# Presentation: 236095

## Understanding How A Pandemic Influenza Outbreak Could Impact Job Corps

***Presented by:***
- Lynda R. Dunlop, R.N.
- Hartford Job Corps Academy
- Hartford, Connecticut

**Notes:**
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## A scenario for Job Corps
W.H.O pandemic phases
Review of infection control, procedures and standard precautions
Clinical management
Pre-needs for work and home

- A scenario for Job Corps
- W.H.O pandemic phases
- Review of infection control, procedures and standard precautions
- Clinical management
- Pre-needs for work and home

## Conferral with national, regional and state health departments and national and regional Job Corps regarding national strategy for treatment of pandemic influenza.
Referral of severely ill (from any cause) patients will likely be very difficult due to travel restrictions and should be minimized.
Assessment of existing inpatient treatment capacity with regard to staff and facilities.
Preparation for rapid increase in demand for services during pandemic, specifically regarding:
anticipation of absenteeism among staff;
anticipation of sick staff;
availability of additional staff as needed, 

**Conferral with national, regional and state health departments and national and regional Job Corps regarding national strategy for treatment of pandemic influenza.**
**Referral of severely ill (from any cause) patients will likely be very difficult due to travel restrictions and should be minimized.**
**Assessment of existing inpatient treatment capacity with regard to staff and facilities.**
**Preparation for rapid increase in demand for services during pandemic, specifically regarding:**
**anticipation of absenteeism among staff;**
**anticipation of sick staff;**
**availability of additional staff as needed, **

## Infection control infrastructure, including isolation facilities, and protocols 
Identification of a completely separate building or structure, e.g. school, or JC campus for use as temporary respiratory health-care facility.
Creation of separate waiting areas for patients with fever/respiratory illness.
Creation of a respiratory isolation ward for inpatients.
Mechanisms to increase distancing between beds
Assessment of inventory of existing personal protective equipment (PPE), with standard protocols for use.
Training for all staff

**Infection control infrastructure, including isolation facilities, and protocols **
**Identification of a completely separate building or structure, e.g. school, or JC campus for use as temporary respiratory health-care facility.**
**Creation of separate waiting areas for patients with fever/respiratory illness.**
**Creation of a respiratory isolation ward for inpatients.**
**Mechanisms to increase distancing between beds**
**Assessment of inventory of existing personal protective equipment (PPE), with standard protocols for use.**
**Training for all staff**

## 
Protocols and prioritization strategy for vaccine and antiviral medications use
Preparation of treatment protocols for influenza
Stockpiling of:
	-  antibiotics, IV fluids, other supportive treatments
	-  PPE (masks, gloves, etc)
	-  materials for additional isolation areas 
	-  health education materials
Management of dead bodies

**Protocols and prioritization strategy for vaccine and antiviral medications use**
**Preparation of treatment protocols for influenza**
**Stockpiling of:**
**	****-  **antibiotics, IV fluids, other supportive treatments
- 	-  PPE (masks, gloves, etc)
- 	-  materials for additional isolation areas
- 	-  health education materials
**Management of dead bodies**

## There are two main principles in limiting  the        spread of infection:
	1.   To maximize physical separation between patients.
	2.   To implement standard and droplet precautions

These include:
Hand hygiene (hand washing or hand rub)
Use of PPE when patient contact is anticipated as per standard universal precautions; the minimum requirement should be surgical or procedure masks and face shields, when:               
-    handling blood, 
-    body substances, excretions and secretions from a patient 

***There are two main principles in limiting  the        spread of infection******:***
***	******1.   To maximize physical separation between patients.***
***	******2.   To implement standard and droplet precautions***
_***These include:***_
**Hand hygiene (hand washing or hand rub)**
**Use of PPE when patient contact is anticipated as per standard universal precautions; the minimum requirement should be surgical or procedure masks and face shields, when:****               **
**-    handling blood, **
**-    body substances, excretions and secretions from a patient **

## 
Appropriate handling of patient care equipment and soiled linen
Prevention of needle stick/sharp injuries
Environmental cleaning and spills management
Appropriate handling of waste
Thorough cleaning of surfaces likely to be contaminated by infectious secretions.

