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Assessing hospital emergency management plans: A guide for infection preventionists

  • Terri Rebmann
    Correspondence
    Address correspondence to Terri Rebmann, PhD, RN, CIC, Associate Director for Curricular Affairs, Institute of Biosecurity, Assistant Professor, Division of Environmental and Occupational Health, Saint Louis University, School of Public Health, 3545 Lafayette Ave, Room 361, Saint Louis, MO 63104.
    Affiliations
    Institute of Biosecurity, Saint Louis University, School of Public Health, St Louis, MO
    Search for articles by this author
Published:August 24, 2009DOI:https://doi.org/10.1016/j.ajic.2009.04.286

      Background

      Hospital emergency management plans are essential and must include input from an infection preventionist (IP). Multiple hospital planning documents exist, but many do not address infection prevention issues, combine them with noninfection prevention issues, or are disease/event specific. An all-encompassing emergency management planning guide for IPs is needed.

      Methods

      A literature review and Internet search were conducted in December 2008. Data from relevant sources were extracted. A spreadsheet was created that delineated hospital emergency management plan components of interest to IPs.

      Results

      Of the sources screened, 49 were deemed relevant. Eleven domains were identified: (1) having a plan; (2) assessing hospital readiness; (3) having infection prevention policies and procedures; (4) having occupational health policies and procedures; (5) conducting surveillance and triage; (6) reporting incidents, having a communication plan, and managing information; (7) having laboratory support; (8) addressing surge capacity issues; (9) having anti-infective therapy and/or vaccines; (10) providing infection prevention education; and (11) managing physical plant issues.

      Conclusion

      Infection preventionists should use this article as an assessment tool for evaluating their hospital emergency management plan and for developing policies and procedures that will decrease the risk of infection transmission during a mass casualty event.

      Key Words

      Hospital emergency management plans (hereafter termed the “Plan”) are an essential component of hospital preparedness for mass casualty events (MCE) and need to address all hazards, including biologic threats such as bioterrorism, emerging infectious disease outbreaks, and pandemics. Plan development and assessment is a multidisciplinary and multidepartmental endeavor that must include the input from an infection preventionist (IP).
      • Rebmann T.
      APIC State-of-the-Art report: The role of the infectionpreventionist in emergency management.
      For most hospitals, the Plan consists of multiple components: the main body of the plan that addresses emergency management tasks/needs that are applicable to all MCEs and a series of appendices or annexes that address specific incidents such as chemical, nuclear, or biologic events. Examples of all-hazards components of the Plan include addressing liability issues for health care personnel, providing mental health support for disaster victims and hospital staff, and establishing funding to cover uncompensated costs during an MCE. Although these issues are very important to emergency management and may have an indirect impact on infection transmission during an MCE, ensuring these topics are addressed in a Plan will not fall within the scope of an IP's responsibility at most hospitals. Most IPs will act as a consultant to the hospital emergency management planning committee and will be responsible for assessing the Plan in regards to preventing infection transmission during MCEs.
      • Rebmann T.
      APIC State-of-the-Art report: The role of the infectionpreventionist in emergency management.
      IP involvement will be most important in developing and assessing the Plan's biologic annex.
      Many MCE planning guides are available from national organizations, governmental agencies, and academic institutions. However, these documents either address noninfection prevention MCE planning issues or they provide specific recommendations based on a singular disease, such as smallpox,

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      severe acute respiratory syndrome (SARS),
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.
      or pandemic influenza.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      In 2002, the Association for Professionals in Infection Control and Epidemiology (APIC) Bioterrorism Working Group created guidelines for IPs to prepare for a biologic event, but that document only addresses bioterrorism and does not include more recent recommendations relevant to SARS or pandemic influenza that must be included in hospital emergency management plans.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      An all-encompassing planning guide is needed for IPs that addresses all types of biologic incidents, including bioterrorism, emerging infectious disease outbreaks, and pandemics.
      • Rebmann T.
      APIC State-of-the-Art report: The role of the infectionpreventionist in emergency management.
      The purpose of this article is to compile infection prevention recommendations from various planning agencies and researchers into a single planning guide. This should ease IP's process of assessing hospital emergency management plans for infection prevention issues.
      This article addresses only hospital emergency management plan development topics that have infection transmission implications. Plans need to have an appendix or annex that addresses biologic threats. In addition, there are infection prevention issues that must be addressed by the main component of the Plan, such as having infection prevention policies and procedures in place during any type of MCE. This article addresses all components of the Plan of interest to IPs: the biologic annex as well as the infection prevention issues that would be included in the main component of the Plan. IPs should use this article as a resource to assist in developing or assessing a hospital emergency management plan for infection prevention issues. There is no perfect Plan; the best plans are constantly under review and revision. Therefore, this article cannot provide information on best practices related to all aspects of infection prevention during emergency management. In addition, procedures that work in one hospital or region may not be applicable to all facilities. IPs should use this article to identify gaps in their hospital emergency management plan. Guidance on how to implement specific interventions, such as developing a policy on work quarantine or how to allocate limited amounts of respiratory protection, are provided in other documents.
      • Bartley J.
      • Stricof R.
      • Alexander S.
      • Cain T.
      • Citarella B.
      • Cloughessy M.
      • et al.
      Reuse of respiratory protection in prevention and control of epidemic- and pandemic-prone acute respiratory diseases (ARD) in healthcare.
      • Rebmann T.
      Emergency management.

