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Health Establishments Preparation for Unusual Or Unexpected Cases Or Clusters of Severe Acute Respiratory Infection SARI

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Health Establishments Preparation for Unusual Or Unexpected Cases Or Clusters of Severe Acute Respiratory Infection SARI Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection (SARI) Version APRIL 2009 1 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI CONTENTS 1. Introduction 2. Purpose of the Course 3. General Objectives 4. Specific Objectives 5. Methodology Part I–Detection of and Response to Severe Acute Respiratory Infection (SARI) 6. General Information about Influenza 6.1. Seasonal Influenza 6.2. Influenza of animal origin 6.2.1 Swine Influenza 6.2.2 Avian Influenza 6.3. Pandemic Influenza 7. International Health Regulations 2005 (IHR-2005) 7.1. Necessary Basic Capacities for Surveillance and Response 7.2. IHR and the Risk of a Human Influenza Pandemic 7.3. Operational Aspects of IHR 7.4. Public Health Emergency of International Concern 8. Preparations for an Influenza Pandemic 9. Influenza Surveillance Version APRIL 2009 2 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI 9.1. Definition of ILI and SARI and Confirmed Case of Influenza 9.2. Enhanced Nationwide Surveillance 9.3. Importance of Hospital Surveillance 9.4. Reporting 10. Laboratory 10.1. Laboratory Tests for Diagnosis of Influenza 10.2. Sampling and Shipment to the Laboratory 11. Hospital Infection Control 11.1. ABC of Infection Control 11.2. Specific Orientations for SARI with Pandemic Potential 11.3. Practical Demonstration 12. Dealing with Cases 12.1. Triage 12.2. Evaluation of the Required Level of Care 12.3. Evaluation of the Availability of Medical Management Resources 12.4. Need for Referral and Transportation of Patients 12.5. Organization of the Healthcare Facility for Dealing with Cases 13. Vaccines and Antiviral Agents 13.1. Vaccines 13.2. Antiviral Agents Part II–Hospital Response to a Pandemic 14. Preparedness Plan and Hospital Response to an Emergency with Large Number of Cases of SARI Version APRIL 2009 3 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI 14.1. Introduction 14.2. Organization, Command and Coordination Structure 14.3. Ethical-Legal Aspects 14.4. Triage 14.5. Bed Management 14.6. Resources Management 14.7. Management of Excess Hospital Mortality 14.8. Occupational Health 15. Risk Communication for Healthcare Facilities 16. Annexes Annex 1 Seven strategic actions to guide application of IHR-2005 Annex 2 Epidemiological Surveillance Algorithm Annex 3 Formulas for Calculating the Proportions of Cases of SARI Annex 4 Forms for Weekly Compilation of SARI and Death by SARI Annex 5 Form for Reporting SARI–Generic Protocol for Influenza Surveillance Annex 6 Differential SARI Diagnostic for Laboratory Diagnosis Annex 7 Techniques for Taking Respiratory Tract Samples Annex 8 Packaging of Samples for Transportation Model form for monitoring healthcare workers for detection of diseases similar to flu Annex 9 and for health workers exposed to patients with unusual or unexpected SARI Annex 10 Triage Version APRIL 2009 4 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI 1. INTRODUCTION Emerging respiratory-transmitted diseases pose a substantial risk for humankind due to their very high potential for transmission. These diseases can produce high morbidity, and, in serious forms, show high rates of hospitalization and high case-fatality rates. It is important to emphasize that lack of previous immunity in the population to the new viruses leads to a high number of cases and to greater severity. This potential for severity requires that measures for patient care and control and prevention of new cases be put in place immediately. In the last century there have been three major pandemics: the first occurred in 1918 (type A/H1N1 influenza) and was responsible for the death of approximately 40 to 50 million people throughout the world, mainly young people; the second was in 1957 (type A/H2N2 influenza) and the third in 1968 (type A/H3N2 influenza), with approximately 2 and 1 million deaths throughout the world, respectively. (1) Currently, type A/H5N1 influenza virus has infected birds in more than 50 countries on three continents. This H5N1 strain has rarely infected people, but could easily mutate to a strain capable of infecting human beings. Cases in humans caused by this strain have shown high case-fatality, about 60%. It is not possible to determine if the next influenza pandemic will be caused by the H5N1 strain or by another strain of the influenza virus. Given this fact, world influenza surveillance