HHSA EMERGENCY OPERATIONS PLAN (EOP) APPENDIX 5 OUTBREAK/EPIDEMIOLOGIC RESPONSE PLAN PUBLIC HEALTH DIVISION

Transcription

1 Alice Hughey Acting Agency Directr Karen L. Smith, M.D., M.P.H. Public Health Officer 2344 Old Snma Rad Building G Napa, Califrnia PUBLIC HEALTH DIVISION HHSA EMERGENCY OPERATIONS PLAN (EOP) APPENDIX 5 OUTBREAK/EPIDEMIOLOGIC RESPONSE PLAN NAPA COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA)

2 ANNEX H - APPENDIX 5: OUTBREAK /EPIDEMIOLOGIC RESPONSE PLAN Intentinally Blank Page NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page ii

3 ANNEX H - APPENDIX 5: OUTBREAK /EPIDEMIOLOGIC RESPONSE PLAN RECORD OF CHANGES, UPDATES AND REVISIONS Plan Sectin and Page #. Descriptin f Change Date Signature Updated t reflect the State f Califrnia s Medical/Health Emergency Operatins Manual and related guidance fr the MHOAC prgram and t reflect the recently develped Napa Cunty Mass Casualty Incident Plan June 2012 Dr. Jennifer Henn Overall The wrding in varius sectins f the dcument was simplified t prvide cncise instructins r clear descriptins. September 2013 Dr. Jennifer Henn 2.1, 2.2, 2.4, 2.6 Updated the Outbreak Investigatin sectin t better reflect the steps undertaken during the investigatin prcess. September 2013 Dr. Jennifer Henn 3 Deleted the Outbreak Investigatin Kit September 2013 Dr. Jennifer Henn Deleted Table 2 Cmmunity Cntainment Issues 3.6 Deleted sectin, Cmmunity Mitigatin Strategies (Cmmunity Cntainment CDPH Alert System) Deleted entire sectin, Staffing fr Mnitring Teams September 2013 September 2013 Dr. Jennifer Henn Dr. Jennifer Henn Dr. Jennifer Henn , , , 3.9 Deleted Sectins: EOC Public Infrmatin Officer, Daily Briefings Fr Law Enfrcement, HHSA DOC Operatins and Risk Cmmunicatins and Public Educatin. September 2013 Dr. Jennifer Henn Inserted verbiage n Data Security September 2013 Dr. Jennifer Henn Added an entire sectin n Surveillance September 2013 Dr. Jennifer Henn Overall Applied the fllwing standard language Octber 2013 Dr. Karen NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page iii

4 ANNEX H - APPENDIX 5: OUTBREAK /EPIDEMIOLOGIC RESPONSE PLAN thrughut the dcument: Health Officer (nt Public Health Officer) Public Health Divisin (PHD) instead f Napa Cunty Public Health Used the term case r cases instead f patient r patients, where apprpriate 2.4 Added the Health Officer rles and respnsibilities Octber 2013 Smith Dr. Karen Smith Updated the Cnfidentiality fr clarity Octber 2013 Dr. Karen Smith Cver Page Updated Alice Hughey s name as the Acting Agency Directr Octber 2013 Dr. Karen Smith Inserted language describing infrmatin sharing f epidemilgic surveillance infrmatin with MHOAC prgram Inserted language describing descriptive statistics t be shared with MHOAC prgram during utbreak investigatin December 2013 December 2013 Dr. Jennifer Henn Dr. Jennifer Henn NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page iv

5 ANNEX H - APPENDIX 5: OUTBREAK /EPIDEMIOLOGIC RESPONSE PLAN CONTENTS 1. OUTBREAK RESPONSE PLAN INTRODUCTION Purpse Scpe Related Plans Legal and Prcedural Framewrk OUTBREAK INVESTIGATION Outbreak Investigatin Purpse Outbreak Investigatin Objectives /7 Cmmunicable Disease Reprting Outbreak Investigatin Rles and Respnsibilities Outbreak Actin Planning Actin Planning Team Triggers Infectin Cntrl and Case Management Actins Epidemilgy and surveillance surge capacity Cnfidentiality OUTBREAK RESPONSE WITHIN ICS STRUCTURE Intrductin Operatins Centers HHSA Department Operatins Center (DOC) Respnse Activatins Mass Prphylaxis Risk Cmmunicatin Nn-Pharmaceutical Interventins (NPI) Prcedure Fr nn-pharmaceutical interventins Islatin and Quarantine Intrductin and Legal Definitins HHSA DOC Operatins Branch Actins Related t Islatin and Quarantine Lcatins fr Islatin Lcatins fr Quarantine Islatin and Quarantine Mnitring Mnitring Teams Mnitring Dcumentatin Actins in the Case f Nn-Cmpliance Hspital and Cngregate Care Respnse Hspital Resurce Requests Napa Cunty Medical Surge Capacity fr Islatin and Quarantine Alternate Care Sites and Field Treatment Sites Supprt Services Mental Health Supprt Envirnmental Health Supprt Triage and Transprt in Islatin/Quarantine EOC Legal Officer Cunty Cunsel EOC Operatins Sectin Law (Enfrcement) Branch Amended Laws Relating t First Respnders and Islatin Orders Mass Fatalities NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page v

6 ANNEX H - APPENDIX 5: OUTBREAK /EPIDEMIOLOGIC RESPONSE PLAN 4. EPIDEMIOLOGY AND SURVEILLANCE RESPONSE PLAN Intrductin Cncept f Operatins Plan Activatin Epidemilgical Respnse Cnsultatin And Cnfirmatin Ntificatin Crdinatin Cmmunicatins Investigatin Cntact Tracing Surveillance Recvery and Evaluatin Cnsultatin and Cnfirmatin Ntificatin Crdinatin Cmmunicatin Investigatin Cntact Tracing Recvery and Evaluatin ATTACHMENT A: 24/7 DISEASE REPORTING: ATTACHMENT 1 Answering Service Instructins ATTACHMENT 2 CD Reprts Accunt Vice Mail Instructins and Script fr Reprting Message ATTACHMENT 3 CD Reprts System Drill ATTACHMENT B: OUTBREAK INVESTIGATION: ATTACHMENT 1 Generic Disease Investigatin Frm ATTACHMENT 2 Select Disease Specimen Cllectin and Strage Chart ATTACHMENT 3 HHSA DOC and Cunty EOC Checklists ATTACHMENT C: ISOLATION AND QUARANTINE: ATTACHMENT 1 Islatin/Quarantine Checklists ATTACHMENT 2 - Legal Prcedures and Authrity fr Islatin and Quarantine ATTACHMENT 3 Legal Prcedures fr Scial Distancing ATTACHMENT 4 Matrix f Islatin/Quarantine Laws ATTACHMENT 5 Sample Health Officer Orders NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page vi