      Methods

      A literature review was conducted in December 2008 using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Healthstar, Psych Info, and Medline databases for years 1966 through 2008. The following terms were utilized as key word searches: infection control, infection prevention, hospital, readiness, disaster plan, mass casualties, bioterrorism, pandemic, and emergency management. Only English language articles in peer-reviewed journals were utilized. An Internet search was also conducted in December 2008 using the same search terms as above to identify existing book chapters, reports from response agencies, published standards and guidelines, and other relevant materials related to the development of hospital emergency management plans to address biologic MCEs that were outside the peer-reviewed literature. Inclusion criteria included articles, planning documents, and published reports that addressed infection prevention issues that need to be included in a Plan. Articles that address community, public health, or personal preparedness were excluded. Also excluded were articles that only addressed noninfection prevention emergency management issues, such as developing policies and procedures for incorporating National Incident Management System (NIMS) terminology into the hospital emergency management plan. US- and non-US-based articles and documents/reports were included in the analysis.
      Seven hundred sixty-four journal articles were identified and reviewed for relevance; many were eliminated based on the title or journal (non-peer reviewed or did not meet inclusion criteria) alone. Two hundred seventy-two references were screened by reading the abstract. Data from the relevant sources identified through the literature review and Internet search were extracted. A spreadsheet was created that delineated Plan components of interest to IPs identified by each source. The primary author conducted the article review, data extraction, data analysis, and determination of domains.

      Results

      Of the articles and planning documents/reports screened, 49 references were deemed relevant: 35 were journals articles, and 14 were published reports, regulatory standards, and/or planning documents. There was a lot of overlap between sources when summarizing the infection prevention issues that should be addressed by a hospital emergency management plan. Common infection prevention issues mentioned included having policies and procedures related to infection prevention, conducting syndromic surveillance, having infection prevention coverage, and preparing for a surge in potentially contagious patients. Differences identified by the sources tended to be agent-specific interventions, such as developing a SARS response team,
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      identifying hospitals/health care facilities (types C, X, or R) based on whether or not smallpox patients are housed at the facility,

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      or tracking nosocomial transmission of influenza as part of pandemic influenza preparedness.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      No single document or article identified all of the infection prevention issues that should be addressed by a Plan.
      A full list of the infection prevention issues that should be included in a Plan are divided into themes or domains and are outlined in Table 1 and provided online at www.ajicjournal.org. IPs can use this Table as an assessment tool for evaluating their Plans and developing policies and procedures that will decrease the risk of infection transmission during an MCE. It is important to note that information provided in this article consists of compiled published recommendations that are not considered mandates or regulations except for the Joint Commission standards for accredited US hospitals.
      • Joint Commission
      Hospital accreditation program.

       Domain 1: Hospital emergency management plan and biologic annex

      Hospital emergency management plans need to have an appendix or annex that addresses all biologic threats, including bioterrorism, outbreaks of emerging infectious diseases, and pandemics. This plan must be updated regularly based on lessons learned from disaster exercises, actual events, or published evidence of best practices. The Plan needs to be coordinated with local, state, and federal plans, and contact names and information for key response agencies need to be included. The Plan biologic annex needs to define how biologic events are different from other types of MCEs, how interventions will be stratified by pandemic stage/phase or nature of the biologic attack, and the epidemiologic clues of a potential biologic event.

       Domain 2: Assessing hospital readiness for mass casualty event

      Hospitals must assess their readiness for MCEs, including biologic events. The Plan should state how and when a facility assessment, such as a hazard vulnerability assessment, will be performed. The hazard vulnerability assessment should include aspects of hospital readiness that relate to infection prevention, such as the location and amounts of hand hygiene stations or products, isolation rooms/areas, and others. Disaster exercises that utilize a biologic scenario should be performed by the hospital to assess for biologic MCE readiness. Whenever possible, community-wide exercises should be performed to ensure regional coordination for MCEs.

       Domain 3: Infection prevention policies and procedures

      The Plan needs to outline infection prevention policies and procedures to be implemented during an MCE. These policies and procedures should encompass all aspects of patient care, environmental decontamination, visitor restriction, occupational health practices, and physical plant issues that could contribute to infection spread. There are a number of infection prevention policies and procedures that are needed to prevent infection transmission during patient care. Examples include procedures for when and how to perform patient decontamination, internal and external patient transport, patient placement, isolation, linen management, patient discharge, and postmortem care. Hospitals also need to have around-the-clock infection prevention coverage during a biologic MCE. If the hospital oversees outpatient services or alternate care sites, these facilities and staff will require infection prevention coverage as well. Procedures for conducting and coordinating an epidemiologic investigation with local health officials should be included in the Plan.
      In addition to outlining routine infection prevention policies/procedures, the Plan also needs to address crisis standards of care. Crisis standards of care are needed for times when routine standards cannot be met because of limited or depleted resources. Crisis standards of care that are specific to infection prevention issues include prioritization plans for allocating insufficient or depleted supplies of personal protective equipment (PPE), hand hygiene products, anti-infective therapy or vaccine, and other equipment that may contribute to disease spread during an MCE. Whenever possible, hospital or community ethics committees should be involved in the development of crisis standards of care.

       Domain 4: Occupational health policies and procedures

      The risk of occupational exposure to infectious diseases/agents increases during a biologic MCE. Therefore, it is essential that infection prevention occupational health issues be addressed in the Plan. Examples include having a respiratory protection program, having a nonpunitive sick leave policy that does not encourage staff to work while ill during a biologic event, having procedures for monitoring and managing personnel who experience occupational exposures, and defining protocols for times when PPE or other resources are limited. Hospital emergency management plans should also outline the hospital immunization policy, including how staff compliance will be monitored for annual influenza vaccination. Staff at high risk from infection (ie, pregnant or immunocompromised individuals) or those who are involved in high-risk procedures (such as aerosolizing procedures during a biologic MCE) should be identified. Protocols should be developed that outline how high-risk staff will be managed during a biologic MCE, such as reassignment or furlough.

