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Sarah Chudnow Community

Disaster Plan

Section 5 – Other Disasters

Contents of Section 5 – Other Disasters

5.1 – Internal Flooding

5.2 – Explosion

5.3 – Bomb Threat

5.4 – Civil Disturbance/Terrorism

5.5 – Suspicious Activity

5.6 – Vandalism

5.7 – Chemical Spills

5.8 – Nuclear/Radiological

5.9 – Pandemic Influenza

5.10 – Other Communicable Diseases

5.1 – INTERNAL FLOODING

Department / Internal Flood Responsibilities
Administrator /
  • Assess situation.
  • Confer with dept heads and managers.
  • Direct employees, as needed.

CommunicationCenter / Report the flooding to Maintenance via radio (or ON CALL procedure if after hours), the Utility Guard and Housekeeping.
Housekeeping / Pick up water ASAP with wet vacuums and floor care equipment.
Laundry / Provide blankets, sheets etc., for dams if needed
Maintenance / Find cause, shut off water, repair – If cause or shut offs ARE NOT immediately visible – GO TO SOUTH BASEMENT MECHANICAL ROOM
AND FOLLOW INSTRUCTIONS ON RED SIGNS AT WATER EQUIPMENT.
Utility Guard /
  • If during a weekday, then assist Maintenance and Housekeeping, as needed.
  • If a maintenance man is not on site, then try to shut off the water and pick it up ASAP with wet vacuums and floor care equipment.

All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the Administrator or designee.

ADDITIONAL NOTE: If flooding is in your work area, shut down any electrical equipment, turn off lights, and remove items from floors, as needed.

5.2 – EXPLOSION

Department / Explosion Responsibilities
Administrator /
  • Assess situation.
  • Confer with Maintenance, Nursing and other affected departments.
  • Make sure CommunicationCenter calls 911 to report the situation.
  • Order evacuation, if needed.

CommunicationCenter / Contact 911 to report situation.
Maintenance / Notify any utilities needed depending on nature and extent of damages. Be available to assess damage and prepare for board-up, repairs etc.
Nursing /
  • Treat the injured.
  • Notify nearby hospitals of emergency and impending admissions, casualties.

Utility Guards / Conduct continual building rounds to help keep building as secure as possible.
All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the Administrator or designee.

5.3 – BOMB THREAT

Department / Bomb Threat Responsibilities
Administrator /
  • Order evacuation if needed.
  • Make sure the CommunicationCenter calls 911 to report the situation.

CommunicationCenter /
  • REMAIN CALM!
  • FOLLOW THE BOMB THREAT CHECKLIST at end of this section.
  • Between 7 AM and 7 PM – ANNOUNCE (using the overhead paging system) “DR. BLUE – ATTENTION – DR. BLUE – ATTENTION -DR. BLUE. Please report to your assigned work location.”
  • Call the Mequon Police Department (911) and give the following information: “This is the Sarah Chudnow Retirement Community at 10995 N. Market Street. We have just received a bomb threat. The dispatcher will guide you from there.”
  • Notify the Administrator or designee, theDirector of Facilities, and the Director of Nursing.

Housekeeping /
  • Help search for suspicious packages or items. DO NOT TOUCH THEM. Report any findings to the CommunicationCenter immediately.

Maintenance /
  • Help search for suspicious packages or items. DO NOT TOUCH THEM. Report any findings to the CommunicationCenter immediately.

All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the Administrator or designee.

If you receive a bomb threat, do the following:
  • Ask the following questions:
  • When will go off?
  • Where is it located?
  • What type of bomb is it?
  • What type of explosive is it?
  • Why are you doing this?
  • Who are you?
  • Then immediately contact the Administrator or designee, Director of Facilities, the Maintenance Manager and the Director of Nursing.

SEARCH GUIDELINES AND PEOPLE MOVEMENT CRITERIA:

A search will be started by the Administrator or designee, with instructions that if a strange object or bundle is found – IT SHOULD NOT BE TOUCHED OR MOVED. People should be removed from the immediate area, and the administrator should be informed. When the POLICE or BOMB SQUAD arrives, they will assume command of the situation, and removal of any suspicious objects.

Unusual activities that accompany any bomb alert announcements are frequently noticed by residents and guests. To avoid any panic, the searches should be conducted as efficiently, quietly and calmly as possible. Conversations among staff should be out of earshot of residents or guests, and limited to pertinent facts only.