7 1. OUTBREAK RESPONSE PLAN INTRODUCTION The Outbreak/Epidemilgical Respnse Plan describes activatin, authrities, plicies and prcedures t manage the public health respnse t a significant cmmunicable disease utbreak. The plan describes the fllwing crdinated actins: OUTBREAK INVESTIGATION Receive reprts, gather epidemilgical infrmatin Analyze infrmatin t track disease spread Determine apprpriate utbreak respnse OUTBREAK RESPONSE Issue guidance t the medical cmmunity Issue Health Officer Orders Activate disease cntrl interventins Prvide risk cmmunicatin fr the public Crdinate medical respnse Obtain resurces 1.1 PURPOSE The purpse f the plan is t describe: Public Health prcedures fr utbreak investigatin Health Officer authrities and respnsibilities in utbreak respnse, including disease cntrl interventins, beynd single case management including: Cmmunity cntainment, scial distancing Islatin and quarantine Mass prphylaxis Risk cmmunicatin NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 1

8 Crdinatin and cmmunicatin between the Napa Cunty Health and Human Services Agency (HHSA) Public Health Divisin (PHD), the Cunty Office f Emergency Services (OES), ther Cunty departments and lcal, state and federal agencies and departments Activatin and peratinal flw f activities necessary fr utbreak investigatin and utbreak respnse Crdinatin with hspitals t activate Alternate Care Sites (ACS) Crdinatin with Cunty departments t prvide supprt during utbreak respnse, if necessary 1.2 SCOPE This plan describes crdinatin within the PHD and HHSA with ther cunty departments and with the Califrnia Department f Public Health (CDPH). The plan describes rles and respnsibilities f the PHD and ther cunty departments when disease cntrl interventins are required in respnse t a significant and rapidly spreading cmmunicable disease utbreak. This plan des nt include prcedures fr rutine, n-ging public health case management, islatin and quarantine r infectin cntrl measures. The plan des nt include prcedures fr surveillance, including enhanced surveillance r syndrmic surveillance. These prcedures are included in the PHD Epidemilgy and Surveillance Respnse Plan (Sectin 4 f this dcument) and in the Annex H-Appendix 5: Attachment E Pandemic Influenza Respnse Plan. Planning Assumptins: 1. Outbreak investigatin and respnse require activatin f public health resurces (persnnel, equipment and supplies) and crdinatin with ther cunty departments and agencies, hspitals, medical care prviders, lcal, State and Federal agencies and departments. 2. The Health and Human Services Agency Department Operatins Center (HHSA DOC) and the Operatinal Area Emergency Operatins Center (Op Area EOC) will be activated when additinal resurces are needed t activate and manage the utbreak respnse. 3. PHD utbreak investigatin and utbreak respnse peratins are rganized using the Califrnia Standardized Emergency Management System (SEMS), the Incident Cmmand System (ICS)/NIMS and the Califrnia Emergency Operatins Manual (EOM). 4. The least restrictive means pssible will be used t cntrl disease spread and the PHD will primarily fcus n gaining vluntary cmpliance with utbreak interventins, including islatin and quarantine. 5. The PHD will wrk clsely with physicians, hspitals, health care facilities and health care prviders t crdinate utbreak interventins. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 2

9 6. Apprpriate legal actins will be taken in cases f nn-cmpliance with Health Officer Orders and due prcess will be ensured. 7. Risk cmmunicatin will be activated and public health infrmatinal materials distributed t achieve vluntary cmpliance with utbreak interventins, including cmmunity cntainment, scial distancing, mass prphylaxis, and islatin/quarantine. 8. The needs f access and functinal needs ppulatins during an utbreak will be addressed. 9. Law enfrcement (plice) will enfrce rders given by the Health Officer. 10. Curfews and ther restrictins n mvement may be required. 11. Individuals will be cared fr at hme unless they require intensive treatment at a hspital. 12. In large-scale disease utbreaks with rapidly spreading disease: Mass prphylaxis may be necessary, if a vaccine r pharmaceutical agent is available. Hme islatin and quarantine may be necessary. Law enfrcement (plice) will enfrce rders given by the Health Officer. Curfews and ther restrictins n mvement may be required. Hspitals may be verwhelmed and treatment may be at Alternate Care Sites. Individuals will be cared fr at hme unless they require intensive treatment at a hspital. The 911 system may triage calls and transprtatin t the hspital may nt be by ambulance and may be by uncnventinal means, e.g. buses. Ill patients may be transprted ut f the area fr treatment. Delayed burial may be necessary. 1.3 RELATED PLANS Related respnse prcedures can be fund in the fllwing HHSA Emergency Operatins Plans: Department Operatins Center (DOC) Plan Cuntermeasure Distributin Plan Strategic Natinal Stckpile (SNS) Plan NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 3

10 Medical Surge Plan Epidemilgy Respnse Plan (Sectin 4 f this Plan) Crisis Emergency Risk Cmmunicatin Plan (CERC) Fatality Management Plan 1.4 LEGAL AND PROCEDURAL FRAMEWORK In a declared public health emergency, the Health Officer has legal authrity t take actins necessary t prtect the public health (see Attachment C, Legal Authrities). Operatinal decisins and crdinatin f cuntywide respnse may be assisted by activatin f an EOC Plicy Grup. The Plicy Grup may include: 1. EOC Incident Cmmander 2. Health Officer 3. Cunty Executive Officer 4. Health & Human Services Agency Directr 5. EOC Sectin Chiefs 6. Public Infrmatin Officer 7. Infrmatin Systems Directr 8. Office f Emergency Services Manager 9. Others as required. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 4

