welcome and special greetings. introduction of panelists diane l. adams, md, mph, chs-iii moderator...

Welcome and Special Greetings

Introduction of Panelists

Diane L. Adams, MD, MPH, CHS-III

Moderator and Speaker

WEBINAR—EBOLA 101: MYTHS VS FACTS

EBOLA VIRUS DISEASE GLOBAL AND LOCAL PERSPECTIVES

Daniel Chertow, M.D., M.P.HAssistant Clinical InvestigatorCritical Care Medicine Department, Clinical Center, NIH

What Life is like Inside An Ebola Clinic in West Africa

https://www.youtube.com/watch?v=3CX-sTaEW1Q

This is the Biggest Outbreak

The Current Outbreak in Africa

Ebola Outside Africa?

Enveloped RNA Virus

How do you get infected?

Clinical CoursePhase 1

Fever, body aches, lethargyPhase 2

Large volume watery diarrhea, vomiting

Days post-symptom onset

5 10

Phase 3 Shock with organ failure or

resolution

100% 60% 40%Survival

Treatment

• Supportive care• Fluid and electrolyte therapy• Management of complications

• No FDA approved specific therapy• Experimental measures

Public Health Interventions

• Educate and provide outreach• Isolate the sick• Prevent nosocomial spread• Perform contact tracing• Quarantine/observe at risk groups• Institute safe burials

Take Home Points

• Current outbreak is largest in history• Transmission mediated by

o Infectious body fluids o Mucous membrane or non-intact skin

• Fluids/electrolyte replacement essential• Public health interventions

o Will control outbreak in West Africa o Prevent spread in the United States

The Use of Biocontainment Units in United States

Diane L. Adams, MD, MPH, CHS-III

Retired Commissioned Corps Medical Officer,United States Public Health Service (USPHS)Chairman, North Atlantic Region Emergency

Medical Response Team,Alpha Kappa Alpha Sorority, Inc.

Biocontainment Laboratories

• There are many high containment laboratories throughout the United States (US). These include biosafety level 1-3 and 4 laboratories

• Following September 11, 2001, these facilities increased in number


The following BSL-4 that are active include:

1.NIH Integrated Research Facility (IRF) in Frederick, MD

2.NIH Rocky Mountain Labs in Hamilton MT

3.Center for Disease Control and Prevention (CDC) labs in Atlanta, GA


The following BSL-4 that are active include:4.Galveston National Lab, University of Texas Medical Branch, Galveston, TX5.US Army Medical Research Institute of Infectious Diseases (USAMRID), Frederick, MD6.National Biodefense Analysis and Countermeasures Center (NBACC) Frederick, MD

Designated Biocontainment Centers to Receive Re-Patriated Americans with Ebola

1. NIH2. Emory University Hospital, Atlanta, GA3. Nebraska Medical Center – are

receiving patients from abroad4. Medical centers prepared to care for

returning travelers with Ebola:o Texaso New York

Note: Medical centers across the country have been asked to prepare for returning travelers that may present to their facilities with Ebola.

Photos - Biocontainment PREP

Photos - Biocontainment Unit

Photos - Biocontainment

VIDEO DEMONSTRATES HOW TO USE PROTECTIVE GEAR WHEN TREATING EBOLA

http://abc7news.com/health/step-by-step-guide-to-protect-medical-workers-from-ebola/353015/

•Once all the equipment is gathered, the medical professional then must follow a specific process to both taking on and taking off the protective gear. The steps outlined by the University of Nebraska Medical Center (UNMC) for donning equipment are as follows:

o Surgical gowno Surgical cap/hair covero Face shieldo Standard patient gloves



The steps outlined by UNMC for donning equipment are as follows: (continued)•Large fluid repellent fabric or plastic drape•Surgical boot covers•N95 respirator•Long cuff kc500 purple nitrile gloves•Duct tape•Apron


http://abc7news.com/health/step-by-step-guide-to-protect-medical-workers-from-ebola/353015

The medical professional then must follow a specific process to putting on the required equipment to ensure they are not contaminated. The steps for putting on equipment are as follows:•Perform hand hygiene•Apply scrubs and plastic washable footwear (such as Crocs)•Remove all jewelry•Take and record vital signs•Hydrate•Apply boot covers, surgical cap, and surgical gown; All ties should be properly secured with a SIMPLE BOW•Ensure all fit well and cover the intended areas



The medical professional then must follow a specific process to putting on the required equipment to ensure they are not contaminated. The steps for putting on equipment are as follows (continued):•Perform hand hygiene•Apply N95 respirator•Seal mask to the face ensuring straps are not crossed and properly located at the crown of the head and base of the neck•Perform a fit check of the respirator, breathing deeply in and out, feeling with your hands for any air leakage•Apply face shield (over surgical cap and N95 straps)



The medical professional then must follow a specific process to putting on the required equipment to ensure they are not contaminated. The steps for putting on equipment are as follows (continued):•Apply standard patient care gloves•Bring cuffs of gown over the patient care glove cuff•Apply long cuff KC500 Purple Nitrile gloves over the standard patient care gloves. Make sure that the glove cuff covers the gown sleeve adequately to prevent exposure when providing patient care

Note: There is a second guide on removing the protective gear, which is considered the most dangerous part. After making contact with the patient, the suit may have body fluids on it that are contaminated with Ebola. It takes two people to take the equipment off.

