Project Leader Dr. Giuseppe Ippolito (INMI) Project Advisor 27-28 May 2005 Rome EU Public Health Programme Project Leader Dr. Giuseppe Ippolito (INMI) Project Advisor (Emanuele Nicastri) Project Coordinator (Andrea Stoler) Project Secretary (Ramona Iacovino)

of Infectious Diseases EUNID EUropean Network of Infectious Diseases EUNID is an European network dedicated to improving co-ordination, communication and resource sharing between isolation facilities and the health professionals who work in them.

EUNID Network: 16 Member states Possibility: Member States 2004 and the 4 candidate countries FIN S EE Current members DK IRL UK NL D B L F A I P E EL

EUNID is expected to result in an improved capacity within Europe to respond rapidly and in a co-ordinated fashion to public health threats due to emerging or re-emerging infections or to a deliberate release of biological agents

Work packages HIU infection control: inventory, definitions, precautions – Rome, 2005 Operation guidelines- Management of highly infectious diseases – London 2006 Outbreak Response guidelines and assistance(lists)- Stockholm- 2007 Core curriculum and teaching modules Website and dissemination of information EUNID network project coordination

HIU infection control: inventory, definitions, precautions. Rome 2005 Definition and specification of highly infectious diseases including criteria for patient admission. Consensus definitions and list of diseases in association with infection control precautions Criteria for admitting patients Definition of minimum requirements for isolation facilities in Europe technological (negative pressure room) infection control precautions staff intensive care needs medical equipment other ideas Good practices of infection control precautions including personnel protective equipment consensus PPE requirement

Operation guidelines- Management of highly infectious diseases – London 2006 Archiving of existing national guidelines on isolation and management of patients with highly infectious diseases Language website Consensus management guidelines including medical procedures Another questionnaire- operational protocols Topics includes diagnosis to hospital admission from admission to HIU transport post-mortem specific medical procedures others What are the criticial issues in the management What medical procedures should be included Other issues- suspicion to confirmation. What is necessary

Outbreak Response guidelines and assistance Stockholm 2007 Outbreak Response management guidelines and list of experts Recommendations on surge capacity management communication interactions with other public health agencies and networks Other aspects Lists experts in the management of highly infectious diseases diagnostic laboratories surveillance networks other information important in an outbreak response

Core curriculum and teaching modules What education and training modules are necessary for disease management Safety of health care workers and other patients Safety in managing patients with highly infectious diseases Psychological aspects patient and HCW

Website and dissemination of information List of members List of objectives Annual reports Inventory and statistics Future questionnaires Current National Guidelines Future consensus Guidelines for management Future consensus Guidelines for surge capacity Core curriculum

HIU infection control: inventory, definitions, precautions. Rome 2005 Definition and specification of highly infectious diseases including criteria for patient admission. Good practices of infection control precautions including personnel protective equipment Definition of minimum requirements for isolation facilities in Europe

the basis for a functional inventory and network. HOW?????   Welcome to the EUNID network. This is the first of several questionnaires to be handed out to EUNID participants. The aims of this initial questionnaire are to evaluate what the current situation and numbers of high isolation units (HIU) and health care workers (HCW) involved in the management of highly infectious diseases are. One of the primary objectives of EUNID is to create and maintain a complete and accurate inventory of the above. Please remember only valid and accurate data will be useful in creating the basis for a functional inventory and network. EUNID EUropean Network of Infectious Diseases As of 24 May 2005 11 completed questionnaires Now we have ….

Morning session: some consensus of definitions HIU infection control: inventory, definitions, precautions A2 & A3. Definition and specification of highly infectious diseases including criteria for patient admission. Concise definition and list of diseases in association with infection control precautions Criteria for admitting patients Pose a very high concern because of their potential ease of dissemination or transmission and high morbidity and mortality Are these diseases considered highly infectious? Morning session: some consensus of definitions

Inventory of isolation facilities and the personnel who work in them B1. Total Current Numbers of hospitals and hospital beds in your country Data from 11countries Negative pressure (  6 air changes per hour) + anteroom direct connection with lab area (HIU) Negative pressure (  6 or not defined air changes per hour) Negative pressure ( 6 air changes per hour) (HIU without lab) ( 6 or not defined air changes per hour) ( 6 air changes per hour) ( 6 or not defined air changes per hour Current Hospital 20 3 53 54 65# 4 Planned Hospital* 5 Hospital Beds** 23 (10)§ 300(80) § 117 1167 *Planned hospitals are those currently under construction with estimated opening dates before 12/31/2005 **Hospital beds are the total number of beds with the characteristics from all hospitals # May have anterooms (62, I, data needs to be clarifies) +planned-New ER at Spallanzani