11 2. OUTBREAK INVESTIGATION 2.1 OUTBREAK INVESTIGATION PURPOSE The purpse f any utbreak investigatin is t determine what factrs are assciated with illness and what measures can be undertaken t prevent further illness. This is achieved thrugh epidemilgic and envirnmental investigatins. The HHSA Public Health Divisin may becme aware f a suspected disease utbreak frm several surces including: On-ging 24/7 epidemilgical surveillance and disease reprting Calls and reprts frm hspitals, skilled nursing facilities, schls, churches, labratries, physician ffices, crpratins, cngregate care hmes Enhanced r syndrmic surveillance prgrams established t mnitr disease syndrmes/symptms in the ppulatin Alerts frm ther lcal jurisdictins, the Califrnia Department f Public Health, federal agencies, r the media 2.2 OUTBREAK INVESTIGATION OBJECTIVES Disease utbreak investigatin addresses the public health respnse t reprts f unusual disease in the cmmunity. The fundamental reasns fr investigating utbreaks are t: Prevent additinal cases in the current utbreak Reassure the public Minimize ecnmic and scial disruptin Prevent future utbreaks Cntribute t knwledge and understanding f a disease Outbreak investigatins include the fllwing activities: 1. Cnfirm the utbreak (cnfirm the diagnsis) and establish a preliminary causal hypthesis 2. Identify infected individuals and their cntacts; refer fr medical care and/r prphylaxis as apprpriate NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 5

12 3. Systematically review knwn causal factrs and priritize t guide ptential cntrl measures 4. Emply cntrl measures early, including: Wrk t identify and remve surce f utbreak Prvide health educatin t minimize disease spread Issue infectin cntrl and clinical guidelines t healthcare prviders Use islatin and quarantine, as indicated, t help cntrl transmissin Utilize envirnmental health and ccupatinal health services 5. Cnduct analytical study (e.g. case cntrl) as apprpriate 6. Cntinue surveillance fr additinal cases 7. Cmmunicate findings f the investigatin t partner agencies, healthcare persnnel and the media as apprpriate /7 COMMUNICABLE DISEASE REPORTING Califrnia Cde f Regulatins (CCR), Title 17, 2500 lists diseases and cnditins that physicians, health care prviders, and hspitals must reprt t the lcal Public Health Department within a specified time perid fllwing a suspected r cnfirmed diagnsis. The HHSA PHD maintains an n-ging system t receive and analyze cmmunicable disease reprts. Prcedures fr 24/7 cmmunicable disease reprting are described in Attachment A f this plan. 2.4 OUTBREAK INVESTIGATION ROLES AND RESPONSIBILITIES Health Officer Prvide verall crdinatin and versight f utbreak investigatins and respnse Prvide regular updates n utbreak and respnse t lcal gvernment fficials Serve as lead spkespersn fr the media Issue Health Officer legal rders as indicated Cmmunicable Disease Unit Oversee ntifiable cnditins reprted t the PHD and, in cnsultatin with the Health Officer, cnduct initial investigatin f ptential utbreaks Interview cases and cntacts NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 6

13 Prvide guidance n lab testing and specimen cllectin May prvide testing materials and assist with specimen cllectin in sme circumstances Assist with submissin f human specimens and fd samples t Napa-Slan-Yl- Marin Public Health labratry fr testing Maintain cmmunicatin with lcal healthcare prfessinals Implement cntrl and preventin measures t stp utbreak frm spreading Prvide educatinal infrmatin abut infectius cnditins Crdinate with Envirnmental Health specialist, Epidemilgist, Micrbilgist/Public Health Labratry and Public Health staff in ther jurisdictins as necessary Epidemilgist In cnsultatin with the Health Officer, assist in cnfirming the utbreak and establishing the preliminary causal hypthesis Serve as lead investigatr r primary crdinatr in an utbreak investigatin (CD PHN may als assume this respnsibility), including develpment f questinnaires, assisting with interviews as needed, analysis f data, and prviding recmmendatins fr cntrl Facilitate and guide the steps in an utbreak investigatin Maintain cmmunicatin channels between prgrams, agencies, cunties, and CDPH Crdinate a ht wash fllwing the utbreak respnse and ensure that an utbreak reprt r HSEEP cmpliant AAR is cmpleted as apprpriate Crdinate with PHD Cmmunicable Disease PHN, Envirnmental Health Specialist, Micrbilgist/Public Health Labratry and CDPH staff as necessary Envirnmental Health (as indicated) Cnduct inspectin f fd facilities, recreatinal pls/spas, water systems, etc. In crdinatin with the epidemilgist, identify and address fd r water safety issues that may have cntributed t the utbreak Interview managers and fd handlers abut any illness experienced Cllect fd and envirnmental samples Obtain menu f fd items served Enfrce restrictins and exclusins f ill fd handlers frm wrk Crdinate with PHD Cmmunicable Disease PHN, Epidemilgist, Public Health Officer and apprpriate state agencies as needed Micrbilgist (Lcal Lab) NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 7

14 Test human specimens t verify r cnfirm the diagnsis f the utbreak Cnduct further sub typing r labratry analysis, if apprpriate Crdinate with reference labratries at state r federal labratries Crdinate with PHD Cmmunicable Disease PHN, Health Officer, and/r Epidemilgist The Health Officer, Directr f Nursing (DON) and Immunizatin Crdinatr may prvide additinal versight and guidance during an utbreak respnse. 2.5 OUTBREAK ACTION PLANNING Prir t activatin f an actin planning team r, in events f a larger scale, the DOC r EOC, the Public Health Divisin (PHD) may be able t mnitr the situatin thrugh surveillance and determine respnse actins based n the severity f illness, number f lcal cases and guidelines issued in respnse t natinwide r glbal spread f the disease 1. The Health Officer cnvenes a meeting f key public health persnnel t prepare an actin plan 2. Depending n the situatin, Envirnmental Health and EMS staff may als participate in this meeting r in the subsequent activities. This actin plan may be prepared in any nn-rutine disease utbreak. The actin plan assigns initial respnsibility fr situatin mnitring, surveillance, cmmunicatin with healthcare prviders, public infrmatin, critical resurce inventry, infectin cntrl and case management. The actin planning prcess anticipates future respnse requirements, including, fr example, the need t activate the DOC and/r EOC, the need t activate a vaccinatin r prphylaxis campaign and/r the need fr schl dismissal. The actin plan frmat is described belw. Key Public Health Divisin persnnel wh meet t prepare an utbreak-specific initial Actin Plan are: 1. Health Officer Assembles Public Health Divisin staff and initiates actin planning 2. Directr f Public Health Nursing (DON) 3. Health Educatr 4. Cmmunicable Disease Unit /Epidemilgists 5. Emergency Preparedness Manager 1 In past respnse activatins, guidelines have been issued by the Centers fr Disease Cntrl (CDC), the Wrld Health Organizatin (WHO) and the CA Department f Public Health. 2 The actin plan frmat was riginally prepared and adpted by the Public Health Divisin fr use in July 2010 in respnse t a statewide Pertussis utbreak. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 8

