmission through good respiratory hygiene measures:
Hands should be kept away from the eyes, mouth and nose
Disposable, single-use tissues should be used to cover the nose and mouth
when sneezing, coughing or wiping and blowing noses. Used tissues should be
disposed of promptly in the nearest waste bin
Tissues, waste bins (preferably lined and foot operated) and hand hygiene
facilities should be available for patients, visitors and staff
Hands should be cleaned (using soap and water if possible, otherwise using
alcohol hand rub) after coughing, sneezing, using tissues or after any contact
with respiratory secretions and contaminated objects
Some patients (e.g. older people and children) may need assistance with
containment of respiratory secretions; those who are immobile will need a
container (e.g. a plastic bag) readily at hand for immediate disposal of tissues
In common waiting areas or during transport, symptomatic patients may wear
surgical masks to minimise the dispersal of respiratory secretions and reduce
environmental contamination.
4.6.1.3 Applying Droplet Precautions for Pandemic Influenza
In addition to standard infection control precautions, droplet precautions should be
used for a patient known or suspected to be infected with influenza. Droplet
precautions should be continued until the resolution of fever and respiratory
symptoms.
4.6.1.3.1 Patient Placement
Patients with suspected or confirmed influenza should be placed in single rooms.
When this is not possible, patients should be cohorted (grouped together with other
patients who have influenza or the symptoms of influenza and no other infection) in a
segregated area. A distance of at least one metre should be maintained between
patients’ beds; in communal areas where there are no beds, patients should be kept
at least one metre apart. Special environmental controls, such as negative pressure
rooms, are not necessary to prevent the transmission of influenza either by
respiratory droplets or aerosols. Patient’s cared for in their own homes should be
advised to isolate themselves while symptomatic as far as is possible to reduce the
risk of transmission to other family members.
4.6.1.3.2 Fluid Repellent Surgical Masks
Fluid repellent surgical masks must be worn when working in close contact (within
approximately one metre) of a patient with symptoms. In an area where influenza
patients have been cohorted together, it may be more practical for staff to wear a
surgical mask at all times, rather than only when in close proximity to or close contact
with a patient.
4.6.1.3.3 Patient Transport
The movement and transport of patients from their rooms or the cohorted area
should be limited to essential purposes only
Staff at the destination must be informed that the patient has or is suspected to
have influenza
If transport or movement is necessary, consider offering the patient a surgical
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mask to be worn during transport until the patient returns to the segregated
area, to minimise the dispersal of respiratory droplets. As an alternative, good
respiratory hygiene should be encouraged – ‘Catch it, bin it, kill it’
Hand hygiene is important for staff involved in transfers, and hand hygiene
facilities should be offered to patients when feasible
4.6.1.4 Aerosol-Generating Procedures
It has been suggested that aerosols generated by medical procedures are one route
for the transmission of the influenza virus. However, the evidence necessary to
establish which aerosol-generating procedures are associated with transmission of
influenza or other pathogens is poorly established, with studies being of variable
quality and rigour. A WHO review of such studies found that it was not possible to
draw recommendations from some of the conclusions due to flaws identified within
the methodology.
From the available literature and incorporating UK expert opinion, the following
procedures are considered likely to generate aerosols capable of transmitting
influenza when undertaken on patients with influenza, i.e. are considered to be
potentially infectious aerosol-generating procedures:
Intubation, extubation and related procedures, e.g. manual ventilation and
open suctioning
Cardiopulmonary resuscitation
Bronchoscopy
Surgery and post-mortem procedures in which high-speed devices are used
Dental procedures
Non-invasive ventilation (NIV), e.g. Bilevel Positive Airway Pressure ventilation
(BiPAP) and Continuous Positive Airway Pressure ventilation (CPAP)
High-frequency oscillating ventilation (HFOV)
Induction of sputum
For patients with suspected or confirmed influenza, any of these potentially infectious
aerosol-generating procedures should only be carried out when essential. Where
possible, these procedures should be carried out in well-ventilated single rooms with
the doors shut. Only those healthcare workers who are needed to undertake the
procedure should be present. A gown, gloves, eye protection and an FFP3 respirator
should be worn by those undertaking these procedures and by those in the same
room. In post-mortem examinations where high-speed devices are used, the use of a
powered respirator can be considered as an alternative to a FFP3 respirator.
The rate of clearance of aerosols in an enclosed space is dependent on the extent of
any ventilation – the greater the number of air changes per hour (ventilation rate), the
sooner any aerosol will be cleared. The time required for clearance of the aerosol,
and thus the time after which the room can be entered without a respirator, can be
determined following a risk assessment. The risk assessment should take into
account the characteristics of the room –such as whether it is a room in a theatre
suite or a ward side room – and, if known, the number of air changes per hour as
outlined in WHO guidance. Where feasible, environmental cleaning should be
performed when it is considered appropriate to enter without a respirator.
Visitors to patients ventilated with NIV or HFOV may be exposed to potentially
infectious aerosols. The number of such visitors should be limited where possible.
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Visitors should be made aware of the risks and be offered PPE as recommended for
staff.
Certain other procedures/equipment may generate an aerosol from material other
than patient secretions but are not considered to represent a significant infectious
risk. Procedures in this category include:
Administration of pressurised humidified oxygen
Administration of medication via nebulisation
During nebulisation, the aerosol derives from a non-patient source (the fluid in the
nebuliser chamber) and does not carry patient-derived viral particles. If a particle in
the aerosol coalesces with a contaminated mucous membrane, it will cease to be
airborne and therefore will not be part of the aerosol.
For such procedures, gloves, an apron and a surgical mask (plus eye protection if
there is a risk of splashes to the eyes) are recommended as per standard infection
control and droplet precautions.
4.6.1.5 Personal Protective Equipment (PPE)
PPE is worn to protect staff from contamination with body fluids and to reduce the
risk of transmission of influenza between patients and staff and from one patient to
another. Appropriate PPE for care of patients with pandemic influenza is summarised
in the table below. Standard infection control precautions apply at all times. PPE
should comply with the relevant BS EN standards (European technical standards as
adopted in the UK) where these apply.
4.6.1.5.1 Personal Protective Equipment for Care of Patients with Pandemic
Influenza
Entry to cohorted
area but no
patient contact
Close patient
contact
(within one metre)
Aerosolgenerating
procedures
Hand Hygiene
✓
✓
✓
Gloves
✘
✓
✓
Plastic Apron
✘
✓
✘
Gown
✘
✘
✓
Surgical Mask
✓
✓
✘
FFP3 Respirator
✘
✘
✓
Eye Protection
✘
Risk Assessment
✓
4.6.1.5.2 Eye protection
As part of standard precautions, eye protection should be used when there is a
risk of contamination of the eyes from splashing, e.g. by secretions (including
respiratory secretions), blood, body fluids or excretions
An individual risk assessment should be carried out at the time of providing care
Disposable, single-use eye protection is recommended
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Eye protection should always be worn by all those present in the room during
potentially infectious aerosol-generating procedures
4.6.1.5.3 Surgical masks
Surgical masks are worn to protect the wearer from the transmission of influenza by
respiratory droplets. A recent trial suggests that masks and respirators offer a similar
level of protection to each other against infection with influenza to healthcare workers
during routine patient care (this does not apply to infectious aerosol-generating
procedures).
-
Surgical masks should be fluid repellent and should be worn by healthcare
workers for any close contact with patients with influenza symptoms (i.e. within
approximately one metre). The mask will provide a physical barrier and
minimise contamination of the nose and mouth by droplets
When pandemic influenza patients are cohorted in one area and several
patients must be visited over a short time or in rapid sequence, it may be more
practical for staff to put on a surgical mask on entry to the area and to keep it on
for the duration of the activity or until the surgical mask requires replacement
(i.e. when it becomes wet or damaged)
In outpatient settings it may be more practical for staff working in the
segregated area for influenza patients to put on a surgical mask on entry to the
area and to keep it on for the duration of the activity or until the surgical mask
requires replacement
Surgical masks should:
cover both nose and mouth
not be allowed to dangle around the neck after or between each use
not be touched once put on
be changed when they become moist or damaged
be worn once and then discarded as clinical waste – hand hygiene must be
performed after disposal
4.6.1.5.4 Respirators
A disposable respirator providing the highest possible protection factor available
(i.e. an EN149:2001 FFP3 disposable respirator) should be worn by healthcare
workers when performing procedures that have the potential to generate infectious
aerosols .FFP3 support training materials are available on the DH website
(www.dh.gov.uk).
