4637_half 2/24/06 9:34 AM Page A Emerging Infectious Diseases and the Threat to Occupational Health in the U.S and Canada 4637_series.qxd 2/24/06 9:29 AM Page B PUBLIC ADMINISTRATION AND PUBLIC POLICY A Comprehensive Publication Program Executive Editor JACK RABIN Professor of Public Administration and Public Policy School of Public Affairs The Capital College The Pennsylvania State University—Harrisburg Middletown, Pennsylvania Assistant to the Executive Editor T Aaron Wachhaus, Jr Public Administration as a Developing Discipline, Robert T Golembiewski Comparative National Policies on Health Care, Milton I Roemer, M.D Exclusionary Injustice: The Problem of Illegally Obtained Evidence, Steven R Schlesinger Organization Development in Public Administration, edited by Robert T Golembiewski and William B Eddy Approaches to Planned Change, Robert T Golembiewski Program Evaluation at HEW, edited by James G Abert The States and the Metropolis, Patricia S Florestano and Vincent L Marando 11 Changing Bureaucracies: Understanding the Organization before Selecting the Approach, William A Medina 12 Handbook on Public Budgeting and Financial Management, edited by Jack Rabin and Thomas D Lynch 15 Handbook on Public Personnel Administration and Labor Relations, edited by Jack Rabin, Thomas Vocino, W Bartley Hildreth, and Gerald J Miller 19 Handbook of Organization Management, edited by William B Eddy 22 Politics and Administration: Woodrow Wilson and American Public Administration, edited by Jack Rabin and James S Bowman 23 Making and Managing Policy: Formulation, Analysis, Evaluation, edited by G Ronald Gilbert 25 Decision Making in the Public Sector, edited by Lloyd G Nigro 26 Managing Administration, edited by Jack Rabin, Samuel Humes, and Brian S Morgan 27 Public Personnel Update, edited by Michael Cohen and Robert T Golembiewski 28 State and Local Government Administration, edited by Jack Rabin and Don Dodd 29 Public Administration: A Bibliographic Guide to the Literature, Howard E McCurdy 31 Handbook of Information Resource Management, edited by Jack Rabin and Edward M Jackowski 32 Public Administration in Developed Democracies: A Comparative Study, edited by Donald C Rowat 33 The Politics of Terrorism: Third Edition, edited by Michael Stohl 4637_series.qxd 2/24/06 9:29 AM Page C 34 Handbook on Human Services Administration, edited by Jack Rabin and Marcia B Steinhauer 36 Ethics for Bureaucrats: An Essay on Law and Values, Second Edition, John A Rohr 37 The Guide to the Foundations of Public Administration, Daniel W Martin 39 Terrorism and Emergency Management: Policy and Administration, William L Waugh, Jr 40 Organizational Behavior and Public Management: Second Edition, Michael L Vasu, Debra W Stewart, and G David Garson 43 Government Financial Management Theory, Gerald J Miller 46 Handbook of Public Budgeting, edited by Jack Rabin 49 Handbook of Court Administration and Management, edited by Steven W Hays and Cole Blease Graham, Jr 50 Handbook of Comparative Public Budgeting and Financial Management, edited by Thomas D Lynch and Lawrence L Martin 53 Encyclopedia of Policy Studies: Second Edition, edited by Stuart S Nagel 54 Handbook of Regulation and Administrative Law, edited by David H Rosenbloom and Richard D Schwartz 55 Handbook of Bureaucracy, edited by Ali Farazmand 56 Handbook of Public Sector Labor Relations, edited by Jack Rabin, Thomas Vocino, W Bartley Hildreth, and Gerald J Miller 57 Practical Public Management, Robert T Golembiewski 58 Handbook of Public Personnel Administration, edited by Jack Rabin, Thomas Vocino, W Bartley Hildreth, and Gerald J Miller 60 Handbook of Debt Management, edited by Gerald J Miller 61 Public Administration and Law: Second Edition, David H Rosenbloom and Rosemary O’Leary 62 Handbook of Local Government Administration, edited by John J Gargan 63 Handbook of Administrative Communication, edited by James L Garnett and Alexander Kouzmin 64 Public Budgeting and Finance: Fourth Edition, edited by Robert T Golembiewski and Jack Rabin 65 Handbook of Public Administration: Second Edition, edited by Jack Rabin, W Bartley Hildreth, and Gerald J Miller 67 Handbook of Public Finance, edited by Fred Thompson and Mark T Green 68 Organizational Behavior and Public Management: Third Edition, Michael L Vasu, Debra W Stewart, and G David Garson 69 Handbook of Economic Development, edited by Kuotsai Tom Liou 70 Handbook of Health Administration and Policy, edited by Anne Osborne Kilpatrick and James A Johnson 71 Handbook of Research Methods in Public Administration, edited by Gerald J Miller and Marcia L Whicker 72 Handbook on Taxation, edited by W Bartley Hildreth and James A Richardson 73 Handbook of Comparative Public Administration in the Asia-Pacific Basin, edited by Hoi-kwok Wong and Hon S Chan 74 Handbook of Global Environmental Policy and Administration, edited by Dennis L Soden and Brent S Steel 75 Handbook of State Government Administration, edited by John J Gargan 76 Handbook of Global Legal Policy, edited by Stuart S Nagel 78 Handbook of Global Economic Policy, edited by Stuart S Nagel 79 Handbook of Strategic Management: Second Edition, edited by Jack