September 2005
Dear Colleague:
This special edition of Safety Share provides rapid access to key hurricane resources.
Premier, Inc., its members and suppliers have been actively engaged in relief efforts. At the end of this bulletin is additional information about those efforts, as well as available Safety Institute resources.
Note: This special edition is being added to the Safety Institute's comprehensive Disaster Readiness Web site.
Please share this newsletter with your colleagues.
Sincerely,
Gina Pugliese, editor
Vice President, Premier Safety Institute
Key hurricane resources – Links and downloads
AHA, HHS, and allied organizations
Coordination site. The American Hospital Association (AHA), the U. S. Department of Health and Human Services (HHS), state hospital associations and many national organizations including Premier have set up a Web site to coordinate resources. The Web site is at http://www.hospitalreliefefforts.org/hospitalreliefefforts/.
Volunteer sign-up. HHS is mobilizing up to 40, 250-bed federal emergency shelters to stabilize and provide basic medical care to hospital and nursing home patients evacuated from the affected areas, as well as individuals with storm-related injuries. This site contains a link for individual healthcare professionals wishing to volunteer their services outside the scope of their hospital or health system. Coordinated by the Office of the U.S. Surgeon General, information and sign-up can be found at https://volunteer.ccrf.hhs.gov/.
The joint AHA and HHS Web site has additional resources under the following headings:
- Finding missing persons.
- Caring for displaced patients.
- Information from the Centers for Medicare and Medicaid Services (CMS).
- Federal government resources.
- Legal issues for hospitals and health systems.
Hospitals can log on at http://www.hospitalreliefefforts.org to indicate what resources they can share to help with the Hurricane Katrina relief effort. All information is being forwarded to HHS several times daily. Telephone information can be provided at 800.435.5525.
ASHE
Job skills coordination. To assist HHS in matching volunteer talents with the needs, the American Society of Healthcare Engineering (ASHE) is serving as a communication center linking volunteers to HHS. Individuals who would like to volunteer to go on-site and help with the effort to cleanup and restore hospitals may e-mail ASHE with their names, contact information, and a brief description of their technical and/or management skills. ASHE will include the information in a pool of volunteers shared with HHS. Email ASHE at ashe@aha.org.
Building needs-AHRQ tools. ASHE provides a link to a new report from the Agency for Healthcare Research and Quality (AHRQ) entitled "Use of Former (Shuttered) Hospitals to Expand Surge Capacity" that gives emergency responders and public health officials useful, practical tools for opening shuttered hospitals when an emergency is underway. The information is available at http://www.ahrq.gov/research/shuttered/. The report gives surrounding communities that aren't immediately affected by the hurricane a way to assess their existing facilities to meet future needs. It includes lists of supplies and medications needed by stable medical/surgical patients and checklists to assess facility readiness, staffing needs and levels, and patient transport readiness. The report also contains a tool kit with a list of supplies and equipment needed for operation of a reopened facility.
Related:
- Use of shuttered hospitals report (.pdf) (695 KB)
- Tool kit to open a facility (.pdf) (502 KB)
- Checklist to open a facility (.pdf) (682 KB)
Flood remediation. ASHE's Hurricane Relief Resources provides a link to the University of Minnesota, "Managing Water Infiltration into Buildings: A Systematized Approach for Remediating Water Problems in Buildings due to Floods, Roof Leaks, Potable Water Leaks, Sewage Backup, Steam Leaks and Groundwater Infiltration." (See also CDC's "Healthcare Water System Repair") at http://www.dehs.umn.edu/iaq/flood.html.
APIC, SHEA
The Association for Professionals in Infection Control and Epidemiology (APIC) (www.apic.org) and Society of Healthcare Epidemiologists of America (SHEA) (www.shea-online.org) are working together and with other groups to gather and share information on infection control in a crisis situation. Both organizations are posting materials developed and shared from members on their respective sites.
APIC - shared resources and volunteers. APIC members able to supply information and resources on practical infection prevention guidelines that can be used by healthcare providers being deployed to the affected areas should contact hurricanerecovery@apic.org. Members interested in learning more about volunteering should also reply to hurricanerecovery@apic.org to identify areas of special expertise that may be needed. APIC provides a list of resources on topics such as hand hygiene, hepatitis, and West Nile virus in more than 30 downloadable educational brochures for consumers and healthcare professionals.
SHEA - shared resources and volunteers. SHEA provides lists of resources and volunteer opportunities related to public health, volunteer physicians, and more. SHEA also provides resources directed to patient care in disasters.
