Legionella Bacteria– Potential Outbreak in Central Region, Virginia
Legionella is a bacteria found to be naturally occurring in streams and rivers. When it is aerosolized by man-made machines such as pools, fountains, HVAC units, misting devices, or cooling towers it can cause the respiratory illness named Legionnaires Disease in at risk persons. Legionnaires’ Disease causes pneumonia-like symptoms.
Signs and symptoms of Legionnaires’ disease can include:
Cough
Muscle aches
Fever
Shortness of breath
Headache
Diagnosis is confirmed by chest x-rays and physician exam to check for pneumonia. As well as urine and sputum culturing for Legionella.
Additional Causes, Risks, Signs and Symptoms, Diagnosis and Treatment of Legionnaire’s can all be found on the attached CDC LEGIONNAIRES’ DISEASE FACT SHEET (PDF). ß CLICK LINK or Pictured below
CVHC Specific: Chesterfield Health Department is coordinating sample testing in the potential outbreak area in collaboration with the CDC. A formal media release from VDH is being drafted and will be sent via typical distribution pathways from the state office. Until that media release is posted, VDH has shared the following public information regarding the current status of Legionella Cases in Central Region for CHVC Members review:
11 confirmed cases of Legionella after extensive investigation
Locality is the commonality: NE Chesterfield Co.
Most healthy people do not get sick. Those who are elderly, with chronic illnesses, or immune-compressed are at greater risk.
CDC is being consulted on this effort to identify the environmental source
For more information please speak with your local VDH Health District Coordinator.
Virginia Department of Health. (n.d.). Retrieved August 7, 2019, from http://www.vdh.virginia.gov/environmental-epidemiology/waterborne-hazards-control/legionella/
Volume 1. Issue 4 – July 23, 2019 Written by: Erin M. Nowlin, MSN, RN, CEN, CHEC
The National Association of County and City Health Officials (NACCHO) is a nation-wide association of Local Health Officials and Department Leaders. In our Commonwealth, Virginia Department of Health (VDH) has 35 local health districts. (Pictured below) Each of these districts has an assigned representative to NACCHO for their jurisdiction. (You can find listed contact information on your district’s VDH Emergency Coordinator. District Director is at http://www.vdh.virginia.gov/local-health-districts/.
These County and City Health Officials often integrate with local Emergency Managers, facilities, special populations, government agencies, community stakeholders, and healthcare coalitions such as ours to improve public health in their community. We are lucky in Central Region to have a dedicated and highly engaged number of locality public health officials and coordinators with whom we work closely through CVHC. These relationships become important in planning, responding, and recovering from events and incidents almost daily for Central Region, and often inside of your facilities. It’s important to work together as your facility falls in their community; and their community members will come to your facility for healthcare provision!
Many of our CVHC members have engaged, participated in, and benefit from the great work being done through regional health districts and NACCHO. That’s why Issue 1, Volume 4 of CVHC Preparedness Awareness will outline several resources driven through NACCHO to your local health district for your knowledge and potential networking use.
NAACHO states, “A resilient and well-trained workforce is one that can transition from normal operations to emergency operations and back again in a way that minimizes employee health risk, stress reactions, and burn-out”. To build that resiliency, NACCHO has several training opportunities created to both strengthen the healthcare workforce’s preparedness and develop volunteer guidelines committed to improving the overall public health of the communities served. Four of these notable training programs and initiatives by NACCHO are Project Public Health Ready (PPHR), Roadmap to Ready, The Medical Reserve Corps, and Psychological First Aid for Leaders.
PPHR is an 18-month training program specifically for Local Health Departments through NACCHO and (CDC) to develop core competencies in emergency preparedness through quality improvement models. This allows LHDs to integrate into the response community, collaborate, and build partnerships and end with an all hazards plan development for their jurisdiction that is in line with national standards. Recognition is attained to the Health District for 5 years. Check out which Virginia Health Districts have completed this and when at: https://www.naccho.org/programs/public-health- preparedness/pphr?searchType=standard&lhd-state=VA#map
Roadmap to Ready
In person workshop for new (2yrs or less) preparedness coordinators at local health departments designed to assist with understanding the skills-gaining, networking, mentoring, and resources opportunities aimed at successfully leading and coordinating public health disasters and emergencies.
