262


Caitlin M. Adams Barker et al


Fig. 1. Mass prophylaxis clinic set up. The dashed line (A–C) presents patient flow of a patient not needing provider examination. The dotted line (1–5) represents patient flow of a patient needing a provider examination.


operationalization of a large-scale intervention. The hospital incident command system was activated to assist in establishing methods for notifying staff, patients, and visitors of their exposure and to manage the logistics of providing prophylaxis to a large number of people over a short period of time. The hospital incident command system is activated


in situations in which a large number of people may be affected. Past activations included network outages and contamination of the city water supply. Notifications are sent via a paging system and by telephone to members of the incident command team alerting them of the activation. A dedicated conference room is used as a meeting space and a dedicated phone line is established for conference calling. Those responding to the activation include hospital administrators, subject-matter experts, public informa- tion officers, and emergency management (EM) staff. Because this incident involved patients, staff, and visitors in inpatient and ancillary areas, more team members were utilized than in a typical activation. The incident command team met 3 times daily, and smaller subcommittees met throughout the day to discuss physical setup, location, staffing and dates of the clinic, acquisition of medica- tion, and communication with those exposed. A walk-in clinic was deemed the most efficient way to provide prophylaxis to those exposed. Based on availability and ease of dosing, topical permethrin was selected as prophylaxis. Staff who had the closest contact with the index patient, as determined by a review of the medical record, were notified by email of their exposure and the need to acquire prophylaxis for themselves and their household members. Dates, times, and locations of the clinics were included in this communication. A review of the affected unit’s census was performed to identify


patients who were admitted to the affected unit during the spe- cified period, and a letter was sent to those discharged notifying them of their possible exposure and providing information for attending the clinics. For those who had passed away since their admission, families were notified by a phone call from the nursing director and prophylaxis was offered to the household members. Patients currently on the affected unit at the time of the outbreak were notified by their attending physician and were prescribed permethrin or ivermectin as prophylaxis. A public announcement was made in the local newspaper, television, and radio stations to alert members of the public who may have visited the affected unit during the exposure period. An information hotline was set up through the department of health for anyone with questions about scabies or the clinics. The department of health, in colla- boration with the IP program, released a Health Alert Network (HAN) communication regarding the exposure, and a website was created with contact information and frequently asked questions. Two adjoining conference rooms were used as clinic space.


Figure 1 illustrates the set up and flow of the clinics. Everyone who presented to the clinic was screened using a paper screening tool. All who indicated being on the affected unit during the exposure period or who were a household member of someone who was, were offered prophylaxis. A cohort order was written by the medical director of EM, and a nurse protocol was used to place the order for those needing prophylaxis. The order allowed for heads of households to obtain medication for those living with them. All patients were assessed for allergies or contraindications to permethrin cream before it was given, and heads of household were responsible for reporting allergies and contraindications of those who were not present.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156