15 6. Maternal and Child Health Crdinatr 7. Immunizatin Crdinatr NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 9

16 Sample Actin Plan Actin Descriptin Lead Respnsibility Surveillance Risk Cmmunicatin/Public Infrmatin Healthcare Prvider Infrmatin Critical Resurces Infectin Cntrl & Case Management Vaccinatin/prphylaxis Mnitr cases and hspital capacity. Use resulting data t determine the need fr cunty healthcare surge. Mnitr statewide and natinwide public infrmatin and prvide lcal guidance. Mnitr statewide and natinwide public infrmatin and prvide lcal guidance. Inventry needed supplies, e.g. antivirals and N-95 masks. Cnsider ptential activatin f hme islatin, quarantine, schl dismissal, scial distancing. Develp case interview and tracking tls as needed. Cnsider ptential activatin f vaccinatin/prphylaxis peratins. Epidemilgist, Cmmunicable Disease (CD) Unit Public Health Educatr(s) Health Officer DON Epidemilgist CD Unit Health Officer CD Unit EP Manager Health Officer DON Epidemilgist CD Unit Health Officer DON Epidemilgist CD Unit IZ Crdinatr MMnitr the situatin. IF the fllwing ccurs : Surveillance Illness/case data indicates need fr respnse activatin. Healthcare prviders and the public require infrmatin and guidance. Allcatin and distributin f critical resurces is needed. Scial distancing/schl dismissal may be needed t cntrl spread f disease. CDC and CDPH indicate a vaccine will becme available fr distributin. Cnsider activatin f DOC/EOC. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 10

17 2.6 ACTION PLANNING TEAM TRIGGERS The decisin by the Health Officer t activate an actin planning team is based n: Severity f reprted illnesses Number f cases r sick ppulatin Ptential fr disease spread The particular pathgen, if knwn The level f cmmunity cncern and media interest The Health Officer r her designee is assigned the rle f Actin Planning Team leader. The Actin Planning Team Leader: Activates initial team ntificatin and cmmunicatin and assembles the Actin Planning Team Reviews the fllwing infrmatin with the team: The epidemilgy f the disease Specimen cllectin and available labratry tests Investigatin pririties Regulatins pertinent t the disease situatin Determines schedule fr future meetings f the team A lead is als assigned within each actin planning area (as shwn in the sample plan abve) and is respnsible fr ensuring that tasks assigned during the actin planning meeting are accmplished INFECTION CONTROL AND CASE MANAGEMENT ACTIONS As with rutine utbreaks, public health nurses, clinic nurses and cmmunicable disease investigatrs perfrm the fllwing activities: 1. Fllw-up cases, suspected cases, and cntacts 2. Cnduct surce case investigatins in cllabratin with the Epidemilgist and Envirnmental Health as needed 3. Assess suspects/expsed cntacts fr symptms 4. Refer symptmatic individuals t care sites including hspitals, clinics, physicians ffices, field treatment sites, r alternate care sites NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 11

18 5. Fllw-up with symptmatic individuals/ family members t ensure access t medical care 6. Refer nn-symptmatic individuals t prphylaxis clinics as needed/ apprpriate 7. Instruct individuals f need fr islatin as apprpriate 8. As indicated, cnduct daily fllw-up with nn-symptmatic expsed individuals t assess fr symptms If symptmatic, refer r arrange transprt t a care site as needed 9. Instruct patients/family members n apprpriate infectin cntrl measures, decntaminatin f rms, equipment, vehicles, clthing, etc. 10. Participate in the enfrcement f islatin/quarantine rders as issued by the Health Officer Reference: Quarantine and Islatin fr Ptential Causative Agent EPIDEMIOLOGY AND SURVEILLANCE SURGE CAPACITY Additinal epidemilgy and surveillance staffing supprt may be met thrugh use f Cal STAPH students (graduate students at UC Berkeley wh are members f the Student Assistance fr Public Health grup) r thrugh Napa Cunty Medical Vlunteers/Medical Reserve Crp members. The PHD has an MOU with the CalSTAPH student grup t prvide epidemilgy supprt in the event f a large utbreak r disaster. T request assistance frm CalSTAPH, an agency request frm shuld be cmpleted by ging t (r clicking here). The PHD als has a medical vlunteer and medical reserve crp unit. The Disaster Healthcare Vlunteer (DHV) system CONFIDENTIALITY All staff invlved, paid and vlunteer, in an utbreak investigatin have the respnsibility f maintaining cnfidentiality f the individuals invlved in the utbreak. Only the Health Officer has the authrity t release identifying infrmatin and will prvide any such apprval in writing. Identifying infrmatin will never be released unless authrized by the Health Officer and needed t prperly cnduct the utbreak investigatin and prtect the public s health. Public Health staff are required t cmplete annual cmpliance training, which includes relevant privacy and security laws and regulatins. While utbreak investigatins are a Public Health functin and are HIPAA exempt, prtected health infrmatin will nly be released n rder f the Health Officer. Vlunteers brught in t assist with the utbreak n a shrt term, emergency basis will receive brief training n privacy and security frm the utbreak team lead r designee. This training will NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 12

19 be dcumented using a sign-in sheet with vlunteer and trainer names and signatures. Vlunteers will als sign Napa Cunty s cnfidentiality agreement and cmplete the Emplyee Emergency Cntact Infrmatin sheet. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 13

