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Coronavirus disease (COVID-19) IPC & HEALTH FACILITY SIMULATION EXERCISE
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Agenda Part 1: 08:45 09:00 09:10 09:15 10:45 11:00 12:30 13:00 13:00 Registration Introduction Exercise Objectives and how to play Table-top Simulation Coffee break (15 min) Table-top Simulation Hot-wash Close part 1 Lunch Part 2: 09:00 09:15 10:30 10:45 11:30 12:00 12:30 Re-cap Gaps analysis & action planning (group work) Coffee break (15 min) Action planning continued (group work) Consolidation in plenary session Wrap up and next steps Closing
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Guiding Preparedness and Response 20 October 2020 Since January 2020, WHO has published more than 100 documents about COVID-19. Of these, more than half are detailed technical guidance, on how to find and test cases, how to provide safe and appropriate care for people depending on the severity of their illness, how to trace and quarantine contacts, how to prevent transmission from one person to another, how to protect health care workers, and how to help communities to respond appropriately. During health emergencies like the COVID-19 pandemic, one of WHO’s most vital roles is to gather data and research from around the world, evaluate it, and then advise countries on how to respond. WHO, providing up to date, accurate advice
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What is a Table-Top Exercise (TTX)? page 4 SIMULATION EXERCISE NOVEL CORONAVIRUS (COVID-19) 20 October 2020 A tabletop exercise (TTX) is a discussion based event that uses a progressive simulated scenario, together with series of scripted injects, to make participants consider the impact of a potential health emergency on existing plans, procedures and capacities. “A TTX simulates an emergency situation in an informal, stress-free environment.” -WHO Exercise Manual, 2017
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Design & Purpose Exercise Design This exercise is based on the latest WHO IPC guidance for COVID-19, including: Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or confirmed (interim guidance 29 June 2020) Infection prevention and control for the safe management of a dead body in the context of COVID-19 (interim guidance 4 September 2020). Purpose Through facilitated group discussion, the exercise aims to examine the implementation of IPC strategies required to prevent or limit transmission of COVID-19 in health care facilities. page 5 SIMULATION EXERCISE COVID-19
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General objectives of the TTX page 6 SIMULATION EXERCISE COVID-19 General Objectives Share information on practices on IPC associated with health care for suspected or confirmed cases of COVID-19 and how those precautions could evolve based on the progress of the event in your facility. Identify challenges in bed occupancy and staff management between different departments. Discuss procedures for the collecting and handling of laboratory specimens from COVID-19 patients Reassess the dead body management protocols Identify areas for action in your facilities based on the issues explored in the scenario and on how the scenario could play out in your health facility.
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Rules of the TTX Not an individual test Respect the views of others Consider the scenario as it would impact your assigned unit. Use your existing plans, guidelines and regulations to inform your responses Focus on solutions and forward planning. page 7 SIMULATION EXERCISE COVID-19
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Table-Top Exercise: How to Play Hot-Wash Review of needs in health facility & Discussion (3) page 8 SIMULATION EXERCISE COVID-19 Scenario update Scenario
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SIMULATION EXERCISE COVID-19 page 9 Questions 20 October 2020 ANY QUESTION BEFORE WE START
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Coronavirus disease (COVID-19) IPC & HEALTH FACILITY SIMULATION EXERCISE
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Scenario Heroes Hospital is a 300-bed tertiary facility in the capital with 18 ICU beds. The hospital operates on average at 90-95% capacity (floor plan in handouts.) The hospital was highly impacted during the first COVID-19 outbreak from March-April 2020. During that period, 347 patients were hospitalized with COVID-19, of which 29 died, including 2 children with underlying health conditions. Since then, the government has implemented strict public health and social measures, which in effect have decreased the number of COVID-19 patients. Over the past few months easing of restrictions has led to an increase in infections and this has been reflected by an increase of COVID-19 patients. SIMULATION ONLY page 11 SIMULATION EXERCISE COVID-19 20 October 2020
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Session 1 Questions for discussion Based on your plan and procedures what screening and triage procedures should be in place in this hospital? And is it enough? As the SARS-CoV-2 virus is likely to stay with us for a long time, what would be the IPC recommendations for staff and patients? What isolation and cohorting measures should be in place to manage infectious patients? What kind of equipment, training or other activities would keep staff alert to the need for IPC measures in the presence of high COVID-19 infections? What kind of environmental cleaning and engineering control systems are implemented? Are any administrative controls needed at this stage, and if so what would these be? How will you ensure facility policies will be followed and how do you deal with non-compliance? 30 mins page 12 SIMULATION EXERCISE COVID-19 20 October 2020