**Appropriate handling of patient care equipment and soiled linen**
**Prevention of needle stick/sharp injuries**
**Environmental cleaning and spills management**
**Appropriate handling of waste**
**Thorough cleaning of surfaces likely to be contaminated by infectious secretions.**

## 
 Triage case definition in place
 Triage & separation of people with respiratory symptoms from 
         those without.
 Surgical or procedure masks to be worn by all patients seeking care 
 Admission protocol 
 PPE use ( including when, method of placement, removal and 
         disposal)
 Separation of severely ill
 Case management protocol
 Patient discharge protocol
 Self-health monitoring and reporting if ill

-  **Triage case definition in place**
** ****Triage & separation of people with respiratory symptoms from **
**         ****those without.**
** ****Surgical or procedure masks to be worn by all patients seeking care **
** ****Admission protocol **
** ****PPE use ( including when, method of placement, removal and **
**         ****disposal)**
** ****Separation of severely ill**
** ****Case management protocol**
** ****Patient discharge protocol**
** ****Self-health monitoring and reporting if ill**

##  Defer travel to unaffected areas
 Plan for increased waste caused by increased turnover
 Plan for deaths
 Assess/identify site for burials
 Identify body handlers and burial team
 Access to PPE, knowledge of standard precautions
 Protocol for referrals 
 Protocol for disinfection of contaminated surfaces after
        transporting sick individuals or contacts
 Essential medicines/supplies for usual diseases

** ****Defer travel to unaffected areas**
** ****Plan for increased waste caused by increased turnover**
** ****Plan for deaths**
** ****Assess/identify site for burials**
** ****Identify body handlers and burial team**
** ****Access to PPE, knowledge of standard precautions**
** ****Protocol for referrals **
** ****Protocol for disinfection of contaminated surfaces after**
**        ****transporting sick individuals or contacts**
** ****Essential medicines/supplies for usual diseases**

## Infection Control Procedures

**Patient isolation:**
**Patients should be kept separately in designated multi-bed   rooms or wards**
**Distance between beds should be more than 1 m and beds should preferably be separated by a physical barrier (e.g. partition)**
**Doors should be kept closed at all times**
**A surgical or procedure mask should be worn by all patients when in contact with any staff/visitors**
**Movement and transport of the patient from the room should be limited to essential purposes only. If transport is necessary, minimize dispersal of droplet nuclei by masking the patient**

## What Are Droplet Precautions?

***Droplet precautions***** are designed to reduce the risk of droplet transmission of infectious agents. **
**   ****Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. **
**    ****Transmission via large-particle droplets requires close contact between source and recipient individuals, because droplets do not remain suspended in the air and generally travel only short distances **
**(usually 1 m or less) through the air. **

**What Are Droplet Precautions?**

## Standard precautions synthesize the major features of blood and body fluid precautions, designed to reduce the risk of transmission of blood borne pathogens, and body substance isolation, designed to reduce the risk of transmission of pathogens from moist body substances, and apply them to all patients receiving care in hospitals, regardless of their diagnosis
Standard precautions apply to:
blood; 
all body fluids, secretions and excretions except sweat, regardless of whether or not they contain visible blood; 
non-intact skin; and 
mucous membranes
Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals

**Standard precautions synthesize the major features of blood and body fluid precautions, designed to reduce the risk of transmission of blood borne pathogens, and body substance isolation, designed to reduce the risk of transmission of pathogens from moist body substances, and apply them to all patients receiving care in hospitals, regardless of their diagnosis**
**Standard precautions apply to:**
- blood;
- all body fluids, secretions and excretions except sweat, regardless of whether or not they contain visible blood;
- non-intact skin; and
- mucous membranes
**Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals**

## There are three periods and six phases organized by the World Health Organization (W.H.O.) addressing pandemics. Making it appropriate for the Hartford Job Corps Academy that actions could be as follows:

Interpandemic Period:
Phase 1:  This period is categorized by no new influenza virus being detected in humans, but the virus subtype may be detected in certain animals.

For the HJCA, the actions will include :
	The gathering of information from
media outlets, and 
government sources

***There are three periods and six phases organized by the World Health Organization (W.H.O.) addressing pandemics. Making it appropriate for the Hartford Job Corps Academy that actions could be as follows:***
_***Interpandemic Period:***_
**Phase 1****:****  This period is categorized by no new influenza virus being detected in humans, but the virus subtype may be detected in certain animals.**
_***For the HJCA, the actions will include***__ :_
**	****The gathering of information from**
**media outlets, and **
**government sources**

## Phase 2:  This period is categorized by there being  no new virus being subtype, but there may be a circulating animal influenza virus that poses a substantial risk to humans. 

For the HJCA Health & Wellness services, the actions will include :
Reviewing how to present this information to students and staff in a manner to foster understanding and not to induce fear or panic
Review health & safety protocols within HJCA per the PRH and SOP’s
Academy Director assigns a task force of staff to assist in teaching this information
Identifying needed medical supplies at the Wellness Center and placing orders 
Review students records to ascertain HJCA is in compliance with all vaccinations
Academy Director and Finance & Acquisitions Manager will discuss the purchase of antiviral medications & other supplies as reparation for a potential influenza pandemic

At HJCA there  is a population of migrating and over-wintering birds, it may be necessary to watch the behavior of the birds for illnesses.  If so, the CT Department of Health should be contacted for removal & testing. 

