saintleo university

Infectious Disease Outbreak at Saint Leo Hospital

Healthcare Management-Dr.Bal

Michelle Neeck

4/8/2015

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Disaster preparedness is something many patients and the general public do not think

about on a daily basis, but as a new member of the Saint Leo University Hospital disaster team

this is a constant worry as infections are common in hospitals and one of the number one

contenders for causing complications and possibly hospital wide outbreaks from different

infectious diseases such as staph and the even more deadly MRSA. Creating an effective and

well thought out disaster plan is essential for any hospital especially Saint Leo. One of the most

important factors to keep in mind how different aspects of the healthcare organization can play a

significant role in the development of any such disaster plan and these along with the medical

knowledge we know about various infectious diseases today. When discussing a disaster and

preparedness plan there are several different factors that almost all hospital plans and healthcare

organizations must take into consideration in regards to infections disease. The first of these is to

identify if the infectious is disease is caused naturally or is it a result of bioterrorism which is

defined as “A bioterrorism attack is the deliberate release of viruses, bacteria, or other germs

(agents) used to cause illness or death in people, animals, or plants. These agents are typically

found in nature, but it is possible that they could be changed to increase their ability to cause

disease, make them resistant to current medicines, or to increase their ability to be spread into the

environment.” (Emergency Preparedness and Response, 2015) The fear of bioterrorism is a very

real concern for many countries especially in the United States, the United Kingdom, and Spain

to name a few who have been the targets of terrorist attacks in the past and have taken great

precautions to prevent further attacks. Next after identifying that there is in fact an outbreak the

next step usually involves isolation and quarantine of all individuals in involved in which to

prevent the disease from spreading. These two methods are both associated as common practices

for both hospitals and other healthcare facilities. Keeping these practices in mind the foundation

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of creating a plan and applying modern healthcare organization techniques can help recognize,

contain, and prevent the spread of infectious diseases.

When creating a disaster preparedness plan it is important to keep in mind some of the

challenges to delivering healthcare both on a local and global scale. Focusing on the United

States it is important to take into consideration a systematic view of the healthcare system. There

are several reasons why. First, as the author suggests there are several factors that affect

healthcare such as infrastructure and nutrition, knowing these applying a basic framework can

help better identify what type of disaster plan will be right for a given community. Second,

navigating public policy can affect a disaster plan due to regulation of supplies, financing, and

who does and does not have access to healthcare. Thirdly, the systematic view and its important

with disaster planning also include what is called the value chain which examines the production

of goods of a company and the value associated with the products produced. In healthcare this

translates to the ability to offer state of the art healthcare products and services, being able to

deliver those services through knowledgeable staff, and the results include patient satisfaction

with the treatment they receive. This can have an impact on disaster planning as it is necessary to

apply this view of thinking because when it comes to preventing diseases by having the most up

to date care, delivering the care, and having patients feel secure with decisions of the hospital

and care received. Lastly, the ability to adapt to various changes is equally important as many of

the techniques for containing and responding to infections is constantly changing as our

knowledge of these diseases grows it is important for hospitals and preparedness plans to be

adaptable with the onslaught of new information. (Lawton Burns, 2012) Last year, the globe was

revised by the story of the growing number persons in Africa being infected with the Ebola

Virus. The Ebola Virus had remained quite dormant in the media spotlight for nearly 40 years,

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but news spread that more and more people were being infected with the virus and it spread to

several different countries in Africa some with major airports which fly passengers all over the

world. The threat of an epidemic was high and many held their breath waiting for news of the

next country to be included in this epidemic. The United States was eventually labeled with

persons being concretely diagnosed with the Ebola Virus. Several medical personnel would

eventually be included among those infected with the virus in the United States, but what was

more shocking from this development was the lack of preparedness by the hospital facilities in

disaster planning such as this. Many nurses and other medical professionals stated that they had

received very little training in this area and as a result there was an outcry in reinforcing and re-

teaching important safety policies. In the wake of Ebola being found in Dallas, Texas and a nurse

also being infected many of the nurses there became vocal about their lack of training stating

“There was no advanced preparedness on what to do with the patient. There was no protocol.

