Development and Implementation of First Hospital-Based Epidemic Outbreak Management Plan: Lessons Learned from Nepal

Abstract

Introduction:Patan Hospital, located in Kathmandu Valley, Nepal is a 400-bed hospital that has a long history of responding to natural disasters. Hospital personnel have worked with the Ministry of Health (MOH) and the World Health Organization (WHO) to develop standardized disaster response plans that were implemented in multiple hospital systems after the earthquake of 2015. These plans focused primarily on traumatic events but did not account for epidemics despite the prevalence of infectious diseases in Nepal.Aim:To develop and test a robust epidemic/pandemic response plan at Patan Hospital in Kathmandu that would be generalizable to other hospitals nationwide.Methods:Using the existing disaster plan in conjunction with public health and disaster medicine experts,we developed an epidemic response plan focusing on communication and coordination (between the hospital and MOH, among hospital administration and staff), logistics and supplies including personal protective equipment (PPE), and personnel and hospital incident command (IC) training. After development, we tested the plan using a high-fidelity, real-time simulation across the entire hospital and the hospital IC using actors and in conjunction with the MOH and WHO. We adjusted the plan based on lessons learned from this exercise.Results:Lessons learned from the high-fidelity simulation included the following: uncovering patient flow issues to avoid contamination/infection; layout issues with the isolation area, specifically accounting for donning/doffing of PPE; more sustained duration of response compared to a natural disaster with implications for staffing and supplies; communication difficulties unique to epidemics; need for national and regional surveillance and inter-facility planning and communication. We adjusted our plan accordingly and created a generalizable plan that can be deployed at an inter-facility and national level.Discussion:We learned that this process is feasible in resource-poor hospital systems. Challenges discovered in this process can lead to better national and system-wide preparedness.

Hospital incident command system, the pillar of COVID-19 outbreak response: An experience from Patan Hospital, Nepal

“…In an epidemic disaster like this, the triage and isolation areas in the hospital are of major concern. 10 The The next important thing was optimizing hospital supplies and preparing to overcome the problem of global shortage of supplies. It was important to be aware and educate the staffs about the level of PPE that would be optimal for the safety of healthcare workers, and manage the stock judiciously for use in future.…”

Way forward from the experiences of disaster preparedness and response at Patan Hospital during 2013-2020: Nepal

“…The pandemic response was added to this hospital-based disaster management plan and it was tested by a disaster drill conducted in February 2018. 8 This component was inserted into HDPR and the training was continued in different hospitals in all seven provinces of Nepal. This was followed by disaster drill in province 1,2, 4, 5, 6, and 7.…”

“…So, this twelfth revision of the disaster management plan was implemented in 2018. 8 This plan included epidemic triage, the concept of isolation units, infection prevention, and control during a pandemic, and a plan for maintaining stock. 9 Furthermore, this disaster management plan consisted mainly of preparedness and response cycle so to incorporate the mitigation and recovery part of the disaster cycle, the plan was modified as the thirteenth revision.…”

Perception of understanding COVID-19 among doctors at Patan Hospital, Nepal

“…4 Patan Hospital (PH), Academy of health sciences (PAHS) is the first hospital in Nepal to develop and test hospital based epidemic outbreak management plan. 5 A full scale simulation exercise to test the epidemic outbreak plan was conducted in February 2018. With this preparation, it is of utmost importance for us to know the understanding of COVID-19 among doctors.…”