       Domain 5: Surveillance and triage

      Surveillance will be a critical component of emergency management, especially for biologic MCEs. The Plan should outline the hospital's protocols for implementing, coordinating, and evaluating a syndromic surveillance program to identify or detect a bioterrorism attack, outbreaks of emerging infectious diseases, and pandemics. Protocols should be included for implementing a surveillance program that identifies staff, volunteers, visitors, and patients with potentially contagious diseases; different indicators and/or frequency of reporting may be needed for pre- and postevent time periods. The Plan should also outline procedures for tracking admission and discharge of known or suspected contagious patients; monitoring staff absenteeism related to potentially communicable diseases/conditions; calculating the rate of seasonal influenza-like illness among staff, volunteers, and patients; and monitoring health care-associated infection transmission.

       Domain 6: Reporting, communication plan, and information management

      The hospital emergency management plan biologic annex needs to outline procedures for reporting known or suspected biologic MCEs to internal and external departments, facilities, and response agencies. The names and contact information of the persons responsible for internal and external communication during a biologic MCE also need to be identified. This includes internal communication with hospital staff and volunteers regarding activation of the Plan and external communication with public health authorities, community health care facilities, and response agencies. Protocols for monitoring state and federal public health advisories; health alert network communications; and sharing estimates of hospital patient care equipment and PPE with local, regional, state, and tribal planning groups need to be outlined. It is also critical that IPs identify or create pre-event messages about the most likely biologic agents to be involved in an MCE; these materials can be provided or communicated to staff, visitors, patients, and the general public during a biologic MCE.
      • Rebmann T.
      Emergency management.
      When developing pre- and postevent messages and educational materials, it is important that hospitals use language that is appropriate for individuals with visual, learning, or other disabilities and those who are non-English language speakers.

       Domain 7: Laboratory infection prevention issues

      Hospital emergency management plans need to address laboratory infection prevention issues. Examples include having processes to obtain laboratory services around the clock and on weekends; having protocols for collecting, labeling, packaging, processing, and internal and external transport of laboratory specimens believed to be potential bioterrorism agents or emerging infectious diseases; having the ability to track and stratify all patient specimens and results; and having collection and management procedures for potential evidence during a bioterrorism attack. Laboratory services should be coordinated within the framework of the Laboratory Response Network using local, state, and federal government laboratory protocols.

       Domain 8: Surge capacity issues

      The hospital emergency management plan biologic annex must include protocols for handling an influx of potentially contagious patients. One aspect of surge capacity is assessing on-hand resources and calculating how much might be needed during an MCE. For biologic MCEs, this could include the need for equipment and supplies that would last up to 8 weeks (the estimated wave of a pandemic). These estimates should also take into account that other health care facilities will be placing strains on the supply system during this period and may not be able to meet normal supply needs. Examples of resources that need to be assessed include intravenous pumps, ventilators, anti-infective therapy, vaccination, diagnostic testing materials, linens, respiratory protection, gowns, gloves, eye protection, hand hygiene products, laboratory supplies, isolation rooms/areas, and morgue beds. The need for extra hospital personnel will likely be greater during a biologic MCE compared with other disasters because staff may be less willing or able to work during a biologic event.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      Some factors that may influence health care workers' willingness and ability to work during a biologic MCE include personal illness or quarantine, family obligations, and fear of exposure or illness.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      In addition, worker fatigue may be greater during a biologic MCE because of wearing PPE for extended periods of time or because of psychologic stress. The Plan should include protocols for stockpiling or obtaining additional staff, medical and laboratory equipment/supplies, isolation rooms/areas, and morgue beds.

       Domain 9: Anti-infective therapy, chemoprophylaxis, and vaccination

      Medications will be needed for all types of MCEs, but biologic events will require a disproportionate need for anti-infective therapy and vaccines. The Plan should outline on-hand resources and calculations regarding how much will be needed during a biologic event. Protocols should address the establishment and/or maintenance of a medication and vaccine stockpile that is coordinated with regional health care facilities and/or response agencies. The Plan should also define a prioritization plan for staff and their family members regarding who would be the first priority for anti-infective therapy, chemoprophylaxis, and vaccine during times of limited resources. A procedure is needed for identifying the most current recommendations and guidance on the use of anti-infective therapy and chemoprophylaxis needed for a biologic event because these guidelines become outdated quickly.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      The hospital emergency management Plan biologic annex should outline procedures for administering anti-infective therapy; chemoprophylaxis; or vaccine to staff, patients, visitors, and/or the general public and protocols for follow-up monitoring as needed.

       Domain 10: Infection prevention education

      The Plan should designate a person whose responsibility it is to create, coordinate, and track staff training on emergency management and biologic threats. In addition, the Plan should outline the types of infection prevention training/information that will be provided to patients, visitors, and the general public. Lists of groups requiring infection prevention education related to emergency management have been outlined in the literature.
      • Rebmann T.
      APIC State-of-the-Art report: The role of the infectionpreventionist in emergency management.
      • Shadel B.N.
      • Clements B.
      • Arndt B.
      • Rebmann T.
      • Evans R.G.
      What we need to know about bioterrorism preparedness: results from focus groups conducted at APIC 2000.
      Suggested topics for staff education related to infection prevention during MCEs are outlined in Table 2. Staff education should be based on identified competencies whenever possible and should be in language and formats that are appropriate for clinical and nonclinical personnel.
      • Carrico R.M.
      • Rebmann T.
      • English J.F.
      • Mackey J.
      • Cronin S.N.
      Infection prevention competencies for hospital-based healthcare personnel.
      Table 2Topics for staff education related to infection prevention during emergency management
      Education topics
       • Self-screening for illness
       • Screening/triaging of patients for communicable diseases/conditions
       • Internal and external reporting and communication procedures
       • Surveillance during mass casualty events
       • Plan policies and procedures related to infection prevention
       • Disease transmission methods/routes
       • Isolation procedures
       • Respiratory hygiene
       • PPE use and reuse, including use of respiratory protection
       • Hand hygiene protocols
       • Social distancing
       • Handling contaminated linens
       • Obtaining and handling patient specimens safely
       • Environmental cleaning/disinfection
       • Disinfection and sterilization of medical equipment
       • Waste management procedures
       • Patient decontamination procedures
       • Medical management of biologic event victims, including identification and diagnosis of disease, and clinical care procedures (treatment, isolation, and others)
       • Postmortem care
       • Influenza vaccine
       • Impact of influenza
      PPE, personal protective equipment.

