Emergency Procedures Handbook - Elim Kids · * Hand hygiene – all staff and children must adopt...

P a g e |2

Elim International Kids Emergency Procedures Handbook

Table of Contents:

Emergency Pandemic Plan 3-37

Fire Regulations/Provisions for EIK Building 38-71

Emergency evacuation plan in case of fire or emergency 72-73

EIK Evacuation Scheme 74

Earthquake Procedures 75

Natural and Man-made Emergencies Policy and Procedures 77-88

P a g e |3


Elim International Kids Early Childhood Centre

PANDEMIC ACTION PLAN

Pandemic Manager: Mitch Jordan

Deputy Pandemic Managers: Katie Cornish, Alex Hills

Rationale:

No one knows when or how severe an influenza pandemic might be. It is important that our service has steps in place to protect staff and children from a possible influenza outbreak.

Plan:

Stage 1: Prevention, protection and information:

Influenza Protection Measures:

* Hand Hygiene

Protection measure Where applicable

Hand hygiene, cough etiquette, ventilation Everyone, all the time.

Health and safety policies Every organisation, all the time

Social distancing Everyone, whenever practical

Protective barriers

In situations where regular work practice requires unavoidable, relatively close contact with the public e.g. close contact with children, reception/office.

Disposable surgical mask

Workers in any setting who are caring for the sick (this includes first responders).

Also as a possible adjunct to protective barriers

Disposable particulate respirator masks, eye protection, gloves, gowns, aprons Health care workers.

Staff, children and whanau will be informed of the importance of hand hygiene and workplace cleaning at all times, but especially during a pandemic. This will be done via newsletter, notice board and meeting time.

Personal Hygiene measures will be reinforced as a way to minimise influenza transmission:

P a g e |4


* Cough Etiquette – cover nose and mouth when sneezing. Cough or sneeze into a single use tissue and dispose of it immediately into covered receptacle. If no tissue isimmediately available then cough into elbow. Wash hands.

* Hand hygiene

– all staff and children must adopt good hand washing and drying practices, particularly after coughing, sneezing or using tissues.

- Keep hands away from the mucous membranes of the eyes, mouth, and nose.

- The Centre Management will ensure that adequate supplies of hand hygiene products are available. This is a high planning priority as there may be shortages of soap and paper towels.

- Via notices around the centre and through newsletters hand and personal hygiene information will be transmitted to staff and visitors.

- Hygiene notices will be posted in washrooms and hand washing stations. Those in the children’s wash areas will be simplified to make them appropriate for the children.

Good cleaning practices will be reinforced:

* During a pandemic cleaning will need to be more thorough. Influenza viruses can live up to 2 days on hard surfaces.

* Alcohol and chlorine inactivate the viruses. Surfaces will be cleaned with a neutral detergent followed by a disinfectant solution.

* Surfaces that are frequently touched with hands will be cleaned often, and at least daily. The Manager will source information about appropriate choice and concentration of disinfectants from the Ministry of Health website.

* Usual hygiene practices will be elevated in a pandemic to a higher level than usual.

* Staff and children must not share cups, dishes and cutlery.

* All cups, dishes and cutlery must be thoroughly washed with soap and hot water after use.

* Books may need to be removed from the book corner and magazines from the parent library and staff room to limit the spread of infection.

* Baby Toys, puzzles, blocks, dress-ups, family play equipment and construction sets should be washed daily.

* Play dough and clay will not be used unless each piece can be limited to use by a single child.

* Sand and water play will only be used where it is practical to let each child play with it individually and then it can be thrown out.

P a g e |5


* Communal equipment such as computers, telephones and photocopiers must be wiped down after each use and cleaned daily.

* When a person, with suspected influenza is identified and has left the centre, their work area/office, along with any other known places they have been, will be thoroughly cleaned and disinfected.

* Basic hygiene practices (including hand hygiene) to be followed by cleaners, and methods of waste disposal will be identified and reviewed regularly.