CDC
Following are relevant resources provided by the CDC:
Hurricanes. The Centers for Disease Control and Prevention (CDC) Web page at http://www.bt.cdc.gov/disasters/hurricanes/ contains hurricane health and safety information and timely updates. The following selected areas are listed alphabetically and provide key information.
Animals or insects.
Animal disposal following an emergency. Most states have
guidelines on disposal of dead animals
(.pdf) (147 KB) so people with questions regarding the specific situation in their state are encouraged to contact local or state health and agricultural officials for clarification.
Snake bite - How to prevent or respond. After a natural disaster, snakes may have been forced from their natural habitats and move into areas where they would not normally be seen or expected. When you return to your home, be cautious of snakes (.pdf) (142 KB) hat may have sought shelter in your home. If you see a snake in your home, immediately call the animal control agency in your county.
Electrical safety.
Electrical safety and generators. This summary addresses
preventing electrocutions
(.pdf) (95 KB) associated with generators plugged into household circuits.
Homeowners should not attempt to install any generator that requires hard-wiring
into an existing electrical circuit or that requires a trained, qualified
electrician to hard-wire any generator into a household circuit.
Hand hygiene.
Hand hygiene in emergency situations. After an emergency, it can be difficult to find running water. However, it is still
important to wash your hands
(.pdf) (75 KB) to avoid illness. It is best to wash your hands with soap and
water but when water isn't available, you can
use alcohol-based products
(.pdf) (34 KB) made
for washing hands.
Immunizations.
Interim immunization.
Immunization recommendations
(.pdf) (85 KB) are available for individuals displaced by Hurricane Katrina.
Although measles and rubella are no longer endemic to the United States,
introductions do occur, and crowded conditions may facilitate their spread.
Although Hepatitis A incidence is low in the affected areas, post-exposure
prophylaxis in these settings would be logistically difficult. Consequently,
vaccination is recommended. In addition, the influenza season will begin soon
and influenza can spread easily under crowded conditions. Interim
recommendations are provided.
Vaccine information. Individuals displaced by the hurricane will be offered influenza vaccine. Sanofi [Sanofi Aventis] is making 200,000 of the first doses available for evacuees in the shelters.
Impact of hurricane Katrina on vaccine storage. Most refrigerated vaccines are relatively stable at room temperature for limited periods of time. The vaccines of most concern are measles, mumps, rubella (MMR) and varicella (Varivax), which are sensitive to elevated temperatures. Monitor temperatures, don't discard, but don't administer affected vaccines (.pdf) (131 KB) until you have discussed with public health authorities.
Infection control.
Community shelter guidance following disasters. Community shelters provide housing for persons displaced from their homes following natural disasters such as hurricanes, floods, and earthquakes. In these settings, individuals share living space. Some individuals may have health problems, including acute or chronic infectious diseases. These
recommendations (.pdf)
(93 KB) provide basic infection control information that will help to prevent exposure to or transmission of infectious agents.
Water system repair. Information on water supply disruptions (.pdf) (62 KB) excerpted from the CDC Guidelines for Environmental Infection Control in Health-Care Facilities, 2003 - Recommendations of CDC and the Healthcare Infection Control Advisory Committee (HICPAC). Download the complete Guidelines for Environmental Infection Control from the Premier Safety Institute Web site. (See also ASHE flood remediation.)
Safe food and water. Food may not be safe to eat during and after a natural disaster or power outage. Safe water guidelines (.pdf) (180 KB) provide guidance for using bottled, boiled, or treated water for drinking, cooking, and personal hygiene.
Infectious diseases.
Although infectious diseases are a frightening prospect, widespread outbreaks of infectious disease after hurricanes are not common in the United States. Rare and deadly exotic diseases, such as cholera or typhoid, do not suddenly break out after hurricanes and floods in areas where such diseases do not naturally occur. Communicable disease outbreaks of diarrhea and respiratory illness can occur when water and sewage systems are not working and personal hygiene is hard to maintain as a result of a disaster. However, no disease outbreaks have been reported as of September 8, 2005 in areas affected by Hurricane Katrina. As has been the case in past hurricanes, HHS quickly sets up tracking systems that monitor illnesses in hurricane-affected areas. Floodwaters in New Orleans do contain levels of sewage-associated bacteria (such as E. coli) that are at least 10 times higher than acceptable safety levels, as well as dangerous levels of lead, making direct contact by rescue workers dangerous. For more information, see
http://www.bt.cdc.gov/disasters/hurricanes/
infectiousdisease.asp.
Acute diarrhea - guidelines for management.
Increased incidence of acute diarrhea
(.pdf) (113 KB) may occur in post-disaster situations where access to electricity, clean water, and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted and healthcare seeking behaviors may be altered.
