Implementation Activities in Outbreak Response

ORTP Guidance

Expands on Table 3 in the “Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute Care Hospitals” and pairs potential activities of the healthcare epidemiologist with implementation considerations.

Potential implementation activities are based on Waltz et al “Expert Recommendations for Implementing Change” (ERIC) study of 73 discrete implementation strategies.

Incident Management (IM) Phase Potential IM Activities of the Healthcare Epidemiologist Potential Implementation Strategies Related to these Activities
These strategies may be the responsibility of facility leadership, emergency preparedness leadership, hospital teams, the HE, the implementation team, or other hospital personnel. These activities are paired with the HE’s role in IM for his/her awareness.
  • Identify strengths and/or gaps in EMP and EOP, including potential vulnerabilities found in infection prevention assessments
  • Establish protocols as they relate to outbreak or emerging pathogen management
  • Ensure adequate surveillance and detection of threats
  • Participate and provide input into education and training of HCP
  • Participate in HICS exercises and drills
  • Provide input into resource and staffing needs
  • Develop strategies for limited/constrained resources/surge capacity
  • Provide input into occupational health considerations
  • Provide input into policies for isolation and cohorting
  • Input into application of laws/regulations
  • Review “State Crisis Standards of Care”
  • Identify practices that could undergo change during a facility or emerging pathogen outbreak
  • Create list of stakeholders
  • Identify/recruit leaders/administrators and champions
  • Create and convene implementation team
  • Decide on common language for dissemination and implementation goals
  • Obtain formal commitments for team members
  • Establish how implementation team will meet and interact
  • Conduct KAP survey(s) for review by implementation team
  • Identify barriers to change and facilitators to change (e.g., language(s), how information accessed and accepted, stakeholders’ knowledge, attitudes, and practices (KAP), findings of needs assessments)
  • Tailor interventions to adapt them to setting
  • Work with implementation team on fostering empowerment
  • Identify early adopters
  • Obtain formal commitments for early adopters
  • Identify approaches to dissemination (likely via HIMT and specifically PIO)
  • Identify when/how scale up will occur
  • Identify needs for technical assistance
  • Identify needs for clinical supervision
  • Train stakeholders: consider “train the trainer” strategies, develop and distribute educational materials, conduct dynamic and ongoing training and drills with stakeholders, simulate changes
  • Obtain formal commitments for stakeholders
  • Provide feedback to educational providers/trainers and participants
  • Identify needs and methods for reminders/training refreshers for stakeholders
  • Identify which changes will be mandated and how they will be monitored
  • Develop resource sharing agreements
  • Identify revisions to professional roles and clinician teams (e.g. Job Action Sheets)
  • Conduct local consensus discussions
  • Identify/develop methods for patient/family/visitor education
  • Identify financial impacts, including potential contracts, enhancements, altered incentives/disincentives, fees
  • Identify changes to infrastructure, including record systems, physical structure, equipment, service sites
  • Assess liability considerations
  • Reinforce roles for HIMT
  • Evaluate and recommend alternative management strategies based on suspected mode of transmission
  • Advocate for resources
  • Work with staff/HIMT to ensure adequate supplies, isolation rooms, RME, etc., and input into what may be needed from regional stockpile inventory
  • Work with staff/HIMT in HCP training in PPE
  • Manage HCP exposures
  • Provide guidance for cleaning/disinfection of RME and environment
  • Provide input into strategy for continuing activities
  • Refine approaches based on preparedness activities and knowledge of specific outbreak/crisis
  • Remind stakeholders of roles and responsibilities
  • Intervene with patients/family/visitors to enhance uptake and adherence
  • Inform stakeholders, including opinion leaders, media, public (likely via HIMT and PIO)
  • Fill designated role in HIMT (likely Medical-Technical Specialist)
  • Identify/draft clinical guidance
  • Adjust clinical support activities depending on mode of transmission
  • Monitor incident for infection prevention implications
  • Post-exposure management
  • Input into adapting airflow for surge capacity
  • Provide input into physical plant/waste management
  • Provide input into post-mortem placement or storage
  • Collaboration with communications staff/PIO in education of staff, public, media
  • Consultation with risk management, ethics specialists, local and national public health as needed
  • Enact revised professional roles (JAS) and clinical teams
  • Enact decided-on changes to infrastructure, staff, recordkeeping, finances, and site
  • Keep stakeholders, including mass media, informed (via PIO)
  • Provide technical assistance (likely via HIMT)
  • Provide clinical supervision
  • Capture and share local knowledge (via HIMT and/or implementation team)
  • Facilitate relay of clinical data to providers (likely via HIMT)
  • Provide reminders for stakeholders, including patients/families/visitors
  • Identify infection prevention risks/vulnerabilities
  • Provide input into collaborative strategies with regional partners for delivery of essential services, if needed
  • Provide input into recovery priorities and immediate operating needs
  • Input into revision of policies and procedures based on actions required during the response phase
  • Input into when to shut down HICS and return to normal operations
  • Collaboration with communications staff/PIO
  • Input into how laws/regulations affected the response
  • Return to normal operations (roles, responsibilities, teams, infrastructure, site, etc.)
  • Conduct audit of how changes were implemented and provide feedback
  • Purposefully reexamine implementation plan
  • Obtain and use stakeholder feedback (empowerment evaluation)
  • Obtain and use feedback from patients/family/visitors
  • Keep stakeholders, including media, informed of recovery (via PIO)
  • Assess ongoing monitoring needs
  • Assess potential research needs
  • Assess funding needs and opportunities

Waltz TJ, Powell BJ, Matthieu MM, Damschroder LJ, Chinman MJ, Smith JL, et al. Use of concept mapping to characterize relationships among implementation strategies and assess their feasibility and importance: results from the Expert Recommendations for Implementing Change (ERIC) study. Implement Sci. 2015;10:109. Epub 2015/08/07. doi: 10.1186/s13012-015-0295-0. PubMed PMID: 26249843; PubMed Central PMCID: PMCPMC4527340.