Prince County Hospital for Screening and Management of Patients with Suspected or Confirmed Ebola Virus Disease:

Transcription

1 Prince County Hospital for Screening and Management of Patients with Suspected or Confirmed Ebola Virus Disease: The current outbreak of Ebola Virus Disease (EVD) is in West Africa. There have never been any cases of Ebola in Canada. The World Health Organization (WHO) continues to monitor the evolution of the EVD outbreak in Sierra Leone, Liberia, Guinea, and Democratic Republic of the Congo. IPC measures included in this guidance are based on currently available scientific evidence and guidelines and are subject to review and change as new information becomes available. It should be noted that the PPE worn by health care providers caring for Ebola infected patients in affected countries in Africa may appear different than what is recommended in this document. This is because in that difficult setting different PPE may be required due to limited resources (e.g. lack of running water and disposable equipment and the need to clean and reuse equipment) as compared to what would be expected in a Canadian healthcare facility. What do health care workers need to know about Ebola? Health care workers in Canada are advised to be vigilant for the recognition, reporting and prompt investigation of patients with symptoms of Ebola and other similar diseases that can cause viral hemorrhagic fevers. Person-to-person transmission of Ebola virus is primarily associated with direct contact with blood and body fluids of infected persons. It can also be transmitted through contact with medical equipment contaminated with infected body fluids. Health care workers caring for patients with suspected or confirmed Ebola virus disease must carefully and consistently apply the recommended infection prevention and control precautions. Screening & Reporting All travellers exiting the affected countries are screened and detained if necessary. All individuals entering Canada are screened and if have had any contact with an Ebola patient or a healthcare worker that has cared for sick individuals- those travellers are detained at that site and are quarantined/monitored until the communicability period has ended. Individuals who have travelled from the affected regions with no known contact with the illness are put under a Health Order and instructed to contact the Chief Public Health Office. Those individuals will be monitored daily until the communicability period has ended. Canadian health care workers are advised to exercise vigilant screening for illnesses compatible with EVD in recent travellers (within past 21 days), including health care workers, to affected areas. All suspected and confirmed cases of EVD must be immediately reported. The Provincial Chief Health Office (CPHO) has established a standardized triage screening tool for EBOLA Virus Disease (EVD) for Island health care settings. Every patient who presents to the ER department must be asked: A. Have you travelled outside of Canada in the past 21 days? B. If the answer is yes, has your travel been to or through the following countries in West/Central Africa? Sierra Leone, Guinea, Liberia, and Democratic Republic of the Congo (DRC)

2 If the patient answers yes to the above questions, did the patient have a sudden onset of FEVER AND ONE of the following symptoms: Malaise (weakness) Myalgia (muscle pain) Headache Conjunctival injection (red eyes) Pharyngitis (sore throat) Abdominal pain Vomiting Diarrhea with or without blood Unexplained bleeding/hemorrhage Erythematous maculopapular rash on trunk (rash) Triage, Screening and Assessment Ensure waiting areas are equipped with: products for respiratory hygiene (masks, tissues, hand hygiene (HH) products, and no-touch waste receptacles) Immediately triage patient. If screened positive; have patient don mask and perform hand hygiene with alcohol-based-hand rub (ABHR) Escort patient directly to ER room 5. Keep the room door closed; only essential personnel wearing appropriate PPE to enter Keep a log of all persons entering the room. All suspected cases of EVD must be reported to the CPHO IMMEDIATELY Daytime phone #(902) or after hours at (902) The CPHO will offer further direction of patient assessment, decisions, and disposition will be arranged. The ER team leader is to notify the Unit manager and/or Nursing Supervisor once the CPHO has been contacted. Infection Control Precautions in Hospital The recommended infection prevention and control practices must be implemented immediately for any suspected or confirmed case of EVD. People are contagious once they begin to show symptoms. Patients with suspected or confirmed Ebola must be placed in a private room with its own washroom (or dedicated commode). There must be restricted access. (Door to room to remain closed.) The anteroom will be used for removal of PPE. Limited number of HCW s assigned to patient This provides limited exposure. A negative pressure room is preferable if the patient is requiring an Aerosolized Generating medical Procedure (AGMP).