There was no system. The nurses were asked to call the infectious disease department” if they

had questions, but that department didn't have answers either, the statement said. So nurses were

essentially left to figure things out on their own as they dealt with “copious amounts” of highly

contagious bodily fluids from the dying Duncan.” (Mohan, 2014) This lack of cohesiveness

resulted in several medical professionals contracting Ebola and did not offer the public a sense

that hospitals had an effective response plan in place. This could have been prevented if the

hospitals had been following a systematic approach and following the regulations set in place by

the Center for Disease Control.

While systematic approach and delivery of healthcare is a very important aspect of

providing healthcare and development of a disaster plan, leadership can also play a leading role

when it comes to implementing a disaster plan into practice. Leadership can take many forms

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and it does not always have to come from the seemingly most important person, likewise

leadership can have an effect on any type of situation whether positive or negative. Leadership in

emergency type situations can as Demiroz describes “Leadership in managing disasters and

emergencies can minimize the damage inflicted by an event whilst lack of successful leadership

exacerbates the impact. Leaders should have certain skills and abilities in order to manage

catastrophes based on the environmental conditions, organizations they lead, scope of the

disaster.” (Fatiah Demiroz, 2012) Leadership as described can make or break disaster responses

and the level of perception of the emergency. One of the roles in leadership is to act as a strategic

problem solver and when developing a plan for a possible infectious disease outbreak in a

hospital such as Saint Leo Hospital. There are 8 steps to strategic planning which first begins

with defining the problem such as containing an infectious outbreak. Next is setting the overall

objective which would be to contain the outbreak. Step three is conducting a root cause analysis

to find out what is causing the outbreak such as improper wound cleaning. Following the

analysis is to generate alternatives such as more in depth wound cleaning or better wound care

materials. Step five is comparing these different alternatives which transitions into step six as

selecting best decision and why that are. Step seven is the development of the plan and

implementing it and lastly developing an evaluation plan and evaluating how well your decisions

played out. (Lawton Burns, 2012) Being able to use all 8 steps is one thing, but is entirely

different when the actual disaster is happening. There can be several issues that could arise not

allow the plan to work properly such as a lack of manpower, lack of resources, and confusion. To

help overcome these possible downfalls of the disaster plan it is necessary to identify the type of

leadership role needed in the given situation. Iasija suggests that there are five styles of

leadership approaches that can be used and they are listed as follows: tells, sells, consults, and

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joins. (Iasija, 2012) Telling gives orders to a team and waits for a result. This may not be the

most effective method in disaster planning but it could be used to help decrease confusion and

begin the containment process such as in an infectious disease outbreak. Next, selling is used to

convince the team by focusing on positive and negatives which may be good to help the team

identify what is working and not working during the crisis. Next is consulting, which as Iasija

says “Leader consults the team and allows them to participate in the decision making with the

view to making small adjustments but the main thrust of the decisions of the leader are more or

less final.” (Iasija, 2012) Lastly is joining which is the most influential of all the leadership styles

as the manager gets down in the trenches and “Discusses thoroughly the problem and the likely

course of action. Every member of the team is involved in the discussion and finally the

consensus decision prevails. This style consumes most time but later work is smooth.” (Iasija,

2012) These different styles can be used on their own and they can mix in different orders

depending on the process of the disaster plan which managers may find that some tactics are

more appropriate than others. This is important to keep in the mind as the concern regarding

outbreaks and the world being so interdependent one another that having a well devolved plan

and the leadership skills is necessary. In an article by Margaret Parker she explains “In a

contagious event, there may be a continuous stream of new patients requiring critical care

support, overwhelming our current intensive care unit capacity. Planning to develop processes

that will enable us to expand our intensive care unit capacity, and likely adapt our standard of

care Using the processes and resources we are currently using to improve patient safety can

provide a framework for developing the necessary processes.” (Parker, 2006) In a possible

outbreak in a hospital setting, as Parker describes there may be an onslaught of patients and the

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need to be able to control the amount of patients coming in and out and leadership is definitely

important.