Fitting the respirator correctly is critically important for it to provide proper protection.
Every user should be fit tested and trained in the use of the respirator. In addition to
the initial fit test carried out by a trained fitter, a fit check should be carried out each
time a respirator is worn.
A good fit can only be achieved if the area where the respirator seals against the skin
is clean shaven. Beards, long moustaches and stubble may cause leaks around the
respirator. Other types of respiratory protective equipment (e.g. powered hoods and
helmets) are available and should be considered if a good fit cannot be achieved with
disposable respirators. A powered respirator might be the only type suitable for some
healthcare workers, for example someone who, perhaps for cultural reasons, prefers
not to remove their beard.
Disposable respirators should be replaced after each use and changed if breathing
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becomes difficult, the respirator is damaged or distorted, the respirator becomes
obviously contaminated by respiratory secretions or other body fluids, or if a proper
face fit cannot be maintained. Respirators should be disposed of as clinical (also
known as infectious) waste.
4.6.1.5.5 Putting on PPE
PPE should be put on before entering a side room or cohorted area. If full PPE is
required, for example for a potentially infectious aerosol-generating procedure, all
staff in the room or entering within one hour of the procedure should wear the
following PPE put on in the following order:
1.
Gown (or apron if not a potentially infectious aerosol-generating procedure)
2.
FFP3 respirator (or surgical mask if not a potentially infectious aerosolgenerating procedure)
3.
Eye protection, i.e. goggles or face shield (for a potentially infectious aerosolgenerating procedure and as appropriate after risk assessment)
4.
Disposable gloves
This order is practical but the order for putting on is less critical than the order of
removal given below.
4.6.1.5.6 Removal of PPE
PPE should be removed in an order that minimises the potential for crosscontamination. Before leaving the side room or cohorted area, gloves, gown and eye
protection should be removed (in that order, where worn) and disposed of as clinical
(also known as infectious) waste. After leaving the area, the respirator (or surgical
mask) can be removed and disposed of as clinical waste. (See Appendix 2)
Gloves:
Grasp the outside of the glove with the opposite gloved hand; peel off
Hold the removed glove in gloved hand
Slide the fingers of the un-gloved hand under the remaining glove at the wrist
Peel the second glove off over the first glove and discard appropriately
Gown or apron:
Unfasten or break ties
Pull gown or apron away from the neck and shoulders, touching the inside of
the gown only
Turn the gown or apron inside out, fold or roll into a bundle and discard
Eye protection:
To remove, handle by headband or earpieces and discard appropriately.
Respirator or surgical mask:
Untie or break bottom ties, followed by top ties or elastic, and remove by
handling ties only and discard appropriately
To minimise cross-contamination, the order outlined above should be applied even if
not all items of PPE have been used.
Clean hands thoroughly immediately after removing all PPE.
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4.6.1.6 Visitors
During a pandemic visitors to all areas should be kept to a minimum
Visitors with influenza symptoms should not enter the clinical area and should
be encouraged to return home
All visitors entering an affected clinical area must be instructed on hand hygiene
practice and the wearing of PPE as appropriate
4.6.1.7 Environmental Cleaning
Freshly prepared detergent and warm water should be used for cleaning in
clinical areas. Influenza viruses are removed by detergent, so it is not
necessary to enhance cleaning with chlorine-based disinfectants
Areas used for cohorted patients should be cleaned at least daily
Clinical rooms should be cleaned at least daily and after clinical sessions for
patients with influenza
Frequently touched surfaces such as medical equipment and door handles
should be cleaned at least twice daily and when known to be contaminated with
secretions, excretions or body fluids
Domestic staff should be allocated to specific areas and not moved between
influenza and non-influenza areas
Domestic staff should be trained in which PPE to use and the correct methods
of wearing and removing PPE. In addition to gloves and an apron, a surgical
mask should be worn for cleaning in cohorted areas
4.6.1.7.1 Linen
Treat Linen as used infected; bag linen as per Trust policy for handling used
infective linen safely
Both ‘used’ and ‘infected’ linen must be handled, transported and processed in
a manner that prevents exposures to skin and mucous membranes of staff,
contamination of their clothing and the environment, and infection of other
patients. Gloves and an apron should be worn when handling used linen. Hands
should be cleaned after removing PPE
4.7 Preparing to Respond
The Trust’s Emergency Planning Officer with the co-operation and advice from the
Infection Prevention and Control Team will advise the Trust Board when it is
necessary to activate the Pandemic Influenza Plan and the Major Incident and
Business Continuity Plan in order to ensure the Trust is prepared to respond to the
potential pandemic. During this phase the Trust will ensure its Business Continuity
plans are reviewed and updated and the Pandemic Influenza Planning Group is
mobilised.
In the absence of early or effective intervention there could be widespread social and
economic disruption including:
Threats to the continuity of essential services (including fuel)
Lower production levels of essential goods (including pharmaceuticals)
Travel disruptions causing shortages and distribution difficulties of essential
supplies
All of the above can be mitigated or the effects minimised with good business
continuity management practices.
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Since the potential impact of a pandemic is determined by many factors leading to
uncertainties surrounding the potential severity of any future pandemic, the UK has
the following preparedness arrangements:
UK wide stockpiles and distribution arrangements of antiviral medicines and
antibiotics sufficient for a widespread severe pandemic
Health service preparation for up to 30% of symptomatic patients requiring
assessment and treatment in usual primary care pathways through surge
planning
Health service preparation for between 1 and 4% of symptomatic patients
requiring hospital care through surge planning
Multi-agency planning to cope locally with up to 200,000 additional deaths
across the UK over a 15 week period through excess death planning (this is a
precautionary measure as less widespread and lower impact pandemic the
deaths would be lower)
4.7.1 Staff Absence
The difficulties in maintaining essential services detailed above could be exacerbated
within the Trust further by high levels of staff absence with over 50% of all staff
possibly requiring time off at some stage over the pandemic period through:
Sickness or fear of infection
Care providing responsibilities (especially if schools are closed)
Stress
Bereavement (or other psychological impacts)
Transport disruptions
It is likely that staff absences will be higher and more pronounced in the Trust’s
smaller teams where staff work in close proximity.
4.7.2 Workforce Management
Staff will follow the business continuity procedures in a pandemic with low and
moderate impacts. However in a high impact event the Trust is likely to activate its
major incidents procedures and activate this policy.
4.7.3 Pandemic Influenza Planning Group
Pandemic influenza planning group should meet routinely 2-3 times per year in order
to review this policy and undertake exercises to test the Trusts emergency response.
The group will develop an action list to progress the planning process, this includes
roles and responsibilities for areas including all clinical services, antiviral distribution,
staff welfare and infection control. In developing this plan, the group will consult
widely with subcontracted services and neighbouring organisations on specific
issues.
In the event of a Pandemic the group will meet at least once each day to review
developing and predicted contingencies and to ensure plans are in place to respond
to them.
The following roles make up the core group:
Pandemic Influenza Lead (responsible person TBC)
Emergency Planning Officer
Chief Operating Officer
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Infection Prevention and Control Team
Medical Director
Director of Resources (includes Communications and IT)
Chief Pharmacist
Director of Workforce and Learning
Staff-side / Union representative
Communications Lead
Service Directors for those parts of the organisation affected
Estates and Facilities
Terms of reference of this group are to:
Provide leadership and co-ordination in planning and dealing with the potential
implications of an Influenza pandemic (or similar highly infectious disease)
Monitor identified actions and report progress at each meeting
Co-ordinate the work of subgroups
Discuss and agree the decision making process for the deployment of local
resources, including restricting, withdrawal and cancellation of services
Identify and develop strategies for the maintenance of essential services
Interpret and implement local, national and international guidance on potential
pandemics
Develop communication material for service users in line with national guidance
and local responding organisations
Develop business continuity strategies and co-ordinate post-pandemic return to
normality
Prepare reports on progress or planning issues
Work with the Infection Prevention and Control Team to effectively manage
influenza outbreaks
Co-ordinate bed management including ward/departmental closures
Review effectiveness of this policy in light of lessons learnt from exercises or
incidents.
