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Daniel LaHart, CIHEnvironmental Issues Program Manager
Operations DivisionAnne Arundel County Public Schools
410-360-0138
Edward L. Van Oeveren, M.D., M.P.H.Health Officer, Anne Arundel County Department of Health
Impact of H1N1 on School Facilities: An Outlook for the Future
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Novel H1N1 influenza: Background informationH1N1 outbreak in Anne Arundel County Public
Schools, Spring 2009School response to Novel H1N1 Virus, Fall 2009:
CurrentContingency plans
Potential school design elements to facilitate response to communicable diseases
SummaryQuestions
Outline
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Novel H1N1 influenza: Background information
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What is influenza? A type of virus that causes respiratory infection with systemic
S/S Two types of influenza viruses cause epidemic human disease:
Influenza A: Categorized into subtypes on the basis of 2 surface antigens:
Hemagglutinin Neuraminidase
Influenza B: Two distinct genetic lineages: Yamagata and Victoria Not categorized into subtypes
Seasonal vs. pandemic influenza Seasonal
Virus changes slightly most years (antigenic drift) Season usually October through May ~200,000 persons hospitalized ~36,000 deaths
Pandemic Influenza virus to which most of population lacks immunity Spread to at least two regions in the world
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Novel H1N1 influenza: Background information
N
H
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What is H1N1 influenza?
Antigenically and genetically distinct from other human influenza A (H1N1) viruses in circulation since 1977
Inappropriately referred to as “swine” flu because the virus is related to influenza viruses that affect pigs.
The most affected group of persons is under age 24 years.
Has spread to all regions of the globe—pandemic declared in June 2009.
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How is influenza spread?Seasonal and Novel H1N1
Respiratory droplets from an infectious individual—coughing and sneezing
Can travel up to 3 feet in the airContaminates another person close byLands on surfaces (fomites), e.g., doorknobs,
computer keyboards, faucet handlesInfection begins when the virus is introduced
to the nose or mouth (mucous membranes)
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How are people affected?Seasonal and Novel H1N1
Respiratory illness with systemic signs & symptoms:Fever (100°F or greater), cough, sore throatNasal congestion, muscle aches, headache,
chills, fatigueDiarrhea, vomiting (seen with novel H1N1)Usually abrupt onsetTypical time to recover is 4 days to one week in
healthy people
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Risk Factors for Severe Disease
Immune system disordersHIV, transplant, chemotherapy, etc.
Elderly, infants, pregnant womenOther medical problems:
Lung diseaseDiabetesKidney disease
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Treatment of InfectionSeasonal and Novel H1N1
Rest Drink plenty of liquids Avoid drinking alcohol or smoking Use over-the-counter medications
Labeled “cold and flu” remediesNot aspirin
In some situations, use antivirals Oseltamivir (Tamiflu), zanamivir (Relenza)Prescription medicationsInitiate within 48 to 72 hours of first
symptoms for optimal effectiveness
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Preventing the flu Seasonal and Novel H1N1
Clean hands oftenSoap and waterAlcohol-based hand sanitizers
Cover your cough/sneezeUse a tissue or your sleeve
Avoid close contact with sick people Practice healthy behaviors
Don’t smoke, eat a healthy diet, exercise Use antiviral medication if prescribed
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Novel H1N1 influenza: Background information
Sleeves.wmv
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Preventing the flu Influenza Vaccine
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Flu Vaccines Two types
Trivalent inactivated influenza vaccine (TIV) (injectable)
Live, attenuated influenza vaccine (LAIV) (nasal spray)
Safety (known for seasonal vaccine)Shot: arm soreness, redness, swelling, low
grade fever, mild muscle aches, fatigueNasal spray: low grade fever, runny nose,
headache, sore throat, fatigueDOES NOT CAUSE THE FLU!!
Timing Protection takes at least 10 days
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Flu Vaccines
Seasonal vaccineStill important this yearAvailable now
Novel H1N1 vaccineFirst shipments anticipated ~mid-OctoberTarget and priority groups initiallyIf available, everyone for whom medically
appropriate may be vaccinated over the next 6 months
Not mandatory
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Who will get the H1N1 vaccine?
