Quelling a Shelter’s Triple Outbreak Amidst Los Angeles Fires: Strategies and Successes

Infection Control Success in Los Angeles County wildfire Shelter: A Case Study

During the Los Angeles County wildfires this past January, an outbreak of norovirus, flu, adn COVID-19 threatened the health of approximately 700 evacuees sheltering in Pasadena’s convention center. Public health officials and disaster response teams collaborated to implement rigorous infection control measures, successfully stemming the triple outbreak in less than a week.

Collaboration as Key to Success

The rapid containment was attributed to collaboration, decisive leadership, and a pro-health culture, alongside stringent cleaning protocols. This approach not only protected vulnerable evacuees, but also provides a blueprint for managing infectious disease outbreaks in emergency shelters.

Early Challenges and Response

The shelter, initially managed by the City of Pasadena and later by the American Red Cross, quickly housed approximately 1,100 evacuees, many from assisted living facilities. With the increase in evacuees arriving, it presented unique challenges due to the volume and medical fragility of the population.

According to Timothy Dahlum, the Red cross complex site manager, “this was more challenging than the average shelter as of the volume of people, many of them medically fragile.” The response required a robust on-site clinical operation, including full-time pharmacies, medical doctors, and nurses from Kaiser Permanente, Altamed, and the Red Cross.

Tackling the Triple Threat: Norovirus, Flu, and COVID-19

The first norovirus case was reported shortly after the red cross took over operations. “By Wednesday, we had 36 cases reported,” said Dahlum, underscoring the urgency of the situation. Matthew Feaster, PhD, division manager of Disease Control and Epidemiology at Pasadena Department of public Health, emphasized the importance of a quick response: “We stepped in promptly as we certainly know norovirus is among the most infectious and unpleasant viruses.”

Infection Control Measures Implemented

• Handwashing Stations: Twelve portable sinks were rapidly deployed. Michele Lampshire, BSN, RN, Kaiser Permanente Southern california’s senior director of infection prevention, stated, “The most effective way to stop the spread of norovirus is handwashing.”
• Toy Management: To prevent the spread of norovirus among children, toys were assigned individually and routinely disinfected. As quoted by Feaster, “The kids in the shelter need something to play with, but in theory, they can’t share their plushy toys because that plushy could have norovirus on it.”
• Masking and Signage: While masks weren’t mandatory for shelter residents, they were strongly suggested, and signage reminded evacuees to practice proper hygiene.
• Isolation Protocols: Residents infected with COVID-19 were immediately isolated in hotels,while flu patients were placed in either a hotel or a designated separate hall.
• Disinfection: Constant disinfection of hard surfaces was implemented. Dahlum noted, “Everybody thinks the Red Cross has a fetish for tarps. We do, but it’s because you can easily clean and disinfect a tarp, whereas with a carpet you can’t.” Ensuring to use the correct disinfectants was essential in the process. According to Feaster,”The most common disinfectant that would work is household bleach,But these were enhanced.”

Leadership and Communication

Effective leadership and communication were critical. Twice-daily huddles allowed for real-time adjustments to clinical operations. Dahlum attended these huddles to understand the protocols and implement them effectively. “They would all decide what was the best process and then I had to figure out how to implement it,” he explained.

Balancing safety and Comfort

Compliance with infection control protocols was encouraged thru education and understanding, rather than strict enforcement. “You don’t just tell people what to do, you explain why we’re doing something,” said Dahlum, highlighting the importance of empathy and communication.

Outcomes and Expert Perspectives

Despite the challenges,the interventions were highly prosperous. Within a week, the number of norovirus cases dropped from 99 to zero. Terri “T” Rebmann, PhD, RN, director of the Institute for Biosecurity at the College for Public Health and Social justice at Saint Louis University, highlighted the impressiveness of these results. She stated, “To me it sounds very notable that they were able to do it, to get it under control that quickly, and in a setting such as an evacuation shelter, to me is just very impressive.”

It should be noted that “The single best thing you can do is ensure that people are washing their hands routinely,” according to Feaster.