Adequate ventilation will be maintained:

* All internal spaces will be well ventilated, preferably by fresh air via opening windows, or by properly designed and maintained air conditioning systems. Air conditioning units will be checked and cleared every 6 months.

Social distancing as a strategy to protect staff and children:

* During the ‘plan for it’ and ‘stamp it out’ phases of a pandemic when the centre is still expected to remain open or is operating in an unaffected area management will work to raise awareness of the importance of social distancing. This is not easy to achieve in an early childhood setting.

* Contact with others in the setting will be minimised.

* There will be no planned events involving large gatherings. e.g. family social events.

* No excursions outside the centre will be organised during this time.

* A distance of at least 1 metre should be maintained between persons wherever practical. Larger distances are more effective.

* Where possible we will avoid meeting people face to face and use the telephone, or internet to conduct business.

* Any unnecessary travel will be avoided and non-essential meetings/gatherings/workshops/training sessions will be cancelled.

* Staff will be encouraged to eat away from others by staggering meal breaks.

* Staff will not be encouraged to congregate in areas where they socialise, such as the staffroom, but to do what needs to be done and move on.

* If a face-to-face meeting with people is unavoidable, the meeting time should be minimised, held in a large space or outside and people should sit at least 1 metre away from each other. Handshakes or hugging should be avoided.

* We will set up systems where families and staff can request information via phone/e-mail/fax and have information ready for fast pick-up or delivery.

* Children who are unwell must be kept at home.

P a g e |6


* Staff, parents and whanau who are feeling unwell will be advised not to come in to the Centre.

Emergency Kit :

An emergency kit will be kept at the Centre and checked every 6 months. This will include a supply of drinking water sufficient for three days.

Information sharing:

* This plan will be kept in all the Operations Manuals in the Centre – Copies are held by all Trustees and are also to be found in the Parent Library, the Staffroom, the Office.

* Hygienic Handwashing information/posters are put above all the washbasins.

* Staff, parents and whanau will be informed about the differences in symptoms between influenza and a common cold. This will be done via newsletter.

* On declaration of Code Red notices will be put up at all entry points, advising staff, whanau and visitors not to enter if they have influenza symptoms.

* Ministry of Health information about how to stay healthy during a pandemic will be made available.

See Appendices for examples of notices:

Cluster Group – point of contact?

Copies of this plan will be sent to local Civil Defence

Stage 2: During a Pandemic: (Code Red)

Pandemic Manager – Job Description

Protection of staff, children and visitors:

* Notices at all entry points, advising staff, whanau and visitors not to enter if they display influenza symptoms.

* Children who are unwell must be kept at home and staff, parents and whanau will be be advised not to come in to the Centre when they are feeling unwell, particularly if they are exhibiting any influenza symptoms. Staff, parents and whanau will be informed via newsletter and notices of the differences in symptoms between influenza and a common cold. Unwell staff and children (through their parents/whanau) will be advised to see a doctor, and to stay at home until symptoms resolve.

* Ministry of Health information will be provided to inform staff, parents and whanau how to stay well during a pandemic.

* Ill children and staff must have completed any required quarantine period and must be healthy before returning to the Centre. This must be certified by a medical practitioner.

P a g e |7


(Those who have recovered are unlikely to be re-infected (they will have a natural immunity) and should feel safe to return to the Centre.

Managing staff and children who become ill.

If a person feels ill, or if someone observes that another person is exhibiting symptoms of influenza, they are to contact the “pandemic manager” by telephone if possible.

Using a screening flowchart:

1. The pandemic manager should avoid visiting the person if possible.

2. The pandemic manager should check if the sick person has any of the symptoms outlined in the first section of the flowchart.

3. If the sick person does not have symptoms like those listed in Appendix “The difference between influenza and a common cold” they are very unlikely to have influenza and should be reassured. An adult should be advised to call the pandemic manager again later or to see their GP if they are still concerned. For children, parents/wh�nau should be advised to take these actions.

