6th Edition In-Depth: Emergency Preparedness in Response to the Presentation of Global Communicable Diseases
Standard PCI.8.2: The hospital develops, implements, and tests an emergency management program to respond to the presentation of global communicable diseases.
The fifth edition of the hospital standards included the requirement for hospitals to collect and evaluate data related to epidemiologically significant infections and required hospitals to prepare for disasters which included an infectious disease outbreak. However, the globalization of society has increased the likelihood of the rapid spread of communicable diseases from one country to another. Hospitals need to be vigilant in preparing for the potential spread of diseases endemic to other regions. The development of a new standard for the sixth edition of the hospital standards, standard PCI.8.2, addresses the need for hospitals to respond to the presentation of global communicable diseases.
The new standard requires hospitals to develop, implement, and test an emergency preparedness program to respond effectively to the presentation of global communicable diseases and identifies five areas to be included in this program. These five areas include:
- Communication with organizations participating in worldwide surveillance activities
- Development and implementation of segregation and isolation strategies
- Training, including demonstration, on the use of personal protective equipment appropriate to the type of infectious disease
- Development and implementation of communication strategies
- Identification and assignment of staff roles and responsibilities
Worldwide surveillance activities can provide hospitals with information related to emerging and re-emerging infectious diseases. Early warnings help heighten the hospital’s awareness and can increase the likelihood of prompt recognition of a communicable disease. Measurable element (ME) two of the standard requires the hospital to identify the first points of entry of patients — which may be outpatient departments as well as the emergency department — and target education to these areas on rapid recognition and intervention. This ties to the additions to standard ACC 1.1, ME 1 which requires the hospital to use a triage process that includes early recognition of communicable diseases.
Screening questions can be a simple and effective method for quickly identifying patients who may be infected with a communicable disease. Questions can be used at triage in the emergency department as well as other first points of entry into the hospital, such as at registration as an outpatient or at registration for admission to the hospital as an inpatient. Examples of screening questions may include the following:
- In the past two weeks, have you had a fever (elevated temperatures)?
- In the past two weeks, have you had a rash or unusual skin lesion?
- In the past two weeks, have you traveled outside of the country or had close contact with someone who traveled outside of the country?
- In the past two weeks, have you had a cough, shortness of breath, or trouble breathing?
- Do any of the people that you have close contact with at home, work, school, or among your friends have similar symptoms?
Depending on responses to the questions, the patient may need to be segregated until a more in depth assessment can be obtained. Rapid segregation/isolation strategies can significantly reduce the spread of infection. Additional information regarding screening may be obtained from the following link: https://www1.nyc.gov/assets/doh/downloads/pdf/em/screening-isolation-acute-care.pdf
Other aspects of the emergency preparedness program include implementing staff training on roles and responsibilities in the event of a communicable disease outbreak and providing training on the proper use of personal protective equipment appropriate to the type of disease outbreak. In addition, the hospital is required to develop both internal and external communication plans.
The hospital is required to test the program annually and at the conclusion of the test, conduct a debriefing of the test to identify areas for improvement. Follow-up actions are developed and implemented for any identified areas of improvement.