1. 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

2. 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.

3. 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.

4. 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

5. EUNID consortium

6. 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.

7. 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).

8. 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

10. 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

13. 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

14. 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

15. 3° and final meeting, Rome, today!
EUNID meetings
London, April 7-8, 2006
Rome, May 27-28, 2005
3° and final meeting, Rome, today!

17. 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

18. 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.

19. 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).

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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.

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

28. 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

29. 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.

30. 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

31. 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

32. 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

33. 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

34. 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)

35. 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