The current number of beds in high isolation units with or without lab is 444 in 9 countries

Inventory of …….. and the personnel who work in them Total admissions requiring high isolation in 2003 Number of skilled* physicians Number of skilled* nurses Number of skilled* therapists (respiratory, etc ) Number of skilled* technicians (radiology, etc ) Number of skilled* Laboratory technicians Number of skilled* housekeeping staff Austria - Denmark 42 33 65 Estonia 12 18 2 5 17 Finland 13 6 15 3 1 Germany 4 7 22 Greece Italy 25* 13(108) 45(370) 8 8(15) 12(68) Luxembourg 23 98 Netherlands 16 Sweden 80 45 UK 20 30 11

Inventory of …….. and the personnel who work in them Total admissions requiring high isolation in 2003 Number of skilled* physicians Number of skilled* nurses Number of skilled* therapists (respiratory, etc ) Number of skilled* technicians (radiology, etc ) Number of skilled* Laboratory technicians Number of skilled* housekeeping staff Austria - Denmark 42 33 65 0- Estonia 12 18 2 5 17 Finland 13 6 15 3 1 Germany 4 7 22 Greece Italy 25* 13(108) 45(370) 8 8(15) 12(68) Luxembourg 23 98 Netherlands 16 Sweden 80 45 UK 20 30 11

Inventory of …….. and the personnel who work in them Total admissions requiring high isolation in 2003 Number of skilled* physicians Number of skilled* nurses Number of skilled* therapists (respiratory, etc ) Number of skilled* technicians (radiology, etc ) Number of skilled* Laboratory technicians Number of skilled* housekeeping staff Austria - Denmark 42 33 65 Estonia 12 18 2 5 17 Finland 13 6 15 3 1 Germany 4 7 22 Greece Italy 25* 13(108) 45(370) 8 8(15) 12(68) Luxembourg 23 98 Netherlands 16 Sweden 80 45 UK 20 30 11

Inventory of …….. and the personnel who work in them Total admissions requiring high isolation in 2003 Number of skilled* physicians Number of skilled* nurses Number of skilled* therapists (respiratory, etc ) Number of skilled* technicians (radiology, etc ) Number of skilled* Laboratory technicians Number of skilled* housekeeping staff Austria - Denmark 42 33 65 Estonia 12 18 2 5 17 Finland 13 6 15 3 1 Germany 4 7 22 Greece Italy 25* 13(108) 45(370) 8 8(15) 12(68) Luxembourg 23 98 Netherlands 16 Sweden 80 45 UK 20 30 11 total 91 140 394 27 93 39

Iride: inventory of resources for ID in Europe General inventory In 1997 an Inventory of resources for controlling communicable diseases was carried out in 15 EU Member States and Norway and Switzerland under a contract awarded by EC-DG V to the Italian ISS Lack of subsequent updates

Iride: inventory of resources for ID in Europe/2 In 2000 the EU DG SANCO supported the project Expanded Inventory of resources on Infectious Diseases Control in 31 European countries Software and web-site are developed by CINECA, a non profit Consortium of 15 Italian Universities

Highly contagious serious infections 10 countries have at least one hospital with specific experience or training in the management of patients with highly contagious serious infections. 13 countries one or more hospitals are specially designated to admit such patients Countries lacking specialised centres (2). Surge capacity to care for > 1 patient: max. 24 patients; overall 75 among the IRIDE countries. A total of 18 physicians have been specially trained in the management of these patients. (EUNID , 140)

B2. How are patients handled when there are no HIU facilities ? Call support agencies for assistance Specify agency Transfer to another facility in same country Transfer to facility in another country Isolate patients without negative pressure Isolate patients without negative pressure and evacuate the floor Isolate patient in room with portable negative pressure apparatus Isolate patient in portable negative pressure apparatus and evacuate the floor Austria 1 Our own unit Denmark Estonia Finland 3 2 National Public Health Institute and Helskini Hospital Germany Greece Italy Luxembourg Netherlands Sweden UK

Total= 58

Problems Accuracy of numbers Obtaining data from all the facilities in a country Understanding what information is being asked for Silly computer errors Complicated answers

Referral and National Guidelines* * In most cases, they are CDC, WHO, HPA * use their own as referral guidelines + is not considered highly infectious