       Domain 11: Physical plant infection prevention issues

      Most physical plant issues will be planned for and managed by the hospital facilities engineering department. However, some aspects of the physical plant can contribute to infection spread during an MCE and need to have IP input. The Plan should include protocols for safe food and water handling practices, such as monitoring holding temperatures and times to prevent foodborne illness during events when standard utilities may not be available and having sufficient water for drinking, sanitation, and hand hygiene needs. Other needed protocols include procedures for assessing for water, dust, or other contaminate infiltration; ensuring sewer/sanitation system functioning; obtaining sufficient functional or chemical toilets; and handling/managing an increase in regular and regulated medical waste during MCEs, including times when regular waste management pick-up is not possible because of the event.

      Discussion

      IPs need to be involved in developing and assessing hospital emergency management plans as they relate to infection transmission during mass casualty events. This article provides IPs guidance on aspects of hospital emergency management plans that have implications for infection spread in hospitals. IPs should use this tool to assess their Plan and develop policies and procedures for emergency management that will decrease the risk of infection transmission. This assessment tool is designed to be used with hospital all-hazards emergency management plans, with a special focus on the infection prevention issues that might occur during mass casualty events. Most notably, this article combines information from a variety of national organizations and published articles into 1 tool that can be used to address all types of mass casualty events, including bioterrorism, emerging infectious disease outbreaks, and pandemics.
      The assessment tool outlined in this article provides a starting point for IPs to get involved in hospital emergency management. A full detailing of emergency management best practices, such as describing occupational health respiratory programs, is out of the scope of this article. In addition, many research questions related to infection prevention during emergency management remain unanswered. For example, most national organizations recommend stockpiling of anti-infective therapy, vaccines, and personal protective equipment, but guidelines for how much of a stockpile are needed have not been developed. Researchers agree that surge capacity is needed for all types of mass casualty events, but the exact amount/number of surge beds that need to be available for any given facility has not been outlined.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
      • Hick J.L.
      • Hanfling D.
      • Burstein J.L.
      • DeAtley C.
      • Barbisch D.
      • Bogdan G.M.
      • et al.
      Health care facility and community strategies for patient care surge capacity.
      The number of airborne infection isolation rooms or negative-pressure surge capacity needed by a hospital and the most effective indicators for syndromic surveillance have also not yet been determined. Most researchers state that biologic scenarios should be used in hospital disaster exercises to evaluate hospital preparedness, and the Joint Commission requires hosting disaster exercises at least twice a year,
      • Joint Commission
      Hospital accreditation program.
      but the frequency with which biologic scenarios must be used in these drills has not been established. Indicators for hospital emergency management preparedness vary by the researcher
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      and by the organization.
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.

      Trust for America's Health. Ready or not. Protecting the public's health from diseases, disasters, and bioterrorism. 2007. Available from: http://healthyamericans.org/reports/bioterror07/BioTerrorReport2007.pdf. Accessed May 14, 2008.

      Until some of these research questions are answered, IPs and their hospital emergency management planning committees are left on their own to determine what is best for their facility given their resources and limitations. IPs should continue to monitor information from national organizations and regulatory agencies regarding recommended practices related to emergency management.
      The author thanks Michael Olesen for providing feedback and review during the writing/development of this article.

      Supplementary data

      Table 1Infection prevention components of a hospital emergency management plan
      Hospital emergency management plan and biological annex
       • Addresses all biologic events, including bioterrorism, emerging infectious diseases, and pandemic influenza

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Bartley J.
      • Stricof R.
      • Alexander S.
      • Cain T.
      • Citarella B.
      • Cloughessy M.
      • et al.
      Reuse of respiratory protection in prevention and control of epidemic- and pandemic-prone acute respiratory diseases (ARD) in healthcare.
      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Shadel B.N.
      • Clements B.
      • Arndt B.
      • Rebmann T.
      • Evans R.G.
      What we need to know about bioterrorism preparedness: results from focus groups conducted at APIC 2000.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
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      Hospital preparedness for victims of chemical or biological terrorism.
       • Identifies contact names and numbers for local and state health department, state health association, and tribal health association

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

       • Is coordinated with local, state, and federal emergency management plans

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
      • Lynn M.
      • Gurr D.
      • Memon A.
      • Kaliff J.
      Management of conventional mass casualty incidents: ten commandments for hospital planning.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Maldin B.
      • Lam C.
      • Franco C.
      • Press D.
      • Waldhorn R.
      • Toner E.
      • et al.
      • Toner E.
      • Waldhorn R.
      • Maldin B.
      • Borio L.
      • Nuzzo J.B.
      • Lam C.
      • et al.
       • Identifies the person(s) authorized to implement/activate the biologic annex plan and the organizational structure that will be used, including the delegation of authority to carry out the plan 24/7

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
       • Describes the responsibilities of key personnel and departments (and back-ups for key personnel) within the facility related to executing the biologic annex component of the Plan

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
       • Defines how biologic events are different from other types of MCEs

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
       • Has planning committee focusing on biologic events that includes an infection preventionist and/or hospital epidemiologist
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
       • Stratifies implementation of specific actions on the basis of the WHO pandemic phases, US government pandemic stages, and the pandemic severity index level worldwide, in the United States, and at the local level

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Stratifies implementation of specific actions for a bioterrorism attack on the basis of whether the attack is overt or covert and on the basis of high-risk syndromes or suspected routes of disease transmission