3 In addition to Routine Practices, initiate Enhanced Contact/Droplet Precautions immediately. The WHO Epidemic Outbreak Cart will be placed outside the patient s room and will contain all the PPE necessary. In addition to wearing hospital scrubs; all persons entering the patient room must wear: 2 pairs of Long Nitrile gloves (Green) An impermeable, fluid resistant disposable Gown Eye protection (goggles/face shield) Surgical mask Additional PPE is required for exposure to blood, other body fluids, vomit or feces. Disposable shoe covers Leg coverings Head covering (Hood) *Signage with instructions for donning will be posted outside the patient room and removing PPE signage will be posted inside the anteroom. Hospital Staff are required to adhere to Checklist for Applying and Removing Personal Protective Equipment. To ensure compliance all staff will be observed by a 2 nd staff member when donning and removing PPE. Environmental Cleaning: Environmental Services personnel performing environmental cleaning and disinfection must wear recommended PPE (described above) including the use of additional barriers (shoe and leg coverings, etc.) A Broad spectrum virucide must be used to clean the environment of suspect or confirmed EVD patients. Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is paramount, as blood, sweat, emesis, feces and other body secretions represent potentially infectious materials. All equipment in the patient room that cannot be cleaned and disinfected will be discarded in a biohazard receptacle. Biomedical waste (e.g., items soaked with blood or secretions) should be contained in impervious waste-holding bags or double bags. Blood, suctioned fluids, excretions and secretions should be disposed of in a sanitary sewer or septic system. Patient Care: DO Not Draw any blood work from the patient until discussed with the CPHO to limit exposure of healthcare workers to EBV.

4 Perform hand hygiene and change gloves before and after patient care or contact with patient environment, after any contact with potentially contaminated surfaces, before performing aseptic procedures, and before and after removal of PPE. Hand hygiene can be performed by washing with soap and water or using alcohol-based hand rub. If hands are visibly soiled and after removal of PPE, use soap and water, not alcohol-based hand rubs. Avoid aerosol generating medical procedures (e.g.: bronchoscopy, sputum induction, intubation, and open suctioning of airways). If necessary, they must be performed in a negative pressure room. Limit the number of healthcare workers present during these procedures. A respirator (N95), gloves, a fluid resistant or impermeable gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles must be worn during aerosol generating procedures. Limit use of needles. All needles and sharps must be handled with extreme care and disposed in puncture-proof, sealed containers. Patients will remain in the negative pressure room. Patient movement/ transport must be restricted to essential diagnostic and therapeutic tests only. Only essential hospital personnel should enter the patient s room. Refer to health care & Visitor log. Visitors are restricted. Exceptions will be considered on a case by case basis, in consultation with Infection Control. The Log will be forwarded to CPHO for further follow-up. Clinical and non-clinical personnel must be assigned exclusively to the patient care area and members of this staff cohort must not move freely between isolation area and other clinical areas. Nursing supervisor is to notify scheduling department of staffing requirements. Dedicate medical equipment (preferable disposable) for single patient use only. Health care staff with open skin areas/lesions on hands or forearms should not have contact with suspected or confirmed EVD (PHAC, 2014) Dispose of soiled linen, cleaning/disinfection cloths, disposable gloves and any other item in contact with body fluids (eating utensils) in a biohazard waste disposal bag inside the patient room. Dietary food items are to be served in disposable dishes available from nutrition services and items must be disposed in a biohazard bag. Education All Emergency room staff will attend a one hour education session that will provide general information and practice donning and doffing PPE. A video link will be available for staff to view and PPE will be on the unit for practice purposes.

5 References: Capital Health Infection Prevention and Control. Screening and Management of Patients with a Suspected or Confirmed Ebola Virus disease Guideline. Retrieved from: Centers for Disease Control and Prevention. (2014) An algorithm for evaluation of the Returned traveller. Retrieved from Centers for Disease Control and Prevention. (2014). A checklist for patient s being evaluated for EVD in the United States. Retrieved from: Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever WHO Guidelines: in Health-Care Settings, with Focus on Ebola (August 2014) Retrieved from: PE Department of Health and Wellness. Chief Public Health Office Ebola Virus Disease (EVD) Update. Released September 2, Public Health Agency of Canada (2014). Interim Guidance-Ebola Virus Disease: Infection Prevention and Control Measures for Borders, Healthcare Settings and Self monitoring at Home. Retrieved from: Queen Elizabeth Hospital Protocol for Managing Patients with Suspected or Confirmed Ebola Virus Disease. Released October 14, 2014.

6 Prince County Hospital Health Care Provider and Visitor Log Isolation Room Number & Site Date Time In Time Out Name Department Reason for Entering *Send log to Employee Health when sheet is completed, or no longer required.

7