20 3. OUTBREAK RESPONSE WITHIN ICS STRUCTURE 3.1 INTRODUCTION Outbreak investigatin tracks the curse f disease spread and prvides the Public Health Officer with infrmatin needed t determine and plan fr apprpriate utbreak respnse. Ptential disease cntrl actins that may ccur during activatin f the EOC/DOC include: OUTBREAK RESPONSE ACTIONS ACTIVATE DISEASE CONTROL INTERVENTIONS: ISSUE LEGAL ORDERS: ISSUE GUIDANCE TO PHYSICIANS (Health care prviders, medical cmmunity): ISSUE GUIDANCE TO HOSPITALS, CLINICS, SKILLED NURSING FACILITIES: MEDICAL RESPONSE COORDINATION: ISSUE GUIDANCE TO THE PUBLIC: Cmmunity cntainment, scial distancing Islatin and quarantine Mass prphylaxis Risk cmmunicatin Islatin r Quarantine Bil Water Order, Unsafe Water Alert Outbreak reprting requirements Treatment and supprt Infectin cntrl Dispsitin f patients Persnal Prtective Equipment (PPE) Infectin cntrl Bed status reprting Triage guidelines Islatin guidelines Persnal Prtective Equipment (PPE) Hspital medical surge Use f Alternate Care Sites (ACS) Infectin cntrl/hygiene Hw t get treatment Hw t treat at hme NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 14

21 3.2 OPERATIONS CENTERS Outbreak respnse t a rapidly spreading disease may require activatin f Health and Human Services Department Operatins Center (HHSA DOC), the Operatinal Area Emergency Operatins Center (Op Area EOC), and City EOCs. The HHSA DOC is activated t: Crdinate cntinued utbreak investigatin and case mnitring in the cmmunity and at hspitals Determine apprpriate utbreak interventins and prepare Health Officer Orders and risk cmmunicatin infrmatin, as required Prvide PHD guidance t physicians, health care prviders, and cntact persns at hspitals, skilled nursing facilities and ther cngregate care settings Crdinate the use f hspital resurces and activate Alternate Care Sites (ACS), if necessary (HHSA DOC Operatins Sectin, Medical Branch) Crdinate supprt services t hme islatin and quarantine individuals/families. (EOC Lgistics Sectin and HHSA DOC Operatins Sectin, HHSA DOC Care & Shelter Branch). Crdinate with Emergency Medical Services (EMS) (HHSA DOC Medical Branch) fr patient transprt Crdinate resurces needed t supprt utbreak interventins including cmmunity cntainment, mass prphylaxis, and islatin and quarantine Prvide risk cmmunicatin t the public. Crdinate public health staffing and medical vlunteers The Operatinal Area EOC is activated t: Manage prclamatins, declaratins Issue Emergency Alert System bradcasts Crdinate mutual aid, including medical mutual aid by the Medical Health Mutual Aid Crdinatr (MHOAC) Crdinate law enfrcement supprt (Operatins Sectin, Law Enfrcement Branch) NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 15

22 Obtain additinal resurces t supprt utbreak interventins (Lgistics Sectin) Crdinate transprtatin (Lgistics Sectin, Transprtatin Branch) Mass dispensing site wrker transprt Mass dispensing shuttle buses t sites Secure transprt f SNS pharmaceuticals and supplies 3.3 HHSA DEPARTMENT OPERATIONS CENTER (DOC) When the HHSA DOC is activated, the Incident Cmmand System (ICS) rganizatin chart fr utbreak respnse is shwn belw. The needs f the respnse will dictate which psitins are activated. An rganizatin chart that includes the respnse structure fr vaccine and medical prphylaxis can be fund in the HHSA Pandemic Influenza Respnse Plan. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 16

23 HEALTH OFFICER EOC Care and Shelter/ Medical/Health Branch Directr DOC DIRECTOR DOC Directr Supprt NAPA COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) DOC ORGANIZATION CHART April 2012 Cunty Op Area EOC DOC Crdinatr HHSA PUBLIC INFORMATION OFFICER LIAISON OFFICER HEALTH EDUCATION SAFETY/SECURITY OFFICER Operatins Sectin Chief Supprt OPERATIONS SECTION CHIEF PLANNING/ INTELLIGENCE SECTION CHIEF LOGISTICS SECTION CHIEF FINANCE & ADMINISTRATION SECTION CHIEF HEALTH BRANCH DIRECTOR MEDICAL BRANCH DIRECTOR Situatin Unit Leader Requisitin Tracker Unit Time Unit Leader Cmmunicable Disease Grup Supervisr Medical Transprt Patient Tracking (EMS) Grup Supervisr Epidemilgy & Surveillance Team Leader SERVICES BRANCH DIRECTOR Cst/Claims Unit Leader Labratry (Napa/ Snma) Grup Supervisr Healthcare Facility Crdinatin Grup Supervisr Resurces Unit Leader Cmmunicatins Unit Leader Prcurement Unit Leader Envirnmental Health Grup Supervisr Alternate Care Site Crdinatin Grup Supervisr Dcumentatin Unit Leader Fd Unit Leader Mass Prphylaxis /SNS Grup Supervisr CARE & SHELTER BRANCH DIRECTOR Dembilizatin Unit Leader Medical Unit Leader RECOVERY BRANCH DIRECTOR Technical Specialists Facility/Campus Unit Leader MENTAL HEALTH BRANCH DIRECTOR SUPPORT BRANCH DIRECTOR BUSINESS CONTINUITY Supply Unit Leader Human Resurces Unit Leader Grund Supprt Unit Leader (Transprtatin) NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 17

24 3.4 RESPONSE ACTIVATIONS The fllwing respnse plans and DOC/EOC ICS activatins may be required in a situatin invlving rapid disease spread and large-scale utbreak respnse: 1. Activate the HHSA Cuntermeasure Distributin Plan fr pririty prphylaxis and prphylaxis f the entire ppulatin, if a vaccine r antibitic/antiviral is available and indicated 2. Activate the MCIP/Mass Casualty Plan t triage 911 calls fr transprt t hspitals, Alternate Care Sites (ACS) assciated with hspitals, r ther designated facilities 3. Activate the HHSA Medical Surge Plan 4. If necessary, establish Alternate Care Sites (ACS) fr patient treatment if hspitals are verwhelmed. 5. Activate the HHSA/DOC Care and Shelter Branch t crdinate supprt services fr persns in hme quarantine r islatin 6. Activate the EOC Mass Fatality Branch t crdinate temprary mrgue facilities and dispsitin f remains 7. Activate the Operatinal Area EOC Law Enfrcement Branch t maintain public safety, prvide security t health/medical field sites, assist with detentins, and enfrce Health Officer Orders fr islatin, quarantine and public venue clsures, as necessary 8. Activate the Operatinal Area EOC Lgistics Sectin t crdinate supplies, equipment, cmmunicatin, transprtatin and facility peratins related t utbreak respnse NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 18

