bioterrorism readiness plan shands hospital at the university of florida 2001
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Bioterrorism Readiness Plan
Shands Hospital at the University of Florida
2001
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Tokyo Train Station
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Aerial view of anthrax production facility
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Where and when will bioterrorism hit next?
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Biological Weapons?????
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Bioterrorism Readiness Planning Subcommittee
Sub committee of Infection Prevention and Control Committee
Chair: Kenneth Rand, MD Multidisciplinary Membership
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Multidisciplinary Membership
Infection Control Staff Hospital Epidemiologist Physicians
• Infectious Disease Physicians
• Emergency Medicine Chief and other ER Physicians
• Surgeons
Emergency Department Nurse Manager
Safety Director
Public Relations Respiratory Care Laboratory Facilities Operations Public Health
Administrator & other agencies
Materials Management Administration
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Bioterrorism Readiness Plan Purpose
To be a: Reference on bioterrorism A practical and realistic institutional response for
a real or suspected bioterrorism attack Plan that incorporates local and state health
agencies recommendations A branch of existing disaster preparedness and
other emergency plans
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Bioterrorism Readiness Plan Components
Infection Control Activities Laboratory Policies Public Inquiry Disease Specific Information Appendix
FBI Field Offices Telephone Directory of State and Territorial
Public Health Directors Relevant Websites
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Indications of a Possible Bioterrorism Event
Unusual illness in a population Large number of ill persons with similar disease Large numbers of cases of unexplained diseases or death Higher morbidity or mortality in association with a
common disease or syndrome Single case of unusual agent No illness in persons not exposed to common ventilation
system Threat received indicating exposure
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Bioterrorism Readiness PlanBasic Premises
In a case of suspected/real bioterrorism related event or outbreak All personnel are responsible for immediately
reporting suspected event. The Shands Disaster Plan shall be activated in
conjunction with this Bioterrorism Readiness Plan.
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Bioterrorism Readiness Plan Authority to rapidly implement prevention and control measures
Administration Director On Call
Infection Prevention and Control Hospital Epidemiologist Chairman Director or designee
Safety and Security Director or designee
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Bioterrorism Readiness PlanCommunication Network
IndividualShands
Operator
Infection Control & Safety and Security
Director-On-Call
Public Health
Local and State Authorities
( EMS, Police, Fire Departments)
FBI
CDC
Administration
DEPTS
Public Relations
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Maximum Containment Lab
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Bioterrorism Readiness Plan Staff Education
Initial special program to introduce plan Video tape and module
Ongoing education incorporated into orientation and annual Infection Control and Safety programs
Bioterrorism Preparedness Drills
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Bioterrorism Readiness PlanSection I: General Recommendation for any Suspected Event
Reporting Requirements and Contact Information Internal External
Potential Agents Syndrome Based Epidemiologic Features
Patient, Visitor and Public Information Pharmacy
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Bioterrorism Readiness PlanSection I: General Recommendation for any Suspected Event: Infection Control Practices
Isolation Patient Placement Patient Transport Cleaning, Disinfection and Sterilization Discharge Management Post-mortem Care Post Exposure Management
Decontamination of Patients and Environment Prophylaxis and post-exposure management Triage Psychological Aspects of Bioterrorism
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Bioterrorism Readiness PlanSection I: General Recommendation for any Suspected Event: Infection Control Practices
Laboratory Support and Confirmation Obtaining diagnostic samples Criteria for processing Transportation of clinical specimens Management and handling of criminal investigation
specimens
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Bioterrorism Readiness PlanSection II: Agent Specific Recommendations
Anthrax Botulinum Toxin Plague Smallpox Ricin
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Anthrax
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Anthrax Transmission:
Inhalation Ingestion Skin contact
Associated with infected animals such as sheep, goats, and cattle (Woolsorter’s disease)
No person to person transmission occurs from patients with respiratory disease caused by anthrax
Direct exposure to cutaneous anthrax lesions may result in secondary cutaneous infections
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Anthrax: Mode of Transmission for Bioterrorism
Spore is durable Delivered as an aerosol= inhale spores Ingestion of contaminated food Cutaneous contact with spores or spore-
contaminated material
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Anthrax time curve after incident
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InhalationAnthrax
Incubation Period Range 1 day to 8 weeks (average 5 days)
Period of Communicability A person infected with the respiratory form of
anthrax can not spread it to others.