Pregnant women Health care and emergency
medical workers People who live with or
care for children <6 months old
Persons 6 months through 24 years
Adults 24 through 64 years with high risk health conditions
Pregnant women Health care workers with
direct patient contact People who live with or care
for children <6 months old Children 6 months through
4 years People 5 through 18 years
with high risk health conditions
Target Groups High Priority Groups
CDC. MMWR Early Release. 2009;58 (August 21, 2009).
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The Good News…
Majority of those affected do not require hospitalization and recover without complications.
So far, H1N1 flu appears similar to seasonal flu except for different high-risk groups.
Antivirals still generally effective.Vaccine is developed, studies ongoing.Prevention measures work!
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What else can you do?
Stay home if you or your children are sick! Do not go to work, school or daycare until 24 hours
after the fever has resolved Recovery takes 3-5 days for most people Healthcare workers: Stay home for 7 days after
symptom onset or until S/S resolve Make a family plan
Back-up plans for childcare Look into teleworking with your employer Food & water supplies
Be flexible
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H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009
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Spring 2009: Elementary School – 375 students and staff
What occurredWhat’s going on simultaneously
Family member ill (flu symptoms)
Recently returned from Mexico
Children exposed @ home
Children come to schoolSchool notified, etcHealth Department
directs school system
“Pandemic” flu announced
Media news bites clips focus on people wearing protective masks
H1N1Vaccine not ready yet
Worst is yet to comeAnxiety - probablyPanic – not yet but….
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School System Response
SchoolWith Teachers and Admin.
FacilitiesWith Custodial Staff
In consultation w/HD who, in turn, are following CDC:Family children sent homeMeet w/teachers and staff
Explain situation Advise cleaning protocols Promote good hygiene in
classroom & home Letter sent homeSchool will stay open
School custodial staff backed up with extra volunteers to clean & disinfect classroom Provided training on virus,
disinfection cleaning techniques, overview of disinfectant, and MSDS
Provided gloves, masks, rags, spray bottles, pump sprayers
Team cleaning approach Disinfectant sprayed on Wipe and rinse
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Then what…..
At school Facility Management
Parents swamp phone linesSome kids stay home
RumorsMany are sick
Another child suspected of H1N1
School to close 5-7 days per H.D.
News helicopters, TV reporters & cameras, etc.
Gear up for full school disinfection; desks, chairs, hallways. Lockers, basically all surfaces, handles, sinks, knobs etc.
TV Crews see inside school to see crews with masks, etc.
National news show same scenario in a NY high school.
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Swine Flu Spreads Across D.C. Region
Washington Post Washington Post A federal agent who
traveled to Mexico with President Obama this month probably contracted swine flu and infected several members of his family in Anne Arundel County, prompting assurances yesterday from the White House that the President was safe.
Parents and government officials are debating whether to close schools where suspected cases of swine flu have been discovered. What should officials do?
Keep schools open. Schools should be cleaned and sick children kept home, but closings go too far.39%
Close schools. School officials should take every step possible to protect children from the flu.57%
Other solution. Write your answer in the comments below.2%
Total Votes: 2,648
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Community/parents alarm
Folger McKinsey Elementary School in Anne Arundel County has a student that has been tested for the swine flu. The results have not come back yet. School and county officials were on hand for the opening of school Thursday morning.
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Parents Debate Sending Children to School as Officials Urge Caution
School National The word came so late in
the school day yesterday that officials couldn't send a letter to parents, so they resorted to e-mails and phone calls: A student at Folger McKinsey Elementary School in Severna Park was one of six probable cases of swine flu in Maryland.
At a news conference last night, President Obama recommended that schools with suspected cases of swine flu strongly consider closing. But a spokesman for Gov. O'Malley said afterward that Maryland schools would remain open. "At this point it doesn't appear that it's necessary given the probable cases in Maryland," spokesman Shaun Adamec said.
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CDC Guidance
CDCSchool & Health Department
On a national conference call, CDC states that any school with even a single case of H1N1 influenza should close for 5-7 days (possibly as long as 14 days).
