Outbreak preparedness & control PPHSN Guidelines For the Preparedness, Surveillance And Response To Severe Acute Respiratory Syndrome (SARS) in Pacific Island Countries And Territories Last update PREPAREDNESS - INITIAL ACTION AND RESPONSIBILITIES (Updated 30.04.03) Staff responsibilities for the various actions At the ministry of health level, a task force should be in place and meeting regularly. This task force should include the EpiNet team (or local equivalent) and with one national focal point, an expert committee and a surveillance unit. A hotline, or at least local contact points, should be established.
For the purpose of proper SARS control in hospital environment, this task force and expert committee should include a member experienced in hospital infection control, and who can advise on isolation and barrier nursing issues. Small hospitals may supplement local support with external support, via e-mail.
Priority functions of the task force are to: o identify the facility(ies) where suspected and probable cases of SARS can be nursed; or housed, if hospitalization is not necessary. o perform an inventory of supplies required for nursing such patients (using WPRO SARS Preparedness Kit contents list). o plan how contacts of suspect/probable cases will be managed o liaise with customs/immigration authorities on the best way to provide information to arriving passengers, record travel details for surveillance and plan of action if an individual arrives ill on a plane with suspected SARS. |
The task force should be responsible for all the issues concerning SARS including establishing good communications. The expert committee should be responsible for making a decision on the public health response to reported cases. An urgent task of this task force will be establishing a national surveillance system. The surveillance system should also include private hospitals and clinics. Information should be provided for the media and general public. Designate at least one hospital to isolate cases and one laboratory responsible for managing clinical samples. Good communications should be established between the national focal point and the designated hospital and the designated laboratory. (see Figure 2) The tasks at national level include development of inventory of barrier nursing supplies, community infection control, quarantine at port of entry, and public awareness (avoiding panic).
>> Figure 2: Information Flows Clinical assessment of suspected patients Clinicians must be aware of the symptoms and signs of SARS. Patients with symptoms of SARS and a history of travel from an affected area or contact with a case of SARS should be provided an N95 mask (or best mask available) and triaged immediately to designated examination rooms or wards to minimize exposure to other patients and staff. Where feasible, separate specific reception areas for triaging patients who may have SARS should be established Medical and nursing staff must take precautions when examining the patient ie barrier nursing. Where material resources for barrier nursing are scarce, available supplies should be used sparingly in triage settings (such as by limiting the number of staff working in this area), so in the event of a SARS admission supplies will not have been exhausted. Obtain and record detailed clinical, travel and contact history including occurrence of acute respiratory diseases in contact persons during the last 10 days. Obtain chest X-ray (CXR) and full blood count (FBC).
(See example patient management flow chart in ANNEX 4) Enhanced surveillance Complete PPHSN reporting form or equivalent and send immediately to National Health Authorities, with a cc to PPHSN-CB Focal Point or WHO Suva (through local WHO Office if present). Also send immediately the form WITHOUT reporter and patient details (i.e. page 2) to PacNet or PacNet-restricted. Identify close contacts and give information to contacts. Screen any contacts with compatible symptoms as for suspected cases.
Communications (between members of team and with outside bodies, media etc.) Ensure that lines of communication are clear. Identify spokesperson for the team who will be the focal point for media briefings and will liaise with international agencies eg WHO/SPC (this could be the EpiNet team Focal Point or another person).
Laboratory diagnosis For suspected cases where the diagnosis of SARS is by exclusion and the patient is not very ill (ie no chest X-ray changes compatible with SARS). It is reasonable to take specimens for diagnostic purposes. However health care workers must take full barrier nursing precautions to protect themselves from aerosols or splashing/splattering of blood or other body fluids. For probable cases where the diagnosis of SARS is very likely and particularly if the patient has significant respiratory symptoms, the clinicians must perform a risk/ benefit analysis. There have been documented cases of transmission to HCWs during diagnostic/therapeutic procedures, particularly those prone to the generation of aerosols. Therefore the priority should be for tests likely to influence the clinical management of the patient. If specimens are collected for diagnostic testing (rather than clinical management), they should be stored under appropriate conditions. At this stage, the three laboratories in our region that have agreed to receive specimens are:
o Institute Pasteur, New Caledonia o Victoria Infectious Disease Reference Laboratory (VIDRL), Australia o Clinical Virology, Communicable Disease Programme, Institute of Environmental Science and Research (ESR), New Zealand (See Contact List in ANNEX 1 for addresses) Initial community interventions Provide suitable information to arriving passengers (particularly those who have traveled through affected countries) about the risks of SARS and where they can go to for advice and assistance (as example, see Advice to Arriving Travelers in ANNEX 5). Simple health education messages should be communicated to the public via appropriate media (see Health Advices from Hong Kong in ANNEXES 6 and 7 for examples). WHO travel advice is available at www.who.int/csr/sars/en, and is updated regularly based on the changing global situation and the risk of transmission in the SARS-affected areas. The PPHSN SARS Task Force suggests as much caution and restriction as locally practical, both to and from the more severely SARS-affected areas, given the limitations in the Pacific in safely managing suspected SARS patients, PPHSN travel advice is provided in ANNEX 3, and may be updated on the PPHSN website (www.spc.int/phs/PPHSN).
External (international) reporting, requests for support, and coordination among agencies Report all suspect and probable cases to PPHSN/WHO using the PPHSN reporting form, Contact PPHSN-CB Focal Point or WHO South Pacific if additional information or assistance is required (see contact list in ANNEX 1).
|