4. If the sick person does have symptoms that match some of those listed, they should be treated as a “suspect case.” An influenza notification form should be completed (see appendix); including details of any staff, children and/or visitors they have been in contact with. This information will enable the pandemic manager to identify recent movements and monitor well-being during the pandemic.

5. The sick person should be informed where they can obtain a surgical mask and instructed to wear it immediately. This is to help protect other staff and children.

6. The sick person should be sent home and they or their family should immediately contact a health professional in the manner advised by the Ministry of Health on its website at that time. This may involve phoning the person’s normal doctor or nurse, parent/s, or a specially designated Community Based Assessment Centre (CBAC) to seek further advice. The licensees and staff should be informed of the situation.

7. If sending the person home or collection is not possible the sick person should be isolated from others in a designated space until suitable arrangements can be made for them to leave the premises.

8. The sick person should, if possible, avoid public transport when going home.

9. Contact management It is helpful for employers to:

• identify contacts (once an employee or child is suspected to be infected) • advise contacts that they have been in contact with a person suspected of having

influenza • ask contacts to go home, and stay at home until advised otherwise.

10. Whenever practicable the employee’s or child’s work area should be cleaned and disinfected .

P a g e |8


11. Set up a system to manage the absence and return of the staff member or child and their contacts. Some issues to consider include:

• Advice to the staff member or the child’s family/wh�nau on how long to stay away. (The Ministry of Health website will have advice on this once the characteristics of a pandemic are known).

• Decisions on the leave and cover arrangements for staff.

• Checking on the staff member / child during his/her absence. This will facilitate treatment, contact tracing, etc., if they become ill.

• Establishing a process in your plan for ensuring that:

o the staff member or child is healthy before allowing them to return o they are encouraged to return once they are well.

P a g e |9


Appendices:

A. Hand hygiene notices

HAND HYGIENE

The most important thing you can do to keep from getting sick is to wash your hands!

Hand washing is the single most important measure to reduce the risks of transmitting infection from one person to another.

This will be a key matter to communicate to children by example and practice.

Hand washing with soap and water, alcohol-based hand rub, or antiseptic hand wash should be performed regularly. Hands should be thoroughly dried, preferably using disposable tissues or towels. Use the disposable towel to open the door.

Hand washing and drying should always be done after coughing, sneezing or handling used tissues or after touching objects, materials or hard surfaces that may have been contaminated by someone else with the infectious illness.

Hand-to-face contact such as can occur during eating, normal grooming, or smoking presents significant risks, because of the potential for transmission of influenza from surfaces contaminated with wet respiratory droplets. Hand washing and drying should always be carried out before and after eating, grooming, or any other activity that involves hand-to-face contact.

P a g e |10


PROTECTING YOURSELF AND OTHERS AGAINST RESPIRATORY ILLNESS

HANDWASHING IS THE MOST IMPORTANT THING YOU CAN DO TO PROTECT YOURSELF

Cover your nose and mouth when coughing or sneezing.

o Use a tissue and dispose of this once used in the waste. o Always wash hands after coughing and sneezing or disposing of

tissues.

Keep your hands away from your mouth, nose and eyes.

Avoid contact with individuals at risk (e.g. those with underlying or chronic illnesses such as immune suppression or lung disease) until influenza-like symptoms have resolved.

Avoid contact with people who have influenza-like symptoms.

Ask children to use a tissue and cover their nose and mouth when coughing or sneezing and to wash and dry their hands afterwards.

P a g e |11


Source: Vancouver Coastal Health’s Regional Pandemic Influenza Response Plan

P a g e |12


B. Screening flowchart

For detection and management of suspected pandemic influenza cases

Process

1. Your centre’s influenza manager receives a call from a person suspecting they may have influenza, or from a staff member who has noticed a child who may be ill.

