Ebola Frequently Asked Questions For AHS Staff & Physicians

Transcription

1 Ebola Frequently Asked Questions For AHS Staff & Physicians General Ebola Virus Disease (EVD) Information: Q. How is EVD spread? EVD does not spread easily from person to person and is not transmitted through the air. It is spread only through direct contact with bodily fluids or through contact with material contaminated with bodily fluids. Q. What are the symptoms of EVD? A person with EVD compatible symptoms is defined as an individual presenting with fever of 38.6 degrees Celsius AND at least one of the following additional symptoms/signs: malaise myalgia severe headache conjunctival injection pharyngitis abdominal pain vomiting diarrhea that can be bloody bleeding not related to injury (e.g., petechiae, ecchymosis, epistaxis) unexplained hemorrhage erythematous maculopapular rash on the trunk Further resources can be found at: Q. What is the incubation period for EVD? The incubation period is 2 to 21 days. This means that a person can develop symptoms of EVD from 2 to 21 days after being exposed to a person who has confirmed EVD and is showing symptoms of the confirmed EVD. Q. Is 21 days enough time to be sure a person has not acquired infection? 21 days is enough time to be sure a person has not been infected following exposure to EVD. The incubation period, or the time interval from infection to onset of symptoms, is from 2 to 21 days. Infected persons become contagious once they begin to show symptoms. They are not contagious during the incubation period. Q. When is a person with EVD infectious? A person is infectious if they are showing symptoms of EVD. If a person is not showing symptoms, that person is not infectious. Q. Where can I find information on EVD and actions being taken by Alberta Health Services? All AHS staff, physicians and volunteers are encouraged to visit AHS' EVD website at This site is available from anywhere, anytime you do not need to be on the internal network to access it. On this site, you will find details on the procedures and precautions necessary to identify, isolate and manage suspect EVD cases. The site also has links to important references and information. We will continue to post updated guidance and information as the situation evolves. AHS staff and physicians can also call anytime to address questions and concerns about EVD and AHS preparedness. January ECC Approved Page 1

2 Q. Even with all the information available about EVD, I am still concerned. Are there any other resources? We understand this may be a stressful time. And your health and wellbeing is important. Please reach out to your manager, co-workers, or occupational health nurse. If you are in need of personal support, please contact the Employee and Family Assistance Program (EFAP) by calling This service is available 24 hours a day, 7 days a week. January ECC Approved Page 2

3 Ebola Vaccine Q. During the influenza season, AHS provided influenza vaccinations for employees. Will there be vaccinations for EVD as well? There is currently no approved vaccine for the prevention of EVD. There is currently an experimental vaccine under trail, but is not approved in Canada for human use at this time. Q. How many doses of the experimental vaccine does the Government have? Roughly vials of the experimental vaccine will remain in the Public Health Agency of Canada's possession for further research and in the unlikely event it is needed for compassionate use in Canada. (Compassionate use refers to the use of a new, unapproved drug to aid a seriously ill individual, when no other approved options are available.) Travel and Traveller Screening; Quarantine Q. I have plans to travel to a country that has been affected by EVD. Do I need to let anyone at AHS know before I leave? Yes, you will need to notify your local Workplace Health & Safety (WHS) office prior to departure. WHS will want to know about your travel plans and expected return date. WHS will provide you with a symptom diary for daily self-assessment and instruct you on how to use it. You will also be asked to complete a screening tool before you return to work. This tool will guide you in making decisions regarding returning to work and alert you to possible work restrictions. Q. What is Canada doing to address travellers coming from African countries affected by EVD? All travellers identified as having arrived in Canada from an affected West African country will be referred to a Federal Quarantine Officer for a mandatory health assessment. This includes a temperature check and an evaluation of the traveller s relevant medical history and travel history. It may also include a non-invasive physical examination, including an examination of the traveller s head, neck and extremities. Travellers will also be asked whether they feel ill, and if they have been in contact with someone who is ill. Asymptomatic travellers will be given a thermometer and a diary to record any symptoms and their temperature taken twice a day. Public Health will contact them daily for 21 days following the date the traveller left the affected country. Q. I have recently travelled to a country that has been affected by EVD. Should I come in to work? Who should I contact? Before returning to work, please contact your local Workplace Health & Safety (WHS) office. You will be required to monitor yourself for symptoms for 21 days after any contact with individuals with probable or confirmed EVD. While the risk of falling ill is low for those who simply travelled to an EVD affected country without coming into contact with someone with EVD, it is necessary to be aware and attentive to potentially relevant symptoms given the severity of this potential infection. January ECC Approved Page 3