25 3.5 MASS PROPHYLAXIS Prcedures t activate and manage mass prphylaxis are described in the Napa Cunty HHSA/ Public Health Divisin Cuntermeasure Distributin Plan and Strategic Natinal Stckpile (SNS) Plan. 3.6 RISK COMMUNICATION Prcedures t activate and manage risk cmmunicatin and materials used in risk cmmunicatin are described in the Napa Cunty HHSA Crisis Emergency Risk Cmmunicatin Plan (CERC). 3.7 NON-PHARMACEUTICAL INTERVENTIONS (NPI) Nn-pharmaceutical interventin (NPI) measures are als termed cmmunity cntainment, cmmunity interventins, scial distancing r cmmunity mitigatin measures. These terms refer t fcused and/r cmmunity wide measures t increase scial distance between individuals wh are well and unexpsed, frm individuals wh have been expsed t r infected by a cmmunicable disease. The bjectives f cmmunity cntainment are: Reduce the verall risk f transmissin f a cmmunicable disease at the ppulatin level by limiting scial interactins and preventing inadvertent expsures Reduce the risk f expsure by separating and/r restricting the mvement f persns suspected t have a cmmunicable disease that pses a significant public health threat t the cmmunity Reduce the risk f transmissin f a cmmunicable disease by restricting the mvement f persns wh may have been expsed t an infectius disease, but are nt yet ill During the severe acute respiratry syndrme (SARS) utbreak in 2003, CDPH distributed the fllwing list f cmmunity cntainment measures. These measures wuld be taken in the U.S. in respnse t SARS activity r in respnse t anther cmmunicable disease with persn-tpersn transmissin and ineffective cntrl measures. The Health Officer determines the apprpriate cmmunity cntainment measures depending n the utbreak type and extent. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 19

26 SARS OUTBREAK COMMUNITY CONTAINMENT MEASURES Cnsider measures such as: Fever/symptms mnitring befre public gatherings r entrance t public places Cmmunity-wide shelter in place r snw day strategies Cmmunity-wide triage system fr persns with fever (e.g. call centers t screen utpatients befre ffice presentatin, fever evaluatin centers, triage t designated centers) Cancellatin f public events Clsing f public places and schls Restrictin f mass transit Scial distancing at places f emplyment Distribute prducts/educatin materials n hand hygiene and Cver Yur Cugh Distribute r encurage use f masks fr selected essential persnnel Disseminate infrmatin n restrictins in the quarantine zne (e.g. print/bradcast media; psters, leaflets, flyers dr-t-dr). Distribute infrmatin n quarantine ratinale, prcedures, restrictins t neighbring znes/cmmunities Crdinate rders fr cmmunity-wide restrictins Enfrcement which may include fines, penalties, barricades, visible signs f bundary enfrcement Identify alternative means f supplying essential services; prvided fcused and cmmunity-wide reassurance re: restratin f these services NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 20

27 3.7.1 PROCEDURE FOR NON-PHARMACEUTICAL INTERVENTIONS The Health Officer determines when it is necessary t limit the mvement f individuals thrugh islatin, quarantine r ther cmmunity cntainment measures. Quarantines against ther jurisdictins may require cnsent frm the Califrnia Department f Public Health (CDPH). The Health Officer, in crdinatin with the Directr f HHSA and ther Cunty fficials, may als achieve scial distancing by canceling public gatherings and clsing public venues such as mvie theaters and schls. This is accmplished thrugh a Health Officer Order. Scial distancing/nn-pharmaceutical interventins will nly be enacted after careful cnsideratin and, whenever pssible, in cnsensus with reginal health fficials (such as thrugh special meetings f the Assciatin f Bay Area Health Officials) and the Califrnia Department f Public Health in rder t prvide unified guidelines and messaging. The fllwing prcedure is used t limit mvement: 1. The Health Officer, in cnsultatin with apprpriate Cunty, reginal and state fficials, determines the need fr clsure f public assembly r large-scale (grup r area-wide) quarantine r islatin 2. Health Officer Orders are issued 3. The HHSA DOC Cmmunicable Disease Grup supervisr activates Islatin/Quarantine Mnitring Teams t mnitr cmpliance as needed 4. The HHSA DOC and EOC crdinate t prvide supprt services t thse in quarantine r islatin 5. The Operatinal Area EOC Law Enfrcement Branch is activated fr enfrcement 6. The Health Officer issues prtcls t prtect thse prviding enfrcement and supprt services 7. Just-in-time training and fit-testing are prvided by each agency/facility t their staff and vlunteers 8. EMS crdinates transprtatin f quarantined persns wh becme ill t hspitals r Alternate Care Sites as apprpriate given current surge demand 9. The EOC activates the Legal Officer t crdinate with the District Attrney and Curts t ensure due prcess fr many individuals in grup r area-wide quarantine r islatin NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 21

28 3.7.2 ISOLATION AND QUARANTINE INTRODUCTION AND LEGAL DEFINITIONS Islatin and quarantine are public health cntrl measures designed t prtect the public by limiting cntact between persns wh are, r may be, cntagius and thers wh are susceptible t infectin 3. Bth islatin and quarantine may be cnducted n a vluntary basis r cmpelled n a mandatry basis thrugh legal authrity. A. Cmmunicable Disease An illness due t a specific micrbilgical r parasitic agent r its txic prducts which arises thrugh transmissin f that agent r its prducts frm an infected persn, animal, r inanimate reservir t susceptible hst, either directly r indirectly thugh an intermediate plant r animal hst, vectr, r the inanimate envirnment (17 CCR 2500 (a) (7)). B. Islatin Islatin is defined as separatin f infected persns frm ther persns fr the perid f cmmunicability in such places and under such cnditins as will prevent the transmissin f the infectius agent (17 CCR 2515). C. Strict Islatin If the disease requires strict islatin, the Health Officer shall ensure that instructins are given t the patient and members f the husehld, defining the area within which the patient is t be islated and stating the measures t be taken t prevent the spread f disease (17 CCR 2516) D. Mdified Islatin If the disease is ne in which nly a mdified islatin is required, the lcal Health Officer shall issue apprpriate instructins, prescribing the islatin technique t be fllwed. The islatin technique will depend upn the disease. (17 CCR 2518). E. Quarantine Quarantine is defined as the limitatin f freedm f mvement f persns r animals that have been expsed t a cmmunicable disease fr a perid f time equal t the lngest usual incubatin perid f the disease, in such manner as t present effective cntact with thse nt s expsed. (17 CCR 2520). In rder t receive state funding, Health Officers must prvide: "Cmmunicable disease cntrl, including availability f adequate islatin facilities, and the cntrl f acute cmmunicable 3 Sectins f this plan are excerpted frm the Natinal Assciatin f City and Cunty Health Officials (NACCHO) publicatin, Issues t Cnsider Islatin & Quarantine, January 2006 NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 22

