Isolation & Quarantine FacilitiesAssessment & Recommendations

Assessment Process

Literature Review CD I&Q Definitions WA Administrative Code (WAC) Individual I&Q Conditions

and Principles Potential Disease Agent Characteristics – CDC CDC Infection Control and I&Q Guidance

Interviews Preparedness, CHS, CD-EPI, CBPH, Contracts, Risk

Communications Staffs Research and Review Facility Options Analyze Facility Pros and Cons Develop Recommendations

I&Q Facilities Parameters

Preliminary Objective: Find 300 rooms 100 in each King County Emergency Coordination Zone

Plan for Individual Level I&Q NOT Community Level

Disease Agents Considered: Executive Order 13295 Quarantinable Diseases

AND CDC Category A Bioterrorism Threats

OR Diseases with Potential for Pandemic Spread

I&Q Facility Planning PrioritiesCDC Category A Bioterrorist Agent (BT-A)

OR Potential for Pandemic

Named in Exec Order

13295

Indv. I&Q Planning Priority

Anthrax (BT-A) NO

Botulism (BT-A) NO

Plague (BT-A) YES X

Smallpox (BT-A) YES X

Tularemia (BT-A) NO

Viral Hemorrhagic Fevers (BT-A) YES X

SARS YES X

Pandemic Influenza NO

Distinguishing I&Q Factors

Plague Smallpox VHF SARS

Isolation Period

3 days 3 weeks Late stage 10 days

Quarantine Period

3 days 12 days n/aTiered; 10 days max.

Infection Control Precautions

StandardN-95 mask

N-95 mask; Body

fluids PPE

Standard

Preferred Placement

Home FACILITY Hospital Home

I&Q Facilities Considerations Separate rooms/wings ideal; wards OK in large events Adherence to standard and airborne precautions Adequate water, electricity, heating, cooling, ventilation Maintain a clean and quality facility Easy to coordinate and deliver services (accessibility) Attend to physical, emotional, mental, spiritual needs

communications, comfort, entertainment, acceptability I&Q periods could be as long as 3 weeks

comfortable, functional, securable Compatible with Community Level Quarantine measures

e.g. limit the movement of people; social isolation

A Note on Effectiveness

Quarantine need not be 100% complete to be effective

Voluntary Quarantine is our desired outcome Involuntary Quarantine is resource intensive

Maximum utilization of scarce CD-EPI and/or IQRC resources Law Enforcement and Court System Involvement Requires a More Secure Facility

Recommendations are biased in favor of “publicly acceptable” facilities Motels or similar familiar and comfortable home-like

environments In large events, clean temporary structures vs.

deteriorated structures

I&Q Facility Options Considered Public Facilities “Mothballed” Public Facilities Existing Structures:

Community health centers, nursing homes, treatment centers, apartments, schools, dormitories, hotels

Temporary Structures: Trailers, modular units, barracks, tents, bubble systems,

field hospitals, RVs, youth camps, fire fighter shelters Emergency Declaration of Dedicated Facility:

Hospital, separate hospital building, hotel

Motel Option

Certain motels best address CDC guidance Separate rooms and restrooms Independent air circulation

Allows for client privacy and self-sufficiency Significant factor in long-term periods

Currently used for TB isolation

PRO: High chance for acceptability CON: Post-event stigma of site

HHS – Contingency Stations

Placed inside existing structure

Modular: 50 bed units, up to 250 per station

Includes beds and supplies Available through SNS

4 hours for quarantine (plane) 12 hours for mass care

PRO: Eliminates need for local supply stocking/storage CON: Potential for Post-Event Stigmatization of host

facility

Alaska Structures Tents

Medical Shelter is 650 square feet Erected in 30 minutes or less Soft wall, aluminum frame Modular, expandable Positive pressure ventilation Able to isolate between shelters and

hallways

PRO: Could accommodate HHS-CS option CON: water, electrical hook-up needed; may

require pre-purchase of tent

Sprung Tents

Quickly assembled 30 ft to 300 ft long 30 year guarantee Large, open space Can be placed on any flat surface

PRO: Could accommodate HHS-CS

CON: water, electrical hook-up needed; may require pre-purchase of tent

Mobile Field Hospital Option

Large scale solution May be able to secure one

from military State of Connecticut Model

Serves as alternate hospital facility

PRO: Could accommodate HHS-CS option CON: purchase, storage, site, water,

electrical hook-up are all needed

Pros for Each Option

Motel: High chance for public acceptance Best meets CDC criteria

HHS – CS: Large scale, flexible Eliminates need for local purchase and storage

of supplies Field Hospital:

Large scale, flexible Acute care is possible

Cons for Each Option

Motel: Public stigmatization after event major concern

HHS – CS: Public stigmatization of host facility Common ventilation system, no privacy

Field Hospital: Stocking and staffing - expensive Common ventilation system, no privacy

I&Q Facility Continuum

IsolationQuaranti

ne

Non-Acute Mass Care

Acute Mass Care

Field Hospital X X X

HHS - CS in a Host Structure

X X

Motel Rooms X X

I&Q Facility RecommendationsDevelop a Continuum of Options: Partner with Motels (TB Model) Accommodate HHS – Contingency Stations

Temporary Tents Emergency Declaration of “Designated

Facility” Hospital Wing Hotel

Action Steps

Secure motel agreements (1 underway) Secure HHS-CS accommodation facility

agreements Prepare a list of potential “Designated Facility”

options Develop an Operational Plans

Site specific as secured Generic to be used at any site designated in the event