Common pathogens related to acute diarrhea include:
- E. coli. Escherichia coli (.pdf) (155 KB) is a strain of bacteria that lives in the intestines of humans and animals and is normally found in all streams, lakes and canals.
- Vibrio vulnificus. At least four deaths have been attributed to Vibrio vulnificus, a bacterium common in warm Gulf Coast waters that's usually spread by eating contaminated food but that can penetrate open wounds. V. vulnificus (.pdf) (32 KB) infections do not spread directly from one person to another and are a serious health threat predominantly to persons with underlying illness, such as liver disease or a compromised immune system.
- Norovirus. Noroviruses are very easy to spread and cause diarrhea and vomiting. The Houston Astrodome is handing out alcohol-based hand sanitizers to help prevent spread of norovirus. Some refugees have been found with the illness, although no exact number has been given. Hydration is the most important treatment. More information is available in the norovirus Q&A (.pdf) (16 KB).
- Non-Polio enterovirus. This type of viral infection (.doc) (33 KB) is very common -- second only to the "common cold" viruses – the rhinoviruses – as the most common viral infectious agents in humans.
CDC-NIOSH
Storm and flood cleanup. CDC's National Institute for Occupational Safety and Health (NIOSH) addresses work related activities during storm and flood cleanup activities that can be hazardous. Workers and volunteers involved with flood cleanup should be aware of the potential dangers involved and proper safety precautions. Work-related hazards that could be encountered include electrical hazards, carbon monoxide, musculoskeletal hazards, heat stress, motor vehicles, hazardous materials, fire, confined spaces and falls. Links to information about hazards associated with storm and flood cleanup are available at http://www.cdc.gov/niosh/topics/flood/. A suggested interim guide for personal protective equipment (.doc) (28 KB) is provided.
CMS/HHS
Emergency relief efforts. Centers for Medicare & Medicaid (CMS) of Health and Human Services (HHS) is placing public health officers at emergency medical shelter sites. Staff will then determine local needs and use information from the Web site at http://www.hospitalreliefefforts.org to match resources with needs. Organizations that have submitted a willingness to send staff and resources may not get a request from HHS for several weeks or longer as needs are determined, shelters begin to be staffed with volunteers, and two-week shifts end. CMS has expanded its Web site, http://www.cms.hhs.gov/katrina/, to include more information about CMS emergency relief activities, including a detailed explanation of billing and payment policy revisions, and phone numbers for the state medical assistance offices. Frequently asked questions and their answers will be updated on the site by 2 p.m. daily.
HIPPA exception. HHS has issued an advisory that allows healthcare workers to share protected patient information to provide necessary medical care after Hurricane Katrina. Workers are not required to gather patient signatures when sharing information with disaster-relief organizations if obtaining the signatures would hinder the disaster response. The Health Insurance Portability and Accountability Act (HIPPA), (.pdf ) (30 KB) which sets standards for patient privacy, allows information sharing to coordinate care with relief workers and to notify family members or responsible parties of a patient's location, general condition and death. The advisory allows providers to share information with the police and news media for the purpose of locating or identifying responsible parties and allows healthcare facilities to answer inquiries about whether a patient is at the facility, the patient's location within the facility and general condition.
Special billing and licensing provisions. In a Fact Sheet
(http://www.cms.hhs.gov/media/press/
release.asp?Counter=1546) issued on Sept. 6,CMS announced that the agency has acted to
ensure that the federal Medicare, Medicaid and State Children's Health Insurance Programs (SCHIP) will be flexible to
accommodate the emergency health care needs of affected beneficiaries and medical providers. HHS granted 1135B waivers
(allowing flexibility on certain Medicare, Medicaid, and State Children's Health Insurance Program requirements) under the
Public Health Emergency Act for five states: Alabama, Florida, Louisiana, Mississippi and Texas. Texas has also been included
in this roster, due to the influx of evacuees from directly impacted areas. CMS provisions noted in the fact sheet include
exemptions for complying with normal billing requirements, reimbursement for ambulance transfers, patient evacuations,
providing crisis services, and dialysis in alternative settings, special prior authorization waivers for Medicare, Medicaid or SCHIP managed care plans, waivers of normal licensing requirements for doctors, nurses and other health care professionals who
cross state lines, billing for beds that have been dedicated to other uses, and special indemnity under the Emergency Medical
Treatment and Labor Act (EMTALA) for emergency rooms that transfer patients to other facilities for assessment.
