EBOLA PLANNING BASICS. John Carter RN, EMT-P, MPA

Transcription

1 EBOLA PLANNING BASICS John Carter RN, EMT-P, MPA

2 OBJECTIVES List the components of a hospital Ebola plan Evaluate the adequacy of personal protective equipment available to your facility Discuss the resources available for Ebola planning Provide input through the facilitated discussion portion of the presentation

3 FORMAT OF PRESENTATION Discussion of Plan Components Brief Discussion of PPE Issues Review of Resources Facilitated Discussion

4 WHAT IS EBOLA? Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees). Ebola viruses are found in several African countries. Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa.

5 WHAT ISN T EBOLA?

6 THE SIMPLEST WAY OF LOOKING AT IT Ebola is a blood-borne pathogen and infectious disease Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with: Blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola Objects (like needles and syringes) that have been contaminated with the virus Infected fuit bats or primates (apes and monkeys)

7 PRE-HOSPITAL PLANNING Public Safety Answering Point (PSAP) screening questions Appropriate dispatch information relayed to responding units Response plan Who goes? Ambulance preparation Appropriate PPE? Patient contact Patient screening and assessment

8 PRE-HOSPITAL PLANNING Appropriate destination Communication to receiving hospital Exposure control protocol Employee monitoring Are employees out of service? Are they paid?

9 COMPONENTS OF A HOSPITAL EBOLA PLAN

10 BEFORE WE START Respiratory Protection Program is in place Employees are cleared to wear PAPR Appropriate PPE is available for employees Appropriate training needs to be provided to all staff for each section of the plan

11 OVERVIEW Describes purpose and scope of plan Can be fairly brief

12 ASSUMPTIONS What do we know? Currently outbreak in Africa (Guinea, Sierra Leone, Liberia) Cases in the U.S. are possible Cases in Houston are possible

13 EMERGENCY DEPARTMENT

14 TRIAGE Appropriate signage Triage protocols (DSHS triage flowchart on next slide) Case definitions (using CDC guidelines)

15

16 CONSIDERATIONS What happens when a patient that is highly suspect wants to leave? How does that change if the diagnosis is confirmed?

17 MOVEMENT TO ED TREATMENT ROOM Where are we putting the patient? How do we get them there? Who will take care of the patient? What PPE will be worn based on probability of Ebola? Visitors?

18 IN AN IDEAL WORLD. Private room with bathroom Anteroom is highly preferable (for PPE doffing) Appropriate signage outside room Nearby room available for PPE donning

19 NOTIFICATIONS When do we pull the trigger? Who do we notify? Infection Control Laboratory County/State Health Department Administration Public Information Officer

20 PATIENT TREATMENT Personal Protective Equipment (more on this later) Treatment protocols, including differential diagnoses What procedures will be performed? How will labs be drawn? What happens if the patient crashes?

21 STAFF CONSIDERATIONS For both ED and Inpatient: How will staff be assigned? How long will staff work in PPE? What information will they be given?

22 CONFIRMATION How long will it take to get lab results? What are we doing with the patient while we re waiting? Who gets notified (that hasn t already been)?

23 PATIENT TRANSFER How long will it take? Is there a bed available? Is the patient stable? How do we arrange transfer? Who is responsible for arranging transportation?

24 INPATIENT TREATMENT Where do we put them? Who will be on the treatment team? What procedures will be done? How will visitors be restricted? Movement within hospital

25 CLEANING/DISINFECTION Disposal of contaminated medical waste Laundry Room cleaning Cleaning of durable equipment WHO Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola

26 POST MORTEM CARE (CDC) Body should be wrapped in plastic shroud, preventing contamination of the outside of the shroud Leave IV lines or ET tubes in place Avoid washing/cleaning body Place shrouded body in leak-proof plastic bag not less than 150 μm thick with zipper Place bagged body in another leak-proof plastic bag not less than 150 μm thick and zippered closed before being transported to the morgue

27 POST MORTEM CARE (CDC) Prior to transport to the morgue, perform surface decontamination of the corpsecontaining body bags by removing visible soil on outer bag surfaces with EPAregistered disinfectants which can kill a wide range of viruses. Follow the product s label instructions. After the visible soil has been removed, reapply the disinfectant to the entire bag surface and allow to air dry.

28 OCCUPATIONAL HEALTH Symptom tracking Monitoring exposures Monitoring for acute illness

29 WHAT ELSE?

30 PERSONAL PROTECTIVE EQUIPMENT

31 PERSONAL PROTECTIVE EQUIPMENT Individuals should have appropriate training and demonstrated ability to don and doff PPE in a safe manner A Trained Observer should be present at all times Use an assistant if possible

32 HEALTHCARE PROVIDER PPE Emergency Preparedness Consulting of TX, LLC recommends that the minimum level of protection should include: Appropriate inner clothing and footwear Gloves (always at least 2 pairs) Impervious Tyvek suit Surgical mask PAPR with appropriate filter(s) and full hood If applicable, outer gown and third pair of gloves

33 TRAINED OBSERVER PPE CDC Recommendations: Single-use (disposable) fluid-resistant or impermeable gown that extends to mid-calf, or protective suit Single-use (disposable) full face shield Single-use (disposable) nitrile examination gloves with extended cuffs (2 pairs) Single-use (disposable) fluid-resistant or impermeable shoe covers Our recommendation: Same as HCP if observer is in patient care area Same as Assistant if NOT in patient care area

34 3M BE-10 PAPR

35 3M AIRMATE

36 NOT PREFERRED, BUT COULD WORK

37 BEST CHOICE

38 PPE CONSIDERATIONS Will you use BE-10 or Airmate? How many do you have? How many filters? If using disposable hoods, how many hoods? Consider the cost of buying enough filters against cost of buying Tyvek suits, gloves, gowns, face shields

39 PLANNING RESOURCES

40 RESOURCES CDC World Health Organization Texas Department of State Health Services

41 EMORY UNIVERSITY Basic plan (29 pages with a lot of PPE guidance) Extensive appendices (55 pages)

42 APPENDICES TO EMORY PLAN Occupational Injury Management Protocol Direct Healthcare Provider Symptom Questionnaire PPE and Cleaning Supply List Portable X-ray Process PPE Matrix

43 APPENDICES TO EMORY PLAN Standard Operating Procedures for Unit Donning and Doffing Procedure Waste Management Protocol Management of Contaminated Durable Equipment Lab Protocols Patient Management from Dirty to Clean Room

44 FACILITATED DISCUSSION

45 John Carter RN, EMT-P, MPA