Empowering Emergency Disaster Coordinators: APIC's Guide to Infection Prevention in Shelters Amid Disasters

Emergency shelter

(Adobe Stock 434290093 By elmar gubisch)

With the increasing frequency of natural disasters like hurricanes, tornadoes, and forest fires, individuals in temporary shelters face elevated infection risks.

The Association for Professionals in Infection Control and Epidemiology (APIC) has revised its federal, state, and local infection prevention guide for emergency coordinators. Titled "Infection Prevention and Control for Shelters during Disasters," this guide, compiled by APIC’s Emerging Infectious Diseases task force, offers detailed guidelines to help coordinators safeguard displaced individuals and shelter staff from prevalent infectious diseases, encompassing gastrointestinal, skin-related, and respiratory concerns.

To learn more, Infection Control Today^® (ICT^®) asked Terri Rebmann, PhD, RN, CIC, FAPIC, lead author of the updated resource and a member of APIC’s Emerging Infectious Diseases task force, to explain more about the changes from the original document and what emergency disaster coordinators need to know if traditional infection preventionists aren’t available.

Rebmann is also the director of the Institute for Biosecurity, an adjunct professor in the Department of Epidemiology & Biostatistics at the College for Public Health & Social Justice at

Saint Louis University in Saint Louis, Missouri.

ICT: Can you elaborate on the specific updates made in the 2024 version of the APIC guidebook compared to the original 2009 document, particularly regarding personal protective equipment (PPE) optimization and infection prevention in medical/first aid areas?

Terri "T" Rebmann, PhD, RN, CIC, FAPIC: The original 2009 document had outlined priorities for allocating PPE when supplies are insufficient or depleted. Little was known about that topic when the original APIC guidebook was published. During the COVID-19 pandemic, the CDC developed new guidelines for allocating PPE when supplies are insufficient or depleted. However, these guidelines were updated a few times during the pandemic as the science evolved. Rather than including the current CDC guidelines on optimizing PPE use, the 2024 APIC guidebook instead refers readers to the CDC website to find the current version of guidelines. This was done because the authors of the APIC guidebook worried that the PPE guidance would be outdated soon after the guidebook was published. It made more practical sense to refer individuals to the CDC site, which always has the most updated guidelines.

The section on infection prevention in medical/first aid areas was developed because the original 2009 document did not address that issue. In the 2009 document, there was a single set of guidelines for all shelter areas, regardless of whether or not medical care was provided in that space. The team revising the 2024 guidelines realized that there needed to be a clear distinction about which interventions were needed in the medical area of the shelter vs the main part of the shelter where individuals slept/stayed because there is a higher risk of infection transmission in areas where health care of any kind is being delivered. In addition, the team found newer guidance about using environmental disinfectant products for medical and nonmedical areas that needed to be incorporated into the guidance.

ICT: Given the increasing frequency and intensity of natural disasters, how crucial is it for emergency disaster coordinators to incorporate infection prevention and control measures into their disaster planning, especially when onsite infection prevention experts are unavailable?

TR: Shelter managers must incorporate infection prevention and control measures into disaster planning because we have strong evidence that shelters can be associated with outbreaks of communicable diseases. It is important to implement mitigation strategies to minimize disease spread in shelters, especially during the respiratory virus season in the fall and winter months. The APIC guidebook for shelters is designed to be implemented regardless of whether an infection prevention expert is available onsite. It is written in a way that allows noninfection prevention experts to understand and implement the control measures to help create a safe environment within the shelter.

ICT: The guidebook emphasizes the importance of tracking infections within shelters. Could you discuss the significance of the added log/report feature and how it contributes to better managing and controlling infectious diseases during disasters?

TR: The log was developed to aid shelter workers in keeping track of potentially contagious individuals within the shelter. This can help identify if a small cluster of cases or an increasing trend in cases is occurring within the shelter; this could signify the start of an outbreak in the shelter. It can also help with contact tracing (identifying if someone has potentially been exposed to a communicable disease) if needed.

ICT: In the context of both natural disasters and humanitarian crises, the guidebook addresses the challenge of limited supplies. How does the updated version guide on optimizing PPE when resources are scarce, and what key considerations are highlighted?

TR: The original guidebook outlined extensive protocols for allocating PPE, such as masks and respirators, when supplies are dwindling or depleted. Little was known about that topic when the original APIC guidebook was published. During the COVID-19 pandemic, the CDC developed new guidelines for allocating PPE when supplies are insufficient or depleted. However, these guidelines were updated a few times during the pandemic as the science evolved. Rather than outlining the current CDC guidelines on optimizing PPE use within the guidebook, the 2024 APIC guidebook instead refers readers to the CDC website to find the current version of guidelines. This was done because the authors of the APIC guidebook worried that the PPE guidance would be outdated soon after the guidebook was published, and we did not want readers to use outdated guidelines. It made more practical sense to refer individuals to the CDC site, which always has the most updated guidelines available. We chose to do this because PPE optimization is an area of ongoing research and protocol development.

ICT: The guidebook now includes information on managing linens, universal masking, ventilation considerations, quarantine, and sanitation planning. How do these additions enhance emergency disaster coordinators' overall preparedness and response capabilities in safeguarding displaced residents during crises?

TR: These new sections were added because the team revising the guidelines realized that these topics had either not been mentioned or addressed in the first version or were not covered sufficiently. In addition, some of the new sections address newer science that evolved during the COVID-19 pandemic, such as the critical role that universal masking or ventilation can play in helping to minimize disease spread in crowded or indoor spaces. Adding this new guidance helps shelter managers develop a more comprehensive emergency management plan, which should help further minimize the risk of disease spread within the shelter.