Continuing on, the role of organizational structure can be the make or break in the proper

functioning of a hospital and the functionality of the disaster preparedness plan that will be set in

place to combat an infectious disease outbreak. Organizational structure is then defined as “The

typically hierarchical arrangement of lines of authority, communications, rights and duties of an

organization. Organizational structure determines how the roles, power and responsibilities are

assigned, controlled, and coordinated, and how information flows between the different levels of

management.” (Organizational Structure, 2015) The structure then can lend itself to completing

and assisting with the goals of the organization such as preparing the hospital for a possible

infectious disease outbreak. Some of the best information for creating the right organizational

structure can come from failures in the past such as Ebola outbreaks, pneumonia outbreaks, and

so on. Murat Balamir offers some suggestions on how to help prevent disasters from past

experiences by the following suggestions “(a) the use of information concerning formal planning

procedures; (b) pre- or post-disaster emphasis in preparations; (c) the political or technical basis

of decisions; (d) the extraordinary or routine nature of responses; (e) the general or specialized

nature of financial sources used; (f) and their compatibility with the order of priorities in risk

management An evaluation of the conventional policy in Turkey clarifies a position closer to the

`fatalist' model and indicates the lines of action for improvements.” (Balamir, 2002) When

designing and organizational structure and preventing infectious disease outbreaks using the

model as described by Balamir using technology such as programs designed to keep track of the

number of patients, current treatment regimes, and the patient’s status can help make outbreaks a

bit more manageable. Financial resources are also a cause for concern as if the budget is not big

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enough to compensate for the cost of drugs, and allowances for an increase in the volume of

patients. Adding to this is further evidence of the importance of organizational structure and

handling mass casualties or patients of infectious disease outbreaks. Surgeon Dr. Christopher

Born speaks on behalf of the surgical side of the hospital disaster response plan which can be

important especially for a threat of infectious disease outbreak which may require surgeons to go

in and help clean out some of the disease or infections that might spur from the disease. Dr. Born

states as his thoughts on disaster preparedness as follows “An effective response to disaster and

mass casualty events should focus on an “all hazards” approach, defined as the ability to adapt

and apply fundamental disaster management principles universally to any mass casualty incident,

whether caused by people or nature. Organizational tools such as the Incident Command System

and the Hospital Incident Command System help to affect a rapid and coordinated response to

specific situations.” (Born, 2007) The all hazards approach that Born refers to is similar to the

notion that part of organizational strategy and disaster preparedness is being prepared for every

situation and being able if no plan is in place the ability to adapt to whatever may come out of an

infectious disease outbreak whether it being more members of the hospital than predicated

becoming infected or running out of supplies sooner than expected is all a part of being able to

establish a strong organizational structure and disaster preparedness model. This idea can also be

found in Andrew Milton’s Cambridge journal article Prehospital and Disaster Preparedness

stating that “Hospitals continually have difficulties and failures in several major areas of

operation during a disaster. Common problem areas identified include communication and power

failures, water shortage and contamination, physical damage, hazardous material exposure,

unorganized evacuations, and resource allocation shortages.” (Milton, 2012)These are all

problems that the hospital has to conquer on a daily basis regardless if there is a disaster or not.

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Disaster Preparedness is an important function in being able to capitalize on these normal day to

day functions and being able to streamline all processes such as patient registration, diagnosing

patients, providing care, and making patients well if that is a possibility as it also important to be

understand that during a disaster such as an infectious disease outbreak that all patients will

survive. Implementing proper organizational structure is an essential part of hospital functioning

and keeping in mind the 8 steps to strategically solve problems such as what protocols are

needed to help in the disaster planning of an infectious disease outbreak in the Saint Leo

University Hospital.

Creating a sound organizational structure is an important step in being able to develop

and carry out disaster plans in the event of a crisis such an infectious disease outbreak. Despite

best efforts working in teams during times of high stress periods can create some sort of conflict.

