facts about major deadly diseases VERSIO N 1 Th e r eeme r genc e of infectiou s diseases The threat continues New Infectious Threats continue to Emerge ID: 931305
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Slide1
Managing
epidemics
Key facts about major deadly diseases
VERSIO
N
1
Slide2Slide3Th
e
re-emergence of infectious diseasesThe threat
continuesNew Infectious Threats continue to Emerge
Infectious Diseases
don’t go away.
Since
1970, more
than 1,500 new
pathogens were
discovered,
70% proved
to be
of animal origin:
a connection
that deserves
renewed scrutiny.
Not all of
them
have
had
a
public
health
impact but some ofthem have become famous. They included the Ebola virus,Ebola has surfaced in almost 25 separate and deadly outbreaks, Human immunodeficiency virus (HIV), HIV, infected about 70 million people in just 35 years, killed an estimated 35 million people in the same period.
MANAGIN
G EPIDEMICS | KEY FACTS ABOUT MAJOR DEADLY DISEASES
P
A
R
T
I
14
Slide4Y
ello
w
fever17
12
8
2
4
10
4
57
Chikungunya
8
10
3
29
27
14
4
95
Viral
haemorrhagic
fever
6
4
10
Ebol
a
virus disease1211
4
3122Marburg virus disease
1
124Crimean-Congo haemorrhagic fever3568771349Rift Valley fever111114514Cholera62514737444225308Typhoid fever202352831475Shigellosis25242829421113Plague8761076347Lassa fever212327623West Nile fever1115151111181091Zika virus disease57195452137Meningitis14201919192323137MERS-CoV31017127857Influenza A5679105951Monkeypox22510Nodding syndrome112Nipah virus infection1111152011201220132014201520162017**
Epidemic events* globally, 2011 – 2017**: A total of 1,307 epidemic events Number of epidemic events* by disease and year
TOTAL
* Analysis excluded Poliomyelitis. The following epidemic and pandemic diseases were analysed: Avian Influenza A(H5N1), A(H7N9), A(H7N6) A(H10N8), A(H3N2), A(H5N6), A(H9N2), Chikungunya, Cholera, Crimean-Congo haemorrhagic fever, Ebola virus disease, Lassa fever, Marburg virus disease, Meningitis, MERS-CoV, Monkeypox, Nodding syndrome, Nipah virus infection, Plague, Rift Valley fever, Shigellosis, Typhoid fever, Viral haemorrhagic fever, West Nile fever, Yellow fever, Zika virus disease. If a disease caused more than 1 epidemic event by year in a country, it was only counted once for the year it occurred in that country. Includes cases imported or locally transmitted.
** WHO/IHM data as of 12 January 2018 (note: 2017 data is not complete)
Source: data reported to WHO and in media
MANAGIN
G EPIDEMICS | KEY FACTS ABOUT MAJOR DEADLY DISEASES
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A
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Slide5Will
history
repeat
itself?Yes, it will. Whether
transmitted by mosquitoes,
other insects, contact
with animals
or person-to-person
The
only major uncertainty is
when
they,
or somet
hing
equally
lethal,
will
arrive.
What are
we doing about it?
Slide6D
eeply
scarred
by so many major epidemics.Take the plague, .
A
thing of the past?
A major outbreak in Madagascar
in 2017 led to a
total of
at least
2,417 confirmed, probable and
suspected cases,
including
209 deaths.
D
iseases very rarely
disappear. And
there always seems
to be room for
new
ones.
SARS
–
Severe
acute respiratory syndrome affected more than 8,000 people, killing about one in ten of them, causing fear and panic across the world, and inflicting enormous economic damage,.– PAR
T
I 15The 21st century: already a long series of scourges
Slide7L
ocalized
can now become global very rapidly For
example,
the influenza pandemic of
2009 reachedall
continents in less than
nine weeks.
In 2015,
one traveler returning home
to the
Republic of Korea from spending time
in the Middle
East brought
MERS back with him.