SMALLPOX Yes No Not marked 1 (A) 1 (D) 2 (D,S) 7 3 (D,S,DK) 6 2 (EL,I) Referral guidelines 8 3(S,l,DK) National guidelines 9 2(A,EE) Negative pressure 1 (A) 1 (D) > 6 air CPH 2 (D,S) HEPA 7 3 (D,S,DK) Contact Gloves- single 6 2 (EL,I) 3 (D,A,L) Gloves- double 3 (EL,I,L) 2 Impermeable gown 2 (DK,NL-Tyvek) Droplet Eye protection 2 (I,NK) 3 (D,A,S) Full face mask 3 (I,NK,EL-Hood) 4 Airborne 2 (D,A) FFP2 3 (NL, EE, FlN) 6 (D,UK) FFP3 1 3(D,UK,DK) Mask with HEPA filter 4 (A,DK,EL, EE) 3(D,UK,S)

TB Yes No Not marked 9 1 (A) 1 (D) 2 (D,S) 3 (D,S,DK) Referral guidelines 7 1(D) 3(DK,L,S)) National guidelines 8 3(A,DUK?) Negative pressure 9 1 (A) 1 (D) > 6 air CPH 2 (D,S) HEPA 3 (D,S,DK) Contact 5 (A,DK,UK,EL,EE) 4 Gloves- single 4 (EL,I) 3 (F-N/A,A,D) Gloves- double 1 (EL)/3 LATEX(A,EL,EE) 6 Impermeable gown 4 (A,EL,EE,I) 5 Droplet 4 (NL,FIN,I,S) Eye protection 2 (EL,EE) 3 (D,A,S) Full face mask 1 (EL) Airborne 2 (DK,UK) 2 (D,A) FFP2 4 (I,L,EE, FlN) 2 FFP3 2 (I,NL) 3(D,L,DK) Mask with HEPA filter 3 (S,EE,EL)

VHF YES NO Not marked 2 (I, FIN) 3 (D, A,S) 3 (S-hood) Referral guidelines 8 3 (DK,L,S) National guidelines 9 2 (A,EE) Negative pressure 1 (A) > 6 air CHP 2 (A,S) HEPA 1 (DK) Contact * 11 Gloves-single 4 3 Gloves-double 5 2 Impermeable gown 7 2 (NL-Tyvek, DK) 2 (D-Tyvek, S) Droplet Eye protection 6 2 (I, FIN) 3 (D, A,S) Full face shield 4 (I,FIN,EL,UK) 3 (S-hood) Airborne 10 1 FFP2 FFP3 2 (DK,D-PPAR) Mask with HEPA filter 4 (A,S,EL,EE) * 8 use latex gloves

PULMONARY PLAGUE YES NO Not marked 10 2 (NL, EL) 2 1 (EL) 3(L,DK,NL) Referral guidelines 8 3 (DK,L,S) National guidelines 7 4 (A,DK,EE,S) Negative pressure 6 4(FIN,A,EL,I) 1(S) > 6 air CHP 5 1 HEPA 4 Contact 10 Gloves-single 2 (NL, EL) 2 Gloves-double 1 (EL) Impermeable gown 3(L,DK,NL) 2 (D,S) Droplet Eye protection 5 (I,DK,UK,EL,EE) 2 (L,NL) Full face shield Airborne 2(A) FFP2 2(NL, EE) 3 FFP3 3(NL, EE,UK) Mask with HEPA filter 2(EE,A)

PULMONARY ANTHRAX YES NO Not marked 5 1(FIN) 2 1 (EL) 3(L,DK,NK) Referral guidelines 8 3 (DK,L,S) National guidelines 7 4 (A,DK,EE,S) Negative pressure 3(DK,L,EE) 1(S) > 6 air CHP 2 (DK,L) HEPA 3(I,EE,L) 6 2((S,DK) Contact 5 Gloves-single 1(FIN) 2 Gloves-double 1 (EL) Impermeable gown 3(L,DK,NK) 2 (D,S) Droplet 1 Eye protection 5 (I,DK,UK,EL,EE) 2 (L,NK) 4 Full face shield Airborne 2(A) FFP2 2(NL, EE) 3 FFP3 3(NL, EE,UK) Mask with HEPA filter 2(EE,A)

Critical issues Infection control: suspicion versus overt disease Environmental protection and personal protection: the combination problem The balance between protection and the ability to perform patient care: Is there such a thing as over protection? PPE- proper education and training Expanded EU:different infectious disease prevalence Critical issues

Thank YOU for your participation.