Volunteer sign-up. In the wake of Hurricane Katrina, hospitals across the nation are working diligently to coordinate efforts with the U.S. Department of Health and Human Services (HHS) to provide relief to the areas hardest hit by the storm, as well resources to those displaced by the hurricane. The American Hospital Association, Premier and other national hospital leaders have organized the Hospital Relief Efforts web site which serves as a place where hospitals across the country can volunteer personnel and donate supplies or equipment to areas in need. To date, nearly 700 hospitals have responded through the site. Information entered via this site is regularly forwarded to officials at HHS. The relief process will be a long one and HHS is developing a pipeline of providers to help when and where needed. To accommodate individuals interested in helping, HHS has established a Web site (https://volunteer.ccrf.hhs.gov/) for healthcare professionals and toll-free number (1-866-KAT MEDI) for relief personnel to volunteer their services. HHS has identified needs in 28 multi-disciplinary healthcare and relief expertise, including needs for forensic dentists, radiologic technicians, chaplains and medical examiners. HHS requires that volunteers must be healthy enough to function under field conditions that may include 12-hour shifts, austere conditions, and long periods of standing. Volunteer workers will be unpaid, temporary federal employees, and will therefore be eligible for coverage under the Federal Tort Claims Act for liability coverage and Workman's Compensation. Individuals who do not have a healthcare professional background but who wish to assist can find information on volunteering through the US Freedom Corps Web site at http://www.usafreedomcorps.gov/, or by calling 1-877-USA-CORPS. Volunteers are urged to register through HHS or the U.S. Freedom Corp to ensure that volunteers can be coordinated for both immediate and long-term relief needs.
DHS
Federal assistance. Major disaster areas have been declared for areas impacted by Hurricane Katrina in Louisiana, Mississippi, Florida, and Alabama. The U.S. Department of Homeland Security (DHS) is assisting in the management of federal assistance to the affected communities. See the DHS Web site at http://www.dhs.gov/interweb/assetlibrary/katrina.htm.
FDA
Medical devices. The U.S. Food and Drug Administration (FDA) provides advice at http://www.fda.gov/cdrh/emergency/heathumidity.html about medical devices that have been exposed to unusual levels of heat and humidity. Many medical devices may not function correctly if they have been exposed to high levels of heat or humidity. The manufacturer's instructions in the product labeling may describe the device's tolerance levels for heat and humidity. Medical devices may not function properly outside the tolerance levels recommended in the product labeling. Unusually high levels of heat and humidity may cause instruments to operate in unexpected or unusual ways, reduce shelf-lives or totally destroy products, cause laboratory reagents to lose potency, or compromise the sterility of packaged devices.
FEMA
Key coordinating agency. The Federal Emergency Management Association (FEMA) provides response and recovery information for victims (individuals and businesses) and links to government benefits, services, education and shelter as well as information for federal and military employees. It is the lead agency and is coordinating its efforts with the Centers for Disease Control and Prevention (CDC). http://www.fema.gov/
Occupational Safety and Health Administration (OSHA)
Keeping workers safe. During clean up and recovery operations following hurricanes, OSHA issues alerts on the dangers associated with cleanup and recovery from hurricanes. See http://www.osha.gov/OshDoc/hurricaneRecovery.html
Premier
Relief efforts. A special Disaster Support Team has been coordinating relief efforts among member
hospitals and contracted suppliers. For more on the efforts of those suppliers, go to
https://premierinc.com/all/newsroom/press-releases/
05-sep/hurricane-katrine-update-090805.jsp
Premier's Disaster Support Team is leading Premier's overall corporate response by identifying the needs of affected member organizations and facilitating the acquisition and delivery of supplies and equipment. Premier member hospitals with needs associated with Katrina and contracted suppliers who have supplies and equipment affected hospitals could use, can send their lists to HurricaneRelief@premierinc.com
Safety Institute resources. The Premier Safety Institute's Emergency and Public Health Preparedness page (https://premierinc.com/quality-safety/tools-services/safety//public-health/) also contains relevant and timely news and resources related to the disaster.
Editorial team
- Gina Pugliese, RN, MS editor
- Judene Bartley, MS, MPH, CIC, associate editor
- John Hall, BSJ, contributor
- Judith Luca, RN, BSN, contributor
- Derek Kleckner, BA, Web master
About Premier
Premier, Inc. is a healthcare alliance entirely owned by 200 of the nations leading not-for-profit hospital and healthcare systems. These systems operate or are affiliated with 1,500 hospital facilities and hundreds of other healthcare sites. Premier provides an array of resources supporting health services delivery, including clinical and operational comparative data applications for quality/safety performance improvement, group purchasing and supply chain services, and insurance programs. The Centers for Medicare and Medicaid Services (CMS) has recently partnered with Premier for a three-year quality incentive demonstration project. Participating hospitals using Premier’s Perspective Online ™ database can receive recognition and additional Medicare payment when they meet or exceed specific quality measures.