During any alerts and searches, all doors on all floors including fire doors are to remain open. Doors which exit to the outside may remain closed.

If any residents are to be moved, it should be as follows:

  • Ambulatory residents shall be directed to an area that has been searched, and should remain until an “All Clear” is issued by the authority in charge.
  • Non-ambulatory persons should be moved to an area that has been searched (generally on the same floor, unless ordered differently by the person in charge), and should remain until an “All Clear” is issued by the authority in charge.
  • Bed ridden persons should NOT be moved unless they are in the immediate area of a suspicious item or are ordered to be moved by the authority in charge.

Residents will be evacuated ONLY if a suspicious item is found, or upon the specific orders of the authority in charge.

ONCE THE POLICE/BOMB SQUAD ARRIVE – THEY ASSUME COMMAND.

When you receive a bomb threat, do the following:
  • Ask the following questions:
  • When will go off?
  • Where is it located?
  • What type of bomb is it?
  • What type of explosive is it?
  • Why are you doing this?
  • Who are you?
  • Then immediately contact the Administrator or designee, Director of Facilities, the Maintenance Manager and the Director of Nursing.

5.4 – CIVIL DISTURBANCE/TERRORISM

Department /

Civil Disturbance/Terrorism Responsibilities

Administrator /
  • Meet with department heads to discuss the situation, and to initiate any specific action, as needed.
  • Maintain contact with police and other city authorities.

Maintenance /
  • Lock down all exterior doors as needed to prevent unauthorized entry into the facility.
  • Do more frequent rounds to ensure thecontinued integrity of the buildings and grounds.

Department Heads /
  • Assess the need to make special arrangements to ensure adequate staffing levels, especially if public transportation systems have been compromised.

All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the Administrator or designee.

5.5 – SUSPICIOUS ACTIVITY

Department /

Suspicious Activity Responsibilities

Administrator /
  • Monitor the situation.
  • Meet with department heads to discuss the situation, and to initiate any specific action, as needed.
  • If the activity involves weapons, call 911 immediately.
  • Maintain contact with police until the issue has been resolved.

Communications /
  • Announce “DR. GREEN” (with the location) using both the two-way radio and the public address system.

Department Heads /
  • Respond to location of DR. GREEN, and wait for instructions.

Utility Guards /
  • Respond to location of DR. GREEN, and wait for instructions.

All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the Administrator or designee.

5.6 – VANDALISM

If vandalism is found on the property, the person finding it should have the CommunicationCenter contact the Maintenance Manager, who will assess the situation and determine actions to be taken, if any. The Maintenance Manager shall keep the Administrator informed.

5.7 – CHEMICAL SPILLS

Department /

Chemical Spill Responsibilities

Administrator /
  • Confer with local authorities, Director of Nursing, Director of Facilities as to whether evacuation of facility is needed and when.
  • Oversee evacuation, if necessary.

Housekeeping /
  • Contain and clean up the chemical to the degree that is considered safe by the Director of Facilities, Administrator or designee.

Maintenance /
  • Contain and clean up the chemical to the degree that is considered safe by the Director of Facilities, Administrator or designee.
  • Contract with a professional chemical spill cleanup contractor for clean up and removal, if necessary.

Nursing /
  • Move residents away from the area of the spill.

All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the administrator or designee.

5.8 – NUCLEAR/RADIOLOGICAL

Department /

Nuclear/Radiological Responsibilities

Administrator /
  • Confer with local authorities on the need to evacuate the facility.
  • Oversee evacuation, if necessary.

All Other Employees /
  • Conduct job activities, as usual, unless directed otherwise by the administrator or designee.

5.9 – PANDEMIC INFLUENZA

The recommendations described below are generally applicable throughout pandemic phases. Recommendations may be modified as the situation progresses from limited to widespread illness.

Residents and employees of nursing homes and other residential facilities will be at particular risk for transmission of pandemic influenza and disease complications. Pandemic influenza can be introduced through facility personnel and visitors. Once a pandemic influenza virus enters such facilities, controlling its spread is problematic. Therefore, as soon as pandemic influenza has been detected in the region, the facility will implement aggressive measures to prevent introduction of the virus.