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
       • Describes the epidemiologic signs of a potential bioterrorism attack

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
       • States how often the annex will be updated and by whom, including contact names/information, incorporating lessons learned from exercises/drills, and changes in recommendations related to managing biologic events
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
      • Hui Z.
      • Jian-Shi H.
      • Xiong H.
      • Peng L.
      • Da-Ling Q.
      An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      Assessing hospital readiness for MCE
       • States how and when a facility assessment will be performed that addresses infection prevention issues, such as location and amounts of hand hygiene products, isolation rooms/areas, and others

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
       • Incorporates biologic scenarios, such as pandemic influenza or bioterrorism, into a disaster exercise; whenever possible, this exercise should be community wide
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Case G.G.
      • West B.M.
      • McHugh C.J.
      Hospital preparedness for biologic and chemical terrorism in central New Jersey.
      • Hui Z.
      • Jian-Shi H.
      • Xiong H.
      • Peng L.
      • Da-Ling Q.
      An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China.
      • Karwa M.
      • Currie B.
      • Kvetan V.
      Bioterrorism: preparing for the impossible or the improbable.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Treat K.N.
      • Williams J.M.
      • Furbee P.M.
      • Manley W.G.
      • Russell F.K.
      • Stamper C.D.
      Hospital preparedness for weapons of mass destruction incidents: an initial assessment.
      • Wetter D.C.
      • Daniell W.E.
      • Treser C.D.
      Hospital preparedness for victims of chemical or biological terrorism.
      • DiConsiglio J.
      Mapping a disaster plan.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Kaji A.H.
      • Koenig K.L.
      • Lewis R.J.
      Current hospital disaster preparedness.
      Infection prevention polices and procedures
       • Has a protocol for providing 24/7 infection prevention and control coverage, including coverage for outpatient facilities or alternate care sites owned/operated by the hospital

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Joint Commission
      Hospital accreditation program.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Has a protocol for authorizing the hospital epidemiologist or Infection Control Committee or its designee to rapidly implement prevention and control measures in response to a biologic event

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

       • Has a protocol for personal protective equipment (PPE) use and hand hygiene

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Bartley J.
      • Stricof R.
      • Alexander S.
      • Cain T.
      • Citarella B.
      • Cloughessy M.
      • et al.
      Reuse of respiratory protection in prevention and control of epidemic- and pandemic-prone acute respiratory diseases (ARD) in healthcare.
      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Joint Commission
      Hospital accreditation program.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Hui Z.
      • Jian-Shi H.
      • Xiong H.
      • Peng L.
      • Da-Ling Q.
      An analysis of the current status of hospital emergency preparedness for infectious disease outbreaks in Beijing, China.
      • Karwa M.
      • Currie B.
      • Kvetan V.
      Bioterrorism: preparing for the impossible or the improbable.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Wetter D.C.
      • Daniell W.E.
      • Treser C.D.
      Hospital preparedness for victims of chemical or biological terrorism.
      • Toner E.
      • Waldhorn R.
      • Maldin B.
      • Borio L.
      • Nuzzo J.B.
      • Lam C.
      • et al.
      • DiConsiglio J.
      Mapping a disaster plan.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Bennett R.L.
      Chemical or biological terrorist attacks: an analysis of the preparedness of hospitals for managing victims affected by chemical or biological weapons of mass destruction.
      • Grow R.W.
      • Rubinson L.
      The challenge of hospital infection control during a response to bioterrorist attacks: biosecurity bioterrorism.
      • Ippolito G.
      • Nicastri E.
      • Capobianchi M.
      • Di Caro A.
      • Petrosillo N.
      • Puro V.
      Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy.
      • Levin P.J.
      • Gebbie E.N.
      • Qureshi K.
      Can the health care system meet the challenge of pandemic flu? Planning, ethical, and workforce considerations.
      • Lewis C.P.
      • Aghababian R.V.
      Disaster planning, part I. Overview of hospital and emergency department planning for internal and external disasters.
      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
       • Has a policy for physically isolating and managing contaminated vehicles
      • Higgins W.
      • Wainright III, C.
      • Lu N.
      • Carrico R.
      Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results from a statewide survey.
       • Has a procedure related to more frequent checking of patients' oxygenation and early transfer to an intensive care unit to reduce the risk of infection transmission by allowing for elective, early intubation to be done in a controlled environment by minimal staff
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
       • Includes policies for modifying admission criteria on the basis of current bed capacity and disease status, including procedures for closing the facility to potentially infectious patients or noninfectious patients

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Has a protocol for limiting or restricting visitors to the facility during a biologic event, including coordination with security or local law enforcement to ensure compliance

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Has a protocol for monitoring staff compliance with infection prevention procedures, including PPE use, hand hygiene, isolation, and others
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Joint Commission
      Hospital accreditation program.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Has protocols for environmental decontamination during an MCE, including cleaning patient rooms, managing “white powder” or other environmental contamination incidents, cleaning/disinfection/sterilization of patient care items, reprocessing of equipment when resources are limited, cleaning/decontaminating patients' valuables and belongings when necessary, and cleaning and inspecting environment before reopening a previously closed area of the hospital

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Grow R.W.
      • Rubinson L.
      The challenge of hospital infection control during a response to bioterrorist attacks: biosecurity bioterrorism.
       • Defines a procedure for conducting and coordinating the epidemiologic outbreak investigation of a biologic event with the local health department and identifies a person (and back-up person) at the hospital who will be the leader/coordinator of the investigation at the hospital
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Has a protocol for implementing an on-site quarantine that is coordinated with local public health officials, including plans for ensuring compliance and providing necessary supplies to maintain the quarantine

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
       • Has a protocol for coordinating with security or local law enforcement entities to enforce isolation and quarantine orders on-site