4 PPE & Training Q. What is an Ebola PPE Starter Pack? An Ebola PPE Starter Pack contains Personal Protective Equipment (PPE) intended for use when caring for a suspected or confirmed case of EVD. The purpose is to ensure immediate access to supplies of personal protective equipment that have been endorsed by AHS IPC, WHS, and Critical Care, as necessary for the protection of staff that provide care to patients who have a suspected or confirmed EVD diagnosis. Q. Where will I find the Ebola PPE Starter Packs? All acute care sites have Ebola PPE Starter Packs. EMS also has deployed PPE that aligns with the nature of their services. Q. Should Linen and Environmental Services (LES), Lab Services, and Labour & Delivery (L&D) units be ordering their own PPE? LES, Lab, and L&D units can access the PPE in the Ebola PPE Starter Packs in the Emergency Departments at the designated sites for patient related care, and environmental cleaning. Q. Are Corrections, Community Clinics, Environmental Public Health and Homecare areas going to receive Ebola PPE Starter Packs? For Corrections, Community Clinics, and Homecare, there is no current need for this PPE. Q. Should I open and use the Ebola PPE Starter Pack when there is no suspected or confirmed case of EVD? No. Ebola PPE Starter Packs should not be used for other clinical needs. Sites are to contact their CPSM Site Services representatives for supply needs. Spot audits may be required in the future to ensure Ebola PPE Starter Packs remain on sites unopened/ready for use. Q. How do I replenish the Ebola PPE Starter Packs? Once an Ebola PPE Starter Pack is opened for patient care requirements, IPC, WHS, and CPSM must be notified immediately to ensure training and supply replenishment. CPSM will only send new Starter Packs (as opposed to individual items within a Starter Pack). Each Pack has these instructions attached / included. Q. How do I order PPE supplies for EVD preparedness? Clinical areas are asked to contact their CPSM Zone Leads (see list below) for any supplies pertaining to EVD. This ensures that all purchases can be coordinated and aligned with overall sourcing / purchasing activities. Please Note: due to the surge in demand for particular PPE products, available supplies will be prioritized. CPSM will continue to monitor requisitions for inventory supplies, as well as direct purchase orders. Items which are identified as PPE are being reviewed with the requestors. Items requested for EVD will be redirected to the CPSM Emergency Operations Centre as part of the EVD planning process. CPSM Zone Leads Edmonton Zone: Steve Bowers Steve.Bowers@albertahealthservices.ca Phone (780) North Zone: Bob Dreisbach Bob.Dreisbach@albertahealthservices.ca Phone: (780) Central Zone: Ken Hutchinson Ken.Hutchinson@albertahealthservices.ca Phone: (780) January ECC Approved Page 4

