Table 4.

Preparedness for managing a highly communicable emerging infectious disease

General
•Have a comprehensive facility plan for managing a highly communicable emerging infectious disease.
•Nestle the plan for emerging infectious diseases within the general disaster plan.
•Base the plan on the route(s) of transmission for the infectious agent.
•Incorporate the incident command structure in the plan.
•Periodically train key personnel on the plan.
•The plan should include care of single patients (eg, Ebola) and managing large number of patients in an epidemic (eg, novel influenza).
•Incorporate communications with local and state health department officials.
Screening and signage (when appropriate based on the threat of a highly communicable disease)
•Place signs at every entrance to the hospital and clinics that includes the following: epidemiologic clues to possible disease exposure (ie, travel locations), signs and symptoms of infection, and who to notify if the patient or visitor has both exposure and appropriate signs or symptoms.
•Include messaging about the signs and symptoms of the concerning disease in all telephone contacts with the patient (eg, reminders about appointments) and who to contact prior to arrival at the health care facility.
•Screen all patients immediately at the time of all health care visits.
•Include screening in the electronic medical record (also have alerts in the medical record that require screening).
•Place an appropriate isolation sign on the door of all patients being isolated because of the possibility of a highly communicate disease.
•For diseases transmitted via the droplet or airborne routes emphasize respiratory hygiene (ie, immediate use of a mask and proper disposal of tissues).
•Emphasize the need for proper hand hygiene.
•All messaging should be in appropriate languages for the region.
Triage
•Train frontline person in all clinics and the emergency department in appropriate use of personal protective equipment.
•Have appropriate personal protective equipment available.
•Have a designated location in the emergency department and all clinics in which to immediately place the patient (a private room; ideally with access to a sink and toilet, and if possible, one that meets standards for a disease transmitted by the airborne route (ie, negative pressure, out-exhausted air, >12 air exchanges per hour) if applicable.
•For diseases transmitted by the airborne route and when an airborne isolation room is not available, ideally place a portable high-efficiency particulate air purifier in the room.
•Have a well-defined process for alerting key health care facility officials about the presence of a patient with a possible highly communicative disease (eg, disaster manager, infection preventionist).
•Avoid blood tests or other procedures that may place the laboratory staff or other health care personnel at risk.
•Have a well-defined and safe method for transporting a patient either to a properly equipped emergency department or hospital facility able to safely care for a patient.
Inpatient care
•Have a well-defined plan for the inpatient location that will provide care to a patient with a highly communicative disease (or a plan for transporting such a patient to facility that can provide such care).
•In the inpatient care unit designate areas that are hot (ie, potentially contaminated) and cold (ie, areas that are not contaminated).
•Have a well-trained medical care team. For highly communicable diseases (eg, Lassa, Ebola), ideally provide 3-step training: (1) basic individual training on personal protective equipment donning and doffing (and including how to manage contamination of the environment from a spill and breach of the personal protective equipment. Such training should be individualized to the specialty of the health care providers [ie, physician, nurse, respiratory therapist]); (2) team training using mannequins; and (3) team training in the designated containment unit.
•Train team personnel on donning and doffing using an explicit written list of all donning and doffing steps.
•Screen and exclude health care personnel unable to wear the proper personal protective equipment. Consider excluding from the care team personnel at high risk for disease acquisition or more severe illness, such as persons with nonintact skin, pregnancy, and immunocompromised persons. Consider excluding trainees from providing care.
•Store an adequate supply of personal protective equipment.
•If needed, have dedicated point of care laboratory equipment.
•Develop a method to safely dispose of solid and liquid wastes.
•Restrict visitors (if indicated) and maintain a log of all visitors.
•Maintain a log of all health care personnel providing care.
•Develop a plan for managing health care personnel with unprotected exposure to the infectious agent (eg, needlestick).
•Assure that care team members receive proper rest.