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Rebmann T.
      Emergency management.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
       • Has a protocol for managing animals or pets in the hospital, including care/management of staffs' pets if employees are confined to work for extended periods of time during an MCE
      • Rebmann T.
      Emergency management.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

       • Has prioritization plans/algorithms for allocating limited PPE, hand hygiene products, ventilators, anti-infective therapy or vaccination, and other supplies/products that affect infection transmission during a biologic event
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Bartley J.
      • Stricof R.
      • Alexander S.
      • Cain T.
      • Citarella B.
      • Cloughessy M.
      • et al.
      Reuse of respiratory protection in prevention and control of epidemic- and pandemic-prone acute respiratory diseases (ARD) in healthcare.
      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Toner E.
      • Waldhorn R.
      • Maldin B.
      • Borio L.
      • Nuzzo J.B.
      • Lam C.
      • et al.
       • Describes how the hospital Ethics Committee is involved in the development of crisis standards of care for the facility

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Toner E.
      • Waldhorn R.
      • Maldin B.
      • Borio L.
      • Nuzzo J.B.
      • Lam C.
      • et al.
      Infection prevention policies and procedures related to patient management
       • Has a protocol for identifying when and how to perform patient decontamination related to a biologic event (ie, an overt bioterrorism attack)

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Case G.G.
      • West B.M.
      • McHugh C.J.
      Hospital preparedness for biologic and chemical terrorism in central New Jersey.
      • Karwa M.
      • Currie B.
      • Kvetan V.
      Bioterrorism: preparing for the impossible or the improbable.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Treat K.N.
      • Williams J.M.
      • Furbee P.M.
      • Manley W.G.
      • Russell F.K.
      • Stamper C.D.
      Hospital preparedness for weapons of mass destruction incidents: an initial assessment.
      • Wetter D.C.
      • Daniell W.E.
      • Treser C.D.
      Hospital preparedness for victims of chemical or biological terrorism.
      • Kaji A.H.
      • Koenig K.L.
      • Lewis R.J.
      Current hospital disaster preparedness.
      • Bennett R.L.
      Chemical or biological terrorist attacks: an analysis of the preparedness of hospitals for managing victims affected by chemical or biological weapons of mass destruction.
      • Lewis C.P.
      • Aghababian R.V.
      Disaster planning, part I. Overview of hospital and emergency department planning for internal and external disasters.
      • Higgins W.
      • Wainright III, C.
      • Lu N.
      • Carrico R.
      Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results from a statewide survey.
      • Bradley R.N.
      Health care facility preparation for weapons of mass destruction.
      • Chan J.T.
      • Yeung R.S.
      • Tang S.Y.
      Hospital preparedness for chemical and biological incidents in Hong Kong.
      • DeJohn P.
      Hospital supply chain vital part of disaster plan.
       • Has a protocol for internal and external patient transport of potentially contagious patients, including coordination with local emergency medical services and 9-1-1 services for interfacility transfer

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Ippolito G.
      • Nicastri E.
      • Capobianchi M.
      • Di Caro A.
      • Petrosillo N.
      • Puro V.
      Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy.
      • Lewis C.P.
      • Aghababian R.V.
      Disaster planning, part I. Overview of hospital and emergency department planning for internal and external disasters.
      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
       • Has a protocol for determining patient placement of potentially contagious patients, including plans for cohorting of patients with known or suspected communicable diseases during a biologic event

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
      • Shadel B.N.
      • Rebmann T.
      • Clements B.
      • Chen J.J.
      • Evans R.G.
      Infection control practitioners' perceptions and educational needs regarding bioterrorism: results from a national needs assessment survey.
       • Has a protocol for designating staff limited to work with potentially infected patients (ie, staff cohorting)

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Bartley J.
      • Stricof R.
      • Alexander S.
      • Cain T.
      • Citarella B.
      • Cloughessy M.
      • et al.
      Reuse of respiratory protection in prevention and control of epidemic- and pandemic-prone acute respiratory diseases (ARD) in healthcare.
      • Rebmann T.
      Emergency management.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Has a protocol for instituting Standard and Transmission-Based Precautions for all biologic events (bioterrorism, outbreaks of emerging infectious diseases, and pandemics), including procedures for implementing respiratory hygiene practices2-5.7.9.14.19.24-28.35.37.38.39.42-43,49
       • Has a procedure for identifying and managing vulnerable individuals/groups who may be at an increased risk of infection during a biologic event

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      Emergency management.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Bennett R.L.
      Chemical or biological terrorist attacks: an analysis of the preparedness of hospitals for managing victims affected by chemical or biological weapons of mass destruction.
       • Has an inventory or list of all available isolation rooms/areas, including AIIRs and negative-pressure rooms/areas

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

       • Has a protocol for assessing the functionality of all AIIRs before patient admittance for isolation

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Has a protocol for handling, transporting, and laundering soiled linens, including times when routine linen cleaning/washing cannot occur because of the MCE

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
       • Has a protocol for patient discharge (where they will be discharged to, decision matrix for deciding/prioritizing who is discharged, discharge instructions to reduce the risk of disease spread, and others) specific to biologic events

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
       • Has a protocol for postmortem care procedures that limit infection transmission during a biologic event

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Ippolito G.
      • Nicastri E.
      • Capobianchi M.
      • Di Caro A.
      • Petrosillo N.
      • Puro V.
      Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy.
      Occupational health policies and procedures
       • Has a program that offers and monitors compliance with the annual influenza vaccine for hospital employees

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Xiong W.
      • Hollingsworth E.
      • Muckstadt J.
      • Van Lieu Vorenkamp J.
      • Lazar E.J.
      • Cagliuso N.V.
      • et al.
      Hospital “self-prophylaxis”: strategies for efficient protection of the workforce in the face of infectious disease threats.
       • Has a respiratory protection program that fit-tests staff for respirators or provides and trains staff on the use of PAPRs that do not require fit-testing
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Has a liberal/nonpunitive sick leave policy that addresses the needs of ill and symptomatic personnel during a biologic event, including allowances and encouragement for sick employees to stay home until no longer contagious or furloughing exposed or infected staff
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      Emergency management.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Has a protocol for managing personnel who become ill during a biologic event, including what to do when staff develop symptoms while at work and outlining how long staff must remain off-duty after becoming infected