5 Calgary Zone: Aaron Fraser Phone: (403) South Zone: Ryan Thomson Phone: (403) Q. Who will pay for the Ebola PPE Starter Packs? CPSM will only track purchases as part of ECC approved PPE plans (i.e. inventory purchases or specialized equipment submitted for EVD preparations). Funding for PPE will be determined at a later date. Tracking and funding for all other orders will be the responsibility of the purchasing area. Q. For areas that do not normally have hospital-issued scrubs provided for use, how are they to be obtained? Managers should connect with local Linen and Environmental Services (LES) site leadership on the provision of scrubs. LES is working to identify new areas that need supply and will also provide disposal instructions. The sites that do not have hospital-issued scrubs will be sent disposable scrubs, through CPSM. Q. Will I receive any special training and/or equipment to care for patients who may have EVD? Training and education on caring for EVD patients is ongoing. The training you need is dependent on your role. Your manager will advise you of available sessions. You can also find information on telehealth education/training sessions at Q. What training will be provided and where can I obtain training supplies? PPE training is coordinated by IPC and WHS. The availability of training supplies is being coordinated by IPC and CPSM. For information on these training sessions and training supplies, please contact your site IPC. Q. Is AHS requiring Healthcare Workers to wear N95 respirators? Do we have to wear masks and special clothing? The requirement to wear personal protective equipment (PPE), such as N95 respirators, depends on your role. If you will be working in the vicinity of a patient with suspect or confirmed EVD, then you will need to adhere to the AHS PPE requirements for EVD. If an aerosol generating medical procedure is planned or expected, then a fit-tested and seal-checked N95 respirator must be worn. Required PPE will be provided by AHS. Employees who have not already done so will undergo proper fitting prior to use. If you are unable to wear the N95 respirator for medical or religious reasons, please contact your manager for additional discussion and assessment. AHS is regularly reviewing the EVD situation and adhering to the protocol requirements. Q. Will all clothing worn while caring for an EVD patient be provided for staff? Yes, hospital-issued scrub attire will be available for staff caring for possible/confirmed EVD patients. Healthcare Workers should bring a change of clothing to wear home following their shift. AHS scrub attire must not be worn outside of AHS facilities. Q. How accurate and safe are the PPE we are using for EVD? EVD is present in the blood and body fluids of a patient who is symptomatic with the illness, particularly blood and diarrhea. The virus enters the new host through mucous membranes or non-intact skin. There is no evidence that the disease is spread by the airborne route. There is a theoretical risk of transmission during an aerosol generating medical procedure such as January ECC Approved Page 5

6 intubation. We are confident that the recommended PPE will protect the Healthcare Worker from sprays, splashes and aerosols of blood and body fluids, while allowing them to work safely. It is important that all skin remain covered. The Healthcare Worker must wear a fit-tested and seal-checked N95 respirator if in the room during an aerosol generating medical procedure. There are many combinations of PPE that will effectively protect Healthcare Workers while they are caring for patients with EVD. The combination chosen by AHS is based on appropriateness and availability. PPE product may change over time as alternate combinations become available. PPE combinations in other provinces and countries may look different but their purpose is the same. Q. Should we be using the full body suit with airborne precautions and looking at it from worse case scenario? There is no evidence that EVD is airborne, and AHS has a responsibility to all Albertans to recommend policies and procedures that are evidence-based. A one piece coverall PPE is under procurement in AHS and will provide an alternate option for AHS staff. For aerosol generating medical procedures (AGMP), airborne protection is recommended i.e. an N95 respirator. Q. What procedures do staff need to follow when leaving the unit after caring for an EVD patient? Do they need to change clothes and shower? Following their shift, the Healthcare Worker should proceed to a change room to remove hospital issued scrubs. The PPE is very hot and staff will become very wet with perspiration during their shift and may prefer to shower prior to changing into street clothes. While showering following care is not required, shower facilities will be made available to staff caring for EVD patients. Q. What should the Healthcare Worker do if they get visibly contaminated with body fluids while providing care? It is safe to pause and wipe off intact PPE in the room. Intact PPE can be wiped off with disinfectant wipes or absorbent pads while at the bedside. If PPE has been breached or has failed in some way, e.g. ripped, shifted, or sharps damage, the Healthcare Worker must proceed to the doffing area and inform the PPE Buddy of the breach. WHS has developed a breach protocol for Healthcare Workers who have been exposed to blood or body fluids through non-intact or failed PPE, which is available at (under WHS Quick Reference Documents ). Q. Can staff safely eat and drink during their shift? To prevent dehydration and exhaustion it is essential that staff eat and drink following each care episode. Staff is not to eat or drink in the patient room, and are not to eat or drink while wearing PPE. Q. How does the buddy system address the need for monitoring staff caring for an EVD patient to identify the signs of dehydration and exhaustion due to long periods in PPE? Staff wearing PPE must be supervised. The Healthcare Worker must have a co-worker (PPE Buddy) in the same room, or at the very least, visually monitoring from outside the room. As the co-worker may not be in the room with the patient and the Healthcare Worker, the Healthcare Worker must self monitor for signs of fatigue and act accordingly. It is recommended that Healthcare Workers pre-hydrate by drinking fluids shortly before donning the PPE required to enter the patient room. It is also recommended that the Healthcare Worker spend no more than one hour in the patient room prior to exiting for rest and rehydration. The Healthcare Worker January ECC Approved Page 6