Utilize the Action Cards in Appendix 3
Maintain the incident record log
4.8 Declaring a Pandemic and Action Required
WHO will announce the phases when they are confirmed, indicating the level of
preparedness expected. National authorities are expected to activate their
contingency plans immediately following announcement of WHO Phase 5 (see 4.2.1)
The Secretary of State will inform all health and social care organisations of any
change to the World Health Organisation pandemic alert phases, or UK alert levels,
via the Chief Medical Officers link with Public Health England. Directors of Public
Health within the local authority will ensure a co-ordinated approach from all
organisations involved in the response. In addition the national communication
strategy will ensure information is cascaded in a timely manner.
At this point the Trusts Business Continuity Management Policy will be used in
addition to the local group plans to ensure the pandemic influenza response is coordinated in a timely manner.
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4.8.1 Trust Actions Required During the Phases of the Pandemic
Named
Indicator
Actions / Focus for the Trust
Phase
Initiate the Pandemic Influenza
Planning Group (book rooms etc.)
Initiate urgent review of Trust
current response plans, business
continuity arrangements and surge
arrangements and any findings
from the Local Resilience Forum
Review current response strategies
in respect of any past experiences
Accelerate, consolidate and test all
Trust wide and local pandemic
preparedness efforts
Locally, this phase would
Ensure subcontractors and
start if the World Health
commissioned services have
Organisation phase 4 was
adequate response plans in place
declared or if there was
Increase awareness of the signs,
reliable intelligence or if an
symptoms and epidemiology of
influenza-related ‘Public
pandemic influenza as well as
Health Emergency of
infection control measures,
Detection
International Concern’ was
including posters, intranet and
declared by the WHO
newsletters - training
Review use of infection control
If there was identification
procedures and use of personal
of the novel influenza virus
protective equipment within
in patients in the UK then
services
this would be an indicator
Check stock availability of PPE,
to move to the next stage
antiviral medication, antibiotics etc.
and introduce stringent stock
control measures
Implement record keeping and
surveillance measures for
suspected or confirmed cases of
Pandemic influenza to the Public
Health services
Trust representation at relevant
local committees as part of the joint
management approach
Continue business as normal
Summary of key National healthcare response
Public Health England response supported by primary care
Detection and diagnosis of early cases through testing and contact tracing
Influenza information line may be activated
Local areas to start initial preparations for activation of Antiviral Collection
Points (ACPs)
Preparations to use the National Pandemic Flu Service (NPFS) when required
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Named
Phase
Indicator
Progression on to the next
stage would occur if there
was evidence that cases
were not linked to any
known/ previously
identified cases
Assessment
Actions / Focus for the Trust
Ensure continued Trust
representation at relevant local
committees as part of the joint
management approach
Set up the Situation Reports
(SITREP) see Appendix 1.1 and
1.2 to enhance surveillance and
data collection to reflect Public
Health Services data requests
Review staff sickness levels and
implement Business Continuity
measures if required,
communicating and changes to
services to staff and patients
Increase Infection Prevention and
Control Procedures and distribute
personal protective equipment as
required
Liaise with Public Health teams
locally regarding additional service
requirements e.g. antiviral collection
points, vaccination requirements
etc.
Liaise with local acute trusts
regarding any changes to
admission/discharge criteria
Ensure subcontractors and
commissioned services are putting
their response plans in place (if
required)
Implement any Pandemic Influenza
training as required (i.e. use of
FFP3 mask fitting, basic medical
care and infection control
precautions)
Review staff skills including
volunteers and recently retired staff
lists and their training requirements
Continue business as usual
Summary of key National healthcare response
Influenza information line function activated
ACPs established in hotspots only
Use of existing legislation to allow the supply of antiviral medicines at
premises that are not a registered pharmacy
Detection and assessment collectively form the initial response. The length of this
phrase will depend on the severity and speed by which the virus spreads. These two
initial stages may be combined
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Named
Phase
Indicator
Actions / Focus for the Trust
Work in conjunction with the CCG to
agree establishment of any
additional services i.e. anti-viral
distribution points or vaccination
centres
Complete pre-pandemic or seasonal
flu vaccination of staff if available
and advised by Public Health
Review SITREP reports including
number of infected patients and
staff – implement workforce
management measures as needed
Monitor the provision of services
and implement Business Continuity
During a pandemic, the
measures if trigger points are
need for services may
reached, communicating any
exceed the service’s
changes to service delivery to
available capacity. At
patients and staff
this point a decision
Treatment
Review current cases and advise
would most likely be
changes to admission criteria if
made locally or
necessary (taking into account the
nationally to decide what
impact on vulnerable service users)
additional measures are
Review use of infection control
required
procedures and personal protective
equipment within services and stock
control provisions against current
guidance, implementing any
changes and ordering additional
stock if required
Review use of PPE and masks
Set up a staff welfare team and
agree any measures which may be
introduced to assist staff i.e.
provision of transport
Review Trust plans in light of
current information and public
reaction
Summary of key National healthcare response
Influenza information line function active
NPFS activated as required
Local areas establish ACPs as required
Contingency plans for supporting care at home and respite care
On-going monitoring of the nature and scale of illness locally and nationally and
its effect on healthcare delivery
These two stages together form the treatment phase. In mild pandemics it may not
be necessary to activate the escalation stage but it would be preferential to start
preparing at the start of the Treatment phase
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Named Phase
Escalate
Indicator
The start of this
phase would be
indicated when
influenza activity has
dramatically
increased with
widespread disease
in the UK with most
age groups affected
and/or severe
debilitating illness
with or without
severe or frequent
complications
Actions / Focus
Continue with or start to moderate
actions
Activate major incident command and
control procedures if trigger point is met
Regularly report situation to the
Pandemic Influenza Planning Group
Establish daily briefing bulletin including
number of cases and mortality rate
Review data collection and surveillance
requirements during peak period
Review staff absence rates and ability to
resource essential services
Review staff welfare arrangements and
enable well staff to work
Review implications of change in duties
for redeployed staff
Review use of personal protective
equipment (if available) and stock control
provisions (record level of use during
peak weeks for use during next wave)
Review antiviral medication stocks and
availability for re-ordering
Communicate latest medical and selfcare information for staff and patients
Agree admission and discharge
protocols for local hospitals during peak
weeks
Determine level of care to be provided in
the community for service users in
relation to staffing and resource
availability
Implement alternative mortality
arrangements (if necessary)
Ensure regular communication updates
are issued and Trust messages are
being added to local communication
bulletins
Implement any reduced service policies
agreed with subcontractors
Review policy on visitors to in-patient
facilities during peak of pandemic
Assess availability of medicines and
essential resources
Ensure deputies are appointed to all key
roles in case of illness or absence
Summary of key National healthcare response (escalate phase)
Emphasis on maintaining supplies and staffing
Possible implementation of national legislative changes to facilitate changes in
working practice (e.g. death certification, drivers hours, sickness selfcertification requirements, Mental Health Act, benefits payments)
On-going monitoring of the nature and scale of illness locally and nationally and
its effect on healthcare delivery
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Named Phase
Recovery
Indicator
The start of this phase
would be indicated when
influenza activity has
dramatically reduced in
comparison to the peak or
when activity is within
acceptable parameters
Recovery
(continued)
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Actions / Focus
Continue with or start to
moderate actions
Reduce the frequency of briefing
bulletins as appropriate
Review availability of services
and implement recovery
strategy, recovering services
back to how they were before or
developing a new outlook of
what is normal for a service
Return to business as usual with
the aim of catching up on
activity which was scaled down
due to the pandemic. For
example re-scheduling
cancelled appointments
Address issues relating to staff
fatigue, review absence levels,
and allocate additional or
compassionate leave where
appropriate
Reduce rotas and duties (where
necessary) for seconded /
volunteer staff
Review surveillance and data
collection methods
Review availability of
subcontracted services and
suppliers
Ensure PPE (if available) is
used to minimise the risk of
infection (virus will still be
circulating although number of
cases reducing)
Review antiviral medication use
and stock availability
Review effectiveness of local
communication methods and
information for patients and staff
Review admission protocols for
local hospitals and
reintroduction of services
Agree stand down of control
team
Review level of care provided in
the community and transfer
individuals to appropriate inpatient care as required (where
available)
Assess case loads and redeploy
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Pandemic Influenza Policy
staff and resources where
necessary to relieve short term
pressures
Ensure regular communication
updates are issued regarding
changes to services, postpandemic vaccination availability
etc.
