ship sanitation training network no...

SHIP SANITATION TRAINING NETWORK SHIP SANITATION TRAINING NETWORK No 2007206No 2007206

Christos Hadjichristodoulou SHIPSAN TRAINET Project leader

European Commission – DG SANCO – Executive Agency for Health and Consumers

Workshop on Generic Preparedness (GP) projectsLuxemburg, 30 September – 1 October 2009

Content

• The SHIPSAN project • Objectives • Outcomes• The SHIPSAN manual • The Inspection Programme• The SHIPSAN Network• The partnership vision

The problem•• Ships vehicle of translational transmission of communicable diseShips vehicle of translational transmission of communicable diseasesases

•• Outbreaks and diseases on board Outbreaks and diseases on board –– reported mainly to countries with reported mainly to countries with specific surveillance systems: US VSP, Sydney, EUspecific surveillance systems: US VSP, Sydney, EU--EWGLI, DIVINETEWGLI, DIVINET

•• Increasing numbers of cruise ships & ferries in the EU: Increasing numbers of cruise ships & ferries in the EU: 66 cruise lines, 66 cruise lines, 192 cruise ships (192 cruise ships (119 in US)119 in US)

•• Modern cruise liners designed to carry many more passengers and Modern cruise liners designed to carry many more passengers and crew crew (some 5(some 5--10,000), 19 decks, 30 restaurants 10,000), 19 decks, 30 restaurants ……

•• Approximately 320 million ferry passengers passed through EUApproximately 320 million ferry passengers passed through EU--27 ports 27 ports in 2007 in 2007

•• Surveillance of disease associated with ships is inadequateSurveillance of disease associated with ships is inadequate

•• Quality of hygiene inspections of ships varies enormously betweeQuality of hygiene inspections of ships varies enormously between n countries in Europe, even within countries, even within the samecountries in Europe, even within countries, even within the same portport

When we first realized the problem

• In 2001, during the preparation for the 2004 Olympic games- Hellenic vessel sanitation program

2005 SHIPSAN2007 SHIPSAN TRAINET

The EU Shipsan Project

Started: December 2006Started: December 2006Ended: December 2008Ended: December 2008

Duration: 24 monthsDuration: 24 months

ASSESSING THE USEFULNESS OF AN EU SHIP SANITATION PROGRAMME ASSESSING THE USEFULNESS OF AN EU SHIP SANITATION PROGRAMME AND COORDINATED ACTION FOR THE CONTROL OF COMMUNICABLE AND COORDINATED ACTION FOR THE CONTROL OF COMMUNICABLE

DISEASES IN CRUISE SHIPS AND FERRIESDISEASES IN CRUISE SHIPS AND FERRIES

Project Leadership:Project Leadership: National School of Public Health, Athens, Greece

Scientific Coordination :Scientific Coordination : University of Thessaly, Larissa, Greece

DG Health & ConsumersPublic Health Programme

The SHIPSAN project

Addresses • passenger ships sailing in European waters • sea-going and inland navigation ships• on international and on national voyages

Involves • communicable diseases and outbreak reporting• response and management• hygiene inspections

Target group 3

MS officersPort Health Authorities

Target group 2

IndustryPassenger shipping

companies

Target group 1

Consumers(Passengers & crew members)

The SHIPSAN partnership

•

14 EU Member States – 9 associated – 5 collaborative

•

European Centre for Diseases Prevention and Control

•

World Health Organization

•

CDC Vessel Sanitation Program

•

International Maritime Organization

•

1 passenger ship company

•

2 passenger ship associations

•

1 professional association

The SHIPSAN added value

• Integrated surveillance of communicable diseases on passenger ships across the EU by the EU Port Health Authorities

• Communication and sharing of information among port health authorities

• Comparability of data across the EU

• Standardization and coordination of hygiene inspections

• Avoiding overlapping and duplication of inspections

• Cooperate with shipping industry to deal with communicable diseases on passenger ships when they occur

• Supporting and advice to shipping industry to apply European legislation on passenger ships