7 must identify when they are becoming fatigued or overheated while wearing the PPE and indicate to the co-worker when they wish to exit the patient room. The Healthcare Worker is ultimately responsible for his or her own safety while in the room. Q. What is the role of the PPE Buddy? A PPE Buddy is required to support and assist with PPE donning and doffing procedures of the Healthcare Worker and others. The PPE Buddy is also required to directly supervise and monitor the wellbeing of the Healthcare Worker and others present in the patient s room. The PPE Buddy may be in the same room as the Healthcare Worker, or at the very least, visually monitoring from outside the room. Patient care is not to be provided by the PPE Buddy. Any visitor will be required to wear PPE donned and doffed under the direction of the PPE Buddy who must first attend to AHS staff entering or exiting the room. A visitor cannot be left unsupervised in the patient s room, and is to be monitored by the Healthcare Worker and the PPE Buddy. January ECC Approved Page 7

8 Workplace/Human Resource Concerns Q. Who do I contact if I have concerns about a safe work environment? Please speak with your manager first if you have concerns about your work environment. Your manager may be able to support you with additional training and education. If you have additional concerns or feedback, please AskHR@albertahealthservices.ca Q. What happens if I am exposed to EVD, become ill, and am unable to work? The risk of EVD coming to Canada is considered very low. However, in the event that an AHS employee becomes ill, regardless how EVD was contracted, the employee will be restricted from work for the duration of their illness. Their return to work will be assessed on a case-bycase basis in consultation with a Medical Officer of Health and a Workplace Health & Safety physician. Employees may access their applicable sick leave, disability benefits or WCB benefits for the illness, in accordance with the applicable terms and conditions covering such leave or benefits. Q. I am in regular contact with patients. If I am exposed to EVD at work and become ill, would I be covered by WCB? You are required to advise your local Workplace Health & Safety office of any work-related exposures, so that AHS can ensure the situation is reported in a timely manner to WCB. WCB will make any decisions with respect to WCB coverage and benefits. Q. Will employees be reassigned to work in other units or sites if an EVD outbreak occurs? An outbreak of EVD is extremely unlikely in Alberta. That being said, in the unlikely event of an outbreak, if necessary, employees may be redeployed to other units at the same site provided they have had the appropriate orientation to be able to safely provide care. Redeployment will depend on the nature of the outbreak and sites/units impacted. Q. Can I refuse to provide care to an infected patient? Or, can I refuse to come into work or request to work in another area? We are confident that staff will continue to act with the utmost professionalism when it comes to caring for Albertans. Your health and safety is important to us and we are ensuring that you have the proper training and resources to do your jobs and provide proper patient care. AHS staff are expected to continue working, unless a situation presents an imminent danger to worker health and safety. AHS staff are also expected to report to management any workplace safety hazards. Every worker in Alberta has the right to refuse unsafe work in accordance with section 35 of the Occupational Health and Safety Act ( Worksafe Alberta provides guidance to workers about their responsibilities for safety in the workplace, including the right to refuse unsafe work ( If you are concerned for your personal health and safety, and have sufficient and reasonable grounds that you are at risk of contracting EVD, please discuss this with your manager as this is the first step required in addressing the potential of imminent danger or workplace safety hazards. At the request of your manager, AHS Workplace Health & Safety will review your concerns. They will identify any hazards and areas that may need to be addressed to ensure your safety. You will be informed of redeployment if it is deemed necessary for the safety of employees. Q. What are my rights in regards to refusal to care for infected patients? Employees should contact their immediate supervisor to discuss concerns and rationale why they feel unsafe looking after an EVD patient. In order to refuse unsafe work, the employee January ECC Approved Page 8