Review mortality arrangements
Conducting a review post
pandemic of what went well, what
could have gone better and any
lessons learnt
Prepare a debrief report for the
Trust Board
Prepare for the influenza virus
remerging
Prepare post pandemic
vaccination strategy and allocate
resources
Prepare for post pandemic
seasonal influenza
Summary of key National healthcare response
Emphasis on maintaining supplies and staffing
Provision of psychological counselling for both staff and public will be required
Preparation for 2nd and future waves
4.8.2 Business Continuity Management
For guidance on business continuity management please refer to the detailed plans
described in the Business Continuity Management Policy. Business Continuity
Management (BCM) is a process that helps manage risks to the smooth running of
our organisation or delivery of our services, ensuring continuity of critical functions in
the event of a disruption, and effective recovery afterwards.
Business Continuity Management (BCM) is facilitated through the production of
Business Continuity Plans (BCPs) which, as well describing the steps that need
to be followed to maintain or recover the delivery of services, will also cover
incident management such as the initial impact of an event e.g. evacuation of
patients and staff, media response, etc.
Each major site of the Black Country Partnership NHS Foundation Trust should
have a Business Continuity Plan (BCP) that is specific to that site/service. The
major site plan may well be made up of individual unit/service plans dependant
on the sites requirements
Unit/service BCPs will be available from the service manager in each building
whereas the overall site plan may only be available on the intranet or in a senior
managers office
Business Continuity Plans cover all elements of our services and in addition this
Pandemic Flu Plan contains information specific to BCM during a flu pandemic. The
Civil Contingencies Act requires that all Black Country Partnership NHS Foundation
Trust services:
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Have robust and tested business continuity plans in place which cover
arrangements for dealing with pandemic influenza (see Business Continuity
Management Policy)
Encourage organizations on which they will rely during a pandemic do the same
(i.e., have business continuity plans in place which cover arrangements for
dealing with pandemic influenza)
Guidance for business continuity planning (including a pandemic influenza
checklist for businesses) can be found on the UK Resilience website at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/6
1986/060516flubcpchecklist.pdf
Ensure that their business continuity plans have the flexibility to accommodate
the range of predicted staff absences
4.8.3 Situation Reporting
During the pandemic the Trust will be required to collect the following information as
a minimum and this will be reported through the command and control structures:
Staff availability – sickness rates in staff and volunteers
Number and rates of patient admissions and discharges
Case demographics and other underlying disease profiles
Assessment level of admitted patients
Bed capacity and occupancy
General responses to treatment of pandemic influenza cases
Deaths
Status of core facilities and utilities
Financial impact
Each unit/department will be required to provide a situation report identifying the
current situation and measuring the impact of the pandemic against a number of
identified standards. The frequency of reporting will be determined by the Major
Incident Management Group (MIMG). It is anticipated that as a minimum such
reports will need to be produced and submitted on a daily basis to the Emergency
Planning Officer who will collate the figures and send to the identified point for the
MIMG (see Appendix 1.1 and 1.2).
4.8.4 Impact on Workforce
It is estimated that up to 50% of the workforce may require time off at some stage
over the entire period of the pandemic, with individuals likely to be absent for a period
of seven to ten working days. Absenteeism should follow the pandemic profile, with
an expectation that it will build to a peak lasting for two to three weeks, when
between 15% and 20% of staff from the workforce may be absent, and then decline.
However as the rate of infection in in-patient facilities may be higher over a short
period, higher levels of absence must be planned for. Additional staff absences are
likely to result from other illnesses, taking time off to provide care for dependants,
family bereavement, other psychosocial impacts, fear of infection or practical
difficulties in getting to work.
The Government may advise schools and early years/childcare settings to close in
order to reduce the spread of infection amongst children. This advice will be provided
only if closure is anticipated to produce significant health benefits. Closures will be
area specific (whilst the virus is circulating in the locality) and are likely to be for two
to three weeks, although they may be extended if the pandemic remains in the area.
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A further 5–6% of staff could be absent as a result of school closures, though this is
based on an analysis of informal childcare being available for parents.
4.8.5 Workforce Profile
The workforce profile for the Trust (March 2013) is very diverse in terms of ethnicity.
The majority age group is 41-50 which may increase the risk of absence and severe
illness in staff during a pandemic.
The majority of mental health nursing staff will not have any clinical qualification and
will require training in basic health needs, influenza assessment and treatment, for
use during a pandemic. The Trust sub-contracts some of its services including
maintenance and security. Staff absences in support services will have a direct
impact on the Trust’s ability to provide safe working environments for its own staff
during a pandemic.
4.8.6 Staff Welfare Planning
People are the most valuable resource and the most vulnerable during a pandemic.
As part of the planning process, the Human Resources Department will develop
plans to:
Ensure contact details and skills of the available workforce are captured so that
they can be easily contacted in the event of a pandemic
Work with the Group Directors to identify possible risk in service delivery and
find solutions where possible
Identify staff with personal caring responsibilities that may impact upon their
ability to attend work during ‘normal hours’ and develop plans to support them
with alternative work options
Liaise with the Learning and Development team to develop education and
training that builds capacity into the existing workforce through teaching new
skills, updating existing skills. This may allow staff to take on additional duties
as required
Facilitate arrangements for joint working and ‘buddying up’ of community teams
or specialist services to provide cross boundary cover within the Trust
4.9 Recovery Phase
UK will move into recovery phase as the pandemic phase subsides and there is no
threat of further waves occurring in the UK. The phase will follow guidance in the
recovery phase of a major incident as per emergency planning.
The Black Country Partnership NHS Foundation Trust will need to:
Consider available workforce, both clinical and non-clinical
Consider provision of psychological support to staff (this needs to be in
operation during pandemic as well as recovery stages)
Refer staff to the staff support service and bereavement services as required,
the Spiritual Care Team may be able to offer help and support
Ensure that buildings are adequately cleaned sanitised and otherwise made
ready for resumption of normal service
4.10 Financial Arrangements
The financial arrangements for pandemic influenza planning including stockpiling of
PPE, training and development costs will be agreed with the Director of Finance and
reported to the Board through the Associate Chief Operating Officer.
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Funding for the response to a potential pandemic has been agreed at Board level
including provision of PPE stockpiling, antiviral medication and workforce
requirements including volunteer expenses etc. It is envisaged that the CCG’s will
suspend most targets and regulatory requirements once a pandemic has been
declared, however the Trust will need to maintain services under the Mental Health
legislation which may incur costs including the employment of private professional
staff.
4.11 Communication
All official communications within the organisation will be cascaded through formal
senior management structures. The MIMG will oversee the co-ordination and
dissemination of all information released to staff throughout the Trust.
All Service and Team Managers/Leaders are kept fully informed and briefed at all
times. It is the responsibility of all Group Heads and all Service/Team
Managers/Leaders to ensure all their staff receive and have timely access to all
appropriate information.
The communication team will publish articles and information for staff and service
users in all phases of the pandemic phase to maintain staff awareness of the
pandemic threat and the plans developed by the trust.
5.0 Procedures connected to this Policy
There are no procedures connected to this policy.
6.0 Links to Relevant Legislation
Civil Contingencies Act 2004
The Civil Contingencies Act delivers a single framework for civil protection in the UK.
The Act is separated into 2 substantive parts: local arrangements for civil protection
(Part 1); and emergency powers (Part 2).
Part 1 of the Act and supporting Regulations and statutory guidance ‘Emergency
preparedness’ establish a clear set of roles and responsibilities for those involved in
emergency preparation and response at the local level. The Act divides local
responders into 2 categories, imposing a different set of duties on each.
