Long-Term Care Toolkit Annex M: Emerging Infectious Disease (EID) or High Consequence Infection Disease (HCID)

Reporting requirements and contact information

Notification should immediately include local infection control personnel and the LTC facility’s/agency’s administration, and prompt communication with the local and state health departments. Each LTC facility/agency should include a list containing the following telephone notification numbers in its readiness plan:

Internal contacts

• Infection Control:
• Administration/Public Affairs:

External contacts (see Appendix N for the following)

• Local health department:
  • Find a local health department or community health board
  • Local emergency manager:
    • DPS: County Emergency Managers
• Minnesota Department of Health: 651-201-5735
  • MDH Emerging Infections Unit: 651-201-5414
    • MDH: About the Infectious Disease Epidemiology, Prevention and Control (IDEPC) Division
  • MDH: Health Alert Network

*See excel spreadsheets for all internal/external contacts*

Detection of outbreaks caused by emerging infectious disease (EIC) or high consequence infectious disease (HCID)

A recent example of an Emerging Infectious Disease (EID) is COVID-19. Requirements for infection control, staffing, testing of both staff and residents, and vaccination of both staff and residents changed as more was learned about COVID-19. It is important to have a good infection control plan that can be adapted as needed. Guidance will come from federal and state government.

Pandemics are a unique challenge to long-term care because it can be a drawn-out incident, taking several weeks, months, or even years to conclude. An effective response to a pandemic requires: collaborating with local healthcare coalitions and response partners, planning for increased admits or surge at the facility, and gathering crucial information on an ongoing basis to share with authorities. Awareness of the facility's capacities and the staff's capabilities will allow a dynamic response to a fast-paced situation such as infectious or vector-borne diseases.

A High Consequence Infectious Disease (HCID) is defined by the Minnesota HCID Collaborative (MDH, Mayo Clinic, UMMC, Minnesota Hospital Association, Minnesota Health Care Coalitions, Minnesota HCID-Ready EMS services) as a disease that include any confirmed or suspected infection with a pathogen that meets either of the following criteria:

• Pathogens for which all forms of medical waste (including patient excreta, secreta, blood, tissue, tissue swabs, and specimens in transport media) are classified as category A infectious substances (UN2814) by the U.S. Department of transportation.

Or

• A pathogen with the potential to cause a high mortality rate among otherwise healthy people, and
  • At least some types of direct clinical specimens pose generalized risks to laboratory personnel.
  • Known risk of secondary airborne spread within health care settings or unknown mode of transmission.
  • No routine vaccine exists.

Screening, quarantine, and isolation

This screening guide can be used to assess patients for cough, respiratory symptoms, fever, rash, and travel. MDH: High Consequence Infectious Disease (HCID) Screening Guide

It is important to remember quarantine and isolation guidelines when dealing with an HCID. CDC: Quarantine and Isolation

Antibiotic resistance

Antibiotics are powerful tools for fighting and preventing infections. Antibiotics kill bacteria and have made many medical advancements possible, such as surgery, cancer treatments, and intensive care medicine.

Antibiotic resistance occurs when bacteria change in a way that reduces or eliminates the effectiveness of antibiotics. This means the antibiotic is not able to kill the bacteria.

MDH: Healthcare-Acquired Infections and Antibiotic Resistance in Minnesota Frequently Asked Questions (PDF)

Initial actions: rapid response checklist

• If either the volume or severity of an infectious disease significantly threatens or impacts day-to-day operations, activate facility’s emergency operations plan (EOP) and appoint a Facility Incident Commander (IC).
• Notify appropriate state survey agency to report an unusual occurrence and activation of facility’s EOP.
• Obtain guidance from the local health department and the U.S. Centers for Disease Control and Prevention (CDC).
• Implement appropriate infection control policies and procedures based on current guidance.
• Clearly post signs for cough etiquette, hand washing, and other hygiene measures in high visibility areas. Consider providing hand sanitizer and face/nose masks if practical.
• Consider advising visitors to delay visits if needed to reduce exposure risk to residents.
• Advise staff to screen themselves for signs and symptoms of illness and to not work if sick. Activate emergency staffing strategies as needed.
• Limit exposure between infected and non-infected persons; consider isolation of ill persons.
• Conduct recommended cleaning/decontamination in response to the infectious disease.
• Add other response actions here consistent with the facility EOP.

*See also MDH: High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities

Purpose of toolbox (Updated 9/20/2019):

• Provides ready-to-use editable tools for frontline facilities to prepare and respond to patients who may have a high consequence infectious disease (HCID).
• Helps facilities meet CMS emergency preparedness regulatory requirements for training and testing programs.
• Helps facilities develop a multi-year plan for HCID education and exercises.
• Incorporates standard infection prevention concepts into training and exercises.

*See Base Plan section on Ethical Considerations, which contains information on Crisis Standards of Care, Staffing and Volunteers, and PPE.