Table 2.
Key recommendations
| Domain | No | Key recommendation | National Focal Points | Prep. experts |
|---|---|---|---|---|
| Construction and maintenance of the outbreak preparedness plan | 1 | Staff responsible for outbreak preparedness planning from small healthcare organizations should have access to education and training in outbreak planning. | S | S |
| 2 | The organization's infectious disease preparedness plan should be updated. | S | S | |
| 3 | Healthcare organizations should develop their organizational infectious disease preparedness plan in a multidisciplinary internal committee. | S MU |
S | |
| 4 | Healthcare organizations should tune their organizational infectious disease preparedness plan with all (local/regional/national) organizations that they interact with during outbreaks. | S MU |
S MU |
|
| 5 | The organization's infectious disease preparedness plan should be generic (flexible and adaptable to the actual situation). | S MU |
S MU |
|
| 6 | The organization's infectious disease preparedness outbreak plan should correspond with the national guidelines, but should deviate to fit the local situation. | S MU |
S | |
| 7 | Resources for developing, testing, and updating a preparedness plan should be made available. | S MU |
S | |
| 8 | Healthcare organizations should have a dedicated staff position responsible for infectious disease preparedness. | D | D | |
| 9 | The organization’s outbreak preparedness plan and its updates should be disseminated and implemented in multiple and various ways by the responsible management. | S MU |
S | |
| 10 | Healthcare workers should be able to access the organizations preparedness plan (for example on the intranet). | S | S | |
| Support for health professionals, patients and families | 11 | An infectious disease preparedness plan should include items for staff protection; nb in case of uncertainty protection should start at the highest required level in the actual setting whereby the protection of employees is guaranteed, adapted for the specific situation. | S MU |
S MU |
| 12 | A procedure should be developed to mandate the designated employees to receive the (for the outbreak designated) vaccine and/or antiviral prophylaxisa. | S | S | |
| 13 | Drills and exercises to assess how various healthcare facility's plans interact should be multidisciplinary. | S | S | |
| 14 | Healthcare organizations should evaluate their level of preparedness. | S | S MU |
|
| 15 | Healthcare organizations should provide ongoing infection prevention education programs for employees. | S | S | |
| 16 | Healthcare organizations should organize regular infectious disease drills/exercises | S MU |
S | |
| 17 | Healthcare workers should be educated and trained in outbreak handling. | S | S | |
| 18 | Training materials for infection control measures should be available at the healthcare organization. | S | S | |
| 19 | Instructors providing training should be trained instructors. | S | D | |
| 20 | The senior management should identify staff that has to participate in training programs. | S | S | |
| 21 | The senior management should allocate staff to the defined roles. | S | D | |
| 22 | The senior management should verify that the identified staff participated in the training. | S | S | |
| 23 | All designated professionals should be trained. | S MU |
S MU |
|
| 24 | Healthcare organizations should anticipate addressing mistrust, fear, moral maintenance, and sustainability of health care workers. | S | S | |
| 25 | All relevant employees should be fit-tested for PPE use. | S | D | |
| 26 | The organization should appoint a person who is available for questions from the staff on PPE use. | S | S | |
| 27 | Compliance of healthcare workers with transmission-based precautions should be enforced by diverse strategies. | S | R | |
| 28 | An infectious disease preparedness plan should include items supporting infection control (including measures to prevent contamination) for all phases of the outbreak. | S MU |
S MU |
|
| 29 | Healthcare organizations should take into account that they might need to put potentially infectious (asymptomatic) healthcare workers on administrative leave. | S | S | |
| 30 | Healthcare organizations should plan to monitor the health of exposed healthcare workers for the maximum incubation period. | S | S | |
| 31 | Healthcare organizations should plan to screen patients with infectious disease symptoms. | S | S | |
| 32 | Specific protocols for high risk procedures should be available for high risk infectious diseases. | S | S | |