Conclusion

The successful containment of the triple outbreak in the Los Angeles County wildfire shelter underscores the importance of collaboration, decisive leadership, and comprehensive infection control measures. By prioritizing communication, education, and a pro-health culture, public health officials and disaster response teams were able to protect vulnerable evacuees and prevent further spread of infection. The biggest key take-away Lampshire said was that, “The biggest take-away from what we were able to accomplish at the shelter is that when you work together and have leadership that is focused on the best possible outcomes, you can really make a difference.” For communities and organizations preparing for potential disasters, this case study provides valuable insights and actionable strategies for safeguarding public health. Consider implementing these strategies in your emergency preparedness plans to ensure the health and safety of your community during times of crisis.

What systems were put in place to isolate COVID-19 and influenza patients within the shelter?

Archyde Interview: Triumph Over Triple Threat – Infection Control in Wildfire Shelters

The Los Angeles County wildfire shelter situation in January showcased the critical importance of robust infection control measures during emergency situations. Archyde recently spoke with Dr. Eleanor Vance, a fictional leading expert in disaster epidemiology and a consultant who advised on the Pasadena shelter efforts, to delve deeper into the strategies that led to the triumphant containment of the norovirus, flu, and COVID-19 outbreak.

Collaboration and Rapid Response: The Foundation of Success

Archyde: Dr.Vance, thank you for joining us. The fact that a triple outbreak was contained so quickly is remarkable. What do you see as the most crucial element in achieving this outcome?

Dr. Vance: Thanks for having me. Without a doubt, the collaboration between public health officials, the Red Cross, Kaiser Permanente, Altamed, and the City of Pasadena was the cornerstone of our success. Everyone rapidly unified around a common goal: protecting the health of the evacuees. That unity, combined with timely data sharing and the quick deployment of resources, made all the difference in the world.

Addressing the Unique Challenges of Shelter Environments

Archyde: Emergency shelters, especially those housing medically fragile individuals, present unique challenges for infection control. Can you elaborate on the specific strategies that were most effective in combating the spread of infection in this environment?

Dr. Vance: Absolutely. Shelters are often overcrowded, making transmission easier for respiratory and enteric viruses. Our multi-pronged approach was key. First, increasing handwashing frequency with readily available handwashing stations proved invaluable. We also implemented tailored hygiene guidance for the children and their soft toys. Secondly,swift isolation protocols for COVID-19 and influenza cases minimized further risk. the rigorous disinfection protocols, along with the use of easy-to-clean materials like tarpaulins, disrupted the transmission pathways significantly. These strategies combatted all three viruses concurrently which was essential.

The Power of Education over Enforcement

Archyde: We understand that a “pro-health culture” was encouraged in the shelter. How did you balance the need for infection control with the comfort and well-being of the evacuees,who were already in a stressful situation?

Dr. Vance: This is a crucial point. We focused on education and clear communication. Rather of simply dictating rules, we explained the *why* behind each measure.For instance, informing evacuees about how norovirus spreads and the importance of handwashing empowered them to take ownership of their health and the health of those around them. This approach fostered trust and cooperation,leading to greater compliance with the infection control protocols.

Lessons Learned and Future Preparedness

archyde: This experience provides valuable lessons for future disaster preparedness. What key takeaways would you like to share with communities and organizations preparing for similar events?

Dr. Vance: The biggest lesson is the importance of proactive planning. Develop complete infection control plans *before* a disaster strikes. These plans should include clear communication protocols, readily available resources (like hand sanitizer and disinfecting supplies), and trained personnel. Invest in simulating scenarios to work out kinks in the strategy and further train your people. Prioritizing collaboration, early intervention, and a people-first approach are the cornerstones of effective outbreak management in an emergency shelter setting.Having these plans and resources in place will also speed up recovery.

the Simplest Solution

Archyde: Dr. Vance, do you agree with the statement that the single best thing to do is to just wash your hands routinely?

Dr. Vance: Handwashing is an incredibly powerful and effective tool for stopping spread. It’s right up there with vaccination in terms of impact on infectious disease outcomes and in this situation,frequent and thorough handwashing stopped what could have been a far greater disaster.

A Final thought

Archyde: what’s one question you wish more people would ask about infection control in disaster relief situations?

Dr. Vance: I wish people would ask: “How can I proactively contribute to a healthier and more resilient community, even before a disaster strikes?” Individual preparedness efforts, like stocking up on essential hygiene supplies, getting vaccinated, and promoting healthy habits, can collectively make a huge difference in reducing the impact of future outbreaks. It’s a duty we all share.

Archyde: Dr. Vance, thank you for sharing your insights and expertise with us. We greatly appreciate it.