Rabin, Gerald J Miller, and W Bartley Hildreth 4637_series.qxd 2/24/06 9:29 AM Page D 80 Handbook of Global International Policy, edited by Stuart S Nagel 81 Handbook of Organizational Consultation: Second Edition, edited by Robert T Golembiewski 82 Handbook of Global Political Policy, edited by Stuart S Nagel 83 Handbook of Global Technology Policy, edited by Stuart S Nagel 84 Handbook of Criminal Justice Administration, edited by M A DuPont-Morales, Michael K Hooper, and Judy H Schmidt 85 Labor Relations in the Public Sector: Third Edition, edited by Richard C Kearney 86 Handbook of Administrative Ethics: Second Edition, edited by Terry L Cooper 87 Handbook of Organizational Behavior: Second Edition, edited by Robert T Golembiewski 88 Handbook of Global Social Policy, edited by Stuart S Nagel and Amy Robb 89 Public Administration: A Comparative Perspective, Sixth Edition, Ferrel Heady 90 Handbook of Public Quality Management, edited by Ronald J Stupak and Peter M Leitner 91 Handbook of Public Management Practice and Reform, edited by Kuotsai Tom Liou 92 Personnel Management in Government: Politics and Process, Fifth Edition, Jay M Shafritz, Norma M Riccucci, David H Rosenbloom, Katherine C Naff, and Albert C Hyde 93 Handbook of Crisis and Emergency Management, edited by Ali Farazmand 94 Handbook of Comparative and Development Public Administration: Second Edition, edited by Ali Farazmand 95 Financial Planning and Management in Public Organizations, Alan Walter Steiss and Emeka O Cyprian Nwagwu 96 Handbook of International Health Care Systems, edited by Khi V Thai, Edward T Wimberley, and Sharon M McManus 97 Handbook of Monetary Policy, edited by Jack Rabin and Glenn L Stevens 98 Handbook of Fiscal Policy, edited by Jack Rabin and Glenn L Stevens 99 Public Administration: An Interdisciplinary Critical Analysis, edited by Eran Vigoda 100 Ironies in Organizational Development: Second Edition, Revised and Expanded, edited by Robert T Golembiewski 101 Science and Technology of Terrorism and Counterterrorism, edited by Tushar K Ghosh, Mark A Prelas, Dabir S Viswanath, and Sudarshan K Loyalka 102 Strategic Management for Public and Nonprofit Organizations, Alan Walter Steiss 103 Case Studies in Public Budgeting and Financial Management: Second Edition, edited by Aman Khan and W Bartley Hildreth 104 Handbook of Conflict Management, edited by William J Pammer, Jr and Jerri Killian 105 Chaos Organization and Disaster Management, Alan Kirschenbaum 106 Handbook of Gay, Lesbian, Bisexual, and Transgender Administration and Policy, edited by Wallace Swan 107 Public Productivity Handbook: Second Edition, edited by Marc Holzer 108 Handbook of Developmental Policy Studies, edited by Gedeon M Mudacumura, Desta Mebratu and M Shamsul Haque 109 Bioterrorism in Medical and Healthcare Administration, Laure Paquette 110 International Public Policy and Management: Policy Learning Beyond Regional, Cultural, and Political Boundaries, edited by David Levi-Faur and Eran Vigoda-Gadot 111 Handbook of Public Information Systems, Second Edition, edited by G David Garson 4637_series.qxd 2/24/06 9:29 AM Page E 112 Handbook of Public Sector Economics, edited by Donijo Robbins 113 Handbook of Public Administration and Policy in the European Union, edited by M Peter van der Hoek 114 Nonproliferation Issues for Weapons of Mass Destruction, Mark A Prelas and Michael S Peck 115 Common Ground, Common Future: Moral Agency in Public Administration, Professions, and Citizenship, Charles Garofalo and Dean Geuras 116 Handbook of Organization Theory and Management: The Philosophical Approach, Second Edition, edited by Thomas D Lynch and Peter L Cruise 117 International Development Governance, edited by Ahmed Shafiqul Huque and Habib Zafarullah 118 Sustainable Development Policy and Administration, edited by Gedeon M Mudacumura, Desta Mebratu, and M Shamsul Haque 119 Public Financial Management, edited by Howard A Frank 120 Handbook of Juvenile Justice: Theory and Practice, edited by Barbara Sims and Pamela Preston 121 Emerging Infectious Diseases and the Threat to Occupational Health in the U.S and Canada, edited by William Charney Available Electronically Principles and Practices of Public Administration, edited by Jack Rabin, Robert F Munzenrider, and Sherrie M Bartell 4637_title 4/11/06 2:00 PM Page i Emerging Infectious Diseases and the Threat to Occupational Health in the U.S and Canada edited by William Charney Healthcare Safety Consulting Seattle, Washington CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2006 by Taylor and Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S Government works Printed in the United States of America on acid-free paper 10 International Standard Book Number-10: 0-8493-4637-1 (Hardcover) International Standard Book Number-13: 978-0-8493-4637-8 (Hardcover) Library of Congress Card Number 2006040779 This book contains information obtained from authentic and highly regarded sources Reprinted material is quoted with permission, and sources are indicated A wide variety of references are listed Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the consequences of their use