Briefing for providers in relation to service development for inpatient service for Airborne High Consequence Infectious Diseases.

Transcription

1 Briefing for providers in relation to service development for inpatient service for Airborne High Consequence Infectious Diseases

2 Introductions Joan Ward, Commissioning Manger Highly Specialised Services, NHS England Dr Jake Dunning, Consultant in Infectious Diseases, PHE, Deputy Director, HCID, NHS England Mumtaz Patel, HCID Programme Manager, NHS England Collette Palmer, Specialised Commissioning Procurement Lead Arden GEM CSU Neli Garbuzanova, Procurement Manager Arden GEM CSU

3 High Consequence Infectious Disease High consequence infectious diseases are characterised by: a) acute infectious illness; b) an ability for illness to spread in the community and within healthcare settings including staff if not properly protected; c) high case-fatality rate; d) difficulty in rapid recognition and detection; e) effective treatments often lacking; and f) coordination is required at a national level to ensure an effective and consistent response

4 Diseases in scope for this programme a) Middle East respiratory syndrome (MERS) coronavirus infection b) Avian influenza A(H7N9) infection c) Avian influenza A(H5N1) infection d) Monkeypox virus infection e) Nipah virus infection f) Yersinia pestis infection (pneumonic plague only)) g) Severe acute respiratory syndrome (SARS) coronavirus infection* h) Any new and novel pathogens that may arise Airborne HCIDs are capable of being transmitted person-to-person by the airborne route; this may be in addition to other routes of transmission e.g. contact, droplet. There have been a number of recent outbreaks (outside of the Middle East), for example, an outbreak between May and July 2015 in South Korea infected 186 patients and killed 36. Thousands of patients had to be quarantined. There have been a very small number of patients with MERS treated in NHS hospitals, notably St Thomas (2013). A patient suspected of having MERS caused the closure of an A&E in Manchester in 2015.

5 Reasons for this service development In 2015/16, NHS England established the High Consequence Infectious Disease (HCID) Programme. The objective of the programme is to ensure that there is an agreed approach to managing the end to end patient pathway for known and unknown high consequence infectious diseases (suspected and confirmed). This is turn will ensure that a sustainable response is in place, and is efficiently and effectively actionable, should the need arise. NHS England has services in place for the treatment of patients with viral haemorrhagic fevers such as Ebola (at the Royal Free and Newcastle). These units and also Liverpool and Sheffield are commissioned to maintain a heightened state of readiness should the need arise to rapidly accept patients for treatment There is no commissioned pathway for patients with airborne HCID s

6 Key elements of service to be commissioned Service specifications for service readiness and staff training Must commit to being able to admit a patient with a confirmed diagnosis within 6 hours of notification Adult services must be able to care for 2 patients at a time as a minimum and preferably up to 4 Paediatric services must be able to cope with up to 2 children at a time Interim service for 2 years ; there is a national review of Infectious Disease Services; the long term approach for HCID will be part of the national strategy following on from this review Co location of adult and paediatric services

7 Role of the Unit The purpose of a Special Isolation Unit is the complete containment of any airborne HCID For Adults, the unit will be part of a specialist Infectious Diseases or Critical Care unit; For Children the unit will be situated in a paediatric intensive care unit; sited in an area away from general circulation of staff, patients and visitors such that patients are not admitted through Accident and Emergency department The objectives are to: a)achieve complete physical separation of HCID patients to mitigate against disease spread; b)provide direct access for HCID patients to specialist infectious diseases and critical care clinical expertise; c)ensure security against disruption and crime with appropriate lock down procedures and access and egress records in place to allow for any epidemiological follow up of potential contacts; d)allow for secure and direct transfer of patients from ambulance to unit;

8 Key Requirements The aim of the programme service is provide a treatment facility that can safely and effectively manage a confirmed airborne HCID, such as MERS. Each unit must be able to admit a patient and start treatment within 6 hours of a confirmed diagnosis. Each adult unit will have the capacity to treat 2 patients as a minimum and preferably up to 4. Each paediatric unit must be able to treat up to 2 patients at a time Units should plan for length of stay of up to three weeks.

9 Requirements cont. Units should be able to maintain appropriate facilities and infrastructure for patient care (the Special Isolation Unit) i) Ensure clear segregation of clean and potentially contaminated areas of the Special Isolation Unit. Clearly delineated pathways through the unit for staff, patients, visitors, supplies and waste should be integrated into the structural design. ii) Ensure patient isolation suites within the unit are at negative pressure relative to the rest of the unit. Facilities should comply with Health Building Note Supplement 1 for isolation facilities for infectious patients in acute settings. Air should be HEPA (or equivalent) filtered before discharge into the atmosphere. Ensure environmental monitoring is built-in to monitor the performance of negative pressure ventilation systems. iv) Ensure that all surfaces are easy to clean. Floor, walls and other surfaces must be impervious to water and resistant to damage from disinfectants. v) Ensure security against disruption and crime with appropriate lock down procedures and access and egress records in place to allow for any epidemiological follow up of potential contacts. vi) Allow for secure and direct transfer of patients from ambulance to unit. vii) The Special Isolation Unit must be designed to allow delivery of level 3 critical care to patients with airborne HCID.

10 Other requirements Maintaining a cadre of competent staff who have demonstrated through regular training and exercising that they are capable of operating a safe system of work while providing optimal clinical care i) Relevant staff groups for adults and paediatrics (doctors, nurses, support staff such as physiotherapists and radiographers) must undergo regular training in the safe system of work, including the use of personal protective equipment, and demonstrate relevant competencies. Sufficient staff need to be trained and available to maintain an operational Special Isolation Unit for 3 weeks of continuous clinical care. ii) Training must be complemented by exercising that tests the whole safe system of work iii) Records of training and exercising must be maintained. Services must work as part of a clinical network, one Trust will be the clinical lead iv) Clinical care will be delivered by Infectious Diseases and ICU specialists. It must be possible to deliver level 3 critical care to patients with airborne HCID within the Special Isolation Unit or within the PICU for a child Units must work closely with regional and national EPRR

11 Next Steps WebEx on 20 September 2017 (WebEx information inc. Q&A will be shared) Deadline for receiving Expression of Interests is 29 September 2017 at 5pm Decision on procurement and lotting strategy in October

12 Any Questions?