Health authorities

Regular training Guidance in emergencies

Standards to work with Harmonization of practices

Scientific and technical support

Shipping companies

Harmonization of standardsRecognition of certificates in all EU countries

Provide a “gold standard” certificateSupport in emergencies

A pool of expertise for consultation

Consumers Healthier voyages

Advice for behaviour

SHIPSAN

The benefits from SHIPSAN

What the SHIPSAN has achievedWithin 24 months

• The most appropriate programme for the EU (based on best practice, experience, existing programmes etc) was explored

• Communicable diseases and outbreaks have been published from 1970 to 2006 on passenger ships were collated and included in the State of the Art report

• The European passenger ships market was examined and EU MS were categorized in four groups

• A study was conducted in the 32 countries and 176 authorities

• Identified the EU, national and international legislation applied by competent authorities in the EU

• Description of the current situation in the EU based on study findings (needs, gaps)

• Established a partnership which consists of experts scientists and intends to expand it

• Developed synergies with ECDC, authorities, the industry, key stakeholders and internationally recognized programmes

CD – ROM including the study results

The SHIPSAN TRAINET projectThe SHIPSAN TRAINET project

Project Leadership : University of Thessaly, Larissa, Greece Scientific Coordination : National School of Public Health, Athens, Greece

DG HEALTH & CONSUMER PROTECTIONDG HEALTH & CONSUMER PROTECTION PUBLIC HEALTH PROGRAMPUBLIC HEALTH PROGRAM

DurationDuration : 30 months30 monthsStart : : November 2008 November 2008

End: : May 2011May 2011

• Priority Area Responding to health threats rapidly and in a co-ordinated manner (HT 2007)

