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Icar Pilot (Infection Control Assessment & Response) Executive Summary

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Icar Pilot (Infection Control Assessment & Response) Executive Summary ICAR PILOT (INFECTION CONTROL ASSESSMENT & RESPONSE) EXECUTIVE SUMMARY JUNE 2016 1 TABLE OF CONTENTS ICAR PILOT OVERVIEW…………………………………………………………………………………………….....................3 ASSESSMENT HOSPITAL PROCESS & FINDINGS……………………………………………………………4 FRONTLINE HOSPITAL PROCESS & FINDINGS…………………………………………………………..…..6 EMS INVENTORY…………………………………………………………………………………………………...8 CONCEPT OF OPERATIONS FOR HOSPITAL AREA COMMAND (RESOURCE COORDINATION)……9 PRIORITY GAPS AND STRATEGIES…………………………………………………………………………...10 APPENDICES………………………………………………………………………………………………………11 A: ASSESSMENT HOSPITAL PROCESS & TOOLS………………………………………………………….12 B: FRONTLINE HOSPITAL PROCESS & TOOLS…………………………………………………………….46 C: HOSPITAL RESOURCES…………………………………………………………………………………….71 D: RESOURCE COORDINATION PLAN……………………………………………………………………..143 2 ICAR PILOT OVERVIEW The Florida Department of Health (DOH) was awarded a grant from the Centers for Disease Control and Prevention (CDC) to implement an Infection Control Assessment and Response Program (ICAR). The ICAR program will be a part of the Florida Department of Health’s (DOH) Health Care-Associated Infection (HAI) Prevention Program. The Central Florida Disaster Medical Coalition (CFDMC) was chosen by DOH to participate in a one-year pilot (August 2015 to June 2016) under ICAR to assess Region 5’s healthcare system for its ability to manage highly infectious patients. The pilot includes four deliverables: Complete a minimum of six (6) on-site assessments with participating hospitals to evaluate the hospital’s capability to meet the eleven domains of CDC’s criteria for preparedness to manage patients with highly infectious disease for 5 days. Eight hospitals within the region participated in this component of the pilot. Hospitals were assigned an identifying code and reports will not include hospital names. CDC will use the information gained in this process to further build out the assessment hospital program. The policies, procedures, best practices and lessons learned will enable DOH to establish a health care facility assessment process that can be implemented statewide, and hospitals will be able to use these assessment processes to make improvements in their communicable disease preparedness efforts. Complete a minimum of twenty (20) on-site assessments with participating hospitals to evaluate the capability to meet requirements for a front-line hospital (capability to identify, isolate, inform and prepare for transport a patient suspected of having a highly infectious disease). The national goal is for all hospitals to meet front-line hospital criteria. A total of 24 hospitals participated in the frontline process. Establish and maintain an inventory of EMS agencies in RDSTF Region 5 with capability to transport person with or suspected of having a highly infectious disease. Develop a concept of operations for a coalition-wide hospital area command (the focus for this has transitioned to a regional resource coordination plan). The Coalition established a workgroup to manage each deliverable. 3 ASSESSMENT HOSPITAL PROCESS & FINDINGS The purpose of the assessment hospital site visits was to evaluate hospitals’ capability to manage patients with highly infectious disease for five days. The assessment used the CDC 11 Domains: Facility Infrastructure / Patient Rooms Patient Transportation Laboratory Staffing Training PPE Waste Management Worker Safety Environmental Services Clinical Management Operations Coordination The assessment hospital workgroup met and developed a process, tools and teams to conduct the assessment hospital site visits (see Appendix A). The team recruited hospitals by asking for volunteers. Hospitals were guaranteed anonymity via use of identifying codes. Another recruitment technique was to ensure that the process focused on learning vs. evaluation, with the goal to help hospitals make improvements in communicable disease preparedness efforts, identify gaps, and share best practices. Hospitals and team members were provided with tools/training on the process and criteria on December 14, 2015. CFDMC completed eight assessment hospital site visits in Orange, Volusia, Brevard and Martin Counties. The site visit teams included subject matter experts in emergency medical services (EMS), emergency management, infection control, epidemiology, and laboratory. A logistics call was held with each hospital prior to the site visit to walk through the process and answer any questions. The team met the day before each site visit to review emergency preparedness plans. The day-long site visit included a discussion of these plans, a walk-through of laboratory, patient care area, and waste