The consequences:
A
Korean outbreak,
186 cases, 36 deaths, and
outbreak-related losses of
approximately
US$
8
billion,
all
in
the space of two months.Spread more widely and more quickly, ruinous impacton the economy of the affected country and spill overinto to the global economy, disrupting travel, trade andlivelihoods.MANAGING
EPIDEMIC
S | KEY FACTS ABOUT MAJOR DEADLY DISEASESPAR
T
I 17Faster and further with a greater impact
Slide8Ready
and able
to detect the next outbreakGiven the effects of globalization,
the
intense mobility of
human populations,
and the relentless
urbanization
Initial Delay in RecognizingSerious impact on Travel and Trade
Public Reaction
Anixiety Panic and Confusion
Media Coverage
Global health security
depends crucially on
Awareness Cooperation Collaboration
Improve early detection
The Ebola
outbreak undiagnosed for
more than two months.
virus to spread unseen, capital
cities
where
the
outbreaks grew
into
large
epidemics. MANAGING EPIDEMICS | KEY FACTS ABOUT MAJOR DEADLY DISEASESPART I 18
Slide9Increasing health security is preparedness.
Adapt to any novel (new) agent, Known pathogensHow will they behave, mutateFear of the unknown
Out of proportion to the real threat Inadequate decisions Inappropriate
behavioursRisk Communication is critical Social Political Economic ImpactKnown epidemics: still a severe threat Polio
Measles
MumpsStrengthening
health systems:
essential in
epidemics
Slide10New
lifestyles
spread
diseases furtherIncrease Contact between people, animalsFast Intense mobilityInternational Travel
Mega Cities
Major Transport Hubs Migration from Rural to Urban
Increased Trade
Refuges
Asylum Seekers
Economic migrants
Challenges an
d risk factor
s for 21st century
epidemics
MANAGING EPIDEMIC
S |
KEY
FACTS ABOU
T MAJOR
DEADLY DISEASES
PAR
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Slide11Epidemi
c
phases
and response interventions
Anticipation
Early
detection
Control
and mitigation
Elimination
or eradication
Containment
Introductio
n or emergence
Localized
transmission
Amplification
Reduced
transmission
Response interventions
Epidemic
phases
P
A
R
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Slide12Information on COVID-19 is rapidly changing, sometimes daily. Refer to reliable sources such as the CDC, OSHA, NIOSH, State Health Departments and peer reviewed science publications.
12
Slide1313
Be informed and prepared.
Wear a mask.
Maintain social distancing (6 feet).Wash your hands frequently.Use alcohol-based hand sanitizer.Avoid touching your eyes, nose, and mouth.Stay home when you are sick.Cough or sneeze into a tissue or your elbow.Clean and disinfect frequently touched objects and surfaces such as cell phones.
What can individuals do?
Slide14Slide15What is SARS-CoV-2?
SARS-CoV-2 is the virus that causes coronavirus disease 2019 (COVID-19)
SARS = severe acute respiratory distress syndrome
Spreads easily person-to-personLittle if any immunity in humansDetailed information: https://www.cdc.gov/coronavirus/2019-ncov/index.html
15
Slide1616
Droplet
- respiratory secretions from coughing or sneezing landing on mucosal surfaces (nose, mouth, and eyes)
Aerosol - a solid particle or liquid droplet suspended in air Contact -Touching something with SARS-2 virus on it and then touching mouth, nose or eyes
Other possible routes
: Through fecal matter
COVID-19 is spread from person to person mainly through coughing, sneezing, and talking and breathing.
Transmission
Slide17COVID-19 can cause mild to severe symptoms
Most common symptoms include:
Fever
CoughShortness of breathOther symptoms may include:Sore throatRunny or stuffy noseBody aches
HeadacheChills
FatigueGastrointestinal: diarrhea, nauseaLoss of smell and taste
17
Slide1818
Most people will have mild symptoms and should recover at home and
NOT
go to the hospital or emergency room.Get medical attention immediately if you have:Difficulty breathing or shortness of breath.Persistent pain or pressure in the chest.New confusion or inability to arouse.Bluish lips or face.Severe symptoms – emergency warning signs for COVID-19
Slide19How long does SARS-CoV-2 survive outside of the body?