• ActionHealth security and strategies relevant to communicable diseases control

THE PARTNERSHIP

•

18 EU Member States (11 associated, 7 collaborative)

•

4 Euromed

countries: Jordan, Lebanon, Israel, Turkey

•

European Centre for Diseases Control and Prevention

•

World Health Organization

•

CDC Vessel Sanitation Program

•

International Maritime Organization

•

5 passenger ship companies

•

2 passenger ship associations

•

1 professional association

Health Protection Surveillance Centre,

IRELAND

Health Protection Agency, Centre for Infections, UNITED

KINGDOM

Institute of Public Health of the Republic of Slovenia,

SLOVENIA

National Centre for Epidemiology,

SPAIN

Health Protection Inspectorate,

ESTONIA

Klaipeda Public Health Centre,

LITHUANIA

Hamburg Port Health Centre,

GERMANY

Consulting Management

Training (C.M.T.) Prooptiki Athens,

GREECE

Technological Institute of Athens, Faculty of Health

and Caring Professions,

GREECE

Medical university of Gdansk, Interfaculty

of Maritime and Tropical Medicine,

POLAND

Ministry of Health, Section of Communicable Diseases

Surveillance, BULGARIA

The National Board of Health and

Welfare, Unit of Communicable

Disease Prevention and Control, SWEDEN

Associated Partners 11 EU countries

17 Collaborating Partners

National Institute for Public Health and the Environment,

THE NETHERLANDS

Ministry of Health, Department of alert,

response and preparedness,

FRANCE

Ministry of Public

Health, BELGIUM

Ministry of Health, Medical and Public

Health Services,

CYPRUS

Ministry of Health - Department of

Preventive Hygiene,

ITALY

Ministry of Health, PORTUGAL

Centre of Environment,

FINLAND

Association of Port Health Authorities,

UNITED KINGDOM

Spanish Ministry of Health, SPAIN



FRANCE

Carnival Cruise Lines, UNITED

KINGDOM




FRANCE





FRANCE


Preventive Hygiene,

ITALY





FRANCE

Ministry of Public

Health, BELGIUM


Preventive Hygiene,

ITALY





FRANCE


THE NETHERLANDS

Ministry of Public

Health, BELGIUM


Preventive Hygiene,

ITALY





FRANCE


THE NETHERLANDS

Ministry of Public

Health, BELGIUM


Preventive Hygiene,

ITALY





FRANCE


FINLAND


THE NETHERLANDS

Ministry of Public

Health, BELGIUM


Preventive Hygiene,

ITALY





FRANCEANEK Ferries,

GREECE


FINLAND


THE NETHERLANDS

Ministry of Public

Health, BELGIUM


Preventive Hygiene,

ITALY





FRANCE

Hellenic Centre for Infectious Diseases Control, GREECE

Ministry of Health and Social Solidarity,

GREECE


FINLAND

Passenger Shipping Association,

UNITED KINGDOM


THE NETHERLANDS

Ministry of Public

Health, BELGIUM


Preventive Hygiene,

ITALY





FRANCE

Carnival Cruise Lines, UNITED

KINGDOM

MINOAN Lines,

GREECEBluestar Ferries,

Superfast Ferries, GREECE

Hellenic Association of passenger ships,

GREECE

9 country authorities, 5 associations, 5 shipping companies

European Centre for Diseases Control and Prevention World Health Organization CDC Vessel Sanitation Program International Maritime Organization

Turkey

Jordan

Israel

Lebanon

Aim

The overall aim of the project is to:

• Cover the gaps on a common European strategy and training network on:

• ship sanitation inspections• outbreak investigations• surveillance and control of communicable diseases

on board cruise ships and ferries.

• Facilitate the practical implementation of the International Health Regulations (IHR) (2005) in order to enhance the common EU policy on the prevention of communicable disease related to cruise ships and ferries.

General Objectives

22.. To To strengthen existing public strengthen existing public health structureshealth structures aiming to aiming to safeguard the public health and safeguard the public health and prevent the spread of prevent the spread of communicable diseases among communicable diseases among passengers and crew memberspassengers and crew members

1.1. To promote and establish the To promote and establish the integrated European ship integrated European ship sanitation strategysanitation strategy, based on , based on the SHIPSAN project results the SHIPSAN project results and on the requirements of and on the requirements of the IHR (2005). the IHR (2005).

3.3. To develop a To develop a European training European training networknetwork regarding ship sanitation regarding ship sanitation and control of communicable and control of communicable diseases on board cruise ships diseases on board cruise ships and ferries. and ferries.

4. 4. To produce an To produce an integrated training integrated training programmeprogramme among EU Member among EU Member States regarding ship sanitation, States regarding ship sanitation, outbreak management, surveillance outbreak management, surveillance and control of communicable and control of communicable diseases related to cruise ships and diseases related to cruise ships and ferries.ferries.

5. To provide 5. To provide training on the implementation of the IHR training on the implementation of the IHR (2005)(2005) on issues related to cruise ships and ferries.on issues related to cruise ships and ferries.

SHIPSAN TRAINET specific objectives

EU SHIPSAN

Integrated Programme

Manual for

surveillance and

inspections

Common standards Common training Communication

Training materialand

Training modulesfor

port health professionalsand

seafarers

Training network with

expert scientists

Web-based Port to port

Communication

MethodologyMethodology

State of the ArtSHIPSAN Outputs

Questionnaires

Working Group Meetings

Site Visits

CoordinationStrategy

EvaluationStrategy

DisseminationStrategy

Web Based NetworkPilot Testing

Communication Strategy

What the SHIPSAN TRAINET project will deliver

•

An integrated programme for communicable diseases control and passenger ship hygiene

•

Enhanced harmonised surveillance of disease and outbreak detection and investigation for the EU port health authorities

•

A manual for inspection

•

Training across Europe

•

A network for sharing surveillance data and inspection results

•

Technical support upon request

Timeline for main deliverablesNov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

2008 2009 2010 2011

Manual

Training material

TM1 TM2 TM3 TM4 TM5

6 months pilot network

Project Handbook

State of the Art report

Communication plan

Dissemination & Exploitation plan

Web site

Evaluation plan

Surveillance data

Inspection data

Contact detailsport health authorities

inspectors shipping companies

Corrective action data

Outbreak detection data

Ship registry data

SHIPSAN COMMUNICATION

NETWORK

The SHIPSAN NETWORKThe SHIPSAN NETWORK

SHIPSAN communication network

Objectives

• To create a communications system that can improve consumers (passengers and crew) protection through:– implementation of the EU Port Health Authorities surveillance and

response system (using web based standardized diseases reporting forms for passenger ships)