The Medical Reserve Corps (MRC)
While the MRC is an office under Department of Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR), NACCHO works collaboratively with the agency to help promote and align MRC activities and training for public health and emergency preparedness. MRC is a grouping of local volunteer units who are requested and deployed through an MRC coordinator at VDH to engage the community, enhance public health, decrease risks, build resilience, and improve preparedness, response, and recovery capabilities. Any licensed clinical provider (nurses, doctors, pharmacists, therapists, dentists) can join their local MRC; along with public health officials and general citizens who wish to keep their community, prepared and resilient. Your local MRC Unit Coordinator is able to match your skills with public health needs. For more information on how to become an MRC member, visit their website.
Psychological First Aid for Leaders (PFA-L)
This is a free 90-minute video on core components of Phycological First Aid (PFA).
PFA- L is aimed at the leaders understanding of staff stress risks and reactions to emergencies and disasters.
With this education, leaders can aim to create a more resilient workplace.
PFA is an evidence-based method of assisting persons of all ages, during the aftermath of a disaster, who were involved in or responded to the event.
Leaders in this course will work through scenarios to enhance education.
Why is it important to know what your Local Health District Coordinators are up to and educated in? Because we are all here to support and assist you, and ultimately THE PATIENTS (our community)!
Beyond the Issue
For more information on how to get involved in any of these programs, or have specific public health training provided to you and your workforce, contact your VDH Local Health Coordinator. CVHC can help get you connected! See the current list of Public Health District Coordinators to inquire on specific educational courses, exercises, and training opportunities your facility can get involved in or receive. (ex: Naloxone administration training, Stop the Bleed Training, community CPR courses, environmental risk education, and many more!)
Resources:
“About.” National Association of County and City Health Officials, NACCHO, www.naccho.org/about.
“Division of the Civilian Volunteer – Medical Reserve Corps.” MRC, Assistant Secretary for Preparedness and Response, mrc.hhs.gov/HomePage.
“NACCHO:Public Health Preparedness.” Blue Sky Broadcast, National Association of County and City Health Officials, live.blueskybroadcast.com/bsb/client/CL_DEFAULT.aspClient=354947&PCAT=7365&CAT=7365.
“Project Public Health Ready (PPHR).” NACCHO, National Association of County and City Health Officials, www.naccho.org/programs/public-health-preparedness/pphr.
“Virginia Department of Health.” Go to Virginia Department of Health., Virginia Department of Health, www.vdh.virginia.gov/local-health-districts/.
So, you are aware of the regulations on Emergency Preparedness Education in your Facility:
Joint Commission EMS standards
CMS Rule: “Demonstrate knowledge of emergency procedures and provide training at least annually” (Nov, 15, 2017)
But you’re not sure how to put it into motion? Who can afford the accrual of “non-productive” hours on educating ALL staff (contracted or formal) on events that may never occur? Well, this may be the article to help you wrap your head around that! (Example: You are a 600 bed Level II Acute Care Hospital looking to educated 300 RNs on the 8-hour Hospital Emergency Response Training with a max class size of 30 students at a time, and you will need to perform this annually.)
CVHC has searched far and wide for best practices to create a method of guidance for your development of Core Competencies for Healthcare Facility Staff. Please allow this information to assist development of facility-specific annual education as it relates to your Emergency Preparedness Program and plans. This is an over-reaching template you can place specific educational goals into.
Core competencies in this arena should ultimately be a list of disaster preparedness, response skills, knowledge, and abilities required by healthcare facility staff to perform roles successfully during disaster events in support of your Emergency Operations Plan (EOP). However, each and every role’s day to day duty in the healthcare setting can vary greatly. So how do you decide what is vital for a competency?
It’s based on competencies being offered at three levels:
Awareness: All Staff
Mid-Level: Dependent upon response role. This level builds on the awareness competencies, applicable to clinical, non-clinical, and specialty trained personnel not directly in the line of performing emergency response roles.
Advanced: This level is aimed for direct response members. Advanced level builds on the previous two levels for personnel who are a part of a specialty team (such as the hospital mass casualty response team, a decontamination team, or the incident command team).
How does this translate to action or an education plan?