9 must have a belief based on reasonable and sufficient grounds that there is an imminent danger to their health if the employee continues working. The Manager will then immediately investigate and ensure that all necessary controls are in place. The Manager may use discretion to temporarily reassign the employee to another position or work area until the review has been completed and the potential hazard mitigated. These steps are in accordance with a worker s right to refuse unsafe work under section 35 of the Occupational Health and Safety Act ( Q. If my job requires me to care for patients who may have EVD do I receive any additional compensation? Will my schedule change or will I have to work overtime? No, there will be no additional compensation (for example, there will be no danger or hazard pay ) for employees who are directly caring for patients with EVD. Your schedule and any overtime will be handled according to your collective agreement or terms and conditions of your employment. AHS aims to minimize disruption to employee work schedules and daily routines. If it is necessary to temporarily adjust schedules or re-assign staff to other units, every attempt will be made to provide you with as much notice as possible. Q. Have unions been involved with any EVD planning and preparations at AHS? Yes, representatives from the United Nurses of Alberta, Health Sciences Association of Alberta, and Alberta Union of Provincial Employees have been contacted by AHS and informed of AHS preparations. Q. I am pregnant and do not want to work in an area where I am in contact with a patient who may have EVD. What options do I have? If you have any questions about working while pregnant, including the ability to wear PPE properly due to your pregnancy, we encourage you to discuss this with your manager. As long as proper infection control procedures are followed, including the use of PPE, you can continue to work safely. If you are unable to properly wear PPE during your pregnancy, you may be reassigned or have your work assignments adjusted as part of appropriate accommodation. Q. I have a medical condition that prevents me from using protective personal equipment (PPE). Will I be accommodated and assigned to work in another area until I can return to my regular position? If you have a medical condition (that is supported by medical confirmation from your physician), your situation will be reviewed and appropriate accommodation will be implemented, which may include reassignment to a temporary position. Each situation will be separately assessed by your manager and Human Resources. January ECC Approved Page 9