CARING FOR EBOLA VICTIMS: PERSPECTIVES FROM

THE NURSING PROFESSIONNovember 10, 2014

Leslie Cooper PHD, MPH, BSN, RN, FAAN Retired, Commissioned Corps Nursing Officer, USPHSFormer NIH Program Director/Senior Nurse Advisor

Nurses are Involved in the Ebola Epidemic in many ways

1. Educating our communities with knowledge of the facts so we can promote prevention and early intervention

2. Working in some of the impacted areas of West Africa: Guinea, Liberia and Sierra Leone

3. Working in the US with patients suspected of being Ebola infected or confirmed

The Nurse

• Is one of the primary members of the health care team with probably the most direct contact with a patient

• Must remember that Ebola is just one insult that may have impacted the person

However, the health care team should always be assessing the patient for other health conditions as well

Caring for the Ebola Patient

• Sufficient numbers of nurses are critical to any efforts to prevent transmission of Ebola virus

• Staffing decisions should take into account the demands posed by adherence to current protocols

• Prevention of disease transmission within health care settings must be addressed

• Gaps that lead to such transmission and how to to remedy them must be identified and handled appropriately in a time effective manner

Key Strategy for NursesTo be able to provide excellent nursing care, nurses must:• Be able to practice in environments that

prioritize safety and allow them to follow up-to-date, accurate National Guidelines per CDC– for their patients, co-workers, their families, the community at large, and themselves

• Be provided with adequate personal protective equipment, protective measures, adequate hands-on training in how to use such equipment in the environment where they will be functioning

Critical Needs of the Nurse • Clear communication, transparency,

and evidence-based approaches are critical tools in combatting this disease

• Clear, accurate, consistent and up-to-date information must be made readily available to health care workers and the general public about Ebola virus disease

• Knowledge is power and critical

Critical Needs of the Nurse (cont.)

• Current practices and procedures will change as knowledge of the disease and its effective prevention and treatment continues to evolve

• Nurses are critical team members that must be involved in ALL levels of decision and planning for the treatment of this disease, and in the education to the public at large

• Nurses should also lead and implement research efforts to draw from lessons learned

Nurses Are Critical

As we move forward in fighting the

battle and stigmas against Ebola,

both domestically and internationally

– NURSES ARE CRITICAL MEMBERS

IN THAT FIGHT

PRIMARY RESOURCES

• American Academy of Nursing: http://www.aannet.org

• American Nurses Association: http://www.nursingworld.org

• Centers for Disease Control and Prevention: http://www.cdc.gov

EBOLA – ALTERING TRADITIONS OF GRIEF AND CULTURAL NORMS

Polly S. Turner, DrPH, RPh, MPH

University of Texas School of Public Health

Advisory Board Member and Alumni Association President

EBOLA – ALTERING TRADITIONS OF GRIEF AND CULTURAL NORMS

• Our beliefs, attitudes, and values about death, dying, grief, and loss are initially molded by societal dictates

• Societal and cultural influences may be difficult to recognize. These contextual determinants are so fundamental to our way of seeing the world that we often overlook their profound impact on how we feel and behave about loss. We assume that everyone thinks like us

• A given culture may offer many forms of traditions and institutionalized religion, each with its own interpretation about the meaning of death in human life

THE KEY TERMS IN SOCIOCULTURAL CONTEXT

• Attitude: A state of mind or feeling, disposition: an attitude of open mindedness

• Value: A principle, standard, or quality considered worthwhile or desirable

• Belief: Something believed or accepted as true, especially a particular tenet or a body of tenets accepted by a group of persons

• Societal: Of, or relating to, the structure, organization, or functioning of society, relating to human society and its member; “social institutions,” “societal evolution,” “societal forces,” “social legislation”

• Culture: The totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought

THREE PATTERNS OF SOCIETAL RESPONSES TO DEATH

1. Death-defying – refusal to believe that death would take anything away and believe it could be overcome

2. Death-accepting – viewing death as an inevitable and natural part of the life cycle. Behaviors and events of the dying process are integrated into everyday life

3. Death-denying – refusal to confront death, belief that death is antithetical to living and that it is not a natural part of human existence

CULTURAL BELIEFS AND MYTHS

• All people are shaped to some extent by the culture into which they are born

• For example, Cremation violates values and cultural practices in the western African country: The cremation orders have so disturbed people

that the sick are often kept at home Some infected people are secretly buried,

increasing the risk of more infections Relatives wash bodies by hand before funeral,

putting families at risk of new infection. In Sierra Leone and other parts of western Africa,

there are countless rumors about Ebola in many communities such as.



• For example, Cremation violates values and cultural practices in the western African country (continued): “There is no such thing as Ebola” Outsiders bringing the virus with them Outsiders want to exterminate the infected,

since so few of them return alive One can contract Ebola from a motorcycle

helmet Suspected Ebola patients injected with lethal

substances by health officials



• For example, Cremation violates values and cultural practices in the western African country (continued): The deadly virus can be cured by drinking

Nescafe’ mixed with cocoa and sugar – or eating two large onions

Additionally, some people are not seeking treatment for some of the following reasons:Monetary costsFear of getting positive resultsImpact and potential stigma

RECOMMENDATIONS FOR ALTERING TRADITIONS OF GRIEF AND CULTURAL NORMS

• Increase communications and training about Ebola to the population via radio stations across the country

• WHO coordinate information sessions• WHO train local leaders how the virus is

transmitted and its spread• Use of technology to monitor disease outbreaks• Emergency hotlines to disseminate information

about Ebola• Teach others more about the traditions and

cultures of the people they are treating and educating

WEBINAR– EBOLA 101: MYTHS VS FACTS

Questions

and Answers

CLOSING REMARKS

THANK YOU!Meredith L. Henderson

North Atlantic Regional DirectorAlpha Kappa Alpha Sorority, Incorporated©

andDiane L. Adams, MD, MPH, CHS-III

Retired Commissioned Corps Medical Officer, USPHS

Chairman, North Atlantic Region Emergency Medical Response Team

welcome and special greetings. introduction of panelists diane l. adams, md, mph, chs-iii moderator...

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