management, and a PPE donning/doffing demonstration. At the end of the site visit, the team provided a debrief to the hospital. A summary report was provided to each hospital which included whether the hospital met the criteria within each domain, and strengths, opportunities and recommendations. A summary report of all site visits was provide to the Florida Department of Health and the CDC. Below are the regional strengths identified through the assessment hospital site visits: Comprehensive plans for managing highly infectious patients Worker safety plans / PPE Event management/Incident command plans Waste management plans Training 4 Below are the best practices identified during the assessment hospital site visits: Use of event management software Staff incentives for team membership Detailed clinical medicine and telemedicine plans Use of ghost schedule (a roster which lists when each volunteer is expected/scheduled to be ready for emergency duty, on short notice) Below are the regional opportunities identified during the assessment hospital site visits: Exercise / train a minimum of every six months to maintain proficiency Increase lab capacity to perform minimum CDC testing requirements (resources on criteria/training provided) Strategies to recruit/maintain appropriate staffing levels (Recommendations for Staffing resource provided) Flow/set-up checklists (Highly Infectious Patient Unit Flow resource example was provided to hospitals) Risk Assessment Have appropriate disinfectant soaked pads/chucks on both sides of the doorway 5 FRONTLINE HOSPITAL PROCESS & FINDINGS The purpose of the assessment hospital site visits was to evaluate hospitals’ capability to identify, isolate, inform and prepare for transport a patient suspected of having a highly infectious disease. The national goal is for all hospitals to meet front-line hospital criteria. The frontline hospital workgroup met and developed a process, tools and site visit teams to conduct the frontline hospital site visits, using CDC criteria for frontline hospitals and Florida specific guidance from the DOH. The team actively recruited all hospitals not participating in the assessment hospital site visit process. The major recruitment technique used was that at any moment, a patient with a highly infectious disease can present at the hospital’s emergency department, and this process will help the hospital be better prepared to handle a highly infectious patient. Hospitals were guaranteed anonymity through use of identifying codes and the focus was on learning vs. evaluation. Hospitals and site visit teams were provided two training opportunities (December 14, 2016 and February 10, 2016). The site visit teams included subject matter experts in EMS, infection control, epidemiology, and preparedness. CFDMC completed 24 frontline hospital site visits, across most counties within the region. Hospitals and site visit teams provided training/tools. A logistics call was held with each hospital prior to the site visit to walk through the process and answer any questions. The two hour site visits reviewed preparedness plans and walked through the route from patient arrival to isolation. At the end of the site visit, the team provided a debrief to the hospital. A summary report was provided to each hospital which included whether the hospital met the frontline hospital criteria and included strengths, opportunities and recommendations. A summary report of all site visits was provided to DOH. The hospitals who chose not to participate in either the assessment or frontline hospital process were asked to complete an electronic self-assessment against the frontline hospital criteria. Below are the regional strengths identified during the frontline hospital site visit process. Comprehensive plans have been developed for managing highly infectious patients Dedicated equipment has been identified PPE used exceeds minimal level There are comprehensive waste management plans Facilities have adequate staff and equipment Incident command system and event management capabilities are robust Occupational health plans are robust Below are best practices identified during the frontline hospital site visit process: Exterior screening prior to entrance with equipment and seating Quarterly drills/training Direct supervisor’s personal recruiting 6 Dedicated iPads for communication for room and patient family Web banner on intranet site for infectious diseases Donning and doffing posters Multidisciplinary team approach Checklists (room set-up, donning/doffing, screening web checklist) Event management software Below are opportunities identified during the frontline site visit process: Increase frequency of training / exercises (minimum of every six months) Family reunification/communication plan PPE donning/doffing demonstration posters Communications among
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