Those in Category 1 are organisations at the core of the response to most
emergencies (the emergency services, local authorities, NHS bodies). Category 1
responders are subject to the full set of civil protection duties. They will be required
to:
Assess the risk of emergencies occurring and use this to inform contingency
planning
Put in place emergency plans
Put in place business continuity management arrangements
Put in place arrangements to make information available to the public about civil
protection matters and maintain arrangements to warn, inform and advise the
public in the event of an emergency
Share information with other local responders to enhance co-ordination
Co-operate with other local responders to enhance co-ordination and efficiency
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Provide advice and assistance to businesses and voluntary organisations about
business continuity management (local authorities only)
Health and Social Care Act 2008
The Health and Social Care Act 2008 sets out the code of practice for the prevention
and control of infections. Good Infection prevention, cleanliness and prudent
antimicrobial is essential to ensure that people who use health and social care
services receive safe and effective care. Effective prevention of infection and
cleanliness must be part of everyday practice and be applied consistently by
everyone.
Good management and organisational processes are crucial to make sure that high
standards of infection prevention and cleanliness are set up and maintained.
As the regulator of health and adult social care in England, the Care Quality
Commission (CQC) will provide assurance that the care people receive, meets the
fundamental standards of quality and safety. This Act outlines what registered
providers in England, should do to ensure compliance with registration
requirement12 (2) (h) –providers must assess the risk of, and prevent, detect and
control the spread of, infections, including those that are health care associated. It
also sets out the10 compliance criteria against which registered providers will be
judged.
6.1 Links to Relevant National Standards
CQC Fundamental Standards- Regulation 12: Safe Care and Treatment
The intention of this regulation is to prevent service users from receiving unsafe care
and treatment, in order to prevent any avoidable harm or risk of harm. To meet the
requirement of this regulation, the provider must take appropriate steps to assure
itself that the care and treatment it delivers is safe for all service users. This includes
assessing the risk of, and preventing, detecting and controlling the spread of,
infections, including those that are health care associated.
Health and Social Care Influenza Pandemic Preparedness and Response (DH
2012)
The document outlines the key areas where public, independent and voluntary sector
health and social care organisations should work together to maintain and improve
integrated operational arrangements for planning and response in order to deliver the
best outcomes possible during an influenza pandemic. It reflects the structures and
roles of the NHS and public health organisations in England during the transition
period.
UK Influenza Pandemic Preparedness Strategy 2011 (DH 2011)
This document describes proposals for a UK-wide strategic approach to planning for
and responding to the demands of an influenza pandemic. It builds on, but
supersedes, the approach set out in the 2007 National framework for responding to
an influenza pandemic, taking account of the experience and lessons learned in the
H1N1 (2009) influenza pandemic and the latest scientific evidence. This strategy is
intended to inform the development of updated operational plans by local
organisations and emergency planners.
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6.2 Links to Trust policy/s
Business Continuity Management Policy
Although the Trust is classed as a ‘category 1’ responder under the Civil
Contingencies Act 2004, this is by definition due to its attainment of Foundation Trust
status. Thus, within major incident planning and response arrangements the Trust is
not expected to play a major role within a traditional ‘major incident’ scenario. The
focus for the Trust should therefore be on developing and embedding appropriate
business continuity arrangements to ensure it can effectively meet the challenges of
incidents that can disrupt the continuity of its critical and essential services under the
NHS England Emergency Preparedness Framework 2013.
The aim of this policy is to provide an effective business continuity framework which
will allow the Trust to meet its regulatory obligations.
Infection, Prevention and Control Assurance Policy
The aim of the policy is to:
Ensure that robust arrangements for the prevention and control of infection are
in place within the Trust
Ensure that infection prevention and control is embedded at all levels of the
organisation ‘from the Board to the Ward’
To provide Standard operating procedures for effective infection prevention and
control
6.3 References
DH (2012).Health and Social Care Influenza Pandemic Preparedness and
Response. London: Crown Copyright
DH (2011). UK Influenza Pandemic Preparedness Strategy. London: Crown
Copyright
Health Protection Agency (2012). Infection Control Precautions to Minimise
Transmission of Respiratory Tract Infections (RTIs) in the Healthcare Setting:
Version 1
DH (2007). Pandemic Influenza, Guidance for Infection Control in Hospitals and
Primary Care Settings. London: Crown Copyright
DH (2011). Pandemic Influenza and the Mental Health Act 1983. London:
Crown Copyright
DH (2008). Pandemic Influenza: Guidance on Preparing Mental Health Services
in England. London: Crown Copyright
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7.0 Roles and Responsibilities for this Policy
Title
Role
Responsibilities
Chief Executive
Accountable
- Overall responsibility for all matters relating to Pandemic Influenza
-
Executive Director of
Nursing, AHPs and
Governance
Executive Lead
-
Responsible for ensuring this policy is updated, that it represents best practice and includes current evidence based
information and national guidance
Ensure that the daily SITREP response is collated and information is shared with other local, regional and national
agencies as required (see Appendix 1, 1.1 and 1.2)
Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and
understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should
ensure that at least two others are familiar with their action cards and so on
Strategic overview and final responsibility for setting the direction for Pandemic Influenza within the Trust
Oversee the pandemic influenza planning process
Ensure they are represented at the Trust’s Business Continuity and Emergency Preparedness Group at Director level by the
Associate Chief Operating Officer
Trust Board
Strategic
-
Quality and Safety
Committee
Monitoring
- Monitor and review performance in connection with this policy and receive exception and progress reports
Quality and Safety
Steering Group
Scrutiny and
Performance
- Scrutinise the implementation of a systematic and consistent approach to Pandemic Influenza and provide exception and
progress reports to the Quality and Safety Committee
Infection Prevention
and Control Committee
Responsible
Major Incident
Management Group
(MIMG)
Co-Ordinate
Response
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Oversee the implementation of a systematic and consistent approach to this policy
Approve all policies and procedures that relate to their subject matter or area of practice
Provide exception and progress reports to the Trust Board
Members of the committee are responsible for ensuring this policy is accurate and up to date
Coordinate the Trusts response to an influenza pandemic
Identify critical services and resources
Arrange meetings of the Influenza Pandemic Planning Group and notify members of date/time and venue for meetings
Meet regularly from the onset of an influenza pandemic to oversee the Trusts preparedness, response and business
continuity arrangements
Make arrangements for taking minutes of meetings, log decisions taken
Arrange internal debrief sessions
Co-ordinate external debrief attendances as required
Produce hand-outs as required
Ensure the Trusts emergency preparedness is regularly reviewed through regular training, testing and exercises
Make arrangements to develop appropriate tests/exercises with the support of the Emergency Planning and Business
Continuity Officer
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Pandemic Influenza Policy
Title
Role
Responsibilities
-
Human Resources
Management and
Redeployment of
Staff
-
Infection Prevention
and Control Team
(IPCT)
Expert advice and
support
Chief Pharmacist/
Pharmacy Team
Expert advice and
Support
Learning and
Development Team
-
Training
-
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Assist with roster management and redeployment of staff with essential skills to maintain core services
Support the segregation of staff so that healthcare staff who are assigned to care for patients with influenza or work in an
area that has been segregated to care for patients with influenza are not assigned to care for non-influenza patients or work
in non-affected areas. For example one Doctor and Senior Nurse and HCSW could be designated to see all the patients
with symptoms of influenza per shift
Prioritise staff who have recovered from influenza or have received a full course of vaccination against the pandemic strain
to care for patients with influenza as they are considered unlikely to develop of transmit influenza
Ensure staff welfare throughout the pandemic is considered and support is provided
Ensure daily SITREP report is maintained (Appendix 1.1 and 1.2)
Escalate the notification of the threat of an emerging Pandemic to the DIPC and EPO in order to initiate the Trusts
preparedness response and activation of this policy
Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and
understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure
that at least two others are familiar with their action cards and so on
Assist with ensuring this policy is updated in line with any new legislation or best practice guidance
Provide expert advice in the planning for and in dealing with an influenza pandemic with the aim to prevent and control
infection particularly within the in-patient service areas
Declare an outbreak and inform the Major Incident Management Group (MIMG) and Chief Executive
Attend MIMG group meetings as required
Head and co-ordinate the epidemiological investigation
Collate infection control surveillance data
Provide infection prevention and control advice to other healthcare professionals in the organisation