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Joint Commission
      Hospital accreditation program.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
      • Xiong W.
      • Hollingsworth E.
      • Muckstadt J.
      • Van Lieu Vorenkamp J.
      • Lazar E.J.
      • Cagliuso N.V.
      • et al.
      Hospital “self-prophylaxis”: strategies for efficient protection of the workforce in the face of infectious disease threats.
       • Has a protocol for identifying and managing staff who are at an increased risk for infection during a biologic event (eg, pregnant women, immunocompromised workers, and employees of age 65 years or older), such as administrative leave, furlough, altering work assignment or location, and others

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      Emergency management.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Has a protocol for tracking staff who have had contact with a potentially contagious patient or contaminated source (ie, an exposure) during a biologic event, including offering PEP when indicated

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Joint Commission
      Hospital accreditation program.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Ippolito G.
      • Nicastri E.
      • Capobianchi M.
      • Di Caro A.
      • Petrosillo N.
      • Puro V.
      Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy.
      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
      • Higgins W.
      • Wainright III, C.
      • Lu N.
      • Carrico R.
      Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results from a statewide survey.
      • Xiong W.
      • Hollingsworth E.
      • Muckstadt J.
      • Van Lieu Vorenkamp J.
      • Lazar E.J.
      • Cagliuso N.V.
      • et al.
      Hospital “self-prophylaxis”: strategies for efficient protection of the workforce in the face of infectious disease threats.

      Department of Health and Human Services. Proposed guidance on antiviral drug use during an influenza pandemic. 2008. Available from: http://aspe.hhs.gov/panflu/antiviral-n-masks.shtml. Accessed June 1, 2008.

       • Has a protocol for tracking staff who have recovered from illness during a biologic event, including confirmed and probable cases

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Has a protocol that addresses if, how, and when long-term prophylaxis for employees will be provided during a pandemic and to which staff this policy applies

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      Department of Health and Human Services. Proposed guidance on antiviral drug use during an influenza pandemic. 2008. Available from: http://aspe.hhs.gov/panflu/antiviral-n-masks.shtml. Accessed June 1, 2008.

       • Has a protocol for notifying staff's other employers if the staff are exposed or infected during a biologic event
      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.
       • Includes a policy for the prevention of occupational injury and exposure to bloodborne pathogens during an MCE, including times when PPE or other resources are limited

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      Surveillance and triage
       • Identifies a process for syndromic surveillance to identify or detect a biologic event, including bioterrorism, outbreaks of emerging infectious diseases, and pandemic influenza; collection indicators (chief complaint, hospital admissions, unusual clusters of pneumonia, rashes, flu-like illness, and others, are identified in plan)

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Karwa M.
      • Currie B.
      • Kvetan V.
      Bioterrorism: preparing for the impossible or the improbable.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Ippolito G.
      • Puro V.
      • Heptonstall J.
      Hospital preparedness to bioterrorism and other infectious disease emergencies.
      • Kaji A.H.
      • Koenig K.L.
      • Lewis R.J.
      Current hospital disaster preparedness.
      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
      • Higgins W.
      • Wainright III, C.
      • Lu N.
      • Carrico R.
      Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results from a statewide survey.
      • Ransom M.M.
      • Goodman R.A.
      • Moulton A.D.
      Addressing gaps in health care sector legal preparedness for public health emergencies.
       • Outlines the hospital's participation in a community-wide syndromic surveillance program to identify or detect a biologic event; collection indicators (chief complaint, hospital admissions, and others) are identified in plan

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.
      • Rebmann T.
      Emergency management.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
       • Defines the frequency with which syndromic surveillance reports/data will be sent to infection prevention/hospital epidemiology and local public health agency; frequency of data sharing reflects the pandemic security level

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
       • Identifies a process for surveillance to monitor for potentially contagious diseases during a MCE after it is identified, including screening of patients, visitors, and staff; frequency of surveillance (upon admittance to hospital, before each shift, and others) is identified

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.
      • Rebmann T.
      Emergency management.
      • Loutfy M.R.
      • Wallington T.
      • Rutledge T.
      • Mederski B.
      • Rose K.
      • Kwolek S.
      • et al.
      Hospital preparedness and SARS.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Shadel B.N.
      • Rebmann T.
      • Clements B.
      • Chen J.J.
      • Evans R.G.
      Infection control practitioners' perceptions and educational needs regarding bioterrorism: results from a national needs assessment survey.
       • Has a protocol for surveillance based on the level of disease in the community (such as preevent passive surveillance using signage and midevent active surveillance using temperature/symptom screening for hospital visitors)

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Identifies a process for testing and evaluating the syndromic surveillance program/system being used to detect pandemic influenza (the program/system is evaluated during the seasonal influenza period)

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
       • Includes a protocol for tracking admissions and discharges of patients with potentially communicable diseases during a MCE

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.
       • Has a protocol for tracking all onsite individuals (patients, visitors, and staff) who have had contact with a potentially infectious patient during a MCE

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
       • Identifies a protocol for monitoring staff absenteeism for health reasons

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Describes a written protocol for monitoring and reporting seasonal influenza-like illness among hospitalized patients, volunteers, and staff

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Has a procedure for identifying, monitoring, and tracking health care-associated infection transmission among hospitalized patients, volunteers, and staff, including nosocomial transmission of SARS
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      and seasonal influenza

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

       • Identifies a process for monitoring individuals who are quarantined on-site for signs/symptoms of contagious diseases