In conformity with CDC guidance, School and Health Department close school.
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Outcomes
School FacilitiesReopened in 3-4
daysNo outbreakSchool returns to
routine
Vast expenditure of manpower and equipmentLots of overtime
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Lessons Learned from Spring 2009
Use of Incident Command System (ICS) Consistent, uniform messages from key leaders:
Joint Information Center (JIC) Joint Press Conference Manage expectations; pro-actively stress need for flexibility in
response to a dynamic situation. Frequent updates in understandable language:
Public/parents/children: Phone bank Automated phone call-out system Websites Written materials (letters home, posters in schools)
Staff (Schools, Health Department) Collaboration between Schools and Health Department:
Planning (Schools/Health Department MOU; exercises) ImplementationCommunications
(Continued)
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Lessons Learned from Spring 2009 (continued)
After-action analysis/assessment and follow-up action Needs identified:
Formal school-based surveillance systemSchool attendance policiesStaff sick leave policies Identification of personnel and equipment shared between schools
(e.g., buses and bus drivers, itinerant staff) Identification of, and planning for, “higher-order effects” of closure
(e.g., free/subsidized meals, after-school activities, athletics)Tracking costs/expendituresPersonal Protective Equipment (supplies, fit testing) Isolation roomsHandwashing stations
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School response to Novel H1N1 Virus, Fall 2009
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School response to Novel H1N1 Virus, Fall 2009: CDC Guidance--Philosophy
Decision to dismiss students should:Be made locally Balance the goals of:
Morbidity and mortality from influenza with Minimizing social disruption and safety risks to children sometimes
associated with school dismissal. Based on the experience and knowledge gained in jurisdictions
that had large outbreaks in spring 2009, the potential benefits of preemptively dismissing students are often outweighed by negative consequences, including:Students being left home aloneHealth workers missing shifts when they must stay home with their
childrenStudents missing meals, and Interruption of students’ education.
http://pandemicflu.gov/professional/school/
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School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses
Recommendation:Stay home when sick
Separate ill students and staff
Hand hygiene and respiratory etiquette
• Conditions with similar severity as in Spring 2009:
Facilities Issues: Location for screening upon return Instruction (study or teaching)while at home Isolation rooms (students, staff) Staffing Storage of masks (surgical masks for ill; N-95’s for healthcare personnel) Soap & towels, hand sanitizer, tissues:
SuppliesLocations, dispensersRefill, maintenance, securityWaste receptacles
(Continued)
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School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses
Recommendation:Routine cleaning
Early treatment of high-risk students and staff
Consideration of selective school dismissal
• Conditions with similar severity as in Spring 2009:
(continued)
Facilities Issues: Supplies & equipment (gloves, masks, pump and hand sprayers)*
Staffing Compliance with medication regimen Dispensing and storage of anti-viral Rx’s Co-location of high-risk and normal-risk facilities
*American Academy of Pediatrics’ Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 2nd Edition (2009) for guidance on cleaning and sanitizing in schools. (http://aapredbook.aappublications.org/resources/midsheets.dtl )
The EPA provides a list of EPA-registered products effective against flu: http://www.epa.gov/oppad001/influenza-disinfectants.html
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School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses
Recommendation:Active screening
High-risk students and staff members stay home
Students with ill household members stay home
• Conditions of increased severity compared with Spring 2009:
Facilities Issues: Location for screening Equipment/supplies (e.g., thermometers) Staffing Identification of high-risk persons:
Staff Location
Communication with high-risk persons Study/work from home:
Equipment, supplies Staff
Same as above for affected students
(Continued)
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School response to Novel H1N1 Virus, Fall 2009: CDC Guidance—Scalable Responses
Recommendation: Increase distance between
people at schoolsExtend the period for ill
persons to stay homeSchool dismissals