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AnthraxClinical Features
Pulmonary
• Non-specific flu-like symptoms
• 2-4 days after symptoms
– Abrupt onset of respiratory failureWidened mediastinum on chest x-ray
• High mortality almost 100% if treatment initiated after onset of respiratory symptoms
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AnthraxPreventive Measures
Standard Precautions Antibiotic Therapy
Ciprofloxacin Levofloxacin Ofloxacin Doxycycline Amoxicillin for exposed children
Vaccination
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Botulism
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Botulism
Clostridium botulism Present in soil and marine sediment
Foodborne botulism most common disease Inhalation botulism may also occur
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BotulismClinical Features
GI symptoms for food borne disease Responsive patient with absence of feverBlurred visionSymmetric ( on both sides) descending
weakness and paralysisRespiratory failure- inability to breathe
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Botulism: Mode of Transmission
Mode of Transmission Ingestion of toxin-contaminated food Aerosolization of toxin
Incubation Period Neurologic symptoms from food borne botulism
begin 12-36 hours after ingestion Neurologic symptoms of inhalation botulism begin
24-72 hours after aerosol exposure
Not transmitted person to person
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Botulism: Exposure Management
Preventative Measures Vaccine
Standard Precautions Prophylaxis and Post exposure immunization
Botulinum antitoxin Patients may require mechanical ventilation
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Plague
Causative agent:
Yersinia pestis, a gram-negative bacillus usually zoonotic disease of rodents usually transmitted by infected fleas
• Bubonic plague - Lymph system infection
• Septicemia plague - Bloodstream infection
Bioterrorism exposure are expected to be airborne resulting in a pulmonary variant, pneumonic plague - Respiratory Infection
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Life cycle of plague
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PlagueClinical Features
Pneumonic Plague Fever, cough, chest painHemoptysis (Bloody sputum)
Bubonic Plague - skin and tissue disease form
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Plague
Transmission Normally from an infected rodent to man by infected flea Bioterrorism-related = dispersion of an aerosol Person to person transmission of pneumonic plague is possible
via large aerosol droplets Communicability
Via Productive cough Droplet Precautions until 72 hours after initiation of effective
antimicrobial therapy Incubation: 2-8 days due to fleaborne disease or 1-3 days for
pulmonary exposure
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PlaguePreventive Measures
Droplet Precautions Private Room or put cases in together in a
room(cohort), doors closed but no special ventilation needed
Maintain isolation for 72 hours after antibiotics are given
Vaccine not practical since requires multiple doses over several weeks and post exposure immunity has no utility
Post exposure Prophylaxis - See your doctor
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Last known person with smallpox in the world
Public Health Quarantine Sign
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Smallpox
Causative agent:Variola virus Eradicated clinical smallpox from world
Two WHO labs store virus Severe morbidity if released into non-immune
population Single case is considered a public health emergency
Can be aerosolized or contaminated items can be used to deploy this virus as a biological warfare agent
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Smallpox in Child
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SmallpoxClinical Features
Acute viral illness with severe skin lesions Can have fever and aches for 2-4 days before rash
Rash most prominent on face and extremities Rash scabs in 1-2 weeks
Variola rash occurs all at once in contrast to varicella’s “crops” of lesions
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Smallpox
Mode of transmission:
airborne, droplet and contact.
Person to person spread Incubation Period = 7-17 days (ave. = 12 days) Period of Communicability = Variola becomes
infectious at onset of rash and continues to be infectious until their scabs fall off which is approximately 3 weeks
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SmallpoxPreventive Measures
STRICT ISOLATION Negative air pressure room, doors must remain
closed, verify ventilation Mask, gown and glove for entry into room Limit transport Handle all surfaces and supplies as
contaminated
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SmallpoxPreventive Measures
Smallpox vaccine Vaccinia virus is used for vaccine(not smallpox
virus) Does not confer lifelong immunity Must be given within 7 days post exposure to
be effective
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Ricin
Causative agent:
A biological toxin (poison) derived from the castor plant and castor oil.
Exposure routes: inhalation (breathe it in) percutaneous (injection or contact with skin,
eyes, and mucous membranes) ingestion (eat it!)
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RicinClinical Features
Weakness, fever, cough and fluid in lungs occur within 18 hours after inhalation(breathe in toxin) exposure
Progresses to severe breathing trouble and then death from hypoxemia within 36-72 hours
Diagnosis: signs and symptoms found in large number of a geographically clustered group and/or lab tests
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Ricin
Treatment:
support patient, manage symptoms and keep comfortable
Prophylaxis: None available Prevention
Protective mask to prevent inhalation Standard Precautions
• Weak hypochlorite solution (0.1% sodium hypochlorite) and/or soap and water can decontaminate skin surfaces
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Steps in Preparing for a Bioterrorism Event
Know how to locate policy
Review Executive Summary of Plan for inclusion in Disaster Manual
Access Specific Departmental Policies ER Pharmacy
Use Information Sheets for Patients and Public
Learn about bioterrorism by completing module. Get your questions
answered by experts
Coordinate plan with state and local authorities