Let’s take the example of HERT mentioned earlier. Of the 300 RNS previously defined to adhere to the mandated 8hour HERT training, how many will be directly responsible for PPE selection, decontamination tent set up, physical decontamination of patients, donning and doffing of PPE, clinical care of patients during and post decon? Do any of these RN’s fulfill the role of safety or security during the incident to handle unruly patients? Can they trouble shoot water pressure issues in a hot zone? If the answer is no, chances are your focus is too narrow on a whole pre-set classification of staff (in this case, RNs) and not on what roles are needed during an event. It may appear you have met compliance (all 300 nurses were trained to the highest level) but was anyone else educated on their role? Was this the best use of academic time? How successful will your event be based on the staff you’ve educated? Now, let’s take the model above and relate to this example by creating an education plan for our EOP Annex of CBRNE Event:
An education plan for each annex?
Competencies can be demonstrated and tested through seminar, video education, hands-on training, exercises, or even response to a real event. Make sure you are keeping records of education held. Just in time training along with the initial and refresher competency checks will need to occur to maintain skill and performance levels. You may be able to cover “Awareness” during grand orientation. Overall facility efficiency and effectiveness will grow from the foundation of education and practice. Direct that time correctly based on the annex you are discussing.
Why the entire region should adopt this idea?
When applied throughout the region and across a variety of healthcare facilities, consistency will assist in the overall regionally development, response, coordination, and in finality the evaluation of disaster preparedness and response training programs. By joining forces in creating standardized competencies, the idea of facility to facility shared staffing during declared disasters doesn’t seem so daunting for acute care hospitals, LTCs, Home Health and Hospice member facilities. This also helps meet other requirement/regulations on collaborative and community-based preparedness.
Beyond the Issue
For more information on what The Joint Commission discusses as an initial orientation need versus an annual competency necessary items please click on this link to view the Joint Commission Standards: FAQS
Resources
Baack, S. & Alfred, D. (2013). Nurses preparedness and perceived competence in managing disasters. Journal of Nursing Scholarship, 45 (3), 281-287.
Department of Health, Division of Emergency Medical Operations, Florida State. (2011) 3rd Edition, Florida’s Recommended Disaster CoreCompetencies for Hospital Personnel.
Sorenson, B. S. et al, World Health Organization. The Regional Office for Europe of the World Health Organization (2011) Hospital emergency response checklist: An all-hazards tool for hospital administrators and emergency managers.
Have you heard of DBVI? DBVI is The Virginia Department for the Blind and Vision Impaired, and it is housed right here in Richmond!
The Department for the Blind and Vision Impaired (DBVI) is committed to providing quality services to assist Virginia’s citizens who are blind, deafblind or vision impaired in achieving their maximum level of employment, education, and personal independence. The department provides an array of specialized services to blind Virginians of all ages to assist them in attaining the skills, confidence and positive outlook that are critical to independence.
Our primary focus is to assist blind Virginians in achieving quality employment outcomes. Vocational evaluation, job training, job development, placement, follow-up and other services are provided to assist consumers in obtaining jobs in the public and private sectors. Training for and employment as food service managers and vendors are available in cafeterias, snack bars, and other vending facilities in public and private buildings. The Virginia Industries for the Blind provides another employment option for blind Virginians at its two plant locations in Charlottesville and Richmond, its satellite store operations and administrative service positions across the Commonwealth.”
Central Virginia Emergency Management Alliance (CVEMA) has been re-branded! CVEMA is now The Emergency Management Alliance of Central Virginia.
The Emergency Management Alliance of Central Virginia is a collaborative board and committee of jurisdictional emergency managers and community stakeholders who work through the Richmond Regional Planning District (PlanRVA) as a coalition of professionals dedicated to helping the residents of Central Virginia prepare for and recover from disasters. Central Virginia Healthcare Coalition (CVHC) is an active member of this coalition and involved in the planning, awareness, and sharing of resources and efforts in emergency preparedness for our region.
The re-branding of this committee allows overall alignment with federal preparedness initiative “Ready.gov” for “CVEMA” and each county/city/jurisdiction served within it.
As always, CVHC will continue to report any shared information about this committee and others that we serve on during our monthly meetings (Fourth Friday of every Month)!
