Lessons in Epidemic Response: The Case of Pandemic Flu (H1N1) in Pune, India Krishna Bhogaonker.
CUPS Health and Education Centre Response to H1N1.
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Transcript of CUPS Health and Education Centre Response to H1N1.
Health Clinic
• Health Clinic:– 1800 visits per
month
– Primary, episodic, crisis based care
– Mental Health, Women’s Health, Prenatal Care, Chronic Disease Management, Specialist
Family Resource
Centre
•1000 visits/month
•Crisis Counselling & Advocacy•Goal Setting & Ongoing Support•Parenting & Life Skills•Low-income Housing Assistance•Children’s Programming
One World Child Development
Centre
•Early intervention education centre
•Thriving, instead of surviving
•Preschool to Kindergarten
• 60 students
Outreach and Housing
Other agencies visited by CUPS RNs, NPs and MDs:
•Hospitals•Shelters•Detox and Treatment Centres•The street (DOAP & Outreach team)
•2000 visits/month – •the absolute homeless
Inner City Agencies: What did we do?
• Dec 2008 - Pandemic Planning Committee
• Jan 2009 - Influenza Pandemic Preparedness for Inner city Agencies
• Feb 2009 - City of Calgary Infectious Disease Management Plan
• April 2009 - Personal Emergency Preparedness
• May 2009 - Pandemic Influenza 101
CUPS: What did we do?
• Jun-Aug 2009• set up our emergency structure
• June 2009 • Instructions for staff, Microsan stations
• July 2009• Patient triage process implemented and inventory
organized• The ‘Black Book’
PATIENT
RECEPTION?? ASK ??
-cough/cold/fever in last 48hrs?OR
Patient looks very unwell/ is coughing
MICROSAN HANDS
MASK
Continue as usual
NO
2nd LPN to Triage need for immediate care ( treatment room) : ILI symptoms : temp/O2 sats/HR
Seat pt in reserve seats
Notify LPN
YES
Non urgent URGENT
fever> 38 oral
Pt to wait in lab chairsRefer MD/NP onlyCall Agency PRN
Pt to wait in reserve seats. Refer to RN, MD, NP
MICROSAN
Getting ready continued…
• Sept 2009 • Train the Trainer program for managers.
• Presentation on influenza preparedness given to all staff, by department
• N 95 masks for medical staff
• Mandatory staff meeting to present CUPS plan and to address expectations and concerns.
What was our experience?
• More staff than patients sick• Close to 30% absenteeism at the peak• One ICU admission
– Camp Bus Driver: resulted in one child treated with Tamiflu.
• 8-10 patients with ILI symptoms in any one day• NP swabs only on those with risk factors or very ill.
• Aug 2009- First positive H1N1 patient• Only 3-4 positive H1N1 patients thereafter
• H1N1 <10% of all NP swabs
• No known deaths
ImmunizationsSeasonal flu vaccine was received from AHS on Oct 16/09. • Oct 16/09 – Nov 4/09 320 given• Nov 5/09 – Feb 28/10 103 given
H1N1 vaccine was received from AHS on Dec 6/09.• December/09 109 given• January/10 64.5 given• February/10 12 given
Dec 6 - 12
Dec 13 - 19
Dec 20 - 31
Jan 3 - 9
Jan 10 -16
Jan 17 - 23
Jan 24 - 30
Jan 31 -
Feb 6
Feb 7 - 13
Feb 14 - 20
Feb 21 - 27
0
10
20
30
40
50
60
H1N1 Vaccine
Other clinic actions:• CUPS
• Fluids available for patient distribution.• Individual patient teaching on hand washing and use of masks• H1N1 Flu talks for clients - LPN • H1N1 inservices for staff throughout organization - RN
• Agencies• H1N1 inservices for agencies - RN • Patient assessment, and assistance with suspected outbreaks • Teaching and advocacy to other agencies on behalf of patients.• Community Medicine residents helped agencies develop their
pandemic plans
• Outreach staff transported patients to shelters, hospitals, urgent care centre , hospital pharmacy
Patient Reactions to H1N1Measures
• Mostly good• Receptive to teaching, well informed• Barriers: Fluids, Tamiflu• Felt hyped by media• Started asking for H1N1 shots in October
• Transportation• Addiction, Mental Health• Other barriers
Tamiflu
• CUPS received Tamiflu from AHS on Nov 4/09
• 1 course dispense for an adult in early December
• Prescriptions written once universal coverage approved
• Tamiflu prescriptions issued for few staff who became ill
Concerns
• Earlier access to vaccine• Immunization for all staff at partner agencies• Earlier and easier access Tamiflu • Central distribution centre for required supplies • Better communication, clear guidelines for who to
contact
What if things had gotten worse?
• Phase 1: described• Phase 2: 2 clinic sites
• Ill patients • Well patients for routine care
• Phase 3: Shut down majority of programs, organize 3 teams
• Team 1: Routine care for prenatal patients at CUPS site women’s clinic.
• Team 2: Ill patients at CUPS site main clinic, home visits and
care by support staff• Team 3: Outreach RN/NP/MD/support staff going to shelters for triage and care.