Dr Gail ThomsonBiorisk reduction for Dangerous Pathogens (BDP)

Department of Epidemic and Pandemic Alert and Response (EPR)

Biological risks in health service: The WHO experience

WHOWHO

WHO’s objective, as set out in its constitution is:

The attainment by all peoples of the

highest possible level of health

A state of complete physical, mental and social well-being

and not merely the absence of disease or infirmity

Protect the public & the patients from disease;

There is also a need to protect the health care workers

WHO NetworkWHO Network

WHOHQ

PAHO AFRO EURO EMRO SEARO WPRO

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192 MEMBER STATES

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HQ, Geneva

Regional offices:

AFRO, Brazzaville

Harare

PAHO, Washington

EMRO, Cairo

EURO, Copenhague

SEARO, Delhi

WPRO, Manilla

141 country offices

WHO regions

Listen to and address the fears Listen to and address the fears & needs of our HCWs& needs of our HCWs

Global Health workforce is estimated > 100 million people

There is a recognised need to strengthen health care systems

“such systems are impossible without health workers who are the ultimate resource of health systems” Joint Learning Initiative

HCWs: more than a resource

Listen to & address their fears and needs:

– “ We are afraid. We question our safety.

But we are obliged to our patients.”

(Congolese nurse, Ebola outbreak, Hewlett 2005)

1212thth session of the Joint ILO WHO Committee on session of the Joint ILO WHO Committee on Occupational health in 1995 Occupational health in 1995

adopted a new definition of occupational health

aiming at the promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations

Healthcare Worker safetyHealthcare Worker safety

Occupational and Environmental Health Programme

Injection Safety & Related Infection Control

Safe Injection Global Network (SIGN) Secretariat

Department of EPR:

Healthcare-Associated Infections Prevention and Control focal point

Deployment of field teams with Personal Protective Equipment (PPE)

Training materials/ Outbreak Response Leadership Course

The Department of EPR assists with the control of outbreaks. This may be done through triggering the GOARN Network.

GOARN GOARN Global Outbreak Alert & Response NetworkGlobal Outbreak Alert & Response Network

GOARN is an independent network of institutions

The GOARN Project Manager and Secretariat sit inside the Department of EPR, WHO Geneva

WHO has mounted 30 missions since 1 Jan 2006:

Revolved around Avian Influenza

Human or animal epidemiologists

Case management & infection control

Logistics

Social mobilisation

Laboratory experts

Outbreak coordination slideOutbreak coordination slide

Outbreaks show where the Outbreaks show where the strengths and weaknesses are in a systemstrengths and weaknesses are in a system

Find the weak link/s & strengthen it/them

Preferably before an outbreak

Disrupt the interaction between man, agent & environment

Where in the patient’s journey through the health care Where in the patient’s journey through the health care facility is there a risk of nosocomial amplification?facility is there a risk of nosocomial amplification?

The Patient’s journey - the SAFE STEPS

• Hospital level1. Access

2.Triage

3. Risk assessment

4. Further assessment

5. Discuss with public health

Aim toAim tolimitlimit

nosocomialnosocomialamplificationamplification

6. Transport7. Isolation (ICU)8. Staff & PPE

10.Investigations: ECG, CXR sampling

9. Day to day care:“CARE”, Treatment, cleaning

11. Community

Identify at risk personnel & activitiesIdentify at risk personnel & activitiesManage the riskManage the risk

Trying to create a safety culture & climate Trying to create a safety culture & climate at an outbreak at an outbreak

Senior management support for the safety of personnel

Appropriate administrative and engineering controls in place

Hazard identification and risk assessment

Buddy system; can provide informal feedback

Adequate & accessible supplies of PPE

Consistent use of PPE

Review of work processes to ensure that the risk of exposure is eliminated or minimised

Try to identify job hindrances and remove them

Able to smile behind their masksAble to smile behind their masks

InIn certain situations the usual controls may certain situations the usual controls may be absentbe absent

Scenario - Outbreak investigationScenario - Outbreak investigationNon hospital settingNon hospital setting

You are asked as part of a GOARN response to go to a village and investigate an outbreak. This will include taking samples from a sick patient who has a fever, has been vomiting blood and who is unable to leave his/her house because he/she is so weak.

In such a situation it is important to be well prepared and to be aware of the emotions and beliefs of the communityFor example: establishing good links with community leaders, ensuring you have all necessary material with you & decide where to put on and take off PPE

InIn certain situations the usual controls may be certain situations the usual controls may be absentabsent

STOP: Stop, Think, Observe and Plan what to do next

Hazard identification

Risk management

Appropriate precautions

Aiming for SOS:

Safety of Staff & Others resulting in Safe patient care

Community supportCommunity support

In summaryIn summary

An outbreak response requires:

Prompt initiation

Strong coordination

Clear lines of communication

Community support

Adequate & appropriate staff who have their needs addressed

Thank youThank you