Healthcare

Preparedness
for Infectious Diseases
Syra Madad, D.H.Sc., M.Sc., MCP
Saskia Popescu, PhD, MPH, MA, CIC
 Healthcare As A
Healthcare As A
Critical Infrastructure
Critical Infrastructure
Landscape of Healthcare in the U.S.
Healthcare, Hospitals,
and Public Health

Hospitals are the frontlines and not only

identify, test, and treat illness, but they also
play a critical part in disease surveillance and
reporting.
Hospital Outbreaks and Exposures
 9.25.2014– Thomas Duncan visits Texas
Health Dallas Presbyterian Hospital

Two ICU RNs caring for him were found

to have acquired the disease and were
laboratory-confirmed.

Ebola RN filed a lawsuit against Texas Health

Resources (THR, the parent company of
the hospital system) for negligence,
fraud, invasion of privacy, gross
negligence, and damages.
 Ebola
• Entirely novel situation in which virtually no U.S.
hospital had ever trained for. IPC programs were
found to be the primary source for preparedness
efforts across U.S. hospitals.
• No healthcare workers had PPE competencies in
2014
• Changing guidance on
ØPPE and isolation guidelines (Contact/Droplet +
Airborne, jumpsuits vs. gowns, etc.)
ØEnvironment of care
ØWaste management
ØSterilization and disinfection

Current outbreak in DRC/Uganda/Tanzania(?) - >3,200

cases. 18% of cases are nosocomial, >137 HCW
infections
 SARS-CoV

• 2002 – the first cases of the Toronto Outbreak – Phase I and II

novel SARS-CoV were identified • Female patient traveled to/from Hong Kong and returned to Toronto on Feb
in the Guangdong province of 23, dying on March 3. Her son (case A) participated in home care and sought
China. medical care on March 7 – becoming the index case within hospitals.
• Secondary cases following exposure in the hospital began to surface –
• Reports of a strange contagious hospital resources and staff become strained.
disease, but no alerts sent to
WHO. The People’s Republic of • March 26 – SARS-CoV is declared a provincial emergency and hospitals are
China discouraged press ordered to activate diversion/Code Orange. Enhanced IPC practices are
ordered (visitor limitations, additional PPE, social distancing, etc.). Phase I –
coverage and refused to allow 140 cases, 24 deaths. Quarantine used.
the WHO to visit.
• Phase II – began shortly after the provincial discontinuation of enhanced IPC
• Health officials grossly under- practices in early and mid-May (contact precautions + N95 in general areas +
reported cases and the WHO visitors). May 20 – five rehab patients became symptomatic (epi
was not notified until Feb 2003. investigations found the initial case was misdiagnosed w/aspiration
March 2002 - 4,000 cases & 550 pneumonia). HCW at North York hospital placed on work quarantine - 78/79
cases from Phase II were related to exposures before May 23.
deaths.
• Outbreak is declared over on July 2, 2003. Phase I – 140 cases 24 deaths.
Phase II – 79 cases.
 MERS-CoV

• Continued transmission since it was first 2015 South Korea Outbreak - 186 cases, 36 died. 91-99% of
discovered in 2012 in Saudi Arabia. Super- cases were related to exposure from a healthcare facility.
spreaders involved in several outbreaks. 83% of transmission events were related to 5 super-
• Several large outbreaks in Eastern spreaders.
Mediterranean Region and a large 2015
outbreak in South Korea. IPC Challenges:
• Large outbreaks in Saudi Arabia- hospitals •Initial quarantine and definition of close contact failed to
were considerable sources of transmission account for airborne/environmental components
due to: •Asymptomatic patients
• delays in isolation & poor separation of suspected cases •Korean healthcare system – hospital shopping, 4 patients per
• Inconsistent adherence to isolation precautions and IPC
• asymptomatic patients room, lack of access to patient medical info between
• busy emergency departments facilities, Prolonged emergency room stays, and
• uncontrolled patient movement
• substantial visitor traffic.
family/visitors are expected to partake in care.
•IPC failures
 • Outbreaks commonly associated with
zoonotic transmission
• Indo-Bangladesh outbreaks had well-
documented nosocomial transmission.

Nipah virus • In 2001 – a single patient admitted to a

private hospital infected 23 HCW and 8
visitors (poor standard precautions
cited as failure).
• Analysis of 248 cases found 82 involved
human-to-human transmission.
 Hospitals Play A Unique Role in Outbreaks
and Infections
§ Sick patients + visitors + hundreds of healthcare workers = perfect
environment for disease transmission. Now let’s throw in substandard
infection prevention practices and see what happens. In NYC Healthcare
System
preparedness
drills, HCW hand
hygiene
§ Hospitals easily can become amplifiers of disease during outbreaks compliance was
36%
(SARS-CoV, MERS-CoV, norovirus, and MDROs.). Between invasive
medical practices and a revolving door of people…..

§ In the event of an outbreak, an influx of people will occur within

hospitals and healthcare facilities, which amplifies existing IPC
deficiencies.
Tends to fall on IPC while managing their existing duties..
Responding to COVID-
19
üSevere flu season
üInternational PPE shortages
üExposures and outbreaks
üNovel disease = fear and lots of unknowns
üChanging guidance & WH vs CDC COVID-19
messaging
üPrepping for what we see in NYC
Hospital
Preparedness for
COVID-19: 5 S’s
• Staffing
• Stuff
• Space
• System
Risk of Resurgence
A CONTAGION OF MISINFORMATION

This is not just an outbreak of

COVID-19, but also an
outbreak of misinformation
Questions?