Provide resources e.g. patient information leaflets and posters
Brief Lead Nurses and Matrons who will cascade information to clinical services
Provide information leaflets for patients, staff and visitors
Be a member of local health economy pandemic flu planning groups
Provide training on infection prevention and control precautions in relation to pandemic influenza
Advise on use of antiviral medication in line with national guidance
Secure supplies of antiviral, vaccines and antibiotics and ensure distribution to wards and departments as required
Liaise with suppliers to ensure adequate and timely supplies
Prepare information on indications, contraindications and adverse reactions of drugs to be used
Ensure administration of pharmaceutical preparations is undertaken in accordance with group directives
Ensure group directives are updated and approved by the Medicines Management Committee
Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and
understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure
that at least two others are familiar with their action cards and so on
Facilitate training requirements at the earliest opportunity when the possibility of a pandemic is predicted, in liaison with the
Director of Nursing, Medical Director and the Infection Prevention and Control Team to identify the key training
requirements
Ensure infection control and basic physical care skills training is provided
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Pandemic Influenza Policy
Title
Role
Communications Team
Communication
Occupational Health
Provider
Advice
Responsibilities
-
Directors
Implementation
-
Emergency Planning
Officer (EPO)
Operational Lead
-
-
Managers (including
those with on-call)
Operational
-
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Implement the communications strategy, specifically for patients, staff, visitors and contractors
Issue internal media bulletins
Deal with press enquiries and produce media statements based on the advice of the BCEP
Assist with coordination of internal debrief
Meet all the communication requirements detailed in the Major Incident and Business Continuity Plan
Prompt recognition of cases of influenza among healthcare workers is essential to limit the spread of the pandemic
Advise managers on safe return to work of healthcare workers who have been affected
Advise managers if a healthcare worker is at high risk of complications from influenza to ensure vulnerable staff do not
provide direct care to symptomatic patients
Facilitate staff access to antiviral treatment where necessary and implement the vaccination of the healthcare workforce
when required
Attend influenza pandemic planning meetings as required
Ensure they are familiar with this document and the Major Incident and Business Continuity Plan and have alerted staff of
their role in planning for and managing an influenza pandemic
Ensure at least two other appropriate individuals are familiar with their action card (Appendix 4) and understand they may
need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two
others are familiar with their action cards and so on
Responsible for preparing, maintaining, and testing the Trust’s Business Continuity Management Policy including Pandemic
Influenza and associated training
In the event of the major incident plan being implemented the EPO will also be responsible for undertaking a formal review
of the effectiveness of the plan and implementing any need for improvement/amendment identified
Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 4) and
understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure
that at least two others are familiar with their action cards and so on
Keep a list of completed exercises and lessons learned from the exercises
Make the plan available on the Trusts intranet for use by all staff following approval from the CEO
Nominate key personnel to collate the SITREP data (see Appendix 1, 1.1 and 1.2)
Ensure they are familiar with this document and the Major Incident and Business Continuity Plan and have alerted staff of
their role in planning for and managing an influenza pandemic
Ensure at least two other appropriate individuals are familiar with their action card (Appendix 4) and understand they may
need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two
others are familiar with their action cards and so on
Ensure daily SITREP report is maintained for the wards/departments for which they are responsible (Appendix 1 and 1.1)
Ensure that staff attend infection control training as/when required
Ensure an adequate number of staff receive training on administration of vaccines in liaison with Learning and Development
Team
Ensure access to training and ‘Fit-Testing’ for any staff who are required to wear respirator FFP3 face masks in liaison with
the IPCT
Ensure contact details and skills of the available workforce are captured so that they can be easily contacted in the event of
a pandemic
Ensure healthcare workers who are at high risk of complications of influenza (e.g. pregnant women and immunecompromised workers) are considered for alternative work assignments. Away from the direct care of patients, for the
duration of the pandemic or until they have been vaccinated (if it is clinically appropriate)
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Pandemic Influenza Policy
Title
Role
Responsibilities
-
All Employees
Adherence
-
Adhere to the principles detailed within this document
Comply with infection prevention and control procedures detailed within this document to protect themselves and others
from the risks of infection
Report promptly to the Infection Prevention and Control Team all cases (patients or staff) suspected to have the illness
Attend Pandemic Influenza training sessions as requested
Refrain from work if symptomatic with the virus
Assist the Trust as far as possible to maintain essential services as requested by the HR Department
Bank and Agency Staff
Adherence
-
Ensure they do not work across different clinical environments which may increase the risks of transmission
Follow the same deployment advice as permanent staff
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8.0 Training
What aspect(s)
of this policy will
require staff
training?
Specific training
based on
updated national
guidelines which
will be made
widely available
by the DH
Which staff groups
require this
training?
Is this training covered in the
Trust’s Mandatory and Risk
Management Training Needs
Analysis document?
All clinical staff
No
If no, how will the
training be delivered?
Internally
Who will deliver the
training?
Infection Prevention
and Control Team
How often will
staff require
training
Who will ensure and
monitor that staff have
this training?
Only during
planning phase
of any future
pandemics
Learning and Development
Team
9.0 Equality Impact Assessment
Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff
reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact
Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different format e.g. larger print,
Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext. 8067 or email [email protected]
10.0 Data Protection and Freedom of Information
This statement reflects legal requirements incorporated within the Data Protection Act and Freedom of Information Act that apply to staff who work
within the public sector. All staff have a responsibility to ensure that they do not disclose information about the Trust’s activities in respect of service
users in its care to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in
certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business
activities but reserves the right not to disclose information where relevant legislation applies.
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11.0 Monitoring this Policy is working in Practice
As this policy will not be regularly required as influenza pandemics occur infrequently, compliance will be monitored as part of the planning
exercises undertaken and post pandemic de-brief.
What key elements will be
monitored?
(measurable policy objectives)
Business Continuity Plans
Workforce and staffing to
take into account reduced
staffing levels and the need
to redeploy to other areas
Communications with all
staff throughout all phases
of preparation and planning
for pandemic influenza
management
Availability of personal
protective equipment
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Where
described in
policy?
4.7.3 Pandemic
Influenza
Planning Group
4.8.2 Business
Continuity
Management
4.8.6 Staff
Welfare
Planning
7.0 Roles and
Responsibilities
for this Policy
4.8.1 Trust
Actions
Required During
the Phases of
the Pandemic
4.8.1 Trust
Actions
Required During
the Phases of
the Pandemic
How will they be
monitored?
(method + sample size)
Who will
undertake this
monitoring?
How
Frequently?
Group/Committee
that will receive and
review results
Group/Committee
to ensure actions
are completed
Evidence
this has
happened
Each group to provide
assurance that plans
have been reviewed
and updated
Groups
Annually
Pandemic Influenza
Planning Group
Major Incident
Management Group
(MIMG)
Completed
action plan
signed off /
minutes of
meeting
Staff data base
including skills
regularly updated
Human Resources
As and when
required
Pandemic Influenza
Planning Group
Pandemic Influenza
Planning Group
Completed
action plan
signed off /
minutes of
meeting
Core briefings to be
produced by the
communications teams
based on the advice
provided by the
Infection Prevention
and Control team
Each group to assess
their requirements and
procure sufficient
supplies. Availability of
suitable equipment
will be reviewed as
part of the annual PPE
infection control audits
Communications
Teams
As and when
required
Pandemic Influenza
Planning Group
Pandemic Influenza
Planning Group
Completed
action plan
signed off /
minutes of
meeting
Groups
As and when
required
(otherwise
annually)
Infection Prevention
and Control
Committee
Pandemic Influenza
Planning Group
Completed
action plan
signed off /
minutes of
meeting
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Pandemic Influenza Policy
Appendix 1
Inpatient/Residential Unit - Situation Report
UNIT NAME:
Main contact
details:
Date:
Tel:
E-mail:
Time:
No. of beds:
No of beds in use:
No. of flu
cases:
No. of deaths:
No. of recovered
cases:
No. of non-infected:
No. of staff
No. staff recovered
symptomatic
& returned to work
off sick
No. & type of beds available for new
admissions
Daily Situation Report
No. of staff required
(state grade/role or
duties)
Staff available for
re-deployment
(state grade/role or
duties)
Estates issues
Resources
required
Communication
messages
Information
required
Other
Signed (print
name)
E-mail DAILY as instructed (no later than 10 a.m.)