2. Avoid contact with the sick person if possible and manage the process over the telephone. 3. For someone at the centre who is ill, follow the flowchart below:

C. Influenza notification

Ye

s,

tw

o

or

mo

re

o

fs

ym

pt

om

s,

as

Unlikely to be influenza

• Reassure • Advise parents/wh�nau and if

concerned to visit their doctor.

Advise your local Medical Office of Health. Suggest the ill person or parents/caregivers contact their doctor.

Arrange for clean up of the centre.

Advise contacts that they have been in contact with suspect case.

Ask contacts to go home and to stay there until advised otherwise.

No symptoms, as described above

Ask the child or adult and observe them for any of the following symptoms:

• High fever (or they feel feverish or hot) • Headache • Fatigue and weakness • Sore throat, cough, chest discomfort, difficulty breathing • Muscle aches and pains • Beenoverseasrecentlyorincontactwithsomeonediagnosedwithinfluenza.

Child or person unwell. May be a possible case of influenza.

Fill in the suspected influenza Notification Form with names of people in contact with them. Obtain a surgical mask for them, advise their family and organise for them to leave immediately.

P a g e |13


INFLUENZA NOTIFICATION

Influenza is a contagious disease.

There is currently an increase in the numbers of people in New Zealand with influenza.

To prevent the spread of influenza in this service you must tell the staff if your child or immediate family have any of the following flu symptoms:

• chills, shivering and a fever • onset of muscle aches and pains • sore throat • dry cough • trouble breathing • sneezing • stuffy or runny nose • tiredness

P a g e |14


D. Closure notice

SERVICE CLOSED

DUE TO THE INFLUENZA PANDEMIC,

THIS SERVICE IS CLOSED UNTIL FURTHER NOTICE

DO NOT ENTER

For urgent enquiries contact

____________________________

P a g e |15


E. Suspected influenza case

NOTIFICATION FORM

Details of Affected Staff/Students

Name: Site: Location of isolation:

Job title:

Nationality if visitor to site:

Date of birth:

(optional)

Address:

Telephone no:

(W) (H) (M)

Symptoms noticed:

Fever Body aches

Headache Fatigue

Dry cough Others Details:

Cold

Time of fever on-set:

Time of isolation:

P a g e |16


Travel history over the past eight days:

Countries visited: _______________________

Flights taken: _____________________________

Where referred:

Contact List (See separate page)

P a g e |17


F. Contact list

The Ministry of Health currently defines pandemic influenza contacts as people who have had close physical (less than one metre) or confined airspace contact with an infected person, within four days of that person developing symptoms. These are likely to include family members and/or other living companions, workmates, other children in an ECE centre (if in close contact situations or confined airspace environments), and some recreational companions.

Retain this list and provide to the Medical Officer of Health or his/her designated officer on request.

People the affected person has interacted with since displaying symptoms

Name Email Telephone no. Address

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

Note that the definition of a contact is likely to change once the nature of the pandemic strain is known. Employers should refer to Ministry of Health website during a pandemic for up-to-date guidance.

P a g e |18


G. Personal Protective Equipment (PPE)

Guidelines

The Department of Labour and Ministry of Health websites have guidelines which may help you decide on appropriate personal protective equipment to protect staff and children in your ECE service. The Department of Labour also has an article about Personal Protective Equipment (PPE) and practices and influenza pandemic preparedness.

Emergency supplies

The following generic list of emergency supplies approved by the Department of Labour can be used as a starting point for your pandemic preparations. It is an 'over-the-top' type list to cover all contingencies, so you will need to adapt it to your ECE service’s needs and requirements.