No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers For permission to photocopy or use material electronically from this work, please access www copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc (CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400 CCC is a not-for-profit organization that provides licenses and registration for a variety of users For organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe Library of Congress Cataloging-in-Publication Data Charney, William, 1947Emerging infectious diseases and the threat to occupational health in the U.S and Canada / by William Charney p cm (Public administration and public policy ; 120) Includes bibliographical references (p ) ISBN 0-8493-4637-1 (alk paper) Emerging infectious diseases United States Emerging infectious diseases Canada Medicine, Industrial United States Medicine, Industrial-Canada I Title II Series RA643.5.C43 2006 362.196’9 dc22 2006040779 Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com 4637_Discl.indd 5/26/06 1:55:27 PM Dedication This book is dedicated to E.D whose inspiration kept my well fr om running dry This book is also dedicated to all the selfless health care workers who put themselves in harms way, shift after shift, to protect public health May this volume bring some respite to their daily exposures and help protect them in their time of need ix 4637_book.fm Page 412 Thursday, May 25, 2006 3:58 PM 412 Ⅲ Emerging Infectious Diseases American Federation of Government Employees American Federation of State, County and Municipal Employees American Federation of Teachers Building and Construction Trades Department, AFL-CIO Communications Workers of America International Association of Firefighters International Brotherhood of Teamsters International Union, UAW Service Employees International Union United American Nurses United Food and Commercial Workers United Steelworkers of America cc: The Honorable Michael O Leavitt Secretary of Health and Human Services John Howard, MD, Director, NIOSH Jonathan L Snare, Acting Assistant Secretary of Labor for Occupational Safety and Health 4637_book.fm Page 413 Thursday, May 25, 2006 3:58 PM Appendix B Interim Guidance for Protecting Health Care Workers Caring for Patients Potentially Exposed to Aerosolized Yersinia pestis from a Bioterrorism Event 413 4637_book.fm Page 414 Thursday, May 25, 2006 3:58 PM 414 Ⅲ Emerging Infectious Diseases PLAGUE April 4, 2005 This interim guidance provides safety and health recommendations for workers In health care settings who may treat patients infected, or suspected of being infected, with Yersinia pestis (the bacterium that causes plague) as a result of a bioterrorism event It Is NOT intended for emergency responders (e.g., EMTs at the scene of an event or transporting potentially contaminated victims) or first receivers (covered under other guidance: www.osho.gov/dts/osta/bestpractices/html/hospital_ firstreceivers.html) Nor is it intended for health care workers caring for patients with naturally occurring plague Naturally occurring plague is uncommon In the United States and occurs after infection with Y pestis, most commonly transmitted to humans from infected rodents via fleas Bubonic plague is most common Pneumonic plague occurs when Y pestis infects the lungs, either as a primary or secondary (spread of infection to the lungs in a patient with bubonic or septicemic plague) infection The first signs of primary pneumonic plague are fever, headache, weakness, and rapidly developing pneumonia with shortness of breath, chest pain, cough, and, in a later stage, sometimes bloody sputum The pneumonia progresses rapidly, may cause respiratory failure and shock, and without early treatment is frequently fatal Plague is treated with antibiotics As soon as a diagnosis of suspected plague is made, the patient should be hospitalized under droplet precautions Local and state health departments should be notified, confirmatory laboratory work should be initiated, and antibiotic therapy should be started as soon as possible after the laboratory specimens are taken Contacts of pneumonic plague patients should be placed under observation or given preventive antibiotic therapy, depending on the degree and timing of contact Patients (or animals) with pneumonic plague can spread the Infection to other persons through the air, particularly during advanced disease when bloody sputum is present Case reports describing occurrences of pneumonic plague have found that transmission of Y pestis from persons (or animals) with pneumonic plague usually occurs among persons in direct and close contact with the ill person (or animal) Health care workers uncommonly may become infected during the care of patients with naturally occurring infection who develop advanced plague pneumonia Therefore, droplet precautions have been recommended for health care workers caring for patients with pneumonic plague Plague may be encountered during a bioterrorism event, in which case transmission of the infection may occur by breathing in aerosolized 4637_book.fm Page 415 Thursday, May 25, 2006 3:58 PM Appendix B Ⅲ 415 bacteria, and a likely clinical