| Surge capacity | 33 | Health care organizations providing patient care should have an overview of the general features of the organization (e.g. logistic structures including private rooms, toilets, wards, rooms dedicated to infectious disease, rooms equipped with negative pressure systems, safe waste disposal). | S | S |
| 34 | Health care organizations should plan to expand their capacity. | S | S MU |
|
| 35 | Hospitals should have at least one isolation room which is technically well-equipped and logistically adequate. | S | S | |
| 36 | Healthcare organizations should have access to adequate laboratory facilities for screening and follow-up. | S | S | |
| 37 | Healthcare organizations should have access to a single, simple reporting framework to minimize the administrative burden to reporting. | D | D | |
| 38 | Healthcare organizations should have a plan to access, coordinate, and increase labor resources for continued and expanded care. | S | S | |
| 39 | Healthcare organizations should have an up to date inventory of the total number of personnel (medical and non-medical staff) with patient contact and without patient contact. | S | S | |
| 40 | Healthcare organizations should have an access plan in place for stockpiling and distribution. | D | S MU |
|
| 41 | Senior management should prepare to provide adequate resources to respond to an outbreak. | S MU |
S | |
| 42 | Healthcare organizations should prepare for immediate installation of a surveillance network to monitor the burden of disease during an outbreak in relation to the capacity of healthcare. | S | S | |
| 43 | Healthcare organizations should prepare for monitoring of exposed cases. | S | S | |
| 44 | Healthcare organizations should plan to inform ambulance and organization’s (hospital) staff when a case was transferred. | S | S | |
| 45 | Healthcare organizations should have triage protocols for infectious disease outbreaks. | S | S | |
| 46 | Triage protocols should be developed supra institutional. | S | R | |
| 47 | Triage protocols should include an ethical framework to manage competing priorities to relevant pathways of decision making. | S | R | |
| 48 | Healthcare organizations should have a triage system for infectious disease outbreaks. | S | S | |
| 49 | A preparedness plan should include objective criteria to activate and stop triage protocols. | D | S | |
| 50 | Triage protocols should be tuned regionally. | S | R | |
| 51 | The public health preparedness plan should define identify and designate staff for supporting and maintaining (suspected/probable/possible/confirmed) cases in home isolation. | S | S | |
| Communication to the public, patients and families | 52 | Healthcare organizations should have communication strategies for patients and their families. | S | S |
| Coordination and collaboration | 53 | Organizations should have a multidisciplinary organizational preparedness committee to ensure the organization is well prepared. | S | S |
| 54 | Ensure that an outbreak coordinator can be appointed in an outbreak situation. | S | S | |
| 55 | Healthcare organizations should prepare for installing an outbreak control group (e.g. an outbreak management team) in case of a threat to coordinate the response. | S MU |
S | |
| 56 | A communication and coordination system between each healthcare organization and the local/regional/state/country public health authorities should be established. | S MU |
S | |
| 57 | Healthcare organizations should collaborate, coordinate, and communicate with key regional stakeholders for outbreak preparedness. | S | S MU |
|
| 58 | Healthcare organizations should plan to establish a regional outbreak control group to exercise authority and direction over resources in the region. | R | S | |
| 59 | Healthcare organizations should develop an internal information channel to ensure up-to-date information is factual, accurate, and reliable while preventing information overload. | S MU |
S | |
| Facilitators for implementation of plans | 60 | Healthcare organizations should have strategies to ensure effective and responsive leadership. | S | S |
| 61 | Senior-level management should be prepared to provide good leadership. | S | S | |
| New recommendations added | Healthcare organizations should do a risk assessment and develop scenarios for the most probable outbreak situations. | Added by the National Focal Points |
Legenda: S selected, D discussion, R rejected, MU selected for most urgent
aThis recommendation was rejected by the national experts in step 2 but the authors added the recommendation to step 3 because in the Dutch legislation compulsory vaccination is forbidden