Download Laboratories and Pathology - Children`s Hospital of Michigan

Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
Page 1 of 11
Effective Date:
OBJECTIVE
To provide a framework for the early identification and management of unusual or rapidly increasing incidence of
communicable disease cases or symptom clusters which may occur as a result of a natural community exposure or
exposure to suspected bioterrorist agents.
SCOPE
All employees working within, or assigned to the complex, including but not limited to Karmanos Cancer Center,
Karmanos Cancer Institute, Rehabilitation Institute of Michigan, Hutzel Women’s Hospital and Harper University
Hospital.
DEFINITIONS
Natural occurring communicable diseases or potential bioterrorist agents:
1) Bacterial Diseases: Anthrax, Bacterial Meningitis, Brucellosis, Bubonic Plague, Cholera, Diphtheria, Glanders,
Pertussis, Pneumonic Plague, Q Fever, Tuleremia.
2) Viral Diseases: Influenza, Measles, Meningioencephalitis, Smallpox, Venezuelan Equine Encephalitis, Viral
Hemorrhagic Fever, Viral Meningitis.
3) Biological Toxins: Botulism, Ricin, Staph Enterotoxin B, T-2 Mycotoxins
POLICY
1) In the event that an unusual incidence of communicable disease or symptom clusters is identified the
following provisions will be implemented as appropriate: all site staff will cooperate fully with the health
department and law enforcement entities as required due to the nature of the communicable disease event.
2) The AOC (Administrator on Call)
3) The Health Alert Network (HAN) policy may be implemented.
PROVISIONS
The following scenarios warrant investigation as potential indicators for major communicable disease events.
1) A rapidly increasing incidence (e.g. hours or days) in a normally healthy population.
2) An epidemic curve that rises and falls within a short period of time.
3) An unusual increase in the number of people seeking care, especially with fever, respiratory or
gastrointestinal complaints.
4) An endemic disease rapidly emerging at an uncharacteristic time or in an unusual pattern.
5) Lower attack rates among people who have been indoors, especially in areas with filtered air, or closed
ventilation systems, compared with people who have been outdoors.
6) Clusters of patients arriving from a single locale (more likely a chemical attack as biological agents require an
incubation period).
7) Large number of rapidly fatal cases.
8) Any patient presenting with a disease that is relatively uncommon and has bioterrorism potential. Refer
Symptom Cluster Grid Appendix D.
9) Unusual pattern of illness or death among animals (which may be explained or attributed to an agent of
bioterrorism) that precedes or accompanies illness or death in humans.
10) Illness which is unusual for a given population or age group.
Deliberate release of biological agents may be covert or announced. If hospital staff notice suspicious activities or
receive phone notification of a release, attempt to obtain/observe as much information about the agent, location,
and caller (refer to Code Orange directions) and notify Security immediately.
INITIAL NOTIFICATION/COMMUNICATION
After preliminary investigation confirms any of the above scenarios:
1) The Emergency Department Senior Physician or the Hospital Epidemiologist or designee will notify the
appropriate administrator on call who will activate the internal fan out process. Authority is granted to the
Hospital Epidemiologist as described in the Epidemiology Authority Statement HAR 3 IC 003 or 3 HTZ IC
8005, IC 100 KCC.
2) The administrator on call in conjunction with Epidemiology will determine whether to activate the
HAR/HTZ/RIM/KCC Code Yellow Major Communicable Disease Response Plan and will initiate the
communication path according to the plan.
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
Page 2 of 11
Effective Date:
3) In addition, the individuals listed on the fan out list in Appendix A will be immediately notified by the AOC or
designee.
The Emergency Operation Center (EOC), under direction of Command Center, at each site will prepare to
receive patients utilizing the surge capacity grids. See appendices F and G.
EMERGENCY DEPARTMENT and or LABOR RECEPTION CENTER (LRC)
1) The triage nurse or receiving nurse establishes genuine exposure. It will be noted whether patient was
exposed to inhaled substances, or to suspected communicable diseases.
2) Maintain log for patient volume analysis and tracking.
3) Notify Epidemiology of suspected cases via fax using Appendix B
4) Communicate with Nursing Administrative Supervisor regarding patient admissions.
DECONTAMINATION PROCESS
The need for decontamination depends on the suspected exposure and in most cases will not be necessary.
Decisions regarding the need for decontamination should be made in consultation with local and state health
departments.
EPIDEMIOLOGY
1) Notify the local health department of ongoing cases using Appendix B and act as public health liaison.
2) Employ applicable components of Tier 2-IC023 Outbreak Investigation Policy an IC 121 KCC such as case
definition, data collection and documentation.
3) Provide approved information sheets to Media Relations, Nursing Education and Occupational Health
Services (OHS) to quickly educate patients, families and health care workers.
4) Facilitate communication among departments involved in the response plan.
5) Correlate patient data with First Net® data base and Powervision ® in Hutzel Women’s Hospital LRC.