manifestation would be primary pneumonic plague A bioterrorism event with Y pestis may be suspected if several cases of plague are identified within a short period of time (particularly in nonendemic areas) and the cases are not associated with transmission by infected fleas A bioterrorism event can introduce initial uncertainty about the agent (e.g., drug resistance, persistence in the environment, infectiousness) and can place considerable stress on the health care system Complete health care worker compliance with antimicrobial prophylaxis cannot be guaranteed during a bioterrorism event and the organism may be genetically altered to be antibiotic resistant Plague vaccine, which is not currently available in the United States, has demonstrated efficacy only against bubonic plague and does not prevent the development of primary pneumonic plague When there is a suspicion of a bioterrorism event, infection control practice should include droplet and contact precautions Historical and contemporary epidemiological evidence from naturally occurring pneumonic plague outbreaks indicates that the infection is not easily transmitted from person to person and that a surgical mask in combination with other droplet precautions provides adequate protection for health care workers However, given the initial uncertainties associated with a bioterrorism event, additional precautions may be prudent, and the use of an N95 filtering face piece respirator will offer an additional degree of protection In a large-scale bioterrorism event, exigent circumstances may require the suspension of some of the respiratory protection requirements found in the Occupational Safety and Health Administration Respiratory Standards (29 CFR 1910.134), such as fit testing and medical clearance Other complementary strategies should also be in place, including temperature monitoring of unprotected close contacts In addition, the use of antibiotic prophylaxis may be considered These precautions should be continued at least until a definitive diagnosis is established, antimicrobial sensitivity of the agent is known, and the presence of other agents is ruled out If the isolation capacity of the health care facility is adequate, patients should be isolated under droplet precautions for at least 48 hours of effective antibiotic therapy and until clinical improvement has taken place If strict isolation is not possible due to the great number of patients, then patients with pneumonic plague may be cohorted while receiving treatment Health care faciilties should avoid surgery or other aerosol-generating procedures on known or suspected plague cases (including autopsies), unless deemed medically necessary (see “Plague as a Biological Weapon: Medical and Public Health Management” at http://jama.ama-assn.org/cgi/ content/short/283/17/2281) If such procedures are performed, a higher level of respiratory protection may be necessary If such procedures are 4637_book.fm Page 416 Thursday, May 25, 2006 3:58 PM 416 Ⅲ Emerging Infectious Diseases performed on a patient with known or suspected pneumonic plague, airborne precautions should be implemented regardless of agent sensitivity or source of exposure (suspected bioterrorism versus naturally occurring) For more information, visit www.bt.cdc.gov/agent/plague or call CDC at 800-CDC-INFO (English and Spanish) or 888-232-6348 (TTY) 4637_book.fm Page 417 Thursday, May 25, 2006 3:58 PM Index A AFLCIO, letter to Secretary of Health and Human Services, 407–412 Agencies, departments, cooperation among, 325–338 Air-purifying respirators, National Institute for Occupational Safety and Health, tested/certified, 75 Airborne infection isolation room use, 215–216 Airborne pathogens, 71–86, 103–109, 145–146 See also under specific pathogen assigned protection factor, penetration, 77–78 coughing patient airborne concentration/inhaled dose, 83–84 cough particles, 78–81 exposure intensity estimation, 78–86 hypothetical example, 83–84 exposure intensity estimation, 78–86 face seal leakage, vs filter penetration, 75–77 infectious dose model, 73–75 laboratory accident, 84–86 airborne concentration/inhaled dose, 84–85 hypothetical example, 85–86 pathogen emission rate, 81–82 pathogen removal pathways, 82–83 respiratory protection, 75–86 transmission, 103–109 Alabama antiviral availability, 258 effect of flu pandemic, 256, 275 Alaska antiviral availability, 258 effect of flu pandemic, 256, 275 American Federation of Government Employees, letter to Secretary of Health and Human Services, on behalf of, 412 American Federation of Labor and Congress of Industrial Organizations See AFLCIO American Federation of State, County and Municipal Employees, letter to Secretary of Health and Human Services, on behalf of, 412 American Federation of Teachers, letter to Secretary of Health and Human Services, on behalf of, 412 American Public Health Association, 244 American Red Cross in hurricane Katrina disaster, 295 AMRIID See Army Medical Research Institute of Infectious Diseases Anteroom use, effect on infection control guideline compliance, 169 Anthrax, 240–241 Antibiotic resistant tuberculosis, 46–47 417 4637_book.fm Page 418 