It is not clear yet how long the coronavirus can live on surfaces, but it seems to behave like other coronaviruses.
Virus may persist on surfaces for a few hours or up to several days, depending on conditions and the type of surface.
It is likely that it can be killed with a simple disinfectant on the EPA registered list below.https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2There are ongoing investigations to learn more.19
Slide2020
COVID-19 poses a greater risk for severe illness for people with underlying health conditions:
Heart disease
Lung disease such as asthmaDiabetesSuppressed immune systems
The elderly have higher rates of severe illness from COVID-19. Children and younger adults have had less severe illness and death. Because COVID-19 is new, there are a lot of scientific unknowns such as the impact on pregnant women and their fetuses.
Increased risk of severe illness
Slide21Seasonal flu vs. COVID-19
COVID-19 has the potential to cause more deaths and hospitalizations
SARS-CoV-2 is much more infectious and spreads faster than the seasonal flu
21
Slide2222
Flu pandemic fatalities, worldwide, in the last century:
1918 – between 40 and 100 million
1957 – 2 million1968 – 1 million
Experts have been recommending preparedness, warning about the likelihood of future pandemic influenza
outbreaks for decades.
Pandemic influenza
Slide23Protecting workers
23
Start with the most effective method to protect workers.
Physically remove the hazard
Replace the hazard
Isolate people from the hazard
Change the way people work
Protect the worker with Personal Protective Equipment
Slide24Engineering controls
Ventilation
Drive-thru service
Plastic shields and other barriersSneeze guards24
Slide25Administrative controls and work practices to reduce exposure
Enable sick workers to stay home
Establish work from home policy
Minimizing contact among workers and clientsDiscontinue non-essential travelLimiting the number of staff present for high potential exposure tasksTraining
25
Slide26Additional administrative controls
Soft barriers include use of tables, ropes, signs, and floor markings to maintain social distancing.
26
Slide2727
Where applicable, the OSHA PPE standard requires employers to:
Conduct an assessment for PPEProvide PPE at no cost, appropriate to the hazardTrain employees on how to don (put on) and doff (take off) PPETrain workers to maintain, store, and replace PPEProvide medical evaluation and fit testinghttps://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=9777&p_table=STANDARDS
OSHA PPE standard
Slide2828
Employers should develop site specific decontamination procedures.
Depending on the workplace, decontamination may require consultation with the health department or use of a consultant specializing in environmental cleanup.Use of an EPA registered disinfectant effective is recommended.Worker and building occupant protection is essential to protect against the virus and adverse effects of the disinfectant.EPA List: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
Decontamination
Slide2929
An N95 respirator is the minimum level of protection to prevent inhaling coronavirus.
Respirators are needed when there is a potential for aerosol transmission.
Respirators
Slide3030
Advantages of reusable respirators:
Durability
Stand up to repeated cleaning & disinfectionMaintain fit over time
Cost savings
Powered air-purifying respirator (PAPR)Half or full-face elastomeric respirators
Respirators (continued)
Slide3131
Surgical masks
do not
:Fit tightly against the skin to form a sealFilter tiny particles, such as viruses or bacteria that are in the air
Surgical masks are not respirators!
Respirators (continued)
Slide3232
Written program
Selection according to hazard
Medically fit to wearFit testingEnsure proper use of respiratorsRespirator maintenanceLabeling/color coding filtersEmployee trainingProgram evaluationRecordkeepingRespiratory programs must comply with all elements of OSHA Standard 29 CFR 1910.134
Respiratory protection standard
Slide33PPE for jobs with high potential exposure
Face/eye protection
Gloves
GownsRespiratorsAt least N95 PAPR or full or half face elastomeric for greater protectionNOTE: there is a worldwide shortage of PPE!33
Slide3434
Must be hands-on and frequent
Should not be primarily computer based or lectureMust include an opportunity to drill the actual process of donning and doffing PPE and respiratorsShould include a trained observer Cover site specific decontamination procedures.Training and drills
Slide35Prevention in all work settings
Wash hands after removing gloves or when soiled.