29 diseases..., based upn prvisin f... apprpriate preventive measures fr the particular cmmunicable disease hazards in the cmmunity" (17 CCR 1276(c)). T fulfill this requirement, Health Officers are authrized t cntrl cntagius, infectius, r cmmunicable disease and may take measures as may be necessary t prevent and cntrl the spread f disease within the territry under their jurisdictin (H&S ) HHSA DOC OPERATIONS BRANCH ACTIONS RELATED TO ISOLATION AND QUARANTINE 1. Assign staff as needed t the Health and Medical Branches 2. Assist the Health Officer t prepare health alerts and health rders fr islatin/quarantine and scial distancing measures 3. In crdinatin with the Epidemilgy and Surveillance Unit (Planning), mnitr disease spread and, with the Health Officer, determine scial distancing measures t cntrl the spread f disease 4. In crdinatin with the Epidemilgy and Surveillance Unit (Planning), cmmunicate infrmatin related t the spread f disease (# f cases, Epi Curve, case demgraphics, etc) t the MHOAC prgram (see Epidemilgy and Surveillance Respnse Plan fr mre detail) 5. With the Health Officer, prepare advisries fr the use f Persnal Prtective Equipment (PPE) and ther infectin cntrl prtcls. This includes daily briefing infrmatin fr law enfrcement fficers and Emergency Medical Service wrkers 6. Identify needs f islated r quarantined patients in hmes and cngregate care facilities 7. Instruct individuals f need fr islatin as apprpriate and prvide them with Health Officer Orders as needed 8. As indicated, cnduct daily fllw-up with nn-symptmatic expsed individuals t assess fr symptms 9. If quarantined persns becme symptmatic, refer r arrange transprt t a care site as needed 10. Instruct cases/family members f cases n apprpriate infectin cntrl measures, decntaminatin f rms, equipment, vehicles, clthing, etc. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 23

30 11. Maintain regular cntact with hspitals and prvide guidance n infectin cntrl and islating r chrting f patients 12. Mnitr hspital capacity 13. Submit resurce requests and situatin reprts in accrdance with prcedures utlined in the Califrnia Department f Public Health and Medical Emergency Operatins Manual 14. In crdinatin with the Epidemilgy and Surveillance Unit (Planning), prvide situatin status updates t healthcare partners, including hspitals and clinics 15. Prvide mental health and ther health r scial services persnnel with prtcls fr persnal prtectin if cntact with cases in hme r hspital islatin is necessary 16. Mnitr the availability f a vaccine r antibitic t cntrl disease spread 17. When vaccine/antibitic becmes available, as directed by the Health Officer, activate the Cuntermeasure Distributin and Strategic Natinal Stckpile (SNS) Plans LOCATIONS FOR ISOLATION The preferred lcatin fr cases wh are islated is in the hme r at a hspital when acute care is needed. In sme cases, persns in hme islatin may becme t ill t remain in the hme. Similarly, persns in quarantine may develp symptms indicative f active disease and require remval t a different site fr islatin 4. Mnitring by Public Health/Mnitring Team within the ICS structure determines when a higher level f care is required and when persns in quarantine wh develp symptms will be transitined t a hspital r ther facility. Mnitring Teams advise the Cmmunicable Disease Cntrl Unit f the need t transfer a patient. Refer t the HHSA Medical Surge Plan fr infrmatin n Alternate Care Sites in Napa Cunty. Other facilities fr islatin may be designated and may include, but are nt limited t: Htels, mtels Empty ffice buildings r industrial buildings Schl gymnasiums r ther cllege campus facilities Private clinics, surgery centers, medical ffices 4 Ibid i NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 24

31 Skilled nursing r lng term care facilities Necessary evacuatins and transprt f ill and expsed individuals are crdinated by the EOC Operatins Sectin, Fire Branch and Emergency Medical Services with assistance f the EOC Lgistics Sectin, Grund Transprtatin Unit LOCATIONS FOR QUARANTINE Based n the situatin, the Health Officer will cnsider three main ptins fr quarantine f cntacts: hme quarantine, quarantine in designated facilities, and wrking quarantine. Hme quarantine -- Hme quarantine is mst suitable fr cntacts with a hme envirnment that can meet their basic needs and in which unexpsed husehld members can be prtected frm expsure. Persns in hme quarantine must be able t mnitr their wn symptms (r have them mnitred by a caregiver) with limited assistance frm Public Health staff. As is the case fr islatin, a hme shuld be evaluated fr suitability befre being used fr quarantine. The Mnitring Team Lead will prepare a frm t assess suitability fr hme islatin and quarantine. The criteria will depend n the disease agent. Husehld members require n specific precautins as lng as the quarantined persn(s) remains asymptmatic. Hwever, because the nset f symptms can be insidius, it may be prudent fr the quarantined persn(s) t minimize interactins with ther husehld members t prevent expsure during the interval between the develpment and recgnitin f symptms. Precautins might include 1) sleeping and eating in a separate rm, 2) using a separate bathrm, 3) wearing a surgical mask when in a rm with thers, and 4) practicing gd cugh etiquette. Persns in quarantine may be assessed fr symptms by either active r passive mnitring. Persns wh develp symptms must immediately ntify Public Health t arrange fr medical evaluatin. Public Health will mnitr fr develping symptms. Persns with symptms shuld be separated frm thers in the husehld. Husehld members nt quarantined may g t schl, wrk, etc., withut restrictins unless the quarantined persn develps symptms. If the quarantined persn develps symptms, husehld members shuld remain at hme in a rm separate frm the symptmatic persn and await additinal instructins frm health authrities. Husehld members can prvide valuable supprt t quarantined persns by helping them feel less islated and ensuring that essential needs are met. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 25