Emergency Pandemic Supplies

Suggested list - stock pile one to two weeks’ supply

Breathing mask (box 50) 3 per person per day

Eye goggles (1 per staff dealing closely with sick person)

Latex/non latex gloves (100s) 10 per staff per day

Disposable apron for staff (1 per staff per day)

Tissues (box 200) 3 boxes per person per week

Paracetamol (box 20) 1 box per adult per week

Paracetamol (suspension) 50mls per child per week

Disinfectant (2 litres) 1 bottle per 15 people per day

Janola (2 litres) 1 bottle per 15 people per day

Cleaning fluid (1 litre) 1 bottle per 15 people per day

Toilet paper minimum 2 rolls per person per week

Paper towels (2 packets per person over 3

P a g e |19


weeks)

Carton of Chux Cloths

Liquid soap/alcohol wash (1 litre)

You will need to consider staff education and training in the use of personal protection equipment:

• preventative guidelines

• staff awareness

• documentation.

P a g e |20


H. Sample letter 1 Pandemic Stage 1

To parents/caregivers: introduction to pandemic planning

Dear Parents / Caregivers

Most of you will be aware that a ‘bird flu’ virus, H5N1, is currently affecting birds and small numbers of people in countries overseas. Most of the people affected by the virus work with or live close to infected birds. Because New Zealand is off the flight paths of most migratory birds, the current spread of the virus is not seen as a big threat to our country.

But international health experts are concerned the virus could mutate to pass easily between humans, leading to a global influenza pandemic. The government is preparing plans to protect the country from a possible influenza pandemic. As part of this nation-wide planning, our early childhood service has been asked to prepare our own pandemic plan.

Our service has an emergency management plan that covers most emergencies, such as fire and earthquake. Using resources provided by the Ministry of Education, we are now updating our emergency management plan to include plans for coping with an influenza pandemic.

We will keep you informed as our pandemic plan develops. In the meantime, you can reduce the risk of your child catching influenza:

• Teach your children the importance of hand washing and drying – especially before meals and after toileting.

• Teach your children to use a disposable tissue when coughing or sneezing. • Keep your children at home if they have the flu.

An important part of emergency planning is to make sure we have up-to-date contact details for all children and staff. Please ensure that you complete and return the attached form. Your personal details will not be used for any other purpose other than in the context of emergency management.

Find out more about pandemic planning and ‘bird flu’ on these websites: www.moh.govt.nz/pandemicinfluenza www.minedu.govt.nz/goto/pandemicplanning If you have any questions or concerns at this stage, please contact me directly.

Yours sincerely

_________________________[Designation]

P a g e |21


I. Parent contact details

Please take time to fill out this form with up-to-date contact details for you as parents/caregivers of your child. Please also provide two local emergency contacts of people your child knows (eg, family/friends) who could take care of your child in an emergency:

Date: __________________________________________

Child’s name: _____________________________________________

1. Parent/caregiver:_______________________________________

Home phone: _______________________

Work phone: ________________________Mobile phone: ____________________

2. Parent/caregiver:______________________________________ Home phone:_______________________ Work phone:________________________ Mobile phone:_____________________

3. First emergency local contact (eg, friend or family member): Name:__________________________________________

Home phone: _______________________


4. Second emergency local contact (eg, friend or family member: Name:__________________________________________

Home phone: _______________________


P a g e |22


Pandemic Stage 2

J. Sample letter 2

Dear Parents / Caregivers

The government has announced that New Zealand is stepping up its pandemic influenza response plans. This means that the situation overseas has changed and New Zealand’s borders have been tightened in an attempt to stop the virus getting here.

We are talking with health and civil defence officials and we have been advised that there is no reason for alarm. Our service will remain open until further notice. Our own pandemic plans mean that we have systems in place to help us cope if anything changes.

The most important thing that parents and caregivers can do is to help reinforce healthy messages:

• Teach your children the importance of hand washing and drying – especially before meals and after toileting.

• Teach your children to use a disposable tissue when coughing or sneezing.

We ask that all children showing flu like symptoms be kept home until checked and okayed by a doctor or nurse to return to school. The symptoms of influenza and how they differ from common cold symptom are outlined on the next page of this letter.

We are updating our emergency contact details for all children and staff. Please complete the attached form and return it to us.

Thank you.

If you have any questions or concerns please contact me directly.