Although conflict is often thought of with a negative connotation it can also have positive

qualities which can lend themselves to life altering decisions. Identifying and managing conflicts

are two very important abilities to master as the lead of the disaster planning team. Anderson

describes conflict in both local and national terms. The local level of conflict usually involves

“Conflict in the mind of one person and may spill over into the community. By focusing on that

person an aid worker may be able to defuse the conflict.” (Anderson, 2005) This idea of local

conflict can be applied to an infectious disease setting in a sense if infected patients are

quarantined and one of those individuals feels that the efforts made by the doctors and nurses are

hopeless, it may have an effect on all the patients in that particular wing. Conflict in an infectious

disease outbreak can cause many different issues, but there is one important negative impact that

is important for both physicians and other persons to be cognisant of and that is stress among

patients and their perceived ability to recover. If there is a visible or palpable amount of doubt in

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the air this could to physically poor outcomes. Gouin delves into the intricate relationship

between stress and recovery. Gouin studied wound healing and the amount of stress or duress a

patient was experiencing. Gouin found that patients who were experiencing apprehension prior

to surgery were found to consistently suffer from more complications in post-surgical care and

wound care than those who had a positive attitude towards the situation. This is evident in

Gouin’s observations as described “Among 309 consenting consecutive patients who underwent

an elective coronary artery bypass graft surgery, patients who were more optimistic were less

likely to be re-hospitalized than less optimistic individuals. Conversely, patients who

experienced more depressive symptoms were more likely to require hospitalization for infection-

related complications than individuals reporting less distress.” (Gouin, 2011) Stress can be a

common response to conflict especially in an instance of an infectious disease outbreak when the

future of the health of various individuals may be uncertain causing conflict between medical

staff and patients due to unknown outcomes. Keeping patients calm and the mode or moral

positive is essential in a disaster situation. Adding to the need to reduce conflict and stress by

keeping a positive attitude amongst patients and staff, it is also important to look to past failures

to also help reduce conflict. Looking at past failures does not have to be limited to infectious

disease, as a senior hospital executive it is important to draw knowledge from many different

sources to help provide the best care for patients. In 1972 a town called Wilkes-Barre suffered

from a natural disaster, tropical storm Agnes. There was no disaster planning established and as a

result many individuals were displaced and repairing the city was slow going and there arose

many conflicts between competing relief agencies and disgruntled citizens. Despite the obvious

differences between a natural disaster and an infectious disease outbreak, but the need to

establish a plan is clear in this event and any future events. (Heffron, 1977) One manner in which

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to learn from this experience and reduce conflict is through Pre-Disaster planning. Pre-Disaster

planning is an essential tool to help disperse responsibility and establish a chain of command and

create ties between other agencies during time of need; for instance, the Center for Disease

Control or the World Health Organization to help investigate infectious disease outbreaks.

(Heffron, 1977) Other possible conflicts that may arise during an outbreak can originate from

conflicts between the hospital and other agencies. Establishing open communication channels is

important as the free flow of information especially current research on various infectious

diseases is needed to help control and monitor any outbreaks or possibility of an outbreak. Using

other agencies can help the hospitals gain new techniques and insights as to how to control an

infectious disease outbreaks because the agency, CDC, has many world renowned experts

studying and experimenting with some of the world’s deadliest diseases and keeping in contact

with this agency could possibly help reduce the number of outbreaks and reduce recovery time

for patients and reduce stress and conserve materials for all the hospital personnel working to

treat the outbreak.

Reducing conflict and preventing an infectious disease outbreak can be easily prevented

or at least much more manageable if there is a strong sense of quality improvement present in the

hospital setting. Quality improvement as Burns defines is “Is an organized approach to planning

and implementing continuous improvement in performance. QI emphasizes continuous

examination and improvement of work process by teams of organizational members trained in

basic statistical techniques and problem solving tools, and empowered to make decisions based

on their analysis of the data.” (Lawton Burns, 2012) Using this definition that burns has provided

it is clear that quality improvement stats with engaging people within the organization. Some of

the ways in which engaging people might help aid in controlling an infectious disease outbreak is