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Scenario update SIMULATION ONLY Increasing numbers of COVID-19 patients are being admitted to hospital. Suspect cases are put in isolation and tested for the novel virus. The ICU is almost fully occupied with only 2 beds remaining free. Hospital management is considering the set-up of an isolation ward/field hospital A number of health care staff have developed COVID-19 symptoms and are absent and staying at home page 13 SIMULATION EXERCISE COVID-19 20 October 2020
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Session 2 Questions for discussion How will you confirm if suspect patients are infected with the novel Coronavirus? Where will the samples have to be sent to test for COVID-19 and how long will it take to receive results back? To what unit will suspected and confirmed patients be admitted? What considerations would you recommend for clinical management and isolation pathways? Would the current situation pose any challenges in patient bed occupancy and staffing? How could the ICU capacity be enhanced? How will you manage healthcare acquired infections, contact tracing and management of contacts? 8. What other measures might be implemented regarding this situation? 30 mins page 14 SIMULATION EXERCISE COVID-19 20 October 2020
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Session 2- Hospital administration meeting Hospital administration calls a meeting to review the process in place in case numbers continue to increase. Discuss the situation and determine priority actions including: Activation of the health facility surge plan, including respiratory support, PPE supplies, IPC, and mental health support for staff Equipment needs Training needs Staffing needs Environmental cleaning requirements Bed occupancy and staffing management in parallel with isolation needs Patient relocation to other hospitals How will this plan be communicated to external audiences (e.g. media, patients & general public?) 60 mins page 15 SIMULATION EXERCISE COVID-19 20 October 2020
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Scenario update SIMULATION ONLY Five days later the ICU capacity has been extended with 40% extra capacity (e.g. 8 beds) Regular health care has been impacted and some patients have been moved to other hospitals. Other wards have been repurposed to free up space for suspected and confirmed patients Health care staff have been trained to take care of COVID-19 patients. 20% of the health care staff working in the hospital have been infected with the SARS-CoV-19 virus. Unfortunately, several patients have died in the last few days. page 16 SIMULATION EXERCISE COVID-19 20 October 2020
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Session 3 Questions for discussion How will you mitigate the risk of infection for your front line health care workers? How will internal staff contacts of infected health workers be managed, including anticipating a shortage of available health workers, and a safe return to work strategy for infected health workers? How will ambulation/rehabilitation of patients work to facilitate discharge planning? How will dead bodies be managed? What procedures are to be followed? How will you prepare and pack the body for transfer from the hospital to an autopsy unit, mortuary, crematorium or burial site? 30 mins page 17 SIMULATION EXERCISE COVID-19 20 October 2020
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ENDEX Participant Feedback page 18 SIMULATION EXERCISE COVID-19 20 October 2020
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Hotwash/Review of needs Review strengths & gaps Check assumptions Propose ideas to enhance your systems, plans & Procedures ACTION PLAN TASKS: 75 mins In groups, divide a piece of paper into three sections. Review the Readiness Checklist, your plans and notes from your TTX Discuss and write your points in each of the sections to answer: What worked well? (Achievements) What was challenging? (Challenges) Recommendations? (and prioritize, to identify your top 3) Note: the action plan will be done in the next session page 19 SIMULATION EXERCISE NOVEL CORONAVIRUS (COVID-19) 20 October 2020
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Action Plan 24 January 2023 45 mins Key Challenge/ Gap Proposed Solution Timeline for Resolution Responsibility
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Consolidation
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Next steps and wrap up NEXT STEPS
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WHO COVID-19 Partners Platform The COVID-19 Partners Platform supports transparency, collaboration, and efficiency for countries, UN agencies, implementing partners, and donors in their COVID-19 response. In the country checklist please update the indicator related to pillar 6: IPC when this Simulation Exercise has been successfully conducted. For more information visit: https://covid19partnersplatform.who.int/
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WHO RESOURCES THANK YOU! WHO COVID-19 Emergency webpage Scan or Click For SimEx technical support, please contact your WHO country office or regional office focal point: AFRO: stephenm@who.int EMRO: samhourid@who.int EURO: schmidtt@who.int; rashforda@who.int PAHO: andragro@paho.org SEARO: hkatom@who.int; htikem@who.int WPRO: eshofoniea@who.int; More information on coronavirus Scan or Click WHO resources on simulation exercises Scan or Click