**Phase 2:****  ****This period is categorized by there being  no new virus being subtype, but there may be a circulating animal influenza virus that poses a substantial risk to humans.**** **
_***For the HJCA Health & Wellness services, the actions will include***__ :_
**Reviewing how to present this information to students and staff in a manner to foster understanding and not to induce fear or panic**
**Review health & safety protocols within HJCA per the PRH and SOP’s**
**Academy Director assigns a task force of staff to assist in teaching this information**
**Identifying needed medical supplies at the Wellness Center and placing orders **
**Review students records to ascertain HJCA is in compliance with all vaccinations**
**Academy Director and Finance & Acquisitions Manager will discuss the purchase of antiviral medications & other supplies as reparation for a potential influenza pandemic**
***At HJCA there  is a population of migrating and over-wintering birds, it may be necessary to watch the behavior of the birds for illnesses.  If so, the CT Department of Health should be contacted for removal & testing******. ***

## Pandemic Alert Period:

Phase 3:  Human infections with a new subtype, but 
      No Human-to-Human Spread

Phase 4:  Highly localized clusters of Human-to-Human Transmission

_***Pandemic Alert Period:***_
**Phase 3****:  ****Human infections with a new subtype, but **
**      *****No Human-to-Human Spread***
**Phase 4****:  ****Highly localized clusters of *****Human-to-Human Transmission***

## Pandemic Alert Period continued:
Phase 5: Large clusters effected, but remain localized.  The virus is becoming better adapted for human-to-human transmission

For the HJCA,  being in an urban, impoverished city, it is extremely important to track the occurrence of these clusters.

Multiple ethnic groups that establish their own neighborhoods
Hartford has an international airport and municipal transportation so individuals immigrate and emigrate easily and frequently
HJCA needs to consider students families health so it does not pose a threat to students overall health (residential and non-residential)
New student intake may be reduced or ceased  through the decision of the Academy Director, National Job Corps Director & CT Dept. of Public Health 

_***Pandemic Alert Period ***__***continued***__***:***_
**Phase 5****: ****Large clusters effected, but remain localized.  The virus is becoming better adapted for human-to-human transmission**
_***For the HJCA,  ***_**being in an urban, impoverished city, it is extremely important to track the occurrence of these clusters.**
**Multiple ethnic groups that establish their own neighborhoods**
**Hartford has an international airport and municipal transportation so individuals immigrate and emigrate easily and frequently**
**HJCA needs to consider students families health so it does not pose a threat to students overall health (residential and non-residential)**
**New student intake may be reduced or ceased  through the decision of the Academy Director, National Job Corps Director & CT Dept. of Public Health **

**Notes:**
For HJCA, being in an urban, impoverished city, it is extremely important to track the occurrence of these clusters. Hartford is a city characterized by multiple ethical groups that establish their own neighborhoods within the city. There will be individuals that will immigrate and emigrate easily, as there is an international airport with municipal transportation to it, accessed easily and frequently by the population of the State. HJCA may need to consider the individual student’s home situation (both residential and non-residential) to ascertain that the member’s of the family are healthy and pose no threat to the student’s overall health. This will include the use of public health services within the city or other manner of outreach other than HJCA staff making home visits.

## Pandemic Alert Period continued:

Social Distancing or limiting face to fact contact between individuals may be encouraged
Reducing travel
Teleconferencing
Avoiding public gathering areas; malls, movie theaters, etc.
Instruction regarding respiratory etiquette;	
Frequent hand washing
Disinfection of keyboards, phones, desks, etc

*The above actions may reduce the transmission of the virus by 30%

HJCA will depend greatly on the CT Department of Public Health and the Department of Homeland Security dictums to maintain health and safety

_***Pandemic Alert Period ***__***continued***__***:***_
**Social Distancing or limiting face to fact contact between individuals may be encouraged**
**Reducing travel**
**Teleconferencing**
**Avoiding public gathering areas; malls, movie theaters, etc.**
**Instruction regarding respiratory etiquette;****	**
**Frequent hand washing**
**Disinfection of keyboards, phones, desks, etc**
**********The above actions may reduce the transmission of the virus by 30%***
**HJCA will depend greatly on the CT Department of Public Health and the Department of Homeland Security dictums to maintain health and safety**

## Pandemic  Period:
Phase 6: Increased and sustained transmission in the general public

The Dept. of Public Health will declare a “Public Health Emergency”  along with National Job Corps stating that HJCA may be temporarily closed with all students returned to their home address

Individuals could be ill for two weeks; there are two days prior to seeing symptoms that the virus is communicable to other. A cluster of people, or a “wave” could last a total of eight weeks.
It is suggested that the population respond to a threat as if it was a “snow day”. This is interpreted as people go home and stay home. The period for “snow days” has not been ascertained.
The population that has been targeted as most susceptible are as follows:
		-   elderly 			
		-   school age children 
		-   pregnant women 
		-   chronically ill individuals such as having HIV/AIDS.