Wear a mask.
Keep common surfaces such as telephones, keyboards clean.Avoid sharing equipment if possible.Minimize group meetings by using phone, email, and avoid close contact when meetings are necessary.Consider telework.Limit unnecessary visitors to the workplace.Maintain your physical and emotional health with rest, diet, exercise, and relaxation.35
Slide36Protection of essential workers
Fire, police, grocery stores, gas stations, utilities, communications, and health care facilities are examples of essential industries and operations that remain open during a pandemic shutdown.
A site and job task specific risk assessment should be conducted to document the necessary protective measures.
Social distancing measures include use of barriers, signs, modifying work procedures that require close human interaction. Other steps include increased cleaning and disinfection, use of PPE and respirators, and training. 36
Slide37Mental health and stress
As the number of cases of COVID-19 increase, so does the associated anxiety and stress.
Consider the following steps:Use your smart phone to stay connected to family and friends. Shift from texting to voice or video calling to feel more connected.
Keep comfortable. Do more of the things you enjoy doing at home.Practice stress relief whenever you feel anxiety building – do some deep breathing, exercise, read, dig in the garden, whatever works for you.Avoid unhealthy behavior such as excess drinking – that will just increase your anxiety afterwards.Keep looking forward. Think about plans you’d like to make down the road.37
Slide38The Role of the Vaccine
Cases of COVID-19 will decrease with the administration of the vaccine.
With uptake of the vaccine and continued workplace controls in place, occupational exposures will decrease.People who are vaccinated can still be exposed and potentially expose someone else even if they don’t become sick.
A continued focus on maintaining workplace preventive measures is important to protect workers in all industries.38
Slide39Slide40Vaccinations ~ Protect yourself & society
Slide41Slide42Slide43management
Slide44Employee Training Presentation
June 2021COVID-19
Emergency Temporary Standard (ETS)
Healthcare29 CFR 1910.502
Slide45Conduct a hazard assessment and implement a COVID-19 plan for each workplace. Engage employees in the development of the plan.
Designate workplace safety coordinator(s), knowledgeable in infection control principles and practices, with authority to implement, monitor, and ensure compliance with the plan.
Limit and monitor points of entry to settings where direct patient care is provided; screen and triage patients, clients, residents, delivery people and other visitors and non-employees entering the setting for symptoms of COVID-19; and implement patient management strategies.
Develop and implement policies and procedures to adhere to Standard and Transmission-Based Precautions in accordance with Centers for Disease Control (CDC) guidelines.Continued on next pageAs part of OSHA’s commitment to protect workers and deliver stronger worker safety protections, the agency has issued a COVID-19 Healthcare ETS that establishes new requirements to protect workers from exposure to COVID-19 in all settings, with some exceptions, where any employee provides healthcare or healthcare support services. The ETS requires employers to:
Overview of COVID-19 ETS (29 CFR 1910.502)
Slide46Provide and ensure employees wear facemasks when indoors and when occupying a vehicle with other people for work purposes; provide and ensure employees use respirators and other personal protective equipment (PPE) for exposure to people with suspected or confirmed COVID-19 and for aerosol-generating procedures (AGPs) on a person with suspected or confirmed COVID-19; and provide respirators and other PPE in accordance with Standard and Transmission-Based Precautions.
Perform AGPs on persons with suspected or confirmed COVID-19 in an airborne infection isolation room, if available; limit employees present to only those essential; and clean and disinfect surfaces and equipment promptly after the procedure is completed.
Keep employees at least 6 feet apart from others when indoors, unless not feasible for a specific activity (e.g., hands-on medical care).
