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Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era
Appendix 6: minimum specifications for Smallpox Care Centres
Possible, probable and confirmed cases of smallpox will be transferred to specialist Smallpox Care Centres.
Sites suitable for use as Smallpox Care Centres will identified by RSDRGs at Alert Level 0.
It must be possible to activate centres within 24 hours of the first confirmed case. An Alert Level 1 or diagnosis of the first probable case should lead to preparation to activate the Centres.
Building
Size. Suggested number of beds to 20 observation beds and 20 treatment beds.
Additional flexibility could be built into the size of a smallpox care centre by choosing a site with hard standing around the centre e.g. a car park, which could be used to extending the care centre if needed.
Location. It is strongly suggested that any smallpox care centre
"must not have within a quarter of a mile of it either a hospital, whether infectious disease or not,… or a population of as many as 200 persons. The site must not have within half a mile of it as many as 600 persons, whether in institutions or in dwelling houses. A smallpox [treatment location] must not be used at one and the same time for the reception of other diseases"
Access and security. It is recommended that smallpox care centres should have their own private entrance surrounded by a perimeter wall or fence that prevents unauthorised entry into or out of the facility.
Wards and clinical facilities
Two distinct areas should be identified: an observation ward for possible cases, and a treatment ward for probable and confirmed cases. These should have separate air supplies. Ideally, separate but adjacent buildings should be used.
The treatment ward being a combination of bays of four beds and individual rooms for seriously ill patients.
The observation ward, due to the risk of contracting smallpox, even if vaccinated, from other observed patients, should ideally be in separate rooms with their own ventilation, preferably with negative pressure.
Clinical Rooms. should include the following:
an x-ray room with a dedicated x-ray machine, x-ray development equipment and an x-ray viewer
a pharmacy store,
a large store of medical and non-medical items (many of which may be disposable),
a laboratory area (if at all possible a care centre should have an onsite laboratory containing clinical chemistry, haematology analyser, blood coagulation, blood transfusion, bacteriology, and a fridge and a freezer, as is the case at the medium secure unit of the Garrett Anderson Ward. Equipment could be moved from a acute hospital site to the smallpox care centre at the beginning of an outbreak).
a safe area for the secure storage of clinical waste before it is either treated or transported
It is suggested that additional space will also be needed for a staff common room, general office space for the clinical team to use, and a garage for care centre ambulances and delivery vehicles.
Laundry and Decontamination. Space will be needed to decontaminate the waste from the care centre. This could be as much as 120 litres per person of waste per day.
All such waste will need to be decontaminated before it leaves a Smallpox Care Centre.
Autoclaving on-site is preferred but expensive. Incineration or autoclaving off site could be attempted with adequate precautions.
Two rooms to "shower out" would be useful - one with an entrance into it from the treatment ward and one with an entrance into it from the observation ward.
Catering. The majority of meals could be delivered to the sites porters lodge on disposable "airline trays" but food preparation areas would also be needed on site
A communal area with recreational facilities should be provided for mild cases and cases who are convalescing
Dedicated clinical rooms for preparation of laboratory specimens and medications should be available.
Dedicated food preparation and dishwashing facilities should be available. Prepacked microwaveable food would be most convenient.
Mortuary. The smallpox care centre should have a mortuary, which includes facilities for undertaking post mortems. - see
Appendix 18.
Staff accommodation. There may be a need for staff accommodation at the smallpox care centre. In particular, medical staff would need accommodation when on call.
If a smallpox care centre was not sited within easy travelling distance of the staff's homes accommodation should be provided at the site for them.
Staff
Dedicated Staff. facilities should have there own dedicated healthcare and domestic staff who have been appropriately trained in the case of smallpox patients including infectious disease procedures (
Appendix 7). All staff present at the centre should be vaccinated. All members of the staff's immediate family should also be vaccinated.
The estimated head count for staffing a smallpox care centre would be 143 people, 138 of which would need to be vaccinated along with their families. This would mean a total of approximately 316 people would need to be vaccinated to staff each care centre including immediate family members.
It should be noted that the above does not include
intensive care staff.
Ward Staff. It is suggested that ID staff around Scotland are a pool of staff that could be vaccinated and could staff smallpox care centres should an incident occur. The posts left vacant in ID wards could then be back filled with other nurses with far less risk than putting staff unused to infectious disease in a smallpox care centre.
Changing facilities including a cleansing room with a shower must be available. These should be accessible through external and internal doors so that they can be used by smallpox ambulance personnel as well as smallpox care centre staff.
Staff must also have access to their own food preparation and rest areas.
Transport-Parking
On
-site parking and garaging facilities for ambulance and delivery vehicles are also recommended.
Communication
Telephone lines for routine calls to outside lines will be required. There should also be a dedicated line to the RSOCC.
PCs with internet access will also be required.
Consumables
The care centre will need supplies of all of medical equipment and treatments required for the care of critically ill patients. Procedures for requesting, delivering and receiving these will need to be organised.
Equipment will be necessary for the preparation of laboratory specimens as described in
Appendix 1.
Guidelines
Guidelines will be required for:
Transport of patients
Initial suspected and probable cases may require transfer to isolation facilities. In this event, standard category 3 infectious removal procedures should be used, with ambulance crews wearing masks and Tyvek suits. In addition, the patient should be given a mask and a Tyvek wrap, to help further limit the spread of infection. Ambulances used for transfer of these patients should have cabs and bays with a separate air supply.
During an outbreak, smallpox patients will require transport to Smallpox Care Centres. In this event,
smallpox ambulances should be used that are dedicated solely to this purpose for the duration of the outbreak, and are not used for the transport of other patients during this period.
Ambulance personnel should be vaccinated, and in addition should observe the appropriate infection control procedures for the care of smallpox patients, as described in
Appendix 7. Following each transfer, the ambulance should be decontaminated, following the procedures described in
Appendix 15.
Visitors
Only immediate family and other household members will be allowed to visit smallpox patients. As category A contacts they will have been vaccinated, but in addition they should observe the same infection control procedures as smallpox care centre staff (see
Appendix 7). Facilities should be available to allow visitors to change into personal protective equipment (se
Appendix 7) before entering clinical areas, and to shower and change back into their normal clothes after leaving clinical areas.
Parents of children with smallpox will require accommodation close to the centre.
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