_***Pandemic  Period:***_
**Phase 6****: ****Increased and sustained transmission in the general public**
**The Dept. of Public Health will declare a **_***“Public Health Emergency”***_***  *****along with National Job Corps stating that HJCA may be *****temporarily closed with all students returned to their home address***
**Individuals could be ill for two weeks; there are two days prior to seeing symptoms that the virus is communicable to other. A cluster of people, or a “wave” could last a total of eight weeks.**
**It is suggested that the population respond to a threat as if it was a “snow day”. This is interpreted as people go home and stay home. The period for “snow days” has not been ascertained.**
**The population that has been targeted as most susceptible are as follows****:**
- 		-   elderly
- 		-   school age children
- 		-   pregnant women
- 		-   chronically ill individuals such as having HIV/AIDS.

## Pandemic  Period Phase 6 continued:

All Job Corps Centers should consider the following:
Does the student have a home to go to
Transportation to the students home address
If the student is a minor, is there a well  able adult available at home
If the student is disabled, consider the following:
is an accessible sanctuary available
does the student have needed medications/equipment available and working
are there concomitant conditions that increase their risk
Are there local agencies involved for transfer and/or community support that should be involved

_***Pandemic  Period ***_**Phase 6 *****continued*****:**
***All Job Corps Centers should consider the following:***
**Does the student have a home to go to**
**Transportation to the students home address**
**If the student is a minor, is there a well  able adult available at home**
**If the student is disabled, consider the following:**
- is an accessible sanctuary available
- does the student have needed medications/equipment available and working
- are there concomitant conditions that increase their risk
- Are there local agencies involved for transfer and/or community support that should be involved

## Pandemic  Period Phase 6 continued:

If the decision it to localize any potential for infection in the student population at HJCA, the following should be followed:

Designate areas within HJCA for students who are 
potentially infected, 
infected, 
recovering and 
free from illness will be housed and cared for on campus. 
There will be no “influenza designated” hospital within the state of Connecticut;  It may be risky to go to an emergency room at a hospital, as one is increasing the risk of exposure to the virus during the communicable period before symptoms start. 
Distribution and  use of medications for students and health care workers  
Sharing information and statistics with the Department of Public Health, as well as other agencies indicated at that time 
Sharing information with family regarding status of the student

_***Pandemic  Period ***_**Phase 6 *****continued*****:**
**If the decision it to localize any potential for infection in the student population at HJCA, the following should be followed:**
**Designate areas within HJCA for students who are **
- potentially infected,
- infected,
- recovering and
- free from illness will be housed and cared for on campus.
**There will be no **_***“influenza designated”***_** hospital within the state of Connecticut;  *****It may be risky to go to an emergency room at a hospital, as one is increasing the risk of exposure to the virus during the communicable period before symptoms start.***** **
**Distribution and  use of medications for students and health care workers  **
**Sharing information and statistics with the Department of Public Health, as well as other agencies indicated at that time **
**Sharing information with family regarding status of the student**

## Pandemic  Period  Phase 6 continued:

Maintenance of any students that may die 
Use of facility, care-givers, medications for others other than students i.e.:
family
day Care
local Neighborhood
Maintaining the health and well-being  of all care-givers, 
Staff and housed  population via review of care standards and current state of physical and mental health,  (see sample below) as well as following the SARS Quarantine Guidelines (February 2004) (Attachment C and D) 
Continuously teaching and reinforcing respiratory etiquette and hand washing

_***Pandemic  Period  ***_**Phase 6 *****continued*****:**
**Maintenance of any students that may die **
**Use of facility, care-givers, medications for others other than students i.e.:**
- family
- day Care
- local Neighborhood
**Maintaining the health and well-being  of all care-givers, **
**Staff and housed  population via review of care standards and current state of physical and mental health,  (see sample below) as well as following the SARS Quarantine Guidelines (February 2004) (Attachment C and D) **
**Continuously teaching and reinforcing respiratory etiquette and hand washing**

