Standardized Screening Process for Ebola Virus Disease (EVD) and Emerging Disease Screening (EDS)

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1 For Texas Health entities, THPG practices, physicians on the medical staff, and Joint Ventures Table of Contents Emerging Diseases Screening... 2 Isolation Precautions for Ebola and MERS-CoV and Checklist for EVD Initial Assessment... 4 Key Contacts/Phone Numbers... 5 Attachments: CareConnect Screening, Documentation, and Reporting Tools THR-approved Emerging Diseases Paper Screening Form (All attachments can be found at the Ebola Resource Center) 1

2 Guiding Principles for any potential infectious disease patient: Care and safety of the patient come first. If the patient screens positive it is best practice to do the interventions necessary for good care and safety of the patients/staff then come back and document when appropriate. It is extremely important to stop the potential spread of infectious pathogens. As soon as the potential is identified, immediately begin the steps to isolate the patient, protect the staff, notify the necessary providers, and initiate care. It is better to initiate precautions! As soon as the patient is deemed not a potential infectious disease risk the precautions can be stopped. Better to be safe! Most patients will screen negative and no further action will need to be taken. Screening MUST be done on all patients to keep the population safe. CareConnect documentation does not take the place of verbally notifying the physician, Infection Prevention, or any other necessary people of a potentially infectious patient. Emerging Disease Screening The following process should be followed when evaluating patients with suspected emerging diseases: For areas that use CareConnect The expectation is the Emerging Disease Screening tool in CareConnect will be initiated by clinical staff on arrival for all patients at every visit (admissions area does NOT conduct screening). This includes all emergency departments, all inpatient areas, ambulatory, outpatient, procedural, and imaging areas. The Emerging Disease Screening tool asks questions about both Ebola and the Middle Eastern Respiratory Syndrome-Corona Virus (MERS-CoV). The answers to the questions in CareConnect may trigger additional required actions. The alerts are dependent on the documented answers to the required questions. For clinical areas that do NOT use CareConnect The Emerging Disease Screening Questionnaire (attached) is used to screen all patients at every visit. Any CareConnect area MUST use the Emerging Disease screening tool in CareConnect. All patients that come for treatment or testing must be screened face-to-face by a clinician. Telephone screening is not appropriate. The patient is not to fill out this form on their own. The clinician must ask the questions. Admissions/Patient Access Services personnel should not perform screening. (This includes but is not limited to unit secretaries, volunteers, or other clerical staff). The paper form should be utilized only in areas that do not use CareConnect to document. 2

3 The paper form should not to be used as a pre-careconnect tool. The paper form should not be used in the admission paperwork process. The person who fills out the form must sign, date, and time the form. Visitors should not be screened. The form must have the patient ID sticker placed appropriately to correctly identify the patient. Do not make copies of the form. The form needs to be printed out as an original for each use. The form is available on the Ebola Resource Center. The completed form should be sent to HIM as part of the medical record. Do not shred these forms. This paper tool will be part of the downtime packet. There will be a specific form for Inpatient downtime and for Ambulatory downtime. Both the CareConnect tool and the paper tool are based on CDC guidelines and recommendations. Since the CDC is continuing to update its guidelines, please expect the tools to be modified as necessary to meet any new requirements. In some cases the THR tools may be more stringent than the CDC recommendations. Emerging Disease Screening symptom guidelines: The most important symptom is a fever. This includes patient report of a fever, feeling feverish, feeling chilled, sweating, diaphoresis, or any description of fever by the patient. There does NOT have to be an exact measured reading on a thermometer to count as a fever. The patient should also be asked if they have taken any fever-reducing medications (acetaminophen, ibuprofen, etc.). Ebola symptoms are: Fever (report or actual temp of or greater), severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, bleeding/hemorrhage. MERS-CoV symptoms are: Fever, acute respiratory distress, shortness of breath, dyspnea, chills, rigor, headache, non-productive cough, myalgia, sore throat, coryza, sputum production, nausea, vomiting, diarrhea, abdominal pain, runny or stuffy nose, dizziness. 3

4 Ebola Isolation Precaution Indications: High Level Precautions with appropriate personal protective equipment (PPE) (see the Donning and Doffing instructions) should IMMEDIATELY begin for any patient that: 1. Traveled to an Ebola-affected country (especially the countries of Sierra Leone, Liberia, Mali, Guinea, Republic of the Congo) in the last 21 days and fever/symptoms are present. OR 2. Has been exposed to or in contact with any person or human corpse known or suspected of having Ebola and fever/symptoms are present. Middle Eastern Respiratory Syndrome-Corona Virus (MERS-CoV) Precaution Isolation Indications : Standard, Contact, and Airborne precautions with Eye Protection (face shield) should IMMEDIATELY begin for any patient that: 1. Traveled to an MERS-CoV -affected country (Saudi Arabia, Qatar, Jordan, United Arab Emirates, Tunisia, Bahrain, Palestinian territories, Iraq, Iran, Kuwait, Israel, Lebanon, Oman, Syria,Yemen) in the last 14 days and fever/symptoms are present. OR 2. Has had exposure/contact with any person known or suspected of having MERS-CoV and fever/symptoms are present. If the presenting patient meets any of the Isolation Indicators, the appropriate CDC recommendations should be implemented immediately. Questions If you have questions related to these guidelines, please contact your nursing supervisor. Frequently Asked Questions, including your role when faced with an Ebola-risk patient, can be found on the Ebola Resource Center. Key Phone Numbers CDC Hotline CDC-INFO ( ) Tarrant Co. Health Dept during business hours after hours Dallas Co. Dept. of Health and Human Services Outside of Tarrant and Dallas counties, call the Texas Department of State Health Services: Lisa Cornelius, M.D., office, (512) mobile Marilyn Felkner, office, mobile 4

5 CareConnect Screening Information The Emerging Disease Screen content in CareConnect has been developed from the CDC guidelines, Infection Prevention recommendations, and THR leadership requests. The tool is designed to work within the available functionality. In the event of a CareConnect downtime, the paper screening tool is considered the downtime documentation form for the Emerging Disease Screening. Training and Updates Please look in What s New for any updates or changes to the CareConnect build for the Emerging Diseases Screening tool or any of its alerts, reports, or other components Training and screen shots of the Emerging Diseases Screening workflow are posted on the What s New site 5

6 Sample form below. Please find actual form on Ebola Resource Center. Sample form above. Please find actual form on Ebola Resource Center. 6