Prevention or delay of pandemic influenza virus entry into the facility

Despite aggressive efforts to prevent the introduction of pandemic influenza virus, persons in the early stages of pandemic influenza could introduce it to the facility. Residents returning an outside appointment or family visit could also introduce the virus. Early detection of the presence of pandemic influenza in a facility is critical for ensuring timely implementation of infection control measures.

  • Screen potential admissions or readmissions for possible exposure to the pandemic influenza.
  • Early in the progress of a pandemic in the region, increase resident surveillance for influenza-like symptoms. Notify state or local health department officials if a case(s) is confirmed.
  • If symptoms of pandemic influenza are apparent, implement droplet precautions for the resident and roommates, pending confirmation of pandemic influenza virus infection. Residents and roommates should not be separated or moved out of their rooms unless medically necessary. Once a resident has been diagnosed with pandemic influenza, roommates should be treated as exposed cohorts.
  • Discourage unnecessary visits or appointments to medical facilities.

Definition of Influenza–like Illness (ILI):

Influenza is a highly infectious viral respiratory disease. Influenza-like Illness (ILI) is defined as fever 100°F or higher and either a cough, nasal discharge or sore throat. Other symptoms of influenza include headache, myalgia, prostration, and dizziness. Otitis media, nausea, and vomiting are also commonly reported among children. Typical influenza symptoms, such as fever, may not always be present in elderly residents, young children, residents in long-term care facilities, or persons with underlying chronic illnesses.

Because fever may be difficult to determine in elderly residents, the definition of fever used for ILI may be defined as a temperature of 100°F or higher or 2 degrees above the established baseline for that resident.

Transmission:

According to the CDC, influenza is primarily transmitted from person-to-person via large virus containing

Droplets that are expelled when infected persons cough or sneeze; these large droplets can then settle on the mucosal surfaces of the upper respiratory tracts of susceptible persons who are near (e.g., within about 6 feet) infected persons. Transmission may also occur through direct contact or indirect contact with respiratory secretions such as when touching surfaces contaminated with influenza virus and then touching the eyes, nose or mouth. Adults may be able to spread influenza to others from 1 day before getting symptoms to approximately 5 days after symptoms start. Children may be able to spread influenza to others as long as upper

respiratory symptoms continue.

Unlike persons infected with seasonal influenza, persons with H1N1 influenza infections should be considered infectious from 1 day before the onset of illness to at least 7 days after illness onset. Persons who continue to be ill longer than 7 days after illness onset should be considered infectious until 24 hours after the resolution of fever and improvement of symptoms, whichever is longer.

A. Monitoring For Pandemic Influenza and Infection Control Measures

Control of Visitors

  • Visual alerts (in appropriate languages) (English, Spanish, Russian) will be posted at the entrance(s) to the facility restricting entry by persons who have been exposed to or have symptoms of pandemic influenza.
  • To assist in the enforcement of restrictions, receptionists will verbally and visually screen visitors for respiratory symptoms at points of entry to the facility. If they have concerns they will notify the Nursing Supervisor, Infection Control Nurse, or Administrator for follow up.
  • Visitors may contact the RN Supervisor, Infection Control Nurse (ext. 876), Director of Nursing, or Administrator for information on measures used to prevent the introduction of pandemic influenza.
  • Provide educational materials, alcohol gel, tissues and wastebasket, near entrances to the building.

Control of Personnel

  • All personnel have been instructed to report influenza-like symptoms. Symptomatic personnel should be sent home until they are physically able to return to duty.
  • Educational materials, posters and in-services are provided, as needed, regarding the disease process and progress, control measures, testing and vaccinations to emphasize what staff can do to prevent and control the spread of disease.
  • The Infection Control Nurse and JHCC Administration will monitor news broadcasts,

Government and CDC notices or updates and follow any additional recommendations as the pandemic progresses.

  • The facility will provide vaccination, free of charge, to all employees as recommended and available.

Respiratory Hygiene/Cough Etiquette Education

To contain respiratory secretions, all persons with signs and symptoms of a respiratory infection, regardless of presumed cause, should be instructed to:

  • Cover the nose/mouth when coughing or sneezing.
  • Use tissues to contain respiratory secretions.
  • Dispose of tissues in the nearest waste receptacle after use.
  • Perform hand hygiene after contact with respiratory secretions and contaminated objects/materials.

“Source Control” measures to limit spreading of influenza virus from respiratory secretions

Promote the use of masks and spatial separation by persons with symptoms of influenza.