• Conditions of increased severity compared with Spring 2009:
(continued)
Facilities Issues: Space limitations Scheduling Longer duration of above issues
Identification of appropriate schools Impact on co-located facilities (e.g., schools, libraries, recreation centers) Instructional staff facilities & resources Security
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Potential School Design Elements to Facilitate Response to Communicable Diseases
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 1 of 9)
Generally:Collaboration with School Health staff during design phase
Health Room:LocationSizeEquipmentCommunications/support systems (intranet, internet,
phone, fax)SuppliesStorageStaffing
National Clearinghouse for Educational Facilities (National Institute of Building Sciences), Resource List for School-Based Health Facilities--http://www.edfacilities.org/rl/health_centers.cfm
The Center for Health and Health Care in Schools--http://www.healthinschools.org/static/states/MD-guidelines.aspx
http://www.maclearinghouse.com/schoolhealthmanual/PDF/Chapters/Chapter02_D.pdf
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 2 of 9)
Screening Points:Potential uses:
Active screeningReturn from illness
Considerations:Traffic flowLocation:
Ingress/egress to exterior of buildingProximity to:
Health RoomIsolation facilities
Staffing/monitoringFurnishingsEquipmentSupport systems (intranet, internet, telephone, fax)
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 3 of 9)
Isolation capability:“Isolation” vs. “quarantine”Considerations:
CapacityLocation:
Proximity to:Health RoomScreening Points
Ingress/egress to exterior of buildingStaffing/monitoringFurnishingsEquipmentSupport systems (intranet, internet, telephone, fax)
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 4 of 9)
Potential for fomite transmission:Factors affecting infection potentialEnvironmental surfaces:
Floors Handles/knobs Walls Furnishings (e.g., desks, counters) Equipment (e.g., keyboards [membrane covers?]) Considerations:
Infection potential Cleanability/potential to disinfect Costs (total lifetime cost):
o Initialo Maintenanceo Replacement
Durability Esthetics Special characteristics (e.g., non-slip flooring)
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 5 of 9)
Hygiene resources/facilities:Rest Rooms:
SoapTowelsSupply storageWaste/refuse disposalFomite infection risk:
Environmental surfacesFaucet handles
MaintenanceHand hygiene:
Free-standing hand-washing stationsHand sanitizer stations:
LocationsRefilling & MaintenanceSafety & Security
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 6 of 9)
Environmental Control Systems:TemperatureHumidityParticulates (especially allergens)Gases and vaporsAir exchangeDesign easy to change and readily accessible air filtersDesign for adequate ventilation: Solution to Pollution is Dilution Design schools with systems that require no-touch to operate via sensors
Room lightingDrinking fountainsToiletsHand sinks
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 7 of 9 )
Storage: Cleaning & maintenance supplies (e.g., disinfectant) Equipment (e.g., sprayers) Health Room:
Equipment Supplies (e.g., masks, gloves, thermometer covers) Refrigerated storage:
Capacity Temperature Tolerance
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 8 of 9)
Use:Alternate Care Site (e.g., for
local hospital during disaster)
Mass immunization site
Point-of-distribution (POD) for medications
Alternate uses of facility:
Facilities issues:Location/Proximity to
“index” facilityIngress/EgressBuilding systems (HVAC,
electrical, IT)Location/Proximity to
PopulationIngress/EgressTraffic FlowBuilding systems (HVAC,
electrical, IT)Storage (e.g., refrigeration)Same
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Potential School Design Elements to Facilitate Response to Communicable Diseases
(Slide 9 of 9)
Co-located facilities:Examples:
Other schools (e.g., pod of high school, middle school, and elementary school)LibraryRecreation/Community/Social Center
Potential issues:Infection/cross-contamination (directly, or by shared/common population)Facility closure (does closure of one necessitate closure of all)Futility of selective/partial closureShared infrastructure/building systems:
Possible or cost-effective to partially shut down)Effects on health risks/environmental control/comfort (e.g., HVAC)
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Summary
Novel H1N1 influenza: Information relevant to educational facility planners
H1N1 outbreak in Anne Arundel County Public Schools, Spring 2009:
Lessons learnedSchool response to Novel H1N1 Virus, Fall 2009:
CurrentContingency plans
Potential school design elements to facilitate response to communicable diseases
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Questions?
Recommended