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by using job enlargement of various personnel in the nursing staff to help act as a bridge between

the patients who are affected by the outbreak and the healthcare executives who are writing and

creating the disaster plans. (Phillips, 2015) Medical directors are beginning to realize the

importance of incorporating quality improvement methods not just in day to day activities, but

can be equally as effective in applying these techniques to disaster preparedness program such as

on focused on the possibility of an infectious disease outbreak. The necessity to review data is

becoming more common place and as such many executives feel that “The boards of directors of

such health systems are beginning to request methodologically rigorous research and

comparative preparedness data for benchmarking and quality improvement of emergency

management—the customary practice over the past decade for health care quality and, more

recently, patient safety.” (Phillips, 2015) Patient safety is considered a high priority for most

hospitals and because of this it is equally important to apply this priority to disaster preparedness

as well. The goal of quality improvement when it is associated with disaster preparedness is to

provide patients with the access to care that they need. The National Health Security Strategy of

the United States of America (NHSS) has developed several different strategies to help use the

idea of quality improvement to better patient access to care in times of disaster. NHSS has

identified several areas that need immediate attention in order to help fulfill the patient’s need to

access care during an infectious disease outbreak. Some of these areas in need of improvement

include “Develop and maintain the workforce needed for national health security. Ensure

situational awareness. Foster integrated, scalable health care delivery systems. Ensure timely and

effective communications. Promote an effective countermeasure enterprise.” (Preparedness,

2015) Providing quality improvement in healthcare elicits many other skills needed in order to

identify problem areas and provide solutions. For instance, the NHSS cited communication as

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the one major concern in which improvement was drastically needed and in order to use quality

improvement methods communication is an essential skill. Communication skills are needed in

the collection and interpretation of data and then conveying that data in meaningful message to a

board of executives or to the local community to explain how the hospital can improve their

delivery of healthcare to patients both for day to day care and in times of crisis such as an

infectious disease outbreak. Applying these skills and taking the lead from NHSS reviewing

some of their areas of needed focus can help healthcare executives understand more of their own

challenges within their hospital, but there is more to quality improvement than just focusing

inside the hospital to prevent an infectious disease outbreak. Looking beyond the hospital can

help solve and provide solutions to challenges within the hospital such as creating a disaster

preparedness plan for infectious disease outbreak. The CDC (Center for Disease Control) has

developed three different elements to help apply quality improvement methods to preventing an

infectious disease outbreak which is often looked over as part of the disaster preparedness plan.

The first element to be considered is “Strengthen public health fundamentals, including

infectious disease surveillance, laboratory detection, and epidemiologic investigation.”

(Friedman, 2011) The first element provides the foundation for identifying and controlling an

infectious disease outbreak and preventing the disease from reaching the public by giving the

public proper knowledge of diseases and best practices to carry out in order to prevent coming in

contact and spreading said infectious diseases. As a healthcare executive this is one of the most

important steps in creating a disaster plan is by having a very informed public before any threat

has been issued. The second element is classified as “Identify and implement high-impact public

health interventions to reduce infectious diseases.” (Friedman, 2011) High impact intervention

involves looking at risk populations and providing solutions to preventing an infectious disease

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outbreak by focusing on health disparities within a local area as well as using the latest

technology for disease prevention. Hospitals can use their support from stakeholders and various

other sources such as government funding to carry out philanthropic endeavors to help prevent or

reduce risk of infectious disease in their local communities which can help prevent a large scale

crisis. The last element is “Develop and advance policies to prevent, detect, and control

infectious diseases” (Friedman, 2011) Policy writing is a type of quality improvement that can

affect controlling an infectious disease outbreak and providing high quality improved healthcare

to patients. Policy writing extends beyond the hospital creating global ties by implementing the

best known science for solving infectious disease outbreaks and as such can partner very well

with techniques applied to local communities using these quality improvement methods to

contain, treat, and prevent infectious disease in a well thought out and expertly communicated

way.

While quality improvement can be an effective way in which to contain an infectious

diseases outbreak, but what can also help to create a proper procedure for a disaster preparedness

plan through forming alliances with different healthcare organizations. The United States

Department of Health and Human Services provide 10 objectives that should be considered when

creating alliances and how these alliances should help solve healthcare issues and as an executive

of a hospital this is an important venture to carry out. The first objective is to enhance the global

surveillance. Global surveillance is impotent from an alliance and infectious disease point of

view is to help identify, control, and prevent the spread of diseases which from a hospital stand is

crucial to be aware of any type of epidemics or pandemics that might infiltrate a hospital setting.