## General Supplies

**Tables, chairs, portable toilets**
**Pens, pencils, colored markers**
**Clear tape, stapler and staples, paper clips**
**Paper, sticky notes, envelopes**
**Paper towels, tissues, trash bags**
**Garbage containers, food and drink, ID badges for staff**
**Scissors, standard first aid kit**
**Copies of relevant emergency plans, such as AH, CD**
**Appropriate Appendix, SNS plan**
**Immunization records, VISs **
**Colored tape (for arrows on floor)**
**Signage for each station, rope barriers**
**Duct tape, informational signs**
**Cleaning supplies, paper towels, education videos/DVDs**
**File boxes, folders, clipboards**

## 
Cooler, thermometer for cooler, cold packs
Vaccine (pandemic or regular)
Needles; 22-25g, 1”, 1.5”, few 2” or bifurcated
Syringes
Sharps containers, adhesive bandages, exam gloves
Cotton balls, antiseptic (70% EtOH or other)
Alcohol swabs
Paper tape, privacy screens, cots
Anti-bacterial gels 
Gauze, bleach solution (1:10) in sprayers

**Cooler, thermometer for cooler, cold packs**
**Vaccine (pandemic or regular)**
**Needles; 22-25g, 1”, 1.5”, few 2” or bifurcated**
**Syringes**
**Sharps containers, adhesive bandages, exam gloves**
**Cotton balls, antiseptic (70% EtOH or other)**
**Alcohol swabs**
**Paper tape, privacy screens, cots**
**Anti-bacterial gels **
**Gauze, bleach solution (1:10) in sprayers**

## 
Cell phones, telephones (land line), lists of important numbers

Two-way radios (800 MHz or other)

Phone cables, Internet access (optional)

**Cell phones, telephones (land line), lists of important numbers**
**Two-way radios (800 MHz or other)**
**Phone cables, Internet access (optional)**

## Standing orders for emergencies
Inhalants (ammonia or similar)
Alcohol swabs
Two Epi Pens or Two ampoules epinephrine 1:1000
tuberculin syringes with 5/8” needles)
Two ampoules diphenhydramine (Benadryl) 50 mg
22g-25g 1” and 1.5” needles
Tongue depressors, stethoscope, tourniquet
Blood pressure gauge, child and adult cuffs for blood
Thermometers
Adult airway, pediatric airway, asthma inhalers
Adult pocket mask (1-way valve)
Child pocket mask (1-way valve)
AED (defibrillator)
Aspirin, Tylenol, insulin
Oxygen tank with tubing, IV electrolytes with tubing,
Batteries
Biohazard bags, sharps container, emesis basin

**Standing orders for emergencies**
**Inhalants (ammonia or similar)**
**Alcohol swabs**
**Two Epi Pens or Two ampoules epinephrine 1:1000**
**tuberculin syringes with 5/8” needles)**
**Two ampoules diphenhydramine (Benadryl) 50 mg**
**22g-25g 1” and 1.5” needles**
**Tongue depressors, stethoscope, tourniquet**
**Blood pressure gauge, child and adult cuffs for blood**
**Thermometers**
**Adult airway, pediatric airway, asthma inhalers**
**Adult pocket mask (1-way valve)**
**Child pocket mask (1-way valve)**
**AED (defibrillator)**
**Aspirin, Tylenol, insulin**
**Oxygen tank with tubing, IV electrolytes with tubing,**
**Batteries**
**Biohazard bags, sharps container, emesis basin**

## 

http://homelanddefensejournal.com

http://www.who.int/en/

http://www.dph.state.ct.us

http://www.webmd.com/

http://www.cdc.gov

- _[http://homelanddefensejournal.com](http://homelanddefensejournal.com/)_
- _[http://www.who.int/en/](http://www.who.int/en/)_
- _[http://www.dph.state.ct.us](http://www.dph.state.ct.us/)_
- _[http://www.webmd.com/](http://www.webmd.com/)_
- _[http://www.cdc.gov](http://www.cdc.gov/)_

## 
	Lynda R. Dunlop, R.N, B.S.N., M.A.
	Health and Wellness Manager
	Hartford Job Corps Academy
	100 William Shorty Campbell Street
	Hartford, CT 06106
	(860) 952-1746
	dunlop.lynda@jobcorps.org

- 	***Lynda R. Dunlop, R.N, B.S.N., M.A.***
***	******Health and Wellness Manager***
***	******Hartford Job Corps Academy***
***	******100 William Shorty Campbell Street***
***	******Hartford, CT 06106***
***	******(860) 952-1746***
***	***_[dunlop.lynda@jobcorps.org](mailto:dunlop.lynda@jobcorps.org)_