Yours sincerely

________________

[Designation]

P a g e |23


K. The difference between influenza and a common cold

SYMPTOM INFLUENZA COMMON COLD

Fever Usual, sudden onset 38o-40o and lasts 3-4 days.

Rare

Headache Usual and can be severe Rare

Aches and pains Usual and can be severe Rare

Fatigue and weakness Usual and can last 2-3 weeks or more after the acute illness

Sometimes, but mild

Debilitating fatigue Usual, early onset can be severe

Rare

Nausea, vomiting, diarrhoea

In children over 5 years Rare

Watering of the eyes Rare Usual

Runny, stuffy nose Rare Usual

Sneezing Rare in early stages Usual

Sore throat Usual Usual

Chest discomfort Usual and can be severe Sometimes, but mild to moderate

Complications Respiratory failure; can worsen a current chronic condition; can be life threatening

Congestion or ear-ache

Fatalities Well recognised Not reported

Prevention Influenza vaccine; frequent hand-washing; cover your cough

Frequent hand-washing, cover your cough

P a g e |24


1. Background information on influenza pandemic

What is an “influenza pandemic”?

Influenza pandemics are characterised by the spread of a novel type of influenza virus to many parts of the world, causing unusually high morbidity (illness) and mortality for perhaps two to three years. Most people do not have immunity to the virus and therefore are susceptible to influenza infection. A pandemic can overwhelm the resources of a society due to the exceptional number of those affected.

A pandemic may occur as a result of the emergence of a new viral sub-type with the capacity to spread efficiently from human to human.

What does an influenza pandemic look like?

Past pandemics over the centuries have swept quickly through populations, and left considerable damage in their wake. Recovery was impeded by the tendency of pandemics to recur in second and third waves. Age groups and geographical areas not affected initially may prove vulnerable during subsequent waves.

For example, in the 1918-1919 “Spanish flu” pandemic1, there were three waves. For whatever reason the virus in the first wave in June and July caused illness that appeared to be indistinguishable from seasonal influenza. In November, a far more virulent illness appeared. (The first wave provided some protection from the second – those who became ill in the first wave were less likely to get sick in the second wave.) The third wave, in 1919, was much smaller and less intensive than the previous two.

By contrast, the 1957-1958 “Asian flu” pandemic was essentially one long wave, lasting about 3 months, with a very high total attack rate (possibly 70% - 80% of the NZ population) and no significant following waves. The mortality rate was very low.

It is not possible to predict pandemic wave activity or other features before a pandemic. It is probably safe to say that if there is a very large wave with a very high total attack rate (as in 1957) there won't be another of any size resulting from the same virus (or a slightly mutated form) because a high proportion of the population will have developed natural immunity. However, a 20% wave wouldn't preclude another larger one at a later stage (as in 1918).

Current national planning aims to keep influenza out of New Zealand or substantially delay its entry and if it arrives, control clusters within New Zealand until a vaccination campaign could be run. Vaccination will protect the general population against pandemic influenza. However, given the time lapse (several months at least) between virus recognition and production of a vaccine, planning must take into account the possibility that the pandemic may reach New Zealand, and that there may be more than one “wave” of illnesses.

The Ministry of Health has prepared a number of possible scenarios to assist with planning for pandemic influenza, included at the end of this document.

The international weekly journal of science, Nature, has illustrated in the form of a blog how a pandemic might play out with a future scenario. 1 Globally, the Spanish flu pandemic is estimated to have killed 20 to 50 million people. This pandemic disproportionately affected young people aged 20 to 40. Death was sudden, often within 24 hours. In New Zealand, over 8,000 people died. In Western Samoa, 20 to 25 percent of the population died. By contrast American Samoa, which closed its borders, had no deaths.

P a g e |25


How likely is an influenza pandemic?

The World Health Organisation (WHO) and Ministry of Health advise that it is certain there will be an influenza pandemic at some time in the future, but no-one can say when.