(Strategy Objectives, 2015) The second objective is the prevention of infectious disease. The

prevention of an infectious disease outbreak is easier said than done and working with

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organizations to help “Enhance healthcare security and prevent the introduction, transmission

and spread of infectious diseases and other health threats within and across borders.” (Strategy

Objectives, 2015) Alliances working together in order to prevent the transmission of infectious

will be far more successful at keeping infectious disease at bay and as such in order for a hospital

executive to write and carryout a successful disaster preparedness plan. A third objective is to

prepare for and respond to public health emergencies. The ability to mobilize and respond

quickly to public health emergencies is essential to providing high quality healthcare and being

able to tackle a health emergency such as an infectious disease outbreak quickly and effectively

could surely prevent the spread of the disease to other patients as it is more than likely that a

public health emergence will most certainly affect local hospitals. The fourth objective in

ensuring positive relations between various healthcare alliances is the increase in safety and

integrity of global manufacturing and global supply chains. While this object is not an obvious

as other objectives as means for preventing an infectious diseases outbreak the need for high

quality equipment is most important to aid in the treatment of patients and faulty equipment

could spell disaster in contain the infectious disease. The fifth objective is to strengthen

international standards through multilateral engagements and described as such as “Provide

leadership to establish, strengthen and implement science-based international health and safety

standards and support multilateral efforts to improve global health policies, programs, and

practice. (Strategy Objectives, 2015) The sixth objective is to catalyze on health research

globally. This alliance object can help to open doors to further research and new techniques in

order to treat infectious diseases can be obtained through alliances with researchers and

pharmaceutical companies such as Pfizer or AstraZeneca. The seventh objective entails

identifying and exchanging best practices ideas between say a hospital and another healthcare

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organization. Exchanging best practices such what type of scrubbing techniques are best to

prevent the spread of infection in surgical setting can help change how hospitals treat infectious

disease and how disaster plans are written. Objectives eight and nine focus on addressing global

changes in death and illness and focusing on the Global Health Initiative. These two objectives

can be seen working together to understand disease and disparity in healthcare. These objectives

can be used through alliance relationships to understand why some infectious disease cause more

harm than others, what type of treatment work best and why others seem to fail, and providing

equal healthcare treatment to all patients. The final objective is advance health diplomacy, this

objective can be defined as “Engage directly with diplomatic partners, and strengthen peer-to-

peer technical, public health, and scientific relationships. (Strategy Objectives, 2015) Fostering

relationships such as these can help further the knowledge and procedures of infectious disease

control and prevention. These objectives for creating worthwhile alliances by finding the right

partners either through mutual goals are for legal or ethical reasons. Alliances also work in a life

cycle format beginning with emergence and defining the alliance followed by the transition stage

such as hiring a coordinator to begin the establishment of the alliance. (Lawton Burns, 2012) The

final stages include maturity and critical cross roads. The maturity stage involves sustaining a

certain level of commitment towards alliance members and lastly critical cross roads involve

managing the decisions about future alliances either maintain or forming new alliances with

other healthcare organizations. (Lawton Burns, 2012) Alliances can prove to be advantageous

relationships in trying to combat infectious diseases and creating effective and useful disaster

preparedness plans.

Disaster preparedness plans are important delivering quality healthcare while preventing

various public health crises such as an infectious disease outbreak. In creating a disaster plan

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such as this it is important to pay close attention to health policy and regulations. One of the

most important regulations that must be considered is the Health Insurance Portability and

Accountability Act which has a great impact on health providers as HIPPA is a safeguard of a

patient’s privacy and security of protected health information. (Lawton Burns, 2012) Health

information includes anything that could identify a single patient such as medical records, billing

information and other personally identifiable information. Working as a hospital executive it is

important to ensure that all patient information is safeguarded and there is leaking of personal

information especially those that are infected with an infectious disease outbreak. Protecting

patient information is a regulation policy that must be carried out on a daily basis whereas the

Emergency Medical Treatment and Labor Act are applied on a more case by case basis.