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.
       • Includes plans for a designated location that is physically separated from other triage/evaluation areas for triaging patients with possible communicable diseases during a biologic event

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
       • Has a protocol for creating or has triage signage that addresses language barriers, individuals with disabilities (visual, hearing, or others), and varying reading levels

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      Reporting, communication plan, and information management
       • Includes a protocol for 24/7 notification of infection prevention or hospital epidemiology of a known or suspected biologic event, including bioterrorism, outbreaks of emerging infectious diseases, and pandemics

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Rebmann T.
      Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Higgins W.
      • Wainright III, C.
      • Lu N.
      • Carrico R.
      Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results from a statewide survey.
       • Includes a protocol for notifying local health officials and local law enforcement of a known or suspected biologic event, including bioterrorism, outbreaks of emerging infectious diseases, and pandemics

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Rebmann T.
      • Carrico R.
      • English J.
      Hospital infectious disease emergency preparedness: a survey of infection control professionals.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Rebmann T.
      Management of patients infected with airborne-spread diseases: an algorithm for infection control professionals.
      • Rebmann T.
      Infectious disease disasters: bioterrorism, emerging infections, and pandemics.
      • Schultz C.H.
      • Mothershead J.L.
      • Field M.
      Bioterrorism preparedness. I: The emergency department and hospital.
      • Srinivasan A.
      • McDonald L.C.
      • Jernigan D.
      • Helfand R.
      • Ginsheimer K.
      • Jernigan J.
      • et al.
      Foundations of the severe acute respiratory syndrome preparedness and response plan for healthcare facilities.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
      • Higgins W.
      • Wainright III, C.
      • Lu N.
      • Carrico R.
      Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results from a statewide survey.
      • Shadel B.N.
      • Rebmann T.
      • Clements B.
      • Chen J.J.
      • Evans R.G.
      Infection control practitioners' perceptions and educational needs regarding bioterrorism: results from a national needs assessment survey.
       • Identifies the name, title, and contact information of a primary and back-up person assigned to communicate with hospital staff and volunteers regarding activation of the Plan and the status and impact of the biologic event during the incident

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      • Joint Commission
      Hospital accreditation program.
      • Agency for Healthcare Research and Quality
      Bioterrorism emergency planning and preparedness questionnaire for healthcare facilities.
       • Identifies the name, title, and contact information of a primary and back-up person assigned to communicate with public health authorities during a biologic event

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      American Hospital Association. Hospital preparedness for mass casualties. 2000. Available from: http://www.ncha.org/public/docs/bioterrorism/AHA.pdf. Accessed March 2, 2004.

       • Identifies a person assigned to monitor state and federal public health advisories and update the pandemic response coordinator and members of the hospital emergency management committee when pandemic flu has been reported in the United States and is nearing the geographic area

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Joint Commission
      Hospital accreditation program.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.

      Occupational Safety and Health Administration. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers. 2007. Available from: http://www.osha.gov/Publications/OSHA_pandemic_health.pdf. Accessed March 14, 2008.

      • Petrosillo N.
      • Puro V.
      • Di Caro A.
      • Ippolito G.
      The initial hospital response to an epidemic.
       • Includes a list and contact information of other health care entities and key community response entities (fire safety, law enforcement, EMS, public health, and governmental agencies) within the region with which it will be necessary to maintain real-time communication during a biologic event

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

       • Describes the process with which health alert messages, information about contagious diseases, hospital rules for visitors, and need for and use of infection control measures (social distancing practices, isolation, PPE, and others) will be posted and/or communicated within the facility during an MCE (such as through an intranet, hotline, closed-circuit TV, and others)

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Rebmann T.
      Emergency management.
      • Joint Commission
      Hospital accreditation program.
      • Amaratunga C.A.
      • O'Sullivan T.L.
      • Phillips K.P.
      • Lemyre L.
      • O'Connor E.
      • Dow D.
      • et al.
      Ready, aye ready? Support mechanisms for healthcare workers in emergency planning: a critical gap analysis of three hospital emergency plans.
      • Rebmann T.
      • Wilson R.
      • LaPointe S.
      • Russell B.
      • Moroz D.
      Hospital infectiousdisease emergency preparedness: a 2007 survey of infection control professionals.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.
      • Thorne C.D.
      • Levitin H.
      • Oliver M.
      • Losch-Skidmore S.
      • Neiley B.A.
      • Socher M.M.
      • et al.
      A pilot assessment of hospital preparedness for bioterrorism events.
       • Describes the process with which the hospital has arranged mechanisms and content for interfacility communication with other hospitals and health care agencies in the region for safe patient placement during a biologic event, including during admission and discharge procedures (includes information on PPE, isolation, and other infection prevention interventions)

      Centers for Disease Control and Prevention. Smallpox response plan and guidelines version 3.0. 2003. Available from: http://www.bt.cdc.gov/agent/smallpox/response-plan/index.asp. Accessed January 30, 2004.

      • Centers for Disease Control and Prevention
      Severe acute respiratory syndrome. Supplement C: preparedness and response in healthcare facilities.

      Centers for Disease Control and Prevention. Hospital pandemic influenza planning checklist. 2007. Available from: http://www.pandemicflu.gov/plan/healthcare/hospitalchecklist.pdf. Accessed July 2, 2007.

      Association for Professionals in Infection Control and Epidemiology (APIC). April 2002 Interim bioterrorism readiness planning suggestions. 2002. Available from: http://www.apic.org/Content/NavigationMenu/PracticeGuidance/Topics/Bioterrorism/APIC_BTWG_BTRSugg.pdf. Accessed April 7, 2002.

      • Joint Commission
      Hospital accreditation program.
      • Braun B.I.
      • Darcy L.
      • Divi C.
      • Robertson J.
      • Fishbeck J.
      Hospital bioterrorism preparedness linkages with the community: improvements over time.