10 Clinical Care of the Patient Q. Should there be expanded history taking at triage to find out if accompanying family members are symptomatic and then take all symptomatic members to a treatment room for further assessment? All accompanying family members need to be asked about fever/relevant travel. All symptomatic patients are taken into the Department for further assessment. Q. Should only one family member accompany the patient into the Emergency Department / Urgent Care Centre (ED/UCC)? Only one family member may accompany the patient into the ED/UCC. Other accompanying family members may go home AFTER the ED/UCC records their names and contact information in case Public Health needs to do any monitoring and surveillance. Q. Should other accompanying family members be kept in a private waiting area until further directions are received? There is no need to keep accompanying family members in a private waiting area until further directions are received. Other accompanying family members may go home AFTER the ED/UCC records their names and contact information in case Public Health needs to do any monitoring and surveillance. Q. Does the door to the room where a suspect/confirmed EVD patient is present need to be closed at all times? A closed door is required during aerosol generating procedures. While Airborne Precautions are not required at other times, a closed door will minimize unnecessary entry into a suspect/confirmed EVD patient s room by visitors and non-authorized persons. Q. Can you cohort patients in the same room? No, suspect or confirmed EVD patients must not cohort (be grouped together or associate) in the same room. Q. After admission, can family and visitors be at the bedside with a possible or confirmed EVD patient? Visiting of patients hospitalized for EVD should be discouraged. Other strategies to maintain contact, such as Skype, should be considered. With informed consent, ONE adult could be permitted to visit an EVD patient on a case by case basis, e.g., spouse, or parent / guardian of an ill child. The visitor will be required to wear PPE donned and doffed under the direction of the PPE Buddy who must first attend to AHS staff entering or exiting the room. A visitor cannot be left unsupervised in the patient s room, and is to be monitored by the Healthcare Worker and the PPE Buddy. A visitor must not be present during aerosol generating procedures because fit testing for an N95 respirator will not have been done. The visitor must be informed that by visiting the EVD patient, he/she becomes an exposed contact requiring surveillance for 21 days after the last visit. The Public Health Act would not likely be invoked to prevent visitation. Q. What are the protocols if an EVD patient presents in labour? All patients who meet the criteria for patient under investigation for EVD, including women in labour, must be transferred to a designated site, even those requiring immediate care. All Emergency Departments, Urgent Care Centers, and EMS response teams are to be prepared to provide basic care to potential EVD patients. We are confident the recommended wet PPE will January ECC Approved Page 10

11 protect the Healthcare Worker assisting with delivery of an infant. Contingency plans have been developed between Women s Health Programs, Emergency Departments and AHS designated sites. Q. As far as triage is concerned, would it be possible / beneficial to triage patients outside the ED/UCC in tents? Given the very low risk of EVD in Alberta, there is no need to institute the use of tents as an external triage location. AHS is focused on educating and training staff. The use of the tents remains within the AHS Pandemic Plan, as a contingency, should they be required. Q. Is it safe to use a stethoscope? No, if a Healthcare Worker is wearing full Wet PPE, or coverall suit with hood it is impossible to use a standard stethoscope as the Healthcare Worker should not touch, shift or manipulate their head and facial PPE while in the room. The use of a standard stethoscope presents a clear risk to the Healthcare Worker of contracting EVD. Electronic vital signs monitoring is to be used, where clinically indicated. These devices should be dedicated to the patient and must stay in the room for the duration of care. Q. How should aggressive patients be handled? Use of restraints and sedation should occur in accordance with existing clinical protocols for aggressive or delirious patients. If an employee feels unsafe looking after an EVD patient for this reason, the employee should contact his or her supervisor in accordance with work refusal process. January ECC Approved Page 11

12 Environmental Services Q. How long can EVD survive in the environment? The ability for EVD to survive outside a living organism is not well-understood. In general, survivability depends on temperature, humidity and presence of organic matter. Under experimental conditions, the virus has been found to survive for variable periods of time in the environment. Q. Are there directions for waste disposal and what biohazard bins should sites use? The current AHS Waste Management Guidelines can be found at As new information becomes available, information in the AHS Waste Management Guidelines may change. Q. If equipment in the isolation room needs medical device reprocessing, what protocols have been put in place? Disposable patient care items should be used whenever possible and disposed in the biohazardous waste specified bin in the patient s room. Reusable patient care items and medical devices must stay in the room until they can be decontaminated appropriately by trained Healthcare Workers. Infection Prevention and Control staff must be consulted prior to removal of any non-critical, semi-critical or critical reusable equipment from the room. The standard procedures with respect to containment, transportation and decontamination of reusable patient care items and medical devices will be followed. The current standards of practice for cleaning, disinfection and sterilization are adequate to inactivate the virus and prevent transmission. Q. Does AHS have specific non-permeable body bags without zippers for deceased patients who died while symptomatic with EVD? AHS recommends the current body bag product (fluid impermeable with zipper). The deceased s body will subsequently be placed in a hermetically sealed container. January ECC Approved Page 12