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COVID-19: Pandemics and Infectious Disease Exposure Prevention: Removing the Perceived Safety Enigma

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COVID-19: Pandemics and Infectious Disease Exposure Prevention: Removing the Perceived Safety Enigma COVID-19: Pandemics and Infectious Disease Exposure Prevention: Removing the Perceived Safety Enigma Cory Worden, Doctoral Candidate, MS, CSHM, CSP, CHSP, ARM, REM, CESCO Sponsored by: ASSP Healthcare and Public Sector practice specialties Agenda Overview § Introductions § The Safety Improvement Cycle § Contamination Control § Operationalization § What to Do (when everything changes) § Lessons Learned (so far) and Future Applications § ASSP Community Updates 2 The Safety Improvement Cycle § Hazard Analysis § Hazard Controls § Communication § Leading Indicators § Lagging Indicators § Investigations 3 Hazard Analysis § Hazard Identification § Infectious Disease Exposure § COVID-19 § Droplets / Surface contamination § Air-transmitted particles § Risk Assessment § At-risk - Everyone § High-risk - Those interacting with the public § Higher-risk - Those in proximity to known potentially infectious persons 4 Hazard Controls § Hierarchy of Controls § Hazard Elimination § Hazard Substitution § Engineering Controls § Administrative Controls § Personal Protective Equipment (PPE) § Situational Awareness 5 Hazard Controls § Hazard Elimination § Quarantine § Isolation § Telecommute § Reschedule § Hazard Substitution § COVID-19 serves no purpose – we want it to go away § Vaccine is not yet available 6 Hazard Controls § Hazard Elimination – preventing unnecessary congregations All photos by/from Maralee Sartain 7 Hazard Controls § Engineering Controls § Separate areas § Physical separation § Barriers § Negative pressure / ventilation § Administrative Controls § Social distancing § Hand hygiene § Temperature checks § Face masks § Disinfection/decontamination (surface life) 8 Hazard Controls § Engineering Controls – Barriers 9 Hazard Controls § Engineering Controls – Physical separation 10 Hazard Controls § Administrative Controls – Social Distancing 11 Hazard Controls § Administrative Controls – Social Distancing 12 Hazard Controls § Administrative Controls – Face Mask use 13 Hazard Controls § Administrative Controls – Social Distancing plus Face Mask use 14 Hazard Controls § Personal Protective Equipment (PPE) § Gloves § Gown/Clothing Covers § Face Shield § Eye Protection § Respirator § Particulate respirator § N95 § Powered Air Purifying Respirator (PAPR) § Air Purifying Respirator (elastomeric) 15 Hazard Controls § Respiratory Protection Program (29 CFR 1910.134) § Hazard Analysis / Respirator Selection § Medical Evaluation (Medical Questionnaire) § Training § Fit Testing § Readiness (facial hair restrictions, respirator availability and more) 16 Hazard Controls § PPE – Respiratory Protection & Fit Testing 17 Hazard Controls § PPE Use 18 Hazard Controls § Situational Awareness § Dangerous States of Mind (Wilson & Higbee, 2012) § Rushing § Fatigue § Frustration § Complacency / Distractions § OODA Loop (Boyd, 1976) § Observe § Orient § Decide § Act 19 Colonel Boyd’s OODA Loop Observe Orient Decide Act Treat Patient – Be careful! Patient is Treat Patient– Be infectious careful! Norms Occ Training Find PPE / Protect Follow Disease Expectations Yourself Procedures or HIP Hazard Risk Patient Need hazard control Need equipment, need assistance symptoms or assistance Need hazard control or assistance Reassess situation Contamination Control § Cold Zone – donning PPE, eating/drinking, uncontaminated § Hot Zone – contaminated § Warm Zone – doffing PPE, transitional area § Contamination Control Line – delineates contaminated from uncontaminated areas 21 Hazard - isolated/cordoned – nothing contaminated leaves this area Contamination Control Area – decontamination Hot line to egress hazard area (doffing area) Warm Entry Control Point – direct exposure to hazard Contamination Control Line – separates clean and No access without contaminated areas – do not cross until Personal Protection and need to access (donning area) decontaminated less it becomes a secondary hazard On-Scene Control Point – staging area and safe communication area 1.Identify indicators of hazard 2. Personal protection / Secure hazard 3. Decontaminate anything contaminated prior to indicator identification 4. ICS allows for tactical response to hazard while supported by structure out of tactical area Testing Operation 23 Operationalization § Continual cycle of: § Planning • What to do and how to do it § Preparedness • Being ready to respond § Response • Meeting needs of the situation § Recovery • After-action review • Lessons learned • Transition back into Planning phase 24 Hazards: Occupational Disease, BBP, Needlestick/Sharps, Bodily Fluid, Patient Handling Plan, Policies Fit Testing Identification Secure hazard/ Extended tactical AAR and Procedures of Indicator Initial area decon Response / Decontaminate PPE Distribution ICS support Training Don PPE personnel and Inventory Designate and response and area operationalize CCL, CCA, ECP, and OSCP IfIf egressegress notnot possiblepossible Proactive Reactive (Initial Response) Reactive (Evasive Response) What to do (when everything changes) Communication, Indicators and Investigations 26 Challenges § COVID 19 creates multiple moving hot zones that replicate into more hot zones The Tuberculosis Comparison 28 29 Challenges § PPE § Stockpiles and Extensions § Shortages and Emergency Use Authorizations § Reusable vs Disposable vs Disinfection § Donations § Disinfectants § Will it neutralize the virus? • EPA listing • Active ingredients • Minimum concentrations Challenges § Regular Trash vs Hazardous Waste vs Regulated Medical Waste § Risk groups § Common work areas § Vehicles § HIPAA / Americans with Disabilities Act § Tertiary hazards 31 Challenges § National Incident Management System and the Incident Command System § Multi-agency responses § Personnel constraints § Volunteers 32 Challenges § Insurance – Workers’ Compensation 50 Statutes § Compensability = Adjustor’s Decision Not the Employer’s § Incident/Illness Review Process – Details Are Helpful § Post Injury Management Protocol § Advocacy = Psychological Impacts of CV-19 § Psychological First Aid for HCW’s = EAP + WC § PRESUMPTION LAWS = CA, IL, KY, MN, MO, ND, § MN = police officers, fire fighters, paramedics, nurses in direct care, state correctional officers, jail security, EMT, daycare providers of HCW’s 33 Lessons Learned and Future Applications 34 Lessons Learned § Algorithms § Redundancy § Constant change Resources § Continual Improvement Cycle § Safety Decision Making Process § Healthbeat series on Disease Exposure Prevention 36 Future Applications § What’s happening now has the potential to positively affect and reduce future exposure prevention to: § Influenza § Tuberculosis § Meningitis § And countless other infectious diseases 37 High Reliability Principles Reluctance to Simplify Sensitivity to Operations Deference to Expertise Commitment to Resilience Preoccupation with Failure 39 ASSP Communities Updates Healthcare Practice Specialty § Website § Upcoming webinars § Needlestick and Sharps Injury Prevention § USP 800 / Hazardous Drugs § Upcoming initiatives § Conferences and presentations § Publications § Communication § Advisory Board opportunities § Nominations 41 Public Sector Practice Specialty § PSPS ASSP Home Page Administrator Brandon Hody § PSPS Community M.S., CSP, CHSP § Consider joining the PSPS advisory committee or § Join our Volunteer List to Assistant Administrator receive email updates Steven Guillory regarding professional M.S., CSP, REM development activities! 42.
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