MEDIA RELATIONS
1) Use approved agent-specific Fact Sheets for Patient/Visitors appended to Tier 2 IC 029 Major Communicable
Disease Response Plan.
2) Contact Infectious Disease or Epidemiology for other information suitable for public release.
3) Assist as required with directional signage and communication efforts to patients, visitors and staff.
4) Set up hot line(s) as needed, to receive incoming calls from staff members and or provide information to the
community.
5) In conjunction with Guest Relations arrange for translators, as needed, to facilitate communication to patients,
visitors and family members.
NURSING EDUCATION
1) Implement approved agent-specific Fact Sheets for Health Care Workers appended to Tier 2 IC 029 Major
Communicable Disease Response Plan to expedite information communication to staff.
ISOLATION AND PERSONAL PROTECTIVE EQUIPMENT (PPE)
1) Admitted patients will be placed in isolations or special precautions as required according to DMC IC 2 006
Isolation Policy and Precautions and IC 101 KCC or as directed by Epidemiology.
2) Isolation rooms and capacity are listed in Appendix E
3) Standard category isolation is available on the units and must be clearly posted.
4) Designation of patients will be based on the individual patient’s symptoms and or diagnosis and isolated or
cohorted appropriately.
5) Visitors to isolated patients may be limited and an ongoing assessment of these patients will determine
limitations.
6) Nursing Education will serve as a unit-based liaison to facilitate compliance with infection control measures.
FACILITIES-VENTILATION
1) Notify Facilities Engineering to assess building ventilation systems and isolate as appropriate.
2) Activate all negative air rooms.
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
Page 3 of 11
Effective Date:
LABORATORY AND PATHOLOGY
1) Alert DMC University Laboratories and Pathology Directors of potential increases in specimen volume and
suspected pathogens if known.
2) DMC University Laboratory is a level A laboratory and will make presumptive identification to be confirmed by
Michigan Department of Community Health (MDCH).
3) If a bioterrorism event is suspected or known, laboratory specimens may become criminal evidence and
managed under the direction of the Michigan State Police or on-site law enforcement.
OCCUPATIONAL HEALTH
1) Epidemiology will define “exposure” for health care workers and Occupational Health Services will assist with
the identification of exposed individuals.
2) Nursing Administration will monitor health care worker illnesses and notify OHS and refer the HCW to OHS
for evaluation and or treatment.
3) Epidemiology, OHS and Pharmacy will collaborate to assure timely prophylaxis, immunization and treatment
of occupational exposures or illnesses among HCW’s.
4) Consider hole- punching employee I.D. badges to indicate who has been immunized or received prophylaxis
if the situation warrants.
PHARMACY
1) Obtain appropriate antibiotics, vaccines and prophylaxis as indicated based on suspected agent.
2) Work in conjunction with the CDC for receipt and distribution of pharmaceutical supplies.
REFERENCES
Clinical Aspects of Critical Biologic Agents May 2001 Michigan Department of Community Health, Bureau of
Epidemiology
Medical Management of Biological Casualties Handbook, February 2001. U.S. Army Medical Research Institute of
Infectious Diseases
Boiterrorism Readiness Plan: A Template for Healthcare Facilities. APIC Bioterrorism Task Force. CDC Hospital
Infections Program Bioterrorism Working Group April 2002
APPENDIX
(A) Communication Fan Out List
(B) FAX Notification Form
(C) Exposure Tracking Log
(D) Symptom Cluster Grid
(E) Isolation Room Locations
(F) Surge Capacity Karmanos Cancer Center and Rehabilitation Institute of Michigan
(G) Surge Capacity Harper University Hospital and Hutzel Women’s Hospital.
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
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ADMINISTRATIVE RESPONSIBILITY
Defines which management function or individual(s) within the system charged with enforcement, interpretation of, or
exception to the approved policy.
APPROVAL SIGNATURE(S)
Title
Date
Title
Date
REVIEW DATE : January 2010
(REQUIRED). Using Black Arial Font 10, please replace this paragraph with the date of next review, which cannot
exceed three years from the date of approval.
SUPERSEDES: 3HAR IC 8006
January 31 2003
KEY Search Words: (Insert 5 to 7 commonly used/familiar words/abbreviations/acronyms that would be used to
search for this policy):
Please check one:
This policy is: New
Reviewed
XRevised
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
Page 5 of 11
Effective Date:
Communication Fan Out
Person/Dept
Hospital Epidemiologist
DMC V.P. of Safety and
Quality
DMC Emergency
Management Committee
Chair
DMC Epidemiology
Manager
Epidemiology
Harper/Hutzel Hospitals
Epidemiology
Rehabilitation Institute of
Michigan
Epidemiology and Safety
Officer Karmanos Cancer
Centerl
Safety Officer Harper/
Hutzel Hospitals
Safety Officer
Rehabilitation Institute of
Michigan
Other Regulatory
Agencies:
MDCH Bioterrorism
Emergency Notification
Detroit Health Department
FBI Federal Field Office
MDCH Lab
CDC Bioterrorism
Emergency Numbers
CDC for Botulism
Antitoxin
USAMRIID for Vaccine
Immunoglobulin
Name
Appendix A
Phone Number
Pager
G. Alangaden M.D
T. Lundstrom M.D.
313-745-9134
313-745-2548
4865
4052
J. Atas M.D.
993-0848
4964
E. Flanagan
51708
5729
K. Preney/P. Robinson
59136/69081
6424/5744
M. Drogosch
51064
5711
M. E. Lesperance/
L. Engles
576-8047/576-8083
94393/95020
S. Catanese
966-7838
92752
A. Munn
52247
94263
Business Hours:
517-335-8024
313-876-4138
313-965-2323
517-335-2323
770-488-7100 or 770-4884819
404-639-2206
After Hours:
517-335-9030
313-876-0070
Joann Clinchoc
301-619-2833
404-639-2888
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
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Appendix B
FAX Notification
Date:
__________________
To:
Epidemiology Department
€ Harper Hutzel: Fax 313-993-0969, Department Phone: 313-745-9132
€ Rehabilitation Institute of Michigan: Fax 313-745-1224, Department Phone 313-745-1064
€ Karmanos Cancer Center: Fax 313-576-8425, Department Phone 313-576-8047
From:
€ Harper Hospital/Hutzel Women’s Hospital Emergency Department
€ Hutzel Women’s Hospital LRC
Fax:
________________________
Phone: ________________________
# Pages including Cover: ________
SUMMARY OF EXPOSURE ACTIVITY
PATIENT LABEL
DESCRIPTION OF
EXPOSURE/LOCATION
DETROIT HEALTH
DEPARTMENT NOTIFICATION
CONTACT NAME & NUMBER
COMMENTS
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
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Appendix C
Major Communicable Disease Response Plan
Exposure Tracking Log
Visitors and Vendors
Vendor or Visitor
Name
Date of Birth
Social Security
number
Last 4 digits
Address
Phone
Home and
Work
Unit/department
visited
Date/Time/Duration
of Visit
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
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Attachment D
Bioterrorism Agents
Symptom Clusters
Symptoms
Incubation period
Fever
Myalgias
Cough
Sore throat
Respiratory failure
CxR
Anthrax Pulmonary
1-43 days
+
+
+
+
+
Small Pox
7-14 days
+
+
Botulism
12-72 hours
Wide mediastinum
Plerual effusions
Headache
Nausea/vomiting
Abdominal pain
rash
+
+
+
+
Vesicular
Paralysis
Plague Pneumonic
2-3 days
+
+
+
+
+
Patchy/lobar
consolidation
+
+
+
Proximal to distal
+
Diplopia/cranial
Nerve/palsies
Dry mouth
Blurred vision
+
+
Isolation Policies
Universal precautionsbroad
Respiratory Isolation
Private room, surgical
mask
AFB Isolation
Negative pressure room
N-95 respirator
+
+
++
+
+
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
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Attachment E
Airborne Infectious Isolation Rooms
Harper University Hospital, Hutzel Women’s Hospital and Karmanos Cancer Center
Harper
5718 Brush
5719 Brush
4508 ICU
2709 Brush
Hutzel
2105 Webber
2104 Webber
3409 Webber
3407 Webber
3421 Webber
3517 Webber
3817 Brush
Karmanos
5212 Webber
5213 Webber
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
Page 10 of 11
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Attachment F
Surge Capacity
Harper
Unit
2 Brush
4 WS
5 WS
5 BS
5 BN
5 Center
6 Brush
8 WS
9 WS
Hemodialysis
10 WS
4 ICU
5 ICU
6 ICU
8 IMCU
9 ICU
Total
Available
Beds
25
24
32
16
16
20
37
27
34
9
26
10
10
10
9
10
295
Virtual
Beds
15
6
2
0
0
0
0
2
4
9
12
0
0
0
0
0
70
Total Beds
40
30
34
16
16
20
37
29
38
18
38
10
10
10
9
10
365
11
8
19
Airborne Infectious
Isolation
1
2
1
4
Hutzel
Maternal Special Care
Gyn/Surg
OB High Risk
NICU
Mother/Baby
SCN
L&D
LDRP/Mother/Baby 3WS
Total
1
2
1
2
17
7
35
2
8
8
RIM
rd
3 floor
th
4 floor
th
7 floor
Total
26
26
26 No med gases
78
Title:
Policy No:
Major Communicable Disease Response Plan and Bioterrism Plan
HUH/HTZ/RIM/KCC
Karmanos Cancer Center
10WN
9WN
8WN
5WN
Phase 1 Chemo
Pheresis
Chemo Day Treatment *
Four (4) stations with medical gases
Wertz Clinic*
Two (2) stations with medical gases
BMT Clinic
Walt Breast Center*
Three (3) stations with medical gases
Total
Operating
Capacity
19
25
28
24
9
7
41
Surge
Capacity
19
46
28
30
9
7
41
42
42
11
18
11
18
224
251
19
46
28
30
123
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