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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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 completed questionnaires
Now we have ….

13. 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

14. 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

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

19. 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

20. 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

21. 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

22. 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

24. 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

25. 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

26. 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)

27. 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

28. Total= 58

30. 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

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

32. 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)

33. 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)

34. 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

35. 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)

36. 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)

37. 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

38. Thank YOU for your participation.