Public Health Experts on High Alert with Recent Rise in Spread of Infectious Diseases

A significant decline in immunization rates in the past few years has resulted in a dramatic increase in the number of documented cases of infectious diseases previously thought to be virtually eliminated in the United States has risen considerably. Falling immunization rates are attributed to fears that vaccinations can cause autism that are based on flawed studies that have been discredited.

Public health officials are seeing a rise in diseases such as measles and pertussis, commonly known as whooping cough. Measles was declared "eliminated" in the United States in 2000. This year alone there were 161 cases of measles reported across 16 states. While this increase does not suggest a widespread outbreak throughout the nation, it does present local and state public health systems with the new challenge of identifying and responding to a disease outbreak with shrinking budgets. 

Experts explain that the spread of measles in the US is generally traced to individuals who contract the disease outside the United States and then infects people exposed to the disease who were not vaccinated. For example, in Tuscon, Arizona a Swiss woman who had been traveling in Mexico arrived in an emergency room with measles. It took two days for her to be diagnosed and placed in isolation. During the two-day period before her isolation she infected an unvaccinated hospital staffer and an 11-month-old child who was too young to be vaccinated. The final count of infected individuals was 14 confirmed cases and 363 suspected cases that were a result of exposure to the Swiss traveler's measles. Seven of the 14 confirmed cases were contracted while the individuals were in the care of hospitals for other medical conditions. 

Preventing the Spread of Infectious Disease

• Early Detection Systems 
• The Department of Homeland Security recently announced plans to create a real-time disease outbreak alert system that would conduct hourly searches for reports of infectious diseases worldwide and send early warnings to at risk communities with low immunization rates. 
• Biosurveillance automated monitoring systems could help with the early detection of natural disease outbreaks with modifications such as integrating primary-care physician data with emergency room data.

• Establish Vaccination Policies
• To reduce the risk of spreading contagious diseases and limit the numbers of isolations required, health systems should require all staff to be up-to-date with vaccinations of contagious diseases. 

• Identification and Response
• Early identification of infectious diseases should be a goal of all health systems. 
• Once a case is discovered the health system should immediately alert public health officials and other community health systems to aid in rapid identification and limit exposure.
• Employees should be familiar with the protocols for reporting the infectious disease to local public health officials and health systems. 

Inspector General Calls for More Disaster Preparations

CQ HealthBeat reports that a new report by the Office of Inspector General for the Department of Health and Human Services concludes that nursing homes were not adequately prepared for Hurricane Katrina.  An report also concludes that many still lack enough safeguards in case of flood, fire or storm. 

Find "Gaps Continue to Exist in Nursing Home Emergency Preparedness and Response During Disasters: 2007-2010 (April 2012)" at the Office of Inspector General (Report OEI-06-09-00270). 

The Centers for Medicare and Medicaid Services (CMS) requires that homes have detailed written emergency plans and also train staff on how to be prepared for disasters. The OIG’s office reviewed national survey data on those preparations.

In addition, OIG staffers visited 24 nursing homes that were struck by wildfires, floods and hurricanes in 2007 through 2010. Overall, disaster hit 210 nursing homes in seven states during that period, prompting evacuations and “shelter in place” decisions by administrators.

“Administrators and staff from 17 of the 24 selected nursing homes reported facing substantial challenges in responding to disasters, whether they evacuated or sheltered residents in place,” said the OIG report, which was requested by Senate Aging Committee Chairman Herb Kohl, D-Wisc. Kohl had held a hearing on this issue.

The report says, “Challenges included difficulty following emergency plans as written, logistical problems related to transportation and communication, and negative effects of evacuation on resident health. Further, most nursing homes that experienced challenges reported that they had not collaborated with local emergency management agencies to prepare for disasters.”

CQ HealthBeat reports that "Often the homes did not follow checklist tasks recommended by CMS" and that the report indicated that "state long-term care ombudsmen didn’t have any contact with nursing home residents until the disaster was over, and other state officials who deal with the licensing of nursing homes played a limited role."

OIG officials interviewed nursing home administrators, local emergency managers, state officials who oversee nursing homes and representatives from state long term care ombudsman programs.

Most nursing homes met the CMS requirements for both written plans and training, said the OIG report. But there were gaps, and many of them were the same ones identified by the OIG in an earlier study. The 2006 study was the result of the numerous hurricanes in 2004 and 2005, including Katrina, and the concerns they raised about how nursing homes could keep their residents safe.  Find "Nursing Home Emergency Preparedness and Response During Hurricanes (August 2006) at the OIG (Report OEI-06-06-00020)

On paper, the homes appeared to be ready for problems. Among more than 16,000 nursing homes surveyed in 2009 and 2010, the OIG found 92 percent met federal regulations for emergency planning, though that was a slight decrease from the 94 percent that were in compliance in 2004-05. A lower percentage, 72 percent, met standards for training, compared to 80 percent in the earlier report.

In real life, the experiences were different. “For example, one administrator of a nursing home that was flooded reported that its emergency plan did not include procedures for responding to floods, although the nursing home was in a flood plain,” said the OIG. “Administrators of two nursing homes reported that they did not consult their written emergency plans to prepare for evacuation. They reported piecing together transport by calling upon other nursing homes and local emergency entities to evacuate their residents.”

The OIG recommended that:
• CMS should be even more specific about items that should be included in emergency planning lists. The agency also should specify minimum federal standards for the frequency and extent of disaster response training, exercises and drills.
• CMS should develop better guidance for state officials on how they are to review the homes’ emergency plans.
• CMS should do more to promote the use of emergency preparedness checklists by homes.
• The Administration on Aging should develop models for state long term care ombudsmen to follow during disasters to help protect nursing home residents.

CQ HealthBeat reports that Marilyn Tavenner, CMS acting administrator, in a letter agreed with all of the recommendations and said they would be implemented. 

Finally, in a memorandum report (OEI-06-09-00271), the OIG outlines specific guidance that CMS can consider when revising the checklist for health care facilities.


SOURCE: CQ HEALTHBEAT NEWS (April 16, 2012)

"Nursing Homes Need to Step Up Disaster Preparations, OIG Says"
By Jane Norman, CQ HealthBeat Associate Editor