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Appendix 1.1
Non-Inpatient services - Situation Report
UNIT/DEPARTMENT NAME:
Main contact
details:
Date:
Tel:
No. of staff
symptomatic
off sick
Changes to services:
E-mail:
Time:
No. staff recovered
& returned to work
Daily Situation Report
No. of staff required
(state grade/role or
duties)
Staff available for
re-deployment
(state grade/role or
duties)
Estates issues
Resources
required
Communication
messages
Information
required
Other
Signed (print
name)
E-mail DAILY as instructed (no later than 10 a.m.)
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Appendix 1.2
Black Country Partnership NHS Foundation Trust Situation Report (SITREP)
The situation report will provide the Black Country Partnership and other providers of
Health and Social Care both locally and wider through effective links with Public
Health England with a robust reporting pathway to provide decision makers with the
information they need to perform their roles effectively.
Here is the overall Daily Situation Report from the Black Country Partnership
NHS Foundation Trust
Date:
No. of beds:
Male
PICU
Older adult
Female Time:
No of beds
in use:
Male Female
PICU
Older adult
Adult
Adult
Learning
Disabilities
Learning
Disabilities
No. of flu
cases:
No. of deaths:
No. of staff
symptomatic
off sick
No. of
recovered
cases:
No. of noninfected:
No. staff
recovered &
returned to
work
No. & type of beds available for new admissions:
Male
Female
PICU
Older adult
Adult
Learning Disabilities
Detail re staffing or resource issues:
Information to be collated by 12 noon daily
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Appendix 2
Putting on and Removing PPE Poster
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Appendix 3
Pandemic Influenza Action Cards
The enclosed action cards are to be used as directed in the event of an influenza
pandemic.
ACTION CARD
1
Director for Infection Prevention & Control
2
Emergency Planning Officer
3
Service Directors
4
Infection Prevention and Control Team
5
Lead Nurses/Service Managers
6
Estates & Facilities Manager
7
Chief Pharmacist
8
Communications Manager
9
Incident Loggist
10
Admin Support - General
11
Human Resources
12
Chaplaincy Team
ACTION CARD 1: Director of Infection Prevention & Control
Your role
To act as the first point of contact in the event of any potential influenza
pandemic
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate – likely
to be the IPCT
You report on incident progress to and
take direction from
Chief Executive or nominated deputy
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Actions and Responsibilities
Considered
(Yes/No)
a) Log incident by completing the Initial Incident Report Form (see Major Incident
and Business Continuity Plan). Each risk identified should be fully recorded and
evaluated using the Risk Assessment Template. Complete Follow-up Incident
Report Form(s) if further updates required, ensuring that
revised/updated/additional Risk Assessment Templates are completed to
ensure that the pattern of risk and mitigating measures are fully catalogued for
the duration of the incident
b) Determine and review Incident Level or Standby Incident Level using Trust
Incident Assessment Guidelines & declare a Pandemic Outbreak / Outbreak/
Standby as necessary
c) Decide whether to escalate to the on-call Manager
d) Respond throughout in accordance with the relevant Trust policy or policies
where applicable
e) Convene and chair Pandemic Influenza Planning Group, co-opting further
members onto the Group as required ensuring all members have access to the
Pandemic Influenza Contingency Policy and the Major Incident & Business
Continuity Plan
f) Keeping Records
Start the incident log – ensure a loggist is available
Continue to log as appropriate.
Close logging when requested to do so or when the incident is stood down
g) Issue the enclosed action cards to appropriate persons
h) Health and Safety
Assess the likelihood of the incident requiring you to continue responsibility for
longer than 6 hours. If this is the case contact another Manager to take over
responsibilities at an agreed time
Ensure Health and Safety regulations are adhered to by all staff dealing with the
incident, including regular breaks and hand over to another member of staff
i) Ensure that staff working as part of the Pandemic Influenza Planning Group,
have cover for their normal roles
j) Provide regular feedback to CEO & Non-Executive Directors on management of
the incident
k) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
l) Authorise the stand down from major incident (pandemic influenza) status when
considered safe to do so
m) Ensure debrief meetings are arranged once 1st wave of the pandemic is over
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ACTION CARD 2: Emergency Planning Officer
Your role
To ensure the Major Incident & Business Continuity Plan & the Infection
Control Pandemic Influenza Plans are followed
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate – likely
to be the IPCT
You report on incident progress to and
take direction from
Chief Executive or nominated deputy
Considered
(Yes/No)
Actions and Responsibilities
a) Ensure availability & set up of the major incident room
b) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
c) Ensure this plan is regularly reviewed and tested
d) Ensure a formal review of the incident management is undertaken at the end of
the incident in order to advise on any amendments to the plan and include
lessons learnt
e) Maintain a register of test exercises undertaken & lessons learnt
f) Ensure the daily SITREP data is collated, nominating key personnel
g) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
ACTION CARD 3: Service Directors
Your role
To implement the groups business continuity plans as directed
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate – likely
to be the IPCT
You report on incident progress to and
take direction from
Emergency Planning Officer or nominated deputy
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Considered
(Yes/No)
Actions and Responsibilities
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable
b) Implement group contingency plan to mitigate staff `absenteeism and increasing
numbers of sick patients
c) Daily or as instructed, report on staff availability throughout each group and
effectiveness of group flu contingency plans
d) Post pandemic review staff welfare issues – flexitime, leave, time in lieu
e) Ensure staff have real-time access to psychological support and supervision as
required
f) Provide regular feedback to CEO & Non-Executive Directors on management
of the incident
g) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
ACTION CARD 4: Infection Prevention & Control Team
Your role
To collate surveillance data and provide specialist infection control advice
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control or
nominated deputy
Actions and Responsibilities
Considered
(Yes/No)
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable
b) Gather data on patient/staff affected – update at least 1-2 x daily
c) Assist L&D to co-ordinate training for Lead Nurses/Service Managers/Matrons
in mask fitting so they can disseminate training to all areas of responsibility
d) Attend Pandemic Influenza Planning Group meetings as required
e) Develop issue and review infection control guidance in accordance with national
recommendations for all local health and social care establishments.
f) Address the education & training needs of the Trust health care workers in
measures to reduce person-to-person spread of the influenza virus
g) Act as a resource for advice and information to primary healthcare workers on
related infection control issues.
h) Verify & gather information internal & external
i) Communicate with other agencies e.g. CCG, HPA, Acute Trust & Local
Authority Public Health
j) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
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ACTION CARD 5: Lead Nurses/Service Managers/Deputy Modern Matrons
Your role
To ensure business continuity within clinical teams
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control or
nominated deputy
Actions and Responsibilities
Considered
(Yes/No)
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable
b) Organise basic infection control measures within their areas when instructed
by the Pandemic Influenza Planning Group
c) Support the ward managers in preparing the information from Pandemic
Influenza Planning Group to give to visitors and patients
d) Be trained in mask fitting organised by the Infection Control Team to
disseminate training to staff in all areas of responsibility
e) Support the manager in preparing and maintaining isolation zones of those
patients infected with flu
f) Offer support, guidance and advice to members of the team, patients and
carers throughout the pandemic
g) Provide a role model of quiet, confident management
h) Review available staffing/skill mix & report to the Pandemic Influenza Planning
Group
i) Redeploy staff as advised by the Pandemic Influenza Planning Group
j) Make arrangements for maintaining adequate infection control supplies i.e.
