PowerPoint Presentation

How to Prepare for the Next Big Epidemiological Event

Amar P. Patel, DHSc, MS, NRPDirectorCenter for Innovative Learning

apatel@wakemed.org(919) 350-6296 @appatel

ObjectivesDiscuss the components of PPE required to effectively and safely manage a highly infectious patient.Develop a training program that meets the learners needs.Understand the correct use and limitations of PPE, and various types of educational methods.

Current State of AffairsTo understand where we should focus, we have to understand where the current issues are.Salmonella Oranienburg (Oct. 2016)E. coli O157:H7 (Sept. 2016)Listeria monacytogenes (Mar. 2016)Elizabethkingia anophelis (Jan. 2016)Salmonella Sandiego and Salmonella Poona (Oct. 2015)Zika (Oct. 2016)

Preparedness Begins...What is out there?Who will be impacted?How can it be transmitted?How do we protect ourselves?What are WE responsible for?Who makes those TOUGH decisions?

What should we prepare for?Influenza (1.4/100,000 deaths)Severe Acute Respiratory SyndromeMiddle East Respiratory SyndromeBronchitis or Pneumonia (15.9/100,000 deaths)Bronchiolitis (200,000 visits annually)RSV (2.1m visits 65)TB (2.96/100,000 cases, 66% foreign-born)Cancer (171.2/100,000 deaths)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374803/

What should we prepare for?Tick-Borne DiseasesEbola (~15,000 cases)ZikaStreptococcal diseaseHand, Foot, and Mouth DiseaseRabiesChickenpox or MeaslesSmallpox (October 26, 1977 - Somalia)

Lets Compare

Transmission

Why so much concern with Ebola?RNA virus (same as SARS or the common cold)1/5 teaspoon of blood:50,000-100,000 particles (untreated HIV)5-20M particles (untreated Hep C)10B particles (Ebola)Avg. 70% fatality rate. Cost for treatments $1,000/hour

What should we prepare for?Avian H5N1 or H1N1Anthrax (cutaneous, inhalation, and gastrointestinal)Dengue (390M infections/yr)Cholera (1.3-4M infections/yr or 21,000 -143,000 deaths)The reality is we can NEVER be prepared for everything. With proper training we can get prepared Just in Time (JIT).

Where should we focus?

http://outbreaks.globalincidentmap.com/

If we know the focus, we can better be prepared.

What ppe is best?What can I use?

PPEMore is better, right?What level of protection does this provide?What are some challenges with this outfit?

Chemical or Biological?

Is this comfortable?

Knowing your limits

So what is the difference?

Level DThe atmosphere contains no known hazard, andWork functions preclude splashes, immersion, or the potential for unexpected inhalation of or contact with hazardous levels of any chemicals.

Level CThe atmospheric contaminants, liquid splashes, or other direct contact will not adversely affect or be absorbed through any exposed skin;The types of air contaminants have been identified, concentrations measured, and an air-purifying respirator is available that can remove the contaminants; andAll criteria for the use of air-purifying respirators are met.

Level BThe type and atmospheric concentration of substances have been identified and require a high level of respiratory protection, but less skin protection.The atmosphere contains less than 19.5 percent oxygen; orThe presence of incompletely identified vapors or gases is indicated by a direct-reading organic vapor detection instrument, but vapors and gases are not suspected of containing high levels of chemicals harmful to skin or capable of being absorbed through the skin.Note: This involves atmospheres with IDLH concentrations of specific substances that present severe inhalation hazards and that do not represent a severe skin hazard; or that do not meet the criteria for use of air-purifying respirators.

Level AThe hazardous substance has been identified and requires the highest level of protection for skin, eyes, and the respiratory system based on either the measured (or potential for) high concentration of atmospheric vapors, gases, or particulates; or the site operations and work functions involve a high potential for splash, immersion, or exposure to unexpected vapors, gases, or particulates of materials that are harmful to skin or capable of being absorbed through the skin,Substances with a high degree of hazard to the skin are known or suspected to be present, and skin contact is possible; orOperations must be conducted in confined, poorly ventilated areas, and the absence of conditions requiring Level A have not yet been determined.

Head/Face ProtectionFull face shield

Mask with Eye Shield

Head/Face ProtectionGoggles

Glasses

Head/Face Protection

Body Protection

Aprons

Thermal Regulation

Hands

Hands on demo with Glow Germ Power & Lights37

Hands

Respiratory Protection

Respiratory Protection

Respiratory Protection

Feet

Feet

Boot Covers

Communication PlatformsRadiosCell phonesNo communication devices

Communication StylesGeneral talkingUrgent MessagingNon-urgent communication

How does the disease impact the PPE?More layers, more challenges in removing, more heat issues.Time, Distance, ShieldingVisual issuesDexterity and general functionalityIt can be dangerous!We often misjudge what we need to wear.

DonningEasy to do.Must follow a sequence of correct steps to ensure PPE can be safely removed.We get LAZY!Double check a MUST.Pre-medical screening.

Doffing#1 failure, hand hygiene.Process is generally fraught with errors.Routinely misjudge what is dirty and how we handle dirty PPE.Slower than donning.May involve an additional provider at or 1 level below.DeconPost-medical screening

PitfallsDont forget about taking care of each other!The training MUST focus on managing the patient & the providers. Provider related emergencies?Not enough practice time.

Poor hand hygiene!!!!

Lecture15% of the content is lecture-based. Designed to give you the foundational knowledge.Provide a general overview of the current state of things.Include your workflow and processes.Focus on overview and not the detailed work that will be covered in a practical skills session.A written exam?

Practical85% of the content must be hands-on. Application of the foundational knowledge is key!Include simulation.Start simplehand hygiene, putting on an N-95, removing PPEFollow checklists to ensure consistency in the practice and real-time implementation.Drill.drill.drill. This will SAVE YOUR LIFE.

OnlineDevelop a JIT program for those just in case situations.Consider moving lecture components into a pre-course work online program.Dont over utilize thisretention of key information can become challenging.Consider video-based modules and/or games.

At the end of the dayYou have to know your limitations and your peers.It takes more than 1 person to do this effectively.Just because it hasnt happened, doesnt mean it wont.

How to Prepare for the Next Big Epidemiological Event

Amar P. Patel, DHSc, MS, NRPDirectorCenter for Innovative Learning

apatel@wakemed.org(919) 350-6296 @appatel