– facilitating the exchange of information between ports during outbreak investigation

– sharing of information on hygiene inspections

– share epidemiological information among professional groups, competent authorities, and international organizations in a standardized and confidential way

– creating an alert system to ensure that outbreaks and other public health events can be investigated and controlled in a timely manner without over reaction

– facilitating communication by creating registries including contact details for ships, Port Health Authorities and inspectors

Communication Needs

Databases handled by the SHIPSAN Communication Network

Competent Authorities

Industry

Contact details of portsExample: Ports of Italy

Network web based form

Ship

Port Health Authority

National Health

Authority

NFP

ECDC

EWRS

WHO

DG SANCO

SHIPSANWeb based tool

SHIPSAN

Secretariat

Access to SHIPSAN Web based tool

PHA will inspect /

contact ship

Port Health Authority

National Public Health

Authority

National Surveillance

System

International Surveillance

System

Alert generation by national or international surveillance

SHIPSAN

SecretariatIs there an alert?

If no

Trigger alertor

Confirm noalert

PHA alert form

SHIPSAN Web based tool

OutbreakInitial report

(when event/outbreak comes to light)

Case initial report(when a case comes to light)

OutbreakUpdate report

(not less than 4hrs before arriving to the next port of call)

OutbreakUpdate report

(before each port-of-call)

Case/Outbreak final report

Ship

1

2

3

4

5

Case / Outbreak / alert route

SHIPSAN web based tool

PHA

Notification of National or International Surveillance which

needs alert status

Is alert status necessary?

Alert notified

UpdatePHA inspects or checks

progressPHA notifies next port -of-call (if it does not have access to SHIPSAN web based tool)

UpdatePHA inspects or checks

progressPHA notifies next port -of-call (if it does not have access to SHIPSAN web based tool)

PHA Alert (final)Closing the alert

Triggers activeincident status

Yes

No

Active status closedNo further

communication to PHAs

Alert next port-of-call

Recommendations of SHIPSAN on surveillance and response

Integrated surveillance system

Specific outbreak definitions

Specific guidelines for prevention and management of GI diseases (Norovirus etc.)

General guidelines on outbreak management

SHIPSAN reporting forms

1. Case/Outbreak report form2. Routine surveillance form 3. Maritime Declaration of Health

4. Ship registry form5. Health port registry form 6. Inspector registry form7. SHIPSAN inspection 8. Port Health Authority Alert form9. Network reporting form

They are completed by the ship

They are completed by Port Health Authorities or

collected by LOYD’s

Surveillance section of the Manual

Pilot testing of the Network and the Surveillance System

The following countries have agreed to participate:

Two ferries industries in Greece, two big and one small companies from cruise industry will participate voluntary.

In the second phase two more countries, Turkey and Italy, might be added.

Greece UnitedKingdom France Netherlands

Germany Spain Poland Estonia

Recommendation for events/outbreaks management coordination

Initial event/outbreak

alert

Next port-of-call

Provide update alert report

Next port-of-call

Final event/outbreak

alert report

CoordinatingCentre

Support

SubmitCommunicable Disease Routine Surveillance

Reporting Form

SubmitCase/Event/Outbreak

Reporting Form

ViewAnalyze

Choose format of• Archives• Cases• Events• Outbreaks• Syndromes

Passenger ships web based communication tool

Viewfor ship or for port

Port Health Authorities web based communication tool

Create alert & communicate outbreak

management data

Registries

Submitinspection reports

Exchange epidemiological

information

View current events

View archives

Cases/events/outbreaks

Inspection reports

Alerts

Draft inspection report

Final inspection report

Epidemiological information

Ferries & Cruise ships

Port Health Authorities

Inspectors

Ship companies

Other contacts (European, international)