On average, influenza pandemics occur three times every century, but with no recognisable pattern in timing. In the last century, pandemics occurred in 1918-1919 (the “Spanish flu”), 1957-1958 (the “Asian flu”), and 1968-1969 (the “Hong Kong flu”).

The World Health Organisation considers the risk of avian influenza morphing into the next pandemic to be very high. The H5N1 virus has recently expanded its geographical area: originally it had affected several east and south east Asian countries,1 but recently has spread to Russia, Kazakhstan, Turkey, Rumania and Greece. Even if the risk from avian influenza goes away, another influenza virus can be expected to come along months or years later.

The World Health Organisation is advising governments worldwide to take precautionary measures and develop pandemic influenza response plans.

What is avian influenza (“bird flu”)?

Bird flu or avian influenza is a contagious viral infection that can affect all species of birds. Migratory waterfowl (ducks and geese) are a natural reservoir for avian influenza virus overseas, and may carry the viruses without becoming ill. Fortunately, New Zealand is not on the regular migratory pathways of any waterfowl and only very occasionally do waterfowl reach our shores, generally originating from southern Australia.

Bird flu outbreaks among chickens and other birds occur from time to time around the world due to a variety of strains of avian influenza virus. The current outbreak of highly pathogenic avian influenza (HPAI) due to the H5N1 strain is of concern because of the size of the outbreaks, the number of countries becoming affected and the fact that humans have become infected.

The H5N1 virus is highly infectious among birds and in a number of species can be rapidly fatal. Because of their living conditions domestic poultry flocks are particularly vulnerable to the rapid spread of the disease. The disease is not normally spread to humans but some cases have been reported. Most cases to date appear to have resulted from close direct contact with infected birds. There is no suggestion yet that the virus easily spreads from person to person.

Clinical experts are, however, concerned at the potential for H5N1 to adapt to humans and thereby acquire the ability to spread readily from human to human. If this happens there could be a worldwide influenza pandemic. The World Health Organisation considers the current risk to be high, and is advising governments worldwide to take precautionary measures and develop pandemic influenza response plans.

1 As at September 2005, the East Asian and South East Asian countries known to be, or which have been affected, are Japan, China, Korea, Laos, Vietnam, Thailand, Cambodia and Indonesia, Mongolia. The Central Asian countries affected are Russia and Kazakhstan. European countries affected are Turkey, Rumania and Greece.

P a g e |26


Why should New Zealanders be concerned?

Beginning in late July 2005, official reports to the World Animal Health Organisation from government authorities indicated that the H5N1 virus had expanded its geographical range. Russia and Kazakhstan reported outbreaks of avian influenza in poultry in late July 2005, and confirmed H5N1 as the causative agent in early August. Deaths in migratory birds infected with the virus have also been reported. Outbreaks in both countries were attributed to contact between domestic birds and wild waterfowl via shared water sources. These were the first outbreaks of Highly Pathogenic Avian Influenza (HPAI) recorded in the two countries. Both countries were previously considered free of the virus.

In October 2005, Turkey, Rumania and Greece reported outbreaks of avian influenza, and confirmed H5N1 as the causative agent.

Experience in south-east Asia (Viet Nam, Thailand, Cambodia, and Indonesia) indicates that human cases of infection is rare but that there is a high mortality rate (there have been 112 laboratory-confirmed human cases of avian influenza December 2003, of which 57 were fatal). Most, but not all, human cases have been linked to direct exposure to dead or diseased poultry, notably during slaughtering, de-feathering, and food preparation.

Influenza viruses are highly unstable. This means that over time, viruses change and may develop the ability to readily infect humans. Also, when animal influenza viruses are circulating at the same time as human viruses there is potential for the two to "meet" and create a new influenza virus to which humans would have little, if any, protective immunity, and which can spread easily from person to person.

By May 2006, 218 confirmed cases of human H5N1 infection in 10 countries had been reported – 124 of them fatal.