  1. Offer and encourage the use of either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties or elastic) by symptomatic persons to limit dispersal of respiratory droplets.
  2. Encourage coughing persons to sit as far away as possible (3-6 feet) from other persons in common areas.

Co-horting Residents

  1. Designated units or areas of a facility should be used for cohorting residents with pandemic influenza. Therefore, to prevent cross-transmission of respiratory viruses, whenever possible assign only residents with confirmed pandemic influenza to the same room. At the height of a pandemic, laboratory testing to confirm pandemic influenza is likely to be limited, in which case cohorting should be based on having symptoms consistent with pandemic influenza.
  2. Personnel (clinical and non-clinical) assigned to cohorted resident care units for pandemic influenza residents should not “float” or otherwise be assigned to other resident care areas. The number of personnel entering the cohorted area should be limited to those necessary for resident care and support.
  3. Personnel assigned to cohorted resident care units should be aware that residents with pandemic influenza may be concurrently infected or colonized with other pathogenic organisms (e.g., Staphylococcus aurous, Clostridium difficile) and should adhere to infection control practices (e.g., hand hygiene, changing gloves between resident contact) used routinely, and as part of standard precautions, to prevent nosocomial transmission.
  4. Because of the high resident volume anticipated during a pandemic, cohorting should be implemented early in the course of a local outbreak.

Resident Transport

  1. Limit resident movement and transport outside the isolation area to medically necessary purposes. If the resident is scheduled for an outside appointment, a call should be placed to determine if the entity is accepting appointments.
  2. Consider having portable x-ray equipment available in areas designated for cohorting influenza residents.
  3. If transport or movement is necessary, ensure that the resident wears a surgical or procedure mask (N95 if suspected or confirmed). If a mask cannot be tolerated (e.g., due to the resident’s age or deteriorating respiratory status), apply the most practical measures to contain respiratory secretions. Residents should perform hand hygiene before leaving their room or facility.

Control of Nosocomial (facility acquired) Pandemic Influenza Transmission

  • Once residents with pandemic influenza are recognized in the facility, nosocomial surveillance should be heightened for evidence of transmission to other residents and healthcare personnel.
  • If limited nosocomial transmission is detected (e.g., has occurred on one or two resident care units), appropriate control measures should be implemented. These may include:
  • Cohorting of residents and staff on affected units with known or suspected cases of pandemic influenza.
  • Use of antiviral medication, or other treatments, as indicated.
  • Restriction of new admissions (except for other pandemic influenza residents) to the affected unit(s)
  • Restriction of visitors to the affected unit(s) to those who are essential for resident care and support
  • Limit movement within the facility (e.g., temporarily close the dining room and serve meals on nursing units, cancel social and recreational activities).
  • If widespread nosocomial transmission occurs, controls may need to be implemented facility wide and might include:
  • Restricting all non-essential persons
  • A ‘freeze’ on admissions not related to pandemic influenza

Hospitalization

  1. Limit hospitalization of influenza residents to those with severe complications of influenza who cannot be cared for in the facility.
  2. Admit new residents to either a single-resident room or an area designated for cohorting of residents with influenza.

Control of Visitors (when influenza is present in the building)

  • Continues to post visual alerts (in appropriate languages) (English, Spanish, Russian) at the entrance(s) to the facility restricting entry by persons who have been exposed to or have symptoms of pandemic influenza.
  • To assist in the enforcement of restrictions receptionists will verbally and visually screen visitors for respiratory symptoms at points of entry to the facility. If they have concerns they will notify the Nursing Supervisor, Infection Control Nurse, or Administrator for follow up
  • Visitors may contact the RN Supervisor, Infection Control Nurse (ext. 876), Director of Nursing, or Administrator for information on measures used to prevent and control the spread of pandemic influenza.
  • Provide educational materials, alcohol gel, tissues and wastebasket, near entrances to the building.
  • Family members who accompany residents with influenza-like illness to the facility are assumed to have been exposed to influenza and should wear masks.
  • Limit visitors to persons who are necessary for the resident’s emotional well-being and care.
  • Instruct visitors to wear surgical or procedure masks while in the resident’s room.
  • Instruct visitors on hand-hygiene practices.

B. Basic Infection Control Principles for Preventing the Spread of Pandemic Influenza