Install cleanable or disposable solid barriers at fixed work locations in non-patient care areas where employees are not separated from other people by at least 6 feet. Follow standard practices for cleaning and disinfection of surfaces and equipment in accordance with CDC guidelines in patient care areas, resident rooms, and for medical devices and equipment or in all other areas when a person who is COVID-19 positive has been in the workplace in the last 24 hours; in all other areas, clean high-touch surfaces and equipment at least once a day; and provide alcohol-based hand rub that is at least 60% alcohol or provide readily accessible handwashing facilities.Continued on next page
Overview of COVID-19 ETS (29 CFR 1910.502)
Slide47How to Safely Don, Use, and Remove PPE
Slide48Key Points About PPE
Don before contact with the patient, generally before entering the room
Use carefully – don’t spread contamination
Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside roomImmediately perform hand hygiene
Slide49Sequence* for Donning PPE
Gown first
Mask or respirator
Goggles or face shieldGloves*Combination of PPE will affect sequence – be practical
Slide50How to Don a Gown
Select appropriate type and size
Opening is in the back
Secure at neck and waistIf gown is too small, use two gownsGown #1 ties in frontGown #2 ties in back
Slide51How to Don a Mask
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with ties or elasticAdjust to fit
Slide52How to Don a Particulate Respirator
Select a fit tested respirator
Place over nose, mouth and chin
Fit flexible nose piece over nose bridgeSecure on head with elasticAdjust to fitPerform a fit check –
Inhale – respirator should collapse
Exhale – check for leakage around face
Slide53How to Don Eye and Face Protection
Position goggles over eyes and secure to the head using the ear pieces or headband
Position face shield over face and secure on brow with headband
Adjust to fit comfortably
Slide54How to Don Gloves
Don gloves last
Select correct type and size
Insert hands into glovesExtend gloves over isolation gown cuffs
Slide55How to Safely Use PPE
Keep gloved hands away from face
Avoid touching or adjusting other PPE
Remove gloves if they become torn; perform hand hygiene before donning new glovesLimit surfaces and items touched
Slide56How to Safely Remove PPE
Slide57“Contaminated” and “Clean” Areas of PPE
Contaminated – outside front
Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside
Clean – inside, outside back, ties on head and backAreas of PPE that are not likely to have been in contact with the infectious organism
Slide58Sequence for Removing PPE
Gloves
Face shield or goggles
GownMask or respirator
Slide59Where to Remove PPE
At doorway, before leaving patient room or in anteroom*
Remove respirator outside room, after door has been closed*
* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub
Slide60How to Remove Gloves (1)
Grasp outside edge near wrist
Peel away from hand, turning glove inside-out
Hold in opposite gloved hand
Slide61How to Remove Gloves (2)
Slide ungloved finger under the wrist of the remaining glove
Peel off from inside, creating a bag for both gloves
Discard
Slide62Remove Goggles or Face Shield
Grasp ear or head pieces with ungloved hands
Lift away from face
Place in designated receptacle for reprocessing or disposal
Slide63Removing Isolation Gown
Unfasten ties
Peel gown away from neck and shoulder
Turn contaminated outside toward the insideFold or roll into a bundleDiscard
Slide64Removing a Mask
Untie the bottom, then top, tie
Remove from face
Discard
Slide65Removing a Particulate Respirator
Lift the bottom elastic over your head first
Then lift off the top elastic
Discard
Slide66Hand Hygiene
Perform hand hygiene immediately after removing PPE.
If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE
Wash hands with soap and water or use an alcohol-based hand rub* Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub
Slide67Emergency Preparedness and Response Resources
Visit OSHA’s web site for additional information. The OSHA page links to many emergency preparedness and response resources.
www.osha.gov
| www.osha.gov/SLTC/emergencypreparedness/
67
Click on
“A to Z Index”
Scroll to emergency topics in the list.
Slide68For more information
Centers for Disease Control and Prevention (CDC)
http://www.cdc.govOccupational Safety and Health Administration (OSHA) http://www.osha.govWorld Health Organization http://www.who.int/en/
National Institute for Occupational Safety and Health (NIOSH)
http://www.cdc.gov/NIOSH/
NIEHS Worker Training Program
https://tools.niehs.nih.gov/wetp/index.cfm?id=2554
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