Thursday, May 25, 2006 3:58 PM 418 Ⅲ Emerging Infectious Diseases Antiviral/vaccine supply, 233–235, 258–259, 261, 263–266, 268–269, 290–292 Appropriations legislation for prevention/control measures, 261–262 Arizona antiviral availability, 258 effect of flu pandemic, 256, 275 Arkansas antiviral availability, 258 effect of flu pandemic, 256, 275 Armed troops in hurricane Katrina disaster, 296 in quarantine enforcement, 296 (See also Posse Comitatus Act of 1878) Army Medical Research Institute of Infectious Diseases, 288 Attitudes of healthcare workers, effect on compliance, 149–151, 159–161, 171–172 ability to adopt, 149 education, 149 gender, 149 occupation, 149 others’ attitudes, 176–177 risk, perception of, 149 shift work, 149 Availability of protective equipment, effect on infection control guideline compliance, 170–171 Avian flu, 47–48, 252, 261–262 See also Influenza identification of, 252 B Banana oil See Isoamyl acetate Beliefs of healthcare workers, effect on compliance, 149–151, 159–161, 171–173 ability to adopt, 149 perception of, 149 education, 149 gender, 149 occupation, 149 others’ attitudes, 176–177 risk, perception of, 149 shift work, 149 Best practices, of hospital cleaners/housekeepers, 320–322 Biological Weapons Convention, 288 Bioterrorism, 239–246, 348, 407–416 Bird flu, 47–48, 252, 261–262 See also Influenza Bitrex, 65 Blocking export of Tamiflu, 292 Bubonic plague, 413–416 Building and Construction Trades Department, AFL-CIO, letter to Secretary of Health and Human Services, on behalf of, 412 Bureaucracies accountable for public safety, 303–416 agencies, departments, cooperation among, 325–338 cleaners, hospital, 305–324 housekeepers, hospital, 305–324 rural hospitals, 339–348 Bush, George W in hurricane Katrina disaster, 296 quarantine use, approval of, 261, 296 BWC See Biological Weapons Convention C California antiviral availability, 258 effect of flu pandemic, 256, 275 Canada, SARS in, 44 CDAD See Clostridium difficile diarrhea China, flu spread from, 252 City planning for pandemic, 262–263 Class, impact of, in hurricane Katrina disaster, 294–295 Cleaners, hospital, 305–324 See also Attitudes of healthcare workers, effect on compliance best practices, 320–322 CDC recommendations, 310–311 Clostridium difficile diarrhea, 312–313 effect of cleaning, 313–314 job control, 317 Norwalk virus, 312 pandemic hypothesis, 323 resistant organisms, 311 respect issues, 317 routines, cleaning, 322–323 4637_book.fm Page 419 Thursday, May 25, 2006 3:58 PM Index Ⅲ 419 scientific literature, 314–316 teamwork, need for, 318 training, 318–319 working conditions, 317–318 Clostridium difficile diarrhea, 312–313 Colorado antiviral availability, 258 effect of flu pandemic, 256, 275 Commission to Investigate Introduction and Spread of SARS, 31–38 nurses’ union officials reports, 3–38 Communication effect on infection control guideline compliance, 165–167 importance of, 134–136 planning of, 269 Compliance with infection control guidelines, 3–38, 96–98, 149–151, 153–177 anterooms, 169 attitudes, impact of, 171–172 availability of protective equipment, 170–171 beliefs, impact of, 172–173 communication, 165–167 consistency with safety instructions, lack of, 158 content analysis, 156–168 discomfort, 174–175 enforcement by regulatory agencies, 159 environmental decontamination, 170 environmental factors, 98, 168–170 evidenced-based policies, 161–163 exhaustion, 176 fatigue, 176 fit testing, 167–168 individual factors, 98 isolation rooms, 168–169 knowledge, 171 negative pressure rooms, 169–170 organizational factors, 97–98, 158, 168–177 others’, attitudes of, impact of, 176–177 peer environment, 175–176 physical space separation, 168 time constraints, 173–174 training, 164–165 workload, increase in, 174 workplace attitudes, 159–161 Connecticut antiviral availability, 258 effect of flu pandemic, 256, 275 Cooperative synergy, agencies, departments, 325–338 hurricane Katrina, 335–337 Public Health Agency of Canada, 326 SARS case study, 329–335 Coordination, importance of, 223–225 Cost containment, 229–230 Coughing patient, 78–86 airborne concentration/inhaled dose, 83–84 cough particles, 78–81 exposure intensity estimation, 78–86 hypothetical example of, 83–84 D Decontamination, scientific literature coverage, 94 Delaware antiviral availability, 258 effect of flu pandemic, 256, 275 Department of Homeland Security, 252, 295 Department of State, advisory statement about avian flu, 262 Deterioration of public health system, 219–246 bioterrorism, 239–246 public health responses, 221–238 DHS See U.S Department of Homeland Security Diagnosis of influenza, 300–302 Discomfort, effect on infection control guideline compliance, 174–175 District of Columbia antiviral availability, 258 effect of flu pandemic, 256, 275 Droplet-spread respiratory infections, 144–145, 407–412 See also under specific infection Drug availability issues, 233–235, 258–259, 261, 263–266, 268–269, 290–292 E Engineering controls, in healthcare work protection, 140–141, 146–147 4637_book.fm Page 420 Thursday, May 25, 2006 3:58 PM 420 Ⅲ Emerging Infectious Diseases Environmental decontamination, in healthcare work protection, 