is indispensable for detecting new strains of the virus as these appear, through sentinel surveillance of influenza-like illness (ILI) and of atypical clinical manifestations of syndromes of severe acute respiratory infection (SARI). (2) Due to the high risk that this situation poses for humankind, International Health Regulations (IHR-2005), in effect from 15 June 2007, require that any case of human influenza caused by a new viral subtype be reported immediately (within a period of 24 hours) to the World Health Organization (WHO). (3) Version APRIL 2009 5 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI This training module was developed by the Pan American Health Organization (PAHO) with the objective of providing professionals in healthcare facilities the necessary tools for rapid identification and proper management of cases with pandemic potential. This rapid identification will make it possible to set up the actions necessary for prevention and control of new cases. This training module is primarily directed to workers in public and private healthcare facilities, especially those that provide hospitalization services. This includes professionals that provide care as nurses, physicians, laboratory staff, and others. The course should also include medical coordinators and other managers, since it contains components aimed at management of health services. 2. PURPOSE OF THE COURSE Strengthen the capacity of the health services to detect and respond rapidly to one or more cases of unusual or unexpected severe acute respiratory infection (SARI), including human influenza. 3. GENERAL OBJECTIVES Part I Prepare health professionals for detection and early management of cases or clusters of SARI at the level of healthcare facilities. This will permit the early identification of emerging agents and their investigation and control on a timely basis. Part II Provide tools for improvement of the response by healthcare facilities for a situation of cases of SARI that exceed theirs capacity, in order to achieve adequate and efficient care. Version APRIL 2009 6 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI 4. SPECIFIC OBJECTIVES PART I: Detection and Management of SARI That the personnel of every healthcare facility be capable of detecting on a timely basis: • Cases of unusual or unexpected SARI. • Cluster of SARI • Excess cases of SARI. That the personnel of every healthcare facility be capable of responding on a timely basis to: • Carry out treatment of cases and apply infection control standards. • Report the cases immediately to sub-national and/or national authorities for the mobilization of rapid response teams according to the mechanisms set up in the country. • Collect samples from these cases and send them to the laboratory in an adequate and timely way. • Know and comply with the International Health Regulations 2005 and enhance the necessary basic skills for the tasks of surveillance and response. PART II: Hospital Response to a Pandemic • Train the health team in the fundamental measures for treatment response by the healthcare facilities to emergence of Influenza-Like Illness (ILI) or SARI. • Provide the practical tools for organization of treatment response to the increase in expected demand from patients. • Know the measures related to organization of services that contribute to efficient management of cases and utilization of the resources of the healthcare facilities. Version APRIL 2009 7 Health Establishments Preparation for Unusual or Unexpected Cases or Clusters of Severe Acute Respiratory Infection SARI 5. METHODOLOGY The content of the course is based on the Generic Protocol for Surveillance of Influenza developed by PAHO and Centers for Disease Control and Prevention of the United States (CDC) (4), on WHO guides, and on recent scientific articles on the subject. The course, designed for groups of 40 people, will be given in short presentations of 20 to 30 minutes, followed by a period of active and passive discussion. The material presented will be supplemented with exercises, case studies, practical demonstrations, and simulations where participants will act out a pandemic influenza situation, in groups (5 to 8 people). It is important to emphasize that the course is aimed at healthcare workers who treat patients with manifestations of unusual or unexpected SARI in healthcare facilities with hospitalization service. References: 1. WHO Ten things you need to know about pandemic influenza. http://www.who.int/csr/disease/influenza/pandemic10things/en/ 2. World Health Organization (WHO), Interim Protocol:Rapid operations to contain the initial
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