EUNID project: a 3-year-long story National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani  Rome – Italy EUNID project: a 3-year-long story Francesco M. Fusco Project Coordinator

The EUNID project EU contract No:2003207 European Network for Infectious Diseases A brief reminder: The European Network for Infectious Diseases (EUNID) is dedicated to improving collaboration and resource sharing between isolation facilities and the health professionals who work in them.

The EUNID project EU contract No:2003207 European Network for Infectious Diseases Main aims of EUNID: enhance co-operation and exchange of information on highly infectious diseases (HIDs) among ID clinicians, epidemiologists and public health experts; to enhance preparedness and response within Europe to health threats from HIDs.

The EUNID project EU contract No:2003207 European Network for Infectious Diseases Participating countries: Austria, Belgium, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and UK

EUNID consortium

Background: definition of Highly Infectious Diseases (HIDs) According to EUNID consortium, a highly infectious disease is: transmissible from person-to-person; causes life-threatening illness; presents a serious hazard in health care settings and in the community, requiring specific control measures.

First target: definition of HIDs According to EUNID consortium, the agents that satisfy the definition are: Viral haemorrhagic fevers (VHF) viruses; SARS Co-V; Multi- and Extensively- Drug Resistant M tuberculosis; Emerging highly pathogenic strains of influenza virus; Smallpox and other orthopox infections, excluding vaccinia virus; Other emerging highly pathogenic agents, including agents of deliberate release (eg pneumonic plague).

Specific objectives of the Project 1. To develop a part public-part private web site for : sharing information and resources within the network and disseminating guidance, training modules and other results reached by the network. State of the work: done

Specific objectives of the Project 2. To develop an archive of national guidelines on isolation and management of patients with HIDs from all the participating countries, and an archive of relevant international guidelines. State of the work: done Dissemination: on web-site, poster at ECCMID/ICC in Munich

Specific objectives of the Project 3. To share and document best practices and experiences within Europe of isolation procedures and of the management of patients with highly infectious diseases. State of the work: done Dissemination: on web-site

Exchange of data During the meetings, each country representative presented a short presentation about their isolation facilities, and about the policies for isolation in their own country

3° and final meeting, Rome, today! EUNID meetings London, April 7-8, 2006 Rome, May 27-28, 2005 3° and final meeting, Rome, today!

Specific objectives of the Project 4. To prepare an accurate and accessible inventory of highly secure isolation units and other isolation facilities (eg those with one or more rooms with anteroom and negative pressure) in participating countries. State of the work: almost done Dissemination: web-site, poster at IMED, Vienna, article in preparation

Inventory of Isolation Facilities in Europe What has already been done Inventory of Isolation Facilities in Europe Questionnaire collected data on: Number of hospitals and hospital beds provided with negative pressure and anteroom; Technical features of these beds (number of air changes per hour, direct connection with lab, way of air exhausting); Logistic features of these units; Number of beds provided with IC capabilities.

What has already been done European Network for Infectious Diseases Complete data from 12 countries; Partial data from 2 countries (France, Spain); Not confirmed data from 1 country (Portugal); No data from 1 country (Belgium).

67 rooms provided with negative pressure Country N° of hospital N° of hospital beds HIU+ BSL3/4 > 6cph < 6cph HIU HIU IC Austria Denmark 5 38 Estonia 1 15 Finland 10 66 19 France 17 67 rooms provided with negative pressure Germany 4 6 Greece 25 67 NA Ireland Italy 2 2 (10) 243 245 (PD) Luxembourg 7 Netherlands 4 (PD) Portugal 33 UK 12 50 3 Sweden 29 3 (2-IC) 2 (1- IC) 231 Total 151 14 11 491 317 291

Specific objectives of the Project 5. Definition of correct procedures for the donning and removal of PPE during care to a patient with suspected or confirmed HID State of the work: done Dissemination: web-site, oral presentation at IMED, Vienna

EUNID Agreement on PPE in HIUs For each PPE a proposal was shown for discussion with a rating strength of recommendation: R “recommended” Ch “to be Considered” but conferring “Higher protection” Cl “to be Considered” but conferring “Lower protection” D “discouraged” Both for standard condition and high risk procedures