32 Quarantine in designated facilities -- Cntacts wh d nt have an apprpriate hme envirnment fr quarantine (e.g. students in a drmitry setting) may be quarantined in facilities designated fr this purpse. Facilities designated fr quarantine shuld meet the same criteria listed fr hme quarantine.. In general, these sites include: Htels, mtels Empty ffice buildings r industrial buildings Schl gymnasiums r ther cllege campus facilities Private clinics, surgery centers, medical ffices Skilled nursing and lng term care facilities Wrking quarantine -- This restrictin applies t healthcare wrkers r ther essential persnnel wh have been expsed t patients and may need t cntinue wrking (with apprpriate infectin cntrl precautins) but wh are quarantined either at hme r in a designated facility during ff-duty hurs. When ff duty, cntacts n wrking quarantine shuld be managed in the same way as persns in quarantine at hme r in a designated facility. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 26

33 3.7.6 ISOLATION AND QUARANTINE MONITORING Persns in islatin must be mnitred fr prgressin r reslutin f the infectin s that services can be implemented r islatin discntinued as apprpriate. Thse in quarantine must be mnitred fr the develpment f symptms requiring transitin t islatin and, as necessary, an increased level f medical care. Mnitring fr cmpliance with islatin and quarantine restrictins is als required fr these measures t be effective in preventing further transmissin f disease. Implementatin f mre restrictive interventins is given cnsideratin when nn-cmpliance is detected 5. The HHSA DOC Cmmunicable Disease Grup will activate Islatin/Quarantine Mnitring Teams t: Mnitr individual cases and assign teams fr case management f individuals requiring islatin r cntacts requiring quarantine Prvide care instructins and hygiene infrmatin t islated cases and care givers in the hme Prvide infrmatin and instructins t expsed r ill cntacts identified during cntact tracing Refer ill cases t physician and/r hspital care The fllwing mnitring activities were suggested by the CDC during the SARS utbreak. They are included here t describe the types f mnitring required during islatin and quarantine respnse: 1. Active Mnitring Direct cntact, by phne r in persn, with the HHSA DOC mnitring team member at least nce a day t assess the affected persn fr symptms and address any needs. Mre frequent mnitring (tw times each day) can reduce the interval between the nset f symptms and the institutin f precautins. Active mnitring may include randm checks by phne r in persn f islated r quarantined persns t assess cmpliance with Health Officer Orders and treatment. 2. Passive Mnitring Relies n the affected persn t cntact PHD/HHSA DOC mnitring team member if symptms develp. 3. Enhanced Activities: Quarantine f Cntacts- During a large utbreak r in situatins f high-risk expsures (e.g., if transmissin frm a particular case has been demnstrated NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 27

34 by emergence f secndary cases amng ne r mre cntacts), cnsideratin shuld be given t managing cntacts with activity restrictins in additin t active mnitring. This cmbined apprach is referred t as quarantine. The purpse f quarantine is t reduce transmissin by 1) separating cntacts f cases frm thers, 2) mnitring cntacts fr symptms, and 3) instituting apprpriate infectin cntrl precautins as sn as symptms are detected MONITORING TEAMS The HHSA DOC Cmmunicable Disease Grup Supervisr assembles teams t mnitr patients in islatin and case cntacts in quarantine. Napa Cunty Medical Reserve Crp members r Medical Vlunteers may be activated fr this purpse. Because f the limited number f staff available, mnitring will be cnducted primarily by telephne. The Health Officer will determine when it is necessary t deply a mnitring team t a hme, hspital r alternate care site t mnitr patients. Mnitring staff deplyed t hmes, hspitals r alternate care sites will be prvided with apprpriate Persnal Prtective Equipment (PPE) with fit testing, if needed, and infrmatin n necessary precautins. The health f mnitring staff will be mnitred by the Cmmunicable Disease Grup Supervisr. Staff will be referred t a hspital r physician fr necessary treatment if symptms arise. Based n the disease agent and disease spread, the Health Officer will determine criteria r standards fr: Type f mnitring (e.g., active, passive, r enhanced; via telephne r in-persn) Need t change cntainment status: quarantine t islatin, hme t hspital islatin r the lifting f health rder Adequacy f the place f islatin r quarantine Frequency f mnitring Mnitring will include an assessment by phne r in persn f: Cmpliance with any Health Officer Order(s) The patient s understanding f when t seek medical care and the prcedure by which this shuld happen The patient s understanding f signs and symptms f the disease, hw it is transmitted and apprpriate precautins The patient s understanding f hw t self mnitr and t whm t reprt A clinical assessment f disease specific signs and symptms NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 28

35 A psych/scial assessment t determine if essential needs are met The Cmmunicable Disease Grup Supervisr r Mnitring Team Lead will prepare and the Health Officer will apprve mnitring frms and infrmatin t prvide t patients and cntacts. A telephne survey frm will be prvided t Mnitring Team staff mnitring patients by telephne. Patient cnfidentiality and privacy regulatins will apply, althugh the Health Officer and the Califrnia Department f Public Health may waive certain restrictins if necessary t manage mnitring and data frm large grups f individuals. Infrmatin and data is reprted t the Cmmunicable Disease Grup Supervisr and evaluated by the Plans Sectin, Epidemilgy/Surveillance Team. Fllw-up actins are determined by the Cmmunicable Disease Grup Supervisr and/r the Health Officer and may include: Transfer t a hspital r ther facility fr treatment Remval frm islatin Transfer t islatin frm quarantine Dispatch a Mnitring Team member t attend t specific needs MONITORING DOCUMENTATION The fllwing dcumentatin is recmmended fr islatin r quarantine mnitring 6 : Symptm lgs fr passive (self) mnitring (filled in by the patient) Disease specific instructins fr patients and healthcare wrkers Checklist fr assessment f active mnitring in the hme r at the wrk site Frm fr recrding results f clinical evaluatin f active mnitring Guidelines and instructins fr persns in wrking quarantine Instructins fr supervisrs f persns in wrking quarantine Checklist t evaluate hmes fr islatin r quarantine Guidelines fr mnitring cmpliance The Health Officer must apprve discharge f patients wh have been in islatin at a hspital. The Health Officer als must apprve the transfer f ill patients. NAPA COUNTY HHSA PUBLIC HEALTH DIVISION page 29