Responsibilities of the Healthcare Epidemiologist

Phase	Example Activities
Emergency Management Plan (EMP) and Emergency Operations Plan (EOP)
Preparedness: planning actions needed in the case of an emergency or threat	Identify strengths and/or gaps as they relate to infectious diseases outbreaks Bring forward for specific consideration and training findings of infection prevention and control assessments that show potential vulnerabilities or weaknesses, e.g. hand hygiene compliance or environmental cleaning Identify and/or establish protocols within the facility’s EOP as they relate to outbreak or emerging pathogen management: Policies for specific pathogens Environmental decontamination Environmental safety Respiratory etiquette Evaluation, diagnosis, and management of patients, including screening, triage, placement, transport, care Surveillance and triage of HCP, volunteers, patients, and visitors Patient populations that may be disproportionately impacted by a threat (e.g., children, immunocompromised patients) Transfer policies (e.g. LTCF or specialized facility) Post-mortem care Information security Identify and establish points of contact, stakeholders, and resources (see Table 4. Stakeholders and Resources) Provide input into infection prevention and control education and training for HCP, including direct patient care HCP, clinical staff, laboratory staff, housekeeping, emergency personnel, and environmental services, especially in measures such as hand hygiene, respiratory etiquette, and isolation Provide input into exercises/drills to test EOP Provide input regarding resource and staffing needs, including the potential for enhanced supports for laboratory, housekeeping, and environmental services. Provide input into occupational health considerations, including non-punitive sick leave, furlough, quarantine, and post-exposure prophylaxis so that the facility can maintain: Rapid identification of potentially exposed patients/staff/visitors and create line list of those individuals Notification of exposed individuals, with proper documentation Post-exposure prophylaxis (PEP) for exposed individuals Tracking of HCP work Approval of communications by appropriate individuals (e.g. PIO, Risk Management) Ensure adequate surveillance and detection for infectious diseases threats (e.g. syndromic surveillance, monitoring national and global epidemics) Plan how patients with a suspected or confirmed infection would be isolated or cohorted
Mitigation: prevention of an emergency or efforts to reduce the damage from a hazard	Evaluate and recommend alternative management strategies based on the suspected mode of transmission Work with staff/HIMT to ensure adequate supplies of PPE (respiratory protection, eye protection, impervious body coverings, gloves), isolation rooms, and hand hygiene stations and products, and PPE stockpile Work with staff/HIMT in design and/or implementation of HCP training on PPE use Manage HCP exposures Input into quantity needed for disposable and non-disposable supplies and equipment and adequate numbers of RME Provide guidance in cleaning and disinfection of RME and the environment Input into strategy for continuing activities in the setting of limited supply quantities
Response: activities that occur during an emergency	Fill role of Medical-Technical Specialist in HIMT (most likely role of the HE), providing expert medical-technical content Identify/draft clinical guidance pertaining to pathogen, e.g. screening/triage protocols, care protocols, isolation Adjust clinical and support activities depending on mode of transmission Monitor the incident for infection prevention and control implications For HCP, patient, and visitor post-exposure management: Identify and line-list all potentially exposed HCP/patients/visitors Work within structure to notify all exposed individuals Determine whether post-exposure prophylaxis is available and indicated Determine whether exposed individuals need to be furloughed or quarantined Supervise tracking and documentation of all post-exposure management activities, including exposure notification Provide input into physical plant/waste management Provide input into post-mortem placement or storage if needed Collaborate with communications staff/PIO: Ensure effective communication with local and regional public health departments Draft and/or review internal and external messages Serve as media spokesperson on issues pertaining to the pathogen
Recovery: actions needed following an emergency to return to normal	Be familiar with the facility’s recovery plan and the HE’s role, to include: Cleanup Garbage and waste disposal Re-supplying inventory and resources, e.g. PPE; return of outside resources as they pertain to infection prevention and control Equipment repair Physical repair and restoration Follow-up on HCP exposures Employee assistance program Incident debriefing, i.e. review PPE, training, and exposures After-action report Process for formally acknowledging assistance received Identify infection prevention and control risks and vulnerabilities that may impede recovery HCP fatigue and illness Outbreak fatigue Contribute to recovery phase needs assessment: Short and long-term healthcare systems recovery priorities Immediate operating needs for delivery of essential services Revise procedures and policies based on corrective actions required during the response phase Provide input into when the organization may shut down HICS and return to normal operations Collaborate with communications staff/PIO in: Developing messages for HCP and the public explaining the reasons for demobilization and the recovery phase and processes Serving as media spokesperson on issues pertaining to the pathogen Communicating infection prevention and control recovery phase issues to local and state/territorial/regional agencies as indicated
Regulations and Legal Considerations
Preparedness	Local public health laws (state/territorial/regional specific) CMS regulations related to specific pathogens Joint Commission management of a person under investigation (PUI)
Mitigation	Ensure liability coverage for duties undertaken in role of Medical-Technical Specialist in HICS
Response	Seek consultation with internal risk management, ethics specialists, and local and national public health authorities as needed
Recovery	Input into how laws and regulations affected the response
Resource Management
Preparedness	Develop strategies for dealing with limited/constrained resources and/or surge capacity Review “State Crisis Standards of Care”
Mitigation	Input into inventory supplies at the facility Input into items needed from regional stockpile inventory, if necessary Work with staff to ensure adequate supplies of PPE (respiratory protection, eye protection, impervious body coverings, gloves), isolation rooms, and hand hygiene stations and products
Response	Adapt airflow for surge capacity
Recovery	Contribute to recovery phase needs assessment: Identification of facility’s short and long-term recovery priorities Identification of immediate operating needs for delivery of essential services: Personnel Equipment Supplies Along with the facility recovery team, coordinate with internal and external stakeholders such as other hospitals in the network, local and state health departments, and nongovernmental stakeholders (e.g. home care services, LTCF, Red Cross, etc.) to develop collaborative strategies for delivery of essential health services
Clinical Research (this role may be delegated to another qualified individual at the facility)
Preparedness	Identify local investigators Identify key personnel to assist with IRB or IND process Participate in webinars discussing research on emerging infectious diseases
Mitigation	Identifying experimental vaccines or therapeutics for patients cared for within the HE’s institution
Response	Participating in clinical research within the institution, including administration of experimental vaccines or therapeutics, obtaining clinical samples, and conducting chart reviews as part of approved studies
Recovery	Publishing findings of event evaluations as appropriate After-action report Corrective action plans

Incident Management

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