141–142 Epidemiology gaps in scientific evidence, 151–153 scientific literature coverage, 92–93 Exhaustion, effect on infection control guideline compliance, 176 Eye protection, 61 F Face seal leakage, vs filter penetration, 75–77 Fatigue, effect on infection control guideline compliance, 176 Federal Emergency Management Agency in hurricane Katrina disaster, 295 Feedback, in healthcare work protection, 134–136 FEMA See Federal Emergency Management Agency First responders, personal protective equipment, 61 Fit testing, 128–129 effect on infection control guideline compliance, 167–168 scientific literature coverage, 95 types of agents, 65 Fleas, transmission of plague through, 414 Florida antiviral availability, 258 effect of flu pandemic, 256, 275 Flu pandemic, 249–276 antivirals/vaccine, 233–235, 263–266, 269 bird transmission, 267 breaks of twentieth century, 251–253 dangers of, 250–251 initiation of preparedness, 261–262 model estimates, 253–254 mortality, 256–257, 275–276 pig transmission to humans, 267 planning efforts, 259–261 recommendations, 270–276 Southeast Asia, 267 state by state analysis, 254–259 state level, 275–276 state readiness, 262 stockpiling of medications, 265–267 Focus group analysis, protective measures, 96–98, 154–181 anterooms, 169 attitudes, impact of, 171–172 availability of protective equipment, 170–171 beliefs, impact of, 172–173 communication, 165–167 consistency with safety instructions, lack of, 158 content analysis, 156–168 discomfort, 174–175 enforcement by regulatory agencies, 159 environmental decontamination, 170 environmental factors, 98, 168–170 evidenced-based policies, 161–163 exhaustion, 176 fatigue, 176 fit testing, 167–168 individual factors, 98 isolation rooms, 168–169 knowledge, 171 methodology, 154–156 negative pressure rooms, 169–170 organizational factors, 97–98, 158, 168–177 others’, attitudes of, 176–177 participants, 156 peer environment, 175–176 physical space separation, 168 results, 156 time constraints, 173–174 training, 164–165 workload, increase in, 174 workplace attitudes toward safety, 159–161 Future research, priorities, 98–100, 177–183 G Gaps in knowledge, about occupationally acquired respiratory infectious disease control, 89–204 Georgia antiviral availability, 258 effect of flu pandemic, 256, 275 Gulf Coast of U.S., devastation of See Hurricane Katrina 4637_book.fm Page 421 Thursday, May 25, 2006 3:58 PM Index Ⅲ 421 H Hawaii antiviral availability, 258 effect of flu pandemic, 256, 275 Health Insurance Portability and Access Act, 232 HIPAA See Health Insurance Portability and Access Act Hong Kong, SARS in, 44 Hong Kong flu, 252 Housekeepers, hospital, 305–324 See also Attitudes of healthcare workers, effect on compliance best practices, 320–322 CDC recommendations, 310–311 Clostridium difficile diarrhea, 312–313 effect of cleaning, 313–314 job control, 317 Norwalk virus, 312 pandemic hypothesis, 323 resistant organisms, 311 respect issues, 317 routines, cleaning, 322–323 scientific literature, 314–316 teamwork, need for, 318 training, 318–319 working conditions, 317–318 Humber River Regional Hospital, 14–15 Hurricane Katrina, 293–298, 335–337 American Red Cross in, 295 armed troops, use of, 296 Bush Administration, failings of, 296 class, impact of, 294–295 Federal Emergency Management Agency in, 295 lessons from, 293–298 limitations of preparedness, 295–297 race, impact of, 294–295 U.S Department of Homeland Security, 295 I Idaho antiviral availability, 258 effect of flu pandemic, 256, 275 Illinois antiviral availability, 258 effect of flu pandemic, 256, 275 Indiana antiviral availability, 258 effect of flu pandemic, 256, 275 Influenza, 47–48, 247–302 Army Medical Research Institute of Infectious Diseases, 288 Biological Weapons Convention, 288 blocking export of Tamiflu, 292 clinical manifestations, 299–300 diagnosis, 300–302 epidemiology of, 278–281 expanding public health awareness, 292 hurricane Katrina disaster, lessons from, 293–298 planning for devastating effects of, 249–276 prevention, 297–298, 300–302 transmission, 299–300 treatment, 300–302 vaccine development of, 290 production of, 290–292 Interim Recommendations for Selection and Use of Protective Clothing and Respirators Against Biological Agents, 410 International Association of Firefighters, letter to Secretary of Health and Human Services, on behalf of, 412 International Brotherhood of Teamsters, letter to Secretary of Health and Human Services, on behalf of, 412 International Famine and Disaster Assistance, authorization bill, 262 International Union, United Auto Workers, letter to Secretary of Health and Human Services, on behalf of, 412 Iowa antiviral availability, 258 effect of flu pandemic, 256, 275 Irritant smoke, 65 Isoamyl acetate, 65 Isolation, scientific literature coverage, 94 Isolation rooms, 168–169, 215–216 effect on infection control guideline compliance, 168–169 4637_book.fm Page 422 Thursday, May 25, 2006 3:58 PM 422 Ⅲ Emerging Infectious Diseases J M Job control of hospital cleaners/housekeepers, 317 Joint health and safety committees, role of, 19–21 Maine antiviral availability, 258 effect of flu pandemic, 256, 275 Maryland antiviral