1. Text 1 End Text 1 Learning Module 5: Surveillance and Infection Control

2. PREPARE module 5 Slide 2 Government Structure The Centers for Disease Control and Prevention (CDC) –Part of the Dept. of Health and Human Services (HHS) –Federal agency that protects the health and safety of people –Overall goal = to improve health through disease control and prevention, environmental health, and health promotion and education activities

3. PREPARE module 5 Slide 3 CDC’s Partners State and Local Health Departments DHS HHS - FDA - ATSDR - OER - HRSA - SAMHSA EPA DOD FBI DOE FEMA DOT NRC USDA

4. PREPARE module 5 Slide 4 CDC’s Roles Assess the health of people affected Advise state and local health depts. on rapid identification and characterization of potential biologic and chemical agents Train public health laboratories in identifying bioterrorist threat agents and efficiently communicating lab findings Assess the success of federal, state and local terrorism programs Provide training for healthcare professionals in BT and emergency preparedness

5. PREPARE module 5 Slide 5 CDC’s Roles Establish and maintain a registry of people exposed to or contaminated by radioactive materials Maintain the Strategic National Stockpile for pharmaceuticals, antidotes and other medical supplies and equipment Implement smallpox vaccination program and conducts evaluation and research on the anthrax vaccine Maintain a public response hotline Maintain CDC Emergency Preparedness and Response web site

6. PREPARE module 5 Slide 6 Ten Essential Services of Public Health 1. Monitor health status 2. Diagnose and investigate 3. Inform, educate and empower 4. Mobilize state and local partnerships 5. Develop policies and plans 6. Enforce laws and regulations

7. PREPARE module 5 Slide 7 Ten Essential Services of Public Health 7. Link people to personal health services 8. Assure a competent public and personal healthcare workforce 9. Evaluate personal and population-based health service programs 10. Participate in research

8. PREPARE module 5 Slide 8 Key Program Components An infection-control program should include: Surveillance Disease reporting Monitoring Standard and contact precautions Isolation procedures Outbreak control Immunizations Resident and employee health programs Recognize, track, and monitor infections

9. PREPARE module 5 Slide 9 The Cycle of Contagion Process See following slide for corresponding model: Disease-causing agent enters facility (between pathogen and susceptible person) Finds a host (resident, staff, object) (between susceptible person and colonization) Infects host and pathogen multiplies (between colonization and transmission mode) Infected host transmits to others (between pathogen and transmission)

10. PREPARE module 5 Slide 10 The Cycle of Contagion Model

11. PREPARE module 5 Slide 11 Infection Control Practices

12. PREPARE module 5 Slide 12 Infection Control Practices The infection control actions include: Barring the entry of a pathogen Quickly identifying contagious illness Protecting individuals against specific pathogens Treating individuals to eradicate colonization or infection Interrupting transmission through hygienic measures

13. PREPARE module 5 Slide 13 Establish a Surveillance System Determine infections you want to track Identify sources of data Follow-up on all transfers of residents to acute care facilities Adopt written definitions for diagnosing nosocomial infections Collect data on an on-going basis

14. PREPARE module 5 Slide 14 Analyze Surveillance Data Complete a surveillance worksheet Examine data for trends Keep accurate records of all infections Compute the rates of new infections Monitor facility's Quality Indicator UTI Evaluate data weekly to identify emerging trends Compile and share data and statistics Identify and address infection control issues

15. PREPARE module 5 Slide 15 Making Decisions Based on Surveillance Data The surveillance report should include: Summary of infections since last report Summary rates for all nosocomial infections that have occurred since the last report Simple graphs that show infection trends Counts and rates of infection as needed Your recommendations for actions to be taken

16. PREPARE module 5 Slide 16 Influenza Trends

17. PREPARE module 5 Slide 17 Healthcare Provider’s Role Report suspicions of intentional release to your local or state health department. Indications of intentional release of a biologic agent include: –Unusual temporal or geographic clustering of illness –Unusual age distribution for common diseases –A large number of cases of acute flaccid paralysis with prominent bulbar palsies, suggestive of a release of botulinum toxin

18. PREPARE module 5 Slide 18 Infection-Control Personnel The infection-control committee should ensure that the LTC community has access to current telephone numbers for notification of: –Appropriate area hospitals –State and local health departments –FBI field office –CDC Emergency Response office

19. PREPARE module 5 Slide 19 Bioterrorism Surveillance These steps should be in the Emergency Disaster Plan: Recognition and diagnosis by the medical director Communication of surveillance information to public health authorities Epidemiological analysis of the raw surveillance data Delivery of the appropriate medical treatment and public health measures

20. PREPARE module 5 Slide 20 Quarantine Quarantine can be defined as: The compulsory physical separation, including restriction of movement, of populations or groups of healthy people who have been potentially exposed to a contagious disease, or to efforts to segregate these persons within specified geographic areas

21. PREPARE module 5 Slide 21 Quarantine as a Last Resort Legal precedent for the use of quarantine Problems with its implementation Should only be used as a last resort Need to use least restrictive means available should be used Residents of long-term care more at- risk for disease transmission Quarantine does not equal treatment

22. PREPARE module 5 Slide 22 BT Events and Post-Mortem Care Use universal precautions Disaster Plan should: Identify safe location for holding remains. Include procedures for the safe handling, storage, and tacking of bodies. Include arrangements with the county and emergency management agency or other healthcare delivery systems. Include instructions for funeral directors into Disaster Plan.

23. Text 1 End Text 1 End of Module 5 Slides