H5N1 is showing signs of changing and the expanding geographical presence of the virus creates expanded opportunities for human exposure. The emergence of an HPAI strain that is readily transmitted among humans would mark the start of a pandemic.

Where can we find international information updates?

The World Health Organisation website provides updates on the global occurrence of avian influenza, risks to humans, vaccine and anti-viral developments. It also provides useful background information about the nature and characteristics of avian influenza and past pandemics.

The World Organisation for Animal Health provides an international perspective and updates on infection in birds.

The New Zealand Ministry of Health also provides much relevant information.

P a g e |27


What are the symptoms of influenza?

Influenza is a highly contagious viral disease of the respiratory tract.

Influenza is characterised by rapid onset of respiratory and generalised signs and symptoms including: a high fever, headache, muscle aches and pains, fatigue, cough, sore throat, or a runny nose.

How is influenza spread?

Influenza is spread from person to person in the respiratory droplets generated by coughs and sneezes. It can also be spread when a person comes into contact with the respiratory droplets of another person by touching items on which droplets are present, and then touches their own eyes, mouth or nose before washing their hands. The virus may enter through eyes or more commonly through the nose or mouth, and into the throat and lungs where it begins to multiply. The time from first exposure to when symptoms begin is one to four days.

The disease damages the linings of the respiratory tract. Secondary bacterial infections, such as pneumonia, meningitis, sinus and ear infections can then take hold.

How long is the influenza virus infectious?

It is not known for certain if people with influenza are infectious before developing symptoms. An adult with influenza is infectious once they show symptoms and for some days after. Children have been shown to remain infectious for up to 21 days, long after symptoms have disappeared. Some individuals may become infected but never show symptoms.

Influenza viruses may be able to live for up to two days on hard surfaces such as doorknobs, handrails, toys, cups, utensils, telephones. Although it can live on these surfaces it is not as infectious as these surfaces are usually dry.

Is medication available to prevent or treat pandemic influenza?

Vaccine

Vaccines are virus-specific, so pandemic vaccines cannot be produced until the specific pandemic virus has been identified. The time lapse between virus recognition and production is likely to be at least several months, largely because of technical issues around vaccine production. The Ministry of Health is working to ensure New Zealand gets access as quickly as possible to a vaccine once it is developed and available.

Given that the first supplies of vaccine against a novel strain of influenza are unlikely to be available quickly, it is possible that New Zealand would have suffered at least one pandemic wave before a vaccination campaign can provide population immunity.

Will anti-viral medications for pandemic influenza be available?

Many complications from influenza are due to secondary infection. Antibiotics are the preferred treatment for secondary infections, although they are ineffective in the treatment of the viral influenza itself.

P a g e |28


Anti-viral medication can shorten the course of infection, if given early. They can also provide short-term protection against influenza. Several anti-virals have specific activity against the influenza virus, but only one of these (Tamiflu) is thought to be suitable for widespread general use in a pandemic situation.

It is not known if Tamiflu will be effective against a pandemic strain virus as its use in a pandemic situation is untested. The impact of Tamiflu in aiding pandemic management measures cannot be known until a pandemic occurs and epidemiological evidence is available.

The Ministry of Health is stockpiling sufficient Tamiflu to treat 30% of the population, for use if a pandemic occurs. Careful prioritisation of its usage is essential, and exact priorities cannot be identified until the pandemic strain is identified and its epidemiology understood (including which age groups in the population are likely to be the worst affected). Current draft policy envisages that Tamiflu will be used intensively in the early stages as part of a number of initiatives for control of small clusters of illness. If and when the pandemic affects many areas of New Zealand, its usage will be reserved for treatment, and further prioritisation may be required (including for cases at higher risk of complications or death).

Further information and updates about Tamiflu may be found on Ministry of Health website.

Emergency Procedures Handbook - Elim Kids · * Hand hygiene – all staff and children must adopt...

Documents

Transcript of Emergency Procedures Handbook - Elim Kids · * Hand hygiene – all staff and children must adopt...