B. Roles and Responsibilities of the Healthcare Epidemiologist in Facility and Emerging Pathogen Outbreaks

The authors use the 1992 IOM report definition of an emerging pathogen as a new, reemerging, or drug-resistant infection with an incidence in humans that has increased within the past two decades or threatens to increase in the near future.

This section addresses the role of the HE, as well as roles and responsibilities of the facility and direct care HCP, in order to provide context regarding the division of labor and team responsibilities during incident management and outbreak response.

1. Leadership Role of the HE in Incident Management
B.1. Recommendations:

• The HE should be versed and trained in basic HICS response.
• In most facilities, the HE serves as the medical-technical specialist in domains relevant to infection prevention and control and infectious diseases within HICS when the system is being utilized.
• The HE should ensure that liability coverage is provided for the duties undertaken based on his/her role in HICS.

2. Activities and Responsibilities of the HE in Incident Management
B.2. Recommendations:

• The HE should provide input into the facility’s EMP and the four phases of incident management as they relate to infectious diseases and infection prevention and control: preparedness, mitigation, response, and recovery.
• The HE should be involved in the development, maintenance, and evaluation of a facility’s EOP as it relates to infectious diseases outbreaks.
• The HE should ensure that the hospital systematically monitors local, federal, and international public health advisories and alerts of emerging pathogens.
• The HE should ensure the existence of, or help develop when needed, a hospital-wide surveillance program that accurately and rapidly identifies exposed and infected patients and HCP, including protocols for reporting these individuals to infection prevention and control staff.
• The HE should interpret advisories/alerts and surveillance data to identify when the healthcare facility is faced with a potential or actual outbreak, and report this information to the Emergency Program Manager, Incident Commander, and/or appropriate leadership as established by the facility.
• The HE should ensure that the facility develops easily accessible and widely disseminated written multidisciplinary protocols for identifying, investigating, responding to, and containing facility and emerging pathogen outbreaks.

3. Role of HE in Coordination with Stakeholders
B.3. Recommendations:

• When HICS is activated, the HE should assist the IC and the PIO in creating and/or reviewing messaging for internal and external stakeholders. If HICS is not activated, the HE will assist designated facility communications leadership.
• The HE should work collaboratively with internal and external stakeholders to coordinate the outbreak response in accordance with his/her designated role within HIMT.

4. Additional Resources and Assets for Outbreak Response
B.4. Recommendations:

• In coordination with the facility, the HE should know how to access and use the following resources for additional assistance:
  • The facility’s HVA/risk assessment for most likely threats, in order to identify gaps
  • Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE)
  • Internal and external stakeholders
• The HE should have knowledge of:
  • Regional centers with specialized capabilities for managing patients with suspected or confirmed infection with the pathogen of interest
  • Principles and processes related to transfer of care and coordination for EMS transport

5. Clinical and Support Activities
B.5. Recommendations:

• The HE should ensure that a facility’s policies and procedures address, encourage, and facilitate infection prevention and control measures, including but not limited to hand hygiene, respiratory etiquette, and transmission-based precautions.
• The HE should be familiar with facility resources identified in the EMP, including:
  • Number of isolation rooms and their locations
  • Plans and capability to adapt patient care rooms or units’ airflow for surge capacity
  • Cleaning and decontamination processes for both the environment and medical equipment
  • PPE and medical supplies.
• In collaboration with the facility’s Ethics Committee (or equivalent), the HE should provide expertise to leadership, or the IC when HICS is activated, in determining whether clinical care practices warrant modification or avoidance, depending on how the pathogen is transmitted, and whether additional measures or resources are needed to protect patients and HCP.
• The HE should provide input to ensure the facility:
  • Uses syndromic surveillance to detect an emerging pathogen outbreak in collaboration with and based on guidance from public health authorities
  • Is prepared to provide a medical screening examination (MSE) of patients in clinical areas
  • Provides critical care with appropriate PPE
  • Is able to place PUIs in private rooms as soon as possible until transfer to an appropriate isolation room, which may be in another center that has specialized capabilities, if needed
  • Has appropriate environmental controls available, including rooms that meet airborne infection isolation specifications when airborne transmission may be a potential mode of transmission.

6. Equipment and Supplies for Management of an Emerging Pathogen Outbreak
B.6. Recommendation:

• As part of the EMP, the facility should:
  • Maintain and make easily accessible an inventory of PPE and medical equipment that identifies what is on hand and what is needed for specific categories of emerging pathogen outbreaks.
  • Designate an individual responsible for maintaining levels of equipment, managing out-of-date supplies, and determining a plan to relay critical supply shortages to the local and state emergency response centers (e.g. via the Logistics Section Chief in HIMT).
  • Identify and coordinate communication channels with other regional medical centers regarding equipment, supplies, and capacity for a regional response to an emerging pathogen.
  • Depending on the nature of the suspected pathogen, when possible and appropriate, utilize disposable medical equipment to minimize the need for decontamination.

7. Role of HE in Experimental Vaccines, Therapeutics, and Clinical Research during an Emerging Pathogen Outbreak
B.7. Recommendations:

• A facility, depending on its structure and resources, may engage in work on experimental vaccines, therapeutics, and/or clinical research during an emerging pathogen outbreak. If the facility determines it may have a role in these activities, it should identify external partners, resources, and HCP roles during the preparedness phase and outline them in the EOP. The HE may assume a leadership role such activities or the facility may designate another individual to assume this role, which may involve:
  • Collaboration with external partners, including HCCs or other state/territorial/regional public health authorities, industry, the US Food and Drug Administration (FDA), and facility structures such as the Human Subjects Review Committee (or equivalent), to identify experimental vaccines or therapeutics that may be used.
  • Conduct of clinical research, conforming to all applicable regulations.

8. Role of Infection Prevention Staff and Direct Care HCP
B.8. Recommendation:

• During all phases of incident management, infection prevention staff should:
  • Collaborate with and support the HE.
  • Continue to perform outbreak surveillance and effectively communicate this information to the HE.
  • Provide knowledge and skills regarding infection prevention practices.
• Direct care HCP should be able to:
  • Recognize that clusters of patients or HCP with infection, or a single patient or HCP with a very unusual infection, may represent the start of an outbreak
  • Report this to infection prevention and control staff
  • Continue to perform standard infection prevention and control measures while awaiting further guidance from infection prevention and control.
  • Direct care HCP designated to provide patient care during an outbreak setting should demonstrate competency in standard and special protocols to respond to and contain pathogens within their scope of practice.