soap, alcohol based hand rub etc. to all healthcare establishments and
healthcare workers
k) Review patients currently on caseloads for appropriateness
l) Provide communication link from the Pandemic Influenza Planning Group to all
areas within the Group
m) Report back significant issues to the Pandemic Influenza Planning Group
n) Identify medical equipment available and any shortfalls / concerns
o) Identify consumable equipment levels and any concerns re supplies
p) Identify services which may be postponed during the peak of the pandemic
q) Consider security issues for both staff, clients & premises
r) Identify timescales for services that have been postponed to be reintroduced,
taking into consideration decontamination of facilities and staff counselling &
support
s) Keep a log of all actions & decisions taken
t) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
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ACTION CARD 6: Estates & Facilities Manager(s)
Your role
To ensure all supplies & services are maintained
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control or
nominated deputy
Actions and Responsibilities
Considered
(Yes/No)
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
b) Attend Pandemic Influenza Planning Group meetings as required
c) Take a lead on ensuring the availability of all consumables etc.
d) Ensure cleanliness & decontamination of facilities is maintained
e) Liaise with wards/departments daily to identify requirements
f) Monitor stock levels of equipment, consumables, food etc. on a week to daily
basis as required
g) Liaise with suppliers on a weekly to daily basis as required to ensure new stock
delivered on time
h) Provide advice & guidance on the use of medicines as required
i) Provide information to the Pandemic Influenza Planning Group on any
difficulties obtaining supplies
j) Consider security issues of both equipment & premises
k) Keep a log of all actions & decisions taken
l) Provide information to the Pandemic Influenza Planning Group on any
difficulties obtaining supplies
m) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
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ACTION CARD 7: Chief Pharmacist
Your role
To ensure all medicine supplies & pharmacy services are maintained
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control or
nominated deputy
Actions and Responsibilities
Considered
(Yes/No)
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
b) Attend Pandemic Influenza Planning Group meetings as required
c) Take a lead on ensuring the availability of all medicines including antivirals and
vaccines etc.
d) Oversee antiviral collection points within the Trust
e) Monitor use of antibiotics to ensure compliance with the antibiotic prescribing
policy
f) Ensure systems in place for patients requiring Clozapine treatment
g) Liaise with wards/departments to identify pharmaceutical needs
h) Contact suppliers to secure supplies of all essential medicines
i) Provide advice & guidance on the use of medicines as required
j) Provide information to the Pandemic Influenza Planning Group on any
difficulties obtaining supplies
k) Consider security issues of both medication & premises
l) Ensure the administration of pharmaceutical preparations is undertaken in
accordance with group directives
m) Monitor stock levels of equipment, consumables, food etc. on a week to daily
basis as required
n) Liaise with suppliers on a weekly to daily basis as required to ensure new stock
delivered on time
o) Keep a log of all actions & decisions taken
p) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
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ACTION CARD 8: Communications Manager
Your role
To provide senior level communication co-ordination, advice & support
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control or
nominated deputy
Considered
(Yes/No)
Actions and Responsibilities
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
b) Attend Pandemic Influenza Planning Group meetings as required
c) To take a lead on the communication plan for the Trust both internal & external
communications
d) Deal with all media/press enquiries
e) Prepare press statements
f) Liaise with CEO, DIPC, CCG & HPA & Local Authority regarding press release
to ensure consistent messages
g) Assist the Pandemic Influenza Planning Group to prepare internal staff & client
briefings as required
h) Ensure all briefings/press releases are signed off by the Pandemic Influenza
Planning Group prior to circulation
i) Ensure stand down message is communicated promptly
j) Keep a log of all actions & decisions taken
k) Hand over as required to the next Manager, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
ACTION CARD 9: Incident Loggist
Your role
To carefully capture all of the decisions as instructed and agree them in full
with the DIPC as a factual account of what has happened
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control (DIPC) or
nominated deputy
Actions and Responsibilities
Considered
(Yes/No)
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable
b) Attend Pandemic Influenza Planning Group meetings as required
c) Use the standard documentation log book provided to record information
d) Capture all decisions made and the reasons for them
e) Ensure that all decisions taken have a supporting justification/rationale
f) Shadow the DIPC or incident director for the shift ensuring that all breaks are
covered by another loggist
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g) Stand down from the pandemic influenza incident when instructed to do so
h) Hand over as required to the next loggist, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
i) Close log at stand down, returning your log to the incident control room
manager
ACTION CARD 10: Admin Staff (General)
Your role
To provide administrative support and secretarial support within the Incident
Control Room as directed
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control (DIPC) or
nominated deputy
Considered
(Yes/No)
Actions and Responsibilities
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
b) Attend Pandemic Influenza Planning Group (PIPG) meetings as required
c) Reschedule diaries of key members of the PIPG team members as required
d) Arrange venues/refreshments for meetings as instructed
e) Ensure an attendance register is taken at all meetings including the names of
those present & the roles they are undertaking
f) Continually capture details for chronological log
g) Take and transcribe minutes of all Pandemic Influenza Planning Group
Meetings and teleconferences
h) Produce & circulate agendas for each meeting
i) Provide routine call handling
j) Assist in preparation of time critical documents
k) If you have used shorthand ensure your notes are transcribed before you leave
l) Stand down from the pandemic influenza incident when instructed to do so
m) Ensure sufficient breaks & cover for your break times
n) Hand over as required to the next loggist, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
o) Close log at stand down, returning your log to the incident control room
manager
ACTION CARD 11: Human Resources
Your role
To provide advice & support to the DIPC which is informed by established Trust
policies and procedures in respect of the Trust’s human resources & workforce
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control (DIPC) or
nominated deputy
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Considered
(Yes/No)
Actions and Responsibilities
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
b) Attend Pandemic Influenza Planning Group (PIPG) meetings as required
c) Ensure an up-to-date record is maintained of staff emergency contact details,
work skills & qualifications is maintained
d) Assist with re-deployment of staff resources as required
e) Advise staff on access to Occupational Health & Psychological support as
required
f) Hand over as required to the next loggist, providing as comprehensive a
handover as possible, including outstanding and discharged actions/issues
g) Close log at stand down, returning your log to the incident control room
manager
ACTION CARD 12: Chaplaincy Team
Your role
To provide support & advice to patients and staff as required
Your location
Trust HQ Delta House
Incident progress is reported to you by
Staff dealing with the incident as appropriate
You report on incident progress to and
take direction from
Director for Infection Prevention & Control (DIPC) or
nominated deputy
Actions and Responsibilities
Considered
(Yes/No)
a) Respond throughout in accordance with the relevant Trust policy or policies
where applicable.
b) Ensure safe practices implemented when assisting patients & staff in aspects
of faith & worship e.g. communion
c) Informal listening & support to staff as they cope with increasingly stressful
situations
d) Act as a resource in relation to spiritual & religious needs
e) Liaise with faith communities as required in assisting patients, staff & relatives
dealing with a bereavement
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Policy Details
Title of Policy
Pandemic Influenza Policy
Unique Identifier for this policy
BCPFT-COI-POL-02
State if policy is New or Revised
Revised
Previous Policy Title where applicable
Infection Prevention and Control Policy for
Pandemic Influenza
Policy Category
Clinical, HR, H&S, Infection Control etc.
Executive Director
whose portfolio this policy comes under
Policy Lead/Author
Job titles only
Committee/Group responsible for the
approval of this policy
Infection Prevention and Control
Executive Director of Nursing, AHPs and
Governance
Infection Prevention Lead Nurse
Infection Prevention and Control Committee
Month/year consultation process
completed *
N/A
Month/year policy approved
August 2015
Month/year policy ratified and issued
August 2015
Next review date
August 2018
Implementation Plan completed *
Yes
Equality Impact Assessment completed *
Yes
Previous version(s) archived *
Yes
Disclosure status
‘B’ can be disclosed to patients and the public
Key Words for this policy
Flu, Incubation, Situation report, STIREP,
Personal protective equipment, World health
organisation, FluCon, Immunisation, Catch it,
bin it, kill it, Business continuity management
* For more information on the consultation process, implementation plan, equality impact
assessment, or archiving arrangements, please contact Corporate Governance
Review and Amendment History
Version Date
Details of Change
V1.1
Aug 2015
New policy format and minor amendments – National Risk
Register table updated, tables from Green Book updated and
patient placement now incorporates service users in the
community
V1.0
Nov 2013
New policy for BCPFT
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