EMTALA is defined as “Preventing institutions of denying care to anyone seeking emergency

medical treatment, regardless of citizenship, insurance status, or ability to pay. (Lawton Burns,

2012) There are two requirements that are included in health policy regulation. The first requires

that a hospital must perform an initial patient evaluation, which is translated to anyone who

comes to the hospital asking for treatment must receive an evaluation. In regards to an infectious

disease outbreak it is important that all patients who come to the hospital complaining of

symptoms similar to that of any possible infectious disease should be evaluated and determine if

a patient does indeed have an infectious disease or not. The second parameter that is a part of

EMTALA concerns that hospitals stabilize individuals that are deemed to be in the midst of an

emergency situation must be stabilized before being discharged or moved to another facility. In

this case a person who has been determined to have an infectious disease cannot therefore

discharged before treatment is complete of if they must be transferred to another the patient must

be stable to make the journey and must be held responsible until the transfer is complete.

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(Lawton Burns, 2012) The Center for Disease Control is one authority that is responsible for

using and implementing federal regulations in regards to healthcare and infectious disease

control. The CDC identifies two methods for hospitals and other agencies to adhere by as

“Isolation and quarantine help protect the public by preventing exposure to people who have or

may have a contagious disease as the following Isolation separates sick people with a contagious

disease from people who are not sick. Quarantine separates and restricts the movement of people

who were exposed to a contagious disease to see if they become sick.” (Legal Authorities for

Isolation and Quarantine, 2015) These two methods are useful in a hospital setting and should

considered in part of the disaster planning by containing the infectious disease to small area and

reduce the amount of potential exposure to other individuals and hopefully decrease the amount

of time it will take contain and eradicate the disease. Infectious disease policy includes reporting

of any possible outbreaks as such some of the following steps must be “Creating or enhancing

surveillance systems and case information collection tools to allow for simultaneous or

sequential reporting of time-sensitive health data coordinated among local, state, territorial,

tribal, and federal public health authorities. Appropriating federal funding to support the

technology and infrastructure needed to efficiently collect, analyze, and disseminate infectious

disease surveillance and reporting information and allow for transmission among the local, state,

territorial, and federal health authorities.” (Infectious Disease Policy Statement, 2015) As an

executive of a hospital it should be important to develop a plan in order to identify and notify an

infectious disease outbreak in order to receive help funding treatment options or acquiring new

scientific technology to treat an infectious disease outbreak. As well as notifying all important

governing bodies it is important to use healthcare polices to prevent infectious disease. In order

to help prevent the spread of infectious diseases it is important that following health policies

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such as the following are important for adhering to all legal and ethical issues “State and

territorial public health agencies collaborating with local health entities and the clinical sector to

promote basic principles of hygiene and infection control and prevent transmission of existing

and emerging infectious diseases.” (Infectious Disease Policy Statement, 2015) Collaborating

with other public or private entities is equally important to aiding in the maintenance adhering to

all health policies. All federal health regulations are in place to help to reduce risk and increase

patient safety through evidence based practices which are constantly evolving and hospitals are

required to keep up with ever changing practices and developing current disaster plans. (Lawton

Burns, 2012)

The globalization of healthcare has had a dramatic impact on healthcare around the world

and the provisions of such connectedness can be felt in the hospitals as well. Globalization is the

result of “Economic processes, technological developments, political influence, cultural and

value systems, and social and natural environmental factors. These varied forces, as part of the

processes of globalization, impact directly or indirectly on health at a number of different

levels.” (Saker, 2004) Globalization is the gradual openness of national borders to economic

influence, financial, human movement, information, goods and services. (Lawton Burns, 2012)

Overtime infectious disease has been one the main contributors to morbidity around the world

until non communicable disease began to overtake infectious disease on a global scale. In a

global sense infectious disease does not refer just to one disease, but a broad sense of conditions

and the importance of a given disease are also dependent upon the region in which healthcare

professionals find themselves. (Saker, 2004) In the United States there are some infectious

diseases in which hospitals like St. Leo need to extra mindful of such as the following four

infections “ A rise in HIV prevalence in gay men as there were 50,000 new cases in 2011 alone.