SHIPSAN TRAINET Inspection programme

components

SHIPSAN Databases

& Reports

Inspectors inCompetent authorities

Manual for inspections

Communication network

Manual for inspections

Scope

of the SHIPSAN Manual

Description of standards for passenger ships in the EU:

• Communicable diseases reporting requirements

• Hygiene standards

• Administrative issues

• Outbreak management guidelines

• Operational guidelines

Target audience for the final Manual

Scientific community/ Public

National and regional authorities of EU Member States• surveillance • inspections

Port health authorities –Network participants

Shipping industry

Hygiene inspections

SHIPSAN Manual

Food safety

Potable water safety

Swimming Pools

Pest management

Waste management

Housekeeping and facilities

Hazardous substances

AimConsumers Protection

SHIPSAN Manual references

Administrative issues Standards Specific

for ships

Food safety:EU Directives and National

Catering GuidesYes

Waste

management: EU Directive

& IMO conventions Yes

Potable water safety:EU Directive & WHO guidelines

for Water Safety PlansNo

Pest

management:

EU Directive

& IMO

recommendationNo

Hazardous

and/or

inedible

substances:EU Directive

& WHO guidelines No

Housekeeping

and

facilities: No

EU legislation ‐

Recreational

water

safety: No

EU legislation ‐

Manual layout

Port health authorities

The SHIPSAN TRAINET inspection network DATABASE

future development

Passenger shipping companiesSubmit an inspection report

Inspection reports history

Targeting a ship for inspection Submit corrective actions

Cruise ships and ferries

companies directory

Ferries and Cruise ships directory

Port directoryPort Health Authorities Contact detailsInspectors

Administrative issuesInspectors

working in competent authorities of MS

Continuing

professional

development

Trained and

certified in

common

standards

Using a

common EU

Manual for

inspections

Exchange data,

information,

knowledge

through a web‐

based database

Communicate

frequently

Competent authorised officers who have undertaken training should conduct the inspectionsSelection criteria for the inspectors will be defined

StandardisationStandardisationof inspectionsof inspections

Training Frequent communication Written inspection procedures Check list and scoring during inspections Statistical analysis of inspection resultsAuditing of personnel inspection activities

Administrative issuesInspectionsInspections

• Different inspections categories • Frequency of inspections •• Corrective action Corrective action •• Publication of inspection resultsPublication of inspection results•• Fees Fees •• Revision and amendmentsRevision and amendments

Inspection Check list

Instructions to inspectors

Scheme for Inspection Scores

Pilot training modules•

2 train the trainers modules

•

2 training modules for health professionals

•

2 training modules for cruise ships crew members

•

1 training module for ferry crew members

17

trainees

for

each training module 5 days

each training module

Training networkThe partnership will initially determine:

Criteria for trainers

Conditions for membership in the training network

The criteria and the membership conditions will be validated by the steering

committee

The partnership will

seek for experts:

•

An announcement

will be published in SHIPSAN TRAINET website & Eurosurveillance

•

Experts from international and other organizations will be invited to apply

‐

WHO

‐

IMO

‐

CDC‐VSP

‐

ECDC

Working group meeting

•

To select the trainers

•

A checklist will be internally used to cross‐check the trainers’

qualifications with

the selection criteria and the membership conditions

SHIPSAN Partnership strategic plan

Strategic aims

1.

Work to secure political commitment and support

2.

Implementation of a plan for improved communications with stakeholders’

and

the general public

3.

Engagement of qualified best experts for different core activities

4.

Development of trust based relations with collaborators and stakeholders

5.

Establishment of a virtual reference centre for providing training, advice and

guidance

6.

Contribution to scientific knowledge of public health on passenger ships

7.

Provision of a “State of the Art”

programme suggesting a holistic approach to the

public health problem

8.

Development of the means for long‐term funding

The SHIPSAN project partnership vision

“All travellers on passenger ships sailing in European waters

will be protected from communicable diseases through the

implementation of coordinated evidence based actions

taken by European and international authorities, competent

port health authorities of the European countries, shipping

industries and travellers”.

ship sanitation training network no...

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