Viral Haemorrhagic fevers Body protection single gloves double gloves Imperm. gown plastic apron Full body tyvek suit shoe covering surgical boots hair covering standard Cl R Ch high risk D Face protection Full face shield/mask Goggles eyeglasses with lateral shield Hood with face shield Safety glasses Standard R Cl D Ch High risk Respiratory protection Surgical mask FFP2 FFP3 Mask/PAPR with HEPA filter Standard D Cl R Ch High risk

Donning and Removal of PPE PPE must be worn before entering the patient room; a pre-defined sequence to remove PPE after their use has to be known by HCWs, who should be trained in removing PPE; the sequence depends on the PPE chosen; the HCW should be extremely careful in removing protection from the mucous membranes of the face with decontaminated hands, in order to prevent self-contamination with contaminated PPE or hands PPE should be removed in the anteroom, if present. If not, remove ensuring that neither persons or the environment get contaminated

Specific objectives of the Project 6. Definition of a core-curriculum for the infectious disease clinicians involved in the management of patients with HIDs, and development of training modules. State of the work: done Dissemination: web-site, poster at IMED, Vienna, article submitted

What has already been done European Network for Infectious Diseases Definition of a core-curriculum for the infectious disease clinicians involved in the management of patients with HIDs.

What has already been done European Network for Infectious Diseases Development of training modules.

Specific objectives of the Project 7. To define the technical specifications and personnel requirements for isolation facilities in Europe of differing levels of security State of the work: almost done Consensus to be reached today Dissemination: web-site, article in preparation

What has already been done European Network for Infectious Diseases Definition of requirements for High Isolation Units (HIUs): Role of HIUs; Logistic characteristics; Technical issues; Facilities and furniture.

Specific objectives of the Project 8. To identify criteria for admission of patients within an isolation facility, and to define types of isolation facility by level of security State of the work: ongoing Consensus to be reached today Dissemination: web-site, article in preparation

Specific objectives of the Project 9. To develop consensus-based guidelines for the management of HIDs, medical procedures and techniques. Procedures analysed: Intensive Care, bronchoscopy, gastroscopy, imaging exams (CT scan and RMI, Chest X rays and Ultrasound), renal dialysis and post-mortem examinations State of the work: ongoing Consensus to be reached today Dissemination: web-site, article in preparation

Specific objectives of the Project 10. To prepare an accurate, complete and accessible inventory of physicians and other health professionals in Europe with expertise in isolation techniques and in the management of highly infectious diseases (list of experts) State of the work: initial stage To be discussed today Dissemination: web-site

Specific objectives of the Project 11. To examine the feasibility of network input into international outbreak response resources within Europe, complementary to those developed by European Commission, WHO, and others, that would enhance European response capacity in the event of an outbreak of highly infectious disease within , or outside, the Community. State of the work: this deliverable is not more a priority because of establishment of E-CDC

3rd meeting Agenda - Morning 9,30 – 10,00: Current stage of the project and expectations of the meeting (F.M. Fusco) 10,00 – 10,15: XDR-TB: a new entry among HIDs. Original data from West and East Europe (E. Girardi) 10,15 – 10,30: Questions and Discussion 10,30 – 10,50: Administrative topics (R. Iacovino) 10,50 – 11,10: Presentations by some partners about their isolation facilities / Questions and Discussion 11,10 – 11,25: Coffee Break 11,30 – 13,00: Definition of Specifications for High Isolation Units (Session presented and conducted by Barbara Bannister and the Coordination Team. Extensive discussion among partners is required)

3rd meeting Agenda - Afternoon 14,00 – 16,30: Definition of safe procedures inside High Isolation Units, including criteria for patient’s admission and same specific medical procedures (Session presented by Philip W. Smith and conducted by Philippe Brouqui, including presentations by some partners on their internal procedures. Extensive discussion among partners is required) 16,30 – 16,45: Tea Break 16,45 – 17,30: Definition of a list of experts (definition of strategies, extensive discussion among partners is required) 17,30 – 17,45: From consensus to applicability: presentation of the European Network for Highly Infectious Diseases (F.M. Fusco) 17,45 – 18,30: Questions and Discussion / Conclusion of the meeting