ebola preparedness_sf

8/9/2019 Ebola Preparedness_SF

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Background

Ebola, previously known as Ebola hemorrhagic fever, occurs in humans and nonhuman primates.There are five identified Ebola virus species, four of which are known to cause disease in humans.Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic ofthe Congo. Since then, outbreaks have appeared sporadically in Africa, the most recent of which is inWest Africa, in the countries of Sierra Leone, Liberia and Guinea.

According to the CDC, Ebola is spread through direct contact with broken skin or mucous membraneswith exposure to blood or body fluids, including urine, saliva, sweat, feces, vomit, breast milk andsemen; and with equipment contaminated with the virus, such as needles and syringes. Ebola is notspread through the air or by water, or in general, by food.

Assessment

A great deal of work has already been done across the Health System to assure a coordinatedreadiness program. The meeting yesterday convened approximately 60 multidisciplinary experts fromacross the enterprise, and included representation from nursing; infection control; TPI; TUP; TUstudent health services; administrators, physicians and providers from each hospital; emergencypreparedness; environmental services; laboratory; security; human resources; and communications,to name a few.

The following items were discussed: screening criteria; activation algorithms; designated nursing

units at each entity; transfer considerations; personal protective equipment; laboratory testing fordiagnosis and ongoing care; training and drills; waste removal; the role of the CDC and state andlocal agencies; evolving recommendations; and next meeting information.

Recommendations

Recommendations are based on CDC updates and information that is available from Emory,Nebraska, and other centers with advanced isolation units and experience in managing patients withEbola. They continue to be updated and are not meant to preclude procedures and protocols beingimplemented in each department and entity across TUHS.

We are utilizing the CDC screening criteria for points of entry, including the emergency departments,ambulatory clinics, and the student health center. Screeners are being trained to identify high riskpatients. In the event that a patient is identified as high risk, personal protective equipment andisolation procedures will be implemented immediately for health care providers, the patient, andindividuals accompanying the patient. Isolation is a priority, as is correct protocol for transport of thepatient to the appropriate predetermined designated isolation areas in the emergency departmentsand on the units. Individual clinics are determining entity-specific protocols for isolation and transport.

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MedHost and Epic have screening capabilities that have been or are being implemented across thesystem. There are additional points of entry, including preadmission testing and outpatient procedureareas that require additional consideration for screening, and appropriate protocols for these areasare being discussed.

The type of personal protective equipment needed was discussed at length. The ED physicians andinfection control departments are collaborating to assure that we stock the appropriate equipment inthe appropriate designated locations in appropriate quantities. Training of ED and designatedpersonnel on the recommended use of this equipment has already started and will continue. Staffingplans for isolation areas, ancillary personnel and physicians are underway.

Trainees, including any type of student, resident and fellow, may participate in education and

decisions regarding Ebola patients, but are not to come into direct contact with them. Direct contractby health care personnel needs to be kept to the vital minimum.

Laboratory testing was discussed, in terms of collecting the specimen for diagnostic testing and theprotocol for safely packaging the specimen for transfer to state testing facilities. Other diagnostic testswill be performed by the laboratory as point of care testing, or on designated equipment, to avoidcontamination and exposure. Specimen management is also being clarified. We are following CDCprotocols and recommendations for waste containment and removal.

We are working with the state and local agencies to assure that our efforts are coordinated with thoseof other organizations and consistent with the state and local departments of health. By the end of the

month, staff at all TUHS entities will have an opportunity to participate in emergency preparednessdrills to confirm protocols and proficiencies.

Conclusions

There are many efforts underway across the Health System to assure preparedness for themanagement of the Ebola patient and their families. This is a complex preparation, with manyscenarios. At this point, there are identified areas requiring additional clarification and these are allbeing addressed in a thoughtful manner based on the evidence at hand and the expertise of ourhealth care providers. There are several subgroups working on specific protocols and plans. We aremeeting again on Friday morning, and will continue to meet until we are as fully prepared as possible.

I will provide periodic updates. In the interim, if you have concerns that we are not addressing, pleasecontact me.

Sincerely,

Susan L. Freeman, MD, MS

ebola preparedness_sf

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