availability, 258 effect of flu pandemic, 256, 275 Massachusetts antiviral availability, 258 effect of flu pandemic, 256, 275 Medication availability issues, 233–235, 258–259, 261, 263–266, 268–269, 290–292 Michigan antiviral availability, 258 effect of flu pandemic, 256, 275 Ministry of Labour, Canada chronology of events involving, 23–29 events that should have triggered enforcement, 22–23 role of, 21–22 Minnesota antiviral availability, 258 effect of flu pandemic, 256, 275 Mississippi antiviral availability, 258 effect of flu pandemic, 256, 275 Missouri antiviral availability, 258 effect of flu pandemic, 256, 275 Monkeypox, 45–46 Montana antiviral availability, 258 effect of flu pandemic, 256, 275 Mount Sinai Hospital, 15 K Kansas antiviral availability, 258 effect of flu pandemic, 256, 275 Katrina disaster, 293–298, 335–337 American Red Cross in, 295 armed troops, use of, 296 Bush Administration, failings of, 296 class, impact of, 294–295 Federal Emergency Management Agency in, 295 lessons from, 293–298 limitations of preparedness, 295–297 race, impact of, 294–295 U.S Department of Homeland Security, 295 Kentucky antiviral availability, 258 effect of flu pandemic, 256, 275 Knowledge, effect on infection control guideline compliance, 171 Knowledge gaps in occupationally acquired respiratory infectious disease control, 89–204 L Laboratory accident, 84–86 airborne concentration/inhaled dose, 84–85 hypothetical example, 85–86 Leadership in public health arena, importance of, 230–231 Legal issues, public health, 230–231 Lessons from hurricane Katrina disaster, 293–298 Louisiana antiviral availability, 258 effect of flu pandemic, 256, 275 N National Institute for Occupational Safety and Health, 410 air-purifying respirators tested, certified by, 75 Nebraska antiviral availability, 258 effect of flu pandemic, 256, 275 Negative pressure rooms, effect on infection control guideline compliance, 169–170 4637_book.fm Page 423 Thursday, May 25, 2006 3:58 PM Index Ⅲ 423 Nevada antiviral availability, 258 effect of flu pandemic, 256, 275 New Hampshire antiviral availability, 258 effect of flu pandemic, 256, 275 New Jersey antiviral availability, 258 effect of flu pandemic, 256, 275 New Mexico antiviral availability, 258 effect of flu pandemic, 256, 275 New Orleans devastation See Hurricane Katrina New York antiviral availability issues, 258 effect of flu pandemic, 256, 275 Nightingale, Florence, 306 NIOSH See National Institute for Occupational Safety and Health North Carolina antiviral availability, 258 effect of flu pandemic, 256, 276 North Dakota antiviral availability, 258 effect of flu pandemic, 256, 276 Norwalk virus, 312 Nosocomial infection, 133–139, 305–324 See also under specific infection Nursing shortage, effect of, 36–37 O Obama, Barack, Senator, introduction of AVIAN Act of 2005, 261 Occupational Health and Safety Act, 17–19 Ohio antiviral availability, 258 effect of flu pandemic, 256, 276 Oklahoma antiviral availability, 258 effect of flu pandemic, 256, 276 ONA See Ontario Nurses Association Ontario Nurses Association, 3–38 Ontario Public Services Employees Union, 3–30 OPSEU See Ontario Public Services Employees Union Oregon antiviral availability, 258 effect of flu pandemic, 256, 276 Oseltamivir, availability issues, 258–259, 265–266 P Pandemic, flu, 249–276, 281–282 antivirals/vaccine, 233–235, 263–266, 269 bird transmission, 267 breaks of twentieth century, 251–253 dangers of, 250–251 model estimates, 253–254 mortality, 256–257, 275–276 pig transmission to humans, 267 recommendations, 270–276 Southeast Asia, 267 state by state analysis, 254–259 state level, 275–276 state readiness, 262 stockpiling of medications, 265–267 stopping, 285–287 “Pandemic Preparedness and Influenza Vaccine Supply CDC, NIAID, and Office of Secretary of HHS,” 261 PAPR See Powered air-purifying respirator Pathogen emission rate, 81–82 Pathogen removal pathways, 82–83 Patient load per nurse, increase in, 36–37 Peer environment, effect on infection control guideline compliance, 175–176 Pennsylvania antiviral availability, 259 effect of flu pandemic, 257, 276 “The Perplexing Shift from Shortage to Surplus: Managing This Season’s Flu Shot Supply and Preparing for Future,” 261 Personal protective equipment, 39–86, 142–144 airborne pathogens, 71–86 fit testing, 62–68 respirators, 41–70 scientific literature coverage, 94–95 PHAC See Public Health Agency of Canada 4637_book.fm Page 424 Thursday, May 25, 2006 3:58 PM 424 Ⅲ Emerging Infectious Diseases Physical space separation effect on infection control guideline compliance, 168 healthcare worker protection, 139–140, 146 Plague, 409 health care worker protection, 413–416 Pneumonic plague, 414 signs of, 414 Posse Comitatus Act of 1878, 296 Powered air-purifying respirator, 60, 65, 118–125, 345 evaluation of, 345 Prehospital healthcare workers, personal protective equipment, 61 Public Health Agency of Canada, 326 Q Qualitative fit testing agents, types of, 65 Quarantine, governmental approval of, 261, 296 Quarantines, armed troops enforcing, 296 See also Posse Comitatus Act of 1878 R Race, impact of, in hurricane Katrina disaster, 294–295 Red Cross in hurricane