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The second disease that hospitals must consider seriously is hospital acquired infections about

one in 20 people who are hospitalized contract a hospital-acquired infection (HAI). Patients who

have invasive surgery, a catheter or receive a lengthy course of antibiotics are at greater risk for

HAIs. Roughly 99,000 people died from HAIs in 2002, the most recent year for which figures

are available, according to the report. Thirdly, Whooping Cough is now a growing threat as there

is a small movement to not vaccinate their children and therefore a rise in preventable diseases

will see an awakening of centuries old diseases. Lastly, keeping in mind new and old diseases

that can cause a public health crisis is equally important as globalization of healthcare.” (Firth,

2013) Globalization has posed as a challenge for healthcare professionals especially for

executives creating a new plan that must encompass many different varieties of infections of

disease that may come their way as a part of the growing movement of people from one country

to another. When creating a disaster plan, it is important to consider government involvement

especially concerning matters that could have a global effect from any disease that might present

itself in a hospital setting. The government can have beneficial effects on public health and

infectious disease control and as such it is described “The state constitutes the key actor in

infectious disease governance. Governance responses to globalization occur at national,

international, and global levels. National governance occurs when a state acts within its own

territory to respond to globalization. International governance involves states cooperating to

confront globalization challenges and often creates norms, rules, and institutions to facilitate

cooperation. Global governance involves not only states and international organizations but also

non state actors, such as multinational corporations and nongovernment organizations whose

participation becomes critical to the success of governance efforts. (Fidler, 2003) The

government can provide assistance to for issues of global matters as government programs such

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as state programs or the Center for Disease Control which can help control with infectious

disease such as providing up to date research for providing up to date care in the treatment and

management of infectious disease outbreaks. As such hospitals are in charge of providing care to

those who walk through the doors and are looking for care and therefore when treating patients

from visiting countries it is important to take into account regional diseases and the possibility of

spreading such diseases to other patients and hospital personnel such was the case with the Ebola

outbreak as hospital nurses where not fully educated on proper caring procedures for the patients

and therefore resulted in the spread of the disease to medical staff. However, the future of

healthcare is going to continue to be effected on a global scale. According to Morse on the

emergence of infectious of diseases “Specific factors precipitating disease emergence can be

identified in virtually all cases. These include ecological, environmental, or demographic factors

that place people at increased contact with a previously unfamiliar microbe. These factors are

increasing in prevalence; this increase, together with the ongoing evolution of viral and microbial

variants and selection for drug resistance, suggests that infections will continue to emerge and

probably increase and emphasizes the urgent need for effective surveillance and control.”

(Morse, 1995) Which all must be considered as a hospital executive in drafting a disaster plan for

an infectious disease outbreak in preventing an infectious disease outbreaks by taking into

consideration all health and risk factors on a global scale.

Disaster planning is an integral part of an executive’s responsibility to coordinate an

emergency responsiveness plan for containing an infectious disease plan in a hospital setting.

Delivering healthcare at a higher level can be quite challenging and applying effective leadership

skills to devise a plan to contain an infectious disease outbreak and prevent this disease from

spreading into the community. Preventing infectious requires a team effort and structural

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organization is a must for hospital executives to implement team cohesiveness and properly

informing all hospital personnel and other healthcare officials to perform tasks and contributing

ideas to reducing an infectious disease outbreak such as washing of the hands or appropriate use

of antibiotics. New plans such as the ones suggested can from effective communication skills on

behalf of the hospital executive to communicate effectively these ideas through either personal

reminders, seminars, and as well as evidence based research. Each of these methods can

contribute to the quality improvement of hospital quality care. Quality care improvement can be

obtained from implementing new methods of infectious disease control and using these methods

to treat patients. This information can be obtained through strategic alliances and the sharing of

information can contribute new information and new technology and as globalized healthcare is

an ever present threat to caring for patients. The risk of patients being exposed to diseases that

are not regional or are the result of poor public health initiatives that could all be changed with

an effective disaster plan. The proper disaster plan can help prevent the spread of infectious

diseases by evaluating all possibilities that lead and contribute to this pressing healthcare issue

and the ability of a healthcare executive to solve them.

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