Katrina disaster, 295 Research, 92–96, 98–103, 177–183, 233–235, 314–316 Respect issues, hospital cleaners/housekeepers, 317 Respirators, 41–70, 103–109, 127–128 See also Personal protective equipment; Respiratory protection defined, 109–127 fit testing, 62–68 selection criteria, 59 types of, 53–62, 65 Respiratory protection, 75–86 See also Personal protective equipment assigned protection factor, penetration, 77–78 coughing patient airborne concentration/inhaled dose, 83–84 cough particles, 78–81 exposure intensity estimation, 78–86 hypothetical example, 83–84 exposure intensity estimation, 78–86 face seal leakage, vs filter penetration, 75–77 laboratory accident, 84–86 airborne concentration/inhaled dose, 84–85 hypothetical example, 85–86 pathogen emission rate, 81–82 pathogen removal pathways, 82–83 Response coordination, public leadership and, 230–231 Rhode Island antiviral availability, 259 effect of flu pandemic, 257, 276 Risk assessment, scientific literature coverage, 93 Risk management gaps in scientific evidence, 152–153 scientific literature coverage, 93–96 Rodents, transmission of plague through, 414 Rural hospital preparedness, 339–348 education, 343–344 equipment, 344–346 isolation procedures, 346–347 laboratory safety, 347–348 list for, 342 response capacity assessment, 348 trainer training, 343 S Saccharin, 65 SARS, 42–45, 132–133, 139–147, 329–335 in Canada, 1–38 nurses’ union officials report on, 1–38 Scientific literature review, 92–96, 101–103, 177–181, 233–235 Service Employees International Union, letter to Secretary of Health and Human Services, on behalf of, 412 Shortage of nurses, effect of, 36–37 4637_book.fm Page 425 Thursday, May 25, 2006 3:58 PM Index Ⅲ 425 Singapore, SARS in, 44 Smallpox, 241–243 South Carolina antiviral availability, 259 effect of flu pandemic, 257, 276 South Dakota antiviral availability, 259 effect of flu pandemic, 257, 276 Spanish flu, 251, 287, 289 St Michaels Hospital, 15 “The State of Readiness for 2005-2006 Flu Season,” 261 “Study of Efficacy of Nosocomial Infection Control in 1970’s,” Centers for Disease Control recommended, 310 Suits, protective, use of, 61 Sunnybrook, 17 U United American Nurses, letter to Secretary of Health and Human Services, on behalf of, 412 United Food and Commercial Workers, letter to Secretary of Health and Human Services, on behalf of, 412 United Steelworkers of America, letter to Secretary of Health and Human Services, on behalf of, 412 U.S Department of Homeland Security, 252 in hurricane Katrina disaster, 295 U.S Department of State, advisory statement about avian flu, 262 Utah antiviral availability, 259 effect of flu pandemic, 257, 276 T Tamiflu availability issues, 258–259, 265–266, 292 Teamwork, need for, hospital cleaners/housekeepers, 318 Tennessee antiviral availability, 259 effect of flu pandemic, 257, 276 Texas antiviral availability, 259 effect of flu pandemic, 257, 276 TFAH See Trust for America’s Health “The Threat of and Planning for Pandemic Flu,” 261 Time constraints, effect on infection control guideline compliance, 173–174 Training effect on infection control guidelin compliance, 164–165 in healthcare worker protection, 134–136, 148–149, 318–319 Troops enforcing quarantine, 296 (See also Posse Comitatus Act of 1878) in hurricane Katrina disaster, 296 Trust for America’s Health, 252, 271–272 Tuberculosis, antibiotic resistant, 46–47 V Vaccine/antiviral supply issues, 233–235, 258–259, 261, 263–266, 268–269, 290–292 Ventilation systems, 94, 205–218 See also Personal protective equipment; Respiratory protection airborne infection isolation rooms, 215–216 local exhaust ventilation, 216 precautions, transmission-based, 210–212 protective environment rooms, 215–216 scientific literature coverage, 94 solutions, 212–213 standard precautions, 210 transmission, 210 ventilation controls, 213–216 Vermont antiviral availability, 259 effect of flu pandemic, 257, 276 Virginia antiviral availability, 259 effect of flu pandemic, 257, 276 4637_book.fm Page 426 Thursday, May 25, 2006 3:58 PM 426 Ⅲ Emerging Infectious Diseases W Washington antiviral availability, 259 effect of flu pandemic, 257, 276 West Virginia antiviral availability, 259 effect of flu pandemic, 257, 276 Wisconsin antiviral availability, 259 effect of flu pandemic, 257, 276 Working conditions of hospital cleaners/housekeepers, 317–318 Workload increase, effect on infection control guideline compliance, 174 Wyoming antiviral availability, 259 effect of flu pandemic, 257, 276 Y Yersinia pestis, health care worker protection, 413–416 ... identification and explanation without intent to infringe Library of Congress Cataloging -in- Publication Data Charney, William, 194 7Emerging infectious diseases and the threat to occupational health in the. .. away, and the humanists first of all, because they haven’t taken their precautions Albert Camus, The Plague Emerging Infectious Diseases and the Threat to Occupational Health in the U.S and Canada. .. of Juvenile Justice: Theory and Practice, edited by Barbara Sims and Pamela Preston 121 Emerging Infectious Diseases and the Threat to Occupational Health in the U.S and Canada, edited by William