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Preparing for Ebola: What U.S. Hospitals Can Learn From Emory Healthcare and Nebraska
Medical Center
Clinician Outreach and
Communication Activity (COCA)
Webinar
October 14, 2014
Office of Public Health Preparedness and Response
Division of Strategic National Stockpile
TODAYS PRESENTER
RADM Steve ReddSenior Advisor
CDC Ebola Response
TODAYS PRESENTER (2)
Bruce S. Ribner, MD, MPHDirector
Emorys Serious Communicable Disease UnitEmory Healthcare
TODAYS PRESENTER (3)
Alexander P. Isakov, MD, MPHDirector
Section of Prehospital and Disaster MedicineEmory Healthcare
TODAYS PRESENTER (4)
Phillip W. Smith, MDMedical Director
Biocontainment UnitUniversity of Nebraska Medical Center
TODAYS PRESENTER (5)
Angela Hewlett, MDAssociate Director
Biocontainment UnitUniversity of Nebraska Medical Center
PlanningtoTransportPatientswithEbolaVirus
InfectionintheU.S.
AlexanderP.Isakov,MD,MPHDirectorSectionof
Prehospital andDisasterMedicineEmoryHealthcare
MybrotherjustreturnedfromLiberiaandhasfeveranddiarrhea
Screening PSAP HCWs
Safety Destination Missionrecovery
Disinfection,infectiouswaste,followup
PPE/Infectioncontrol
AmbulanceDisinfectionMissionrecovery
Drivercompartmentisolationandpatientcompartmentbarrierdrapes
Decon,disinfectionofambulance,PPEdoffingandwasteremovalALLSUPERVISED
Surveillance
PlanningtoTreatPatientswithEbolaVirusInfection
intheU.S.
BruceS.Ribner,MD,M.P.H.
OnbehalfoftheEmorySeriousCommunicableDiseasesUnit
team
Planning
InvolveseverydepartmentinyourfacilityEmergencyMedicalServices(AIM9/23/14)Medicalstaff ID,criticalcare,anesthesiology,
medicalsubspecialtiesNursingEnvironmentalmanagementFacilitiesSecurityMediarelations
LaboratoryTesting
CDC:Recommendationsforlaboratorytestingbystaff: AnypersontestingspecimensfromapatientwithasuspectedcaseofEbolavirusdiseaseshouldweargloves,waterresistantgowns,fullfaceshieldorgoggles,andmaskstocoverallofnoseandmouth,andasanaddedprecautionuseacertifiedclassIIBiosafetycabinetorPlexiglass splashguardwithPPEtoprotectskinandmucousmembranes.Allmanufacturerinstalledsafetyfeaturesforlaboratoryinstrumentsshouldbeused.
LaboratoryTesting(2)
ASM:TestingshouldbelimitedtoiSTAT orequivalentPOCtestingsystemsandperformedinthepatientsroom
LaboratoryTesting(3)
Realitycheck:ifalabspecimenspillsinthemainlabwe
wouldhavetoclosethelabdownforhourstodecontaminate
ifalabspecimenfromapatientwithEVDcomestothemainlab,fewtechnologists
wouldprocessit
ADedicatedLabSpace
TheSCDunitestablishedasmallpointofcarelabwithintheunit
Dedicatedlabequipmentforourpatients Staffedbylaboratoryvolunteers
LaboratoryTestSupport
Chemistryanalyzer
Hematologyanalyzer
Bloodgasanalyzer
Automatedurinalysisanalyzer
Coagulationanalyzer
MalariaPOCdevice
SurprisesinShipping
WehadlabstafftrainedinCategoryAshipping Commercialcouriers,eventhosecertifiedinCategoryAshipping,refusedtopickupanythingfromEmorylabelledascontainingebola virusanddestinedforCDC
Category A Shipping Containment
ListofRegulationsAssociatedwiththeEbolaResponse
OSHABloodbornePathogensStandard(29CFR1910) CDC/NIHBiosafetyinMicrobiologicalandBiomedicalLaboratories(BMBL)5th Ed.
DepartmentofTransportation(DOT)HazardousMaterialsRegulations(Division6.2BiologicalAgents)
NationalScienceFoundation(NSF)/AmericanNationalStandardsInstitute(ANSI)49(BiosafetyCabinetryCertification)
GeorgiaEnvironmentalProtectionDivision(EPD)
PersonalProtectiveEquipment
FollowedCDCRecommendationsforPrecautionsforPreventionofEbolaTransmission
PersonalProtectiveEquipment(PPE) All persons entering the patient
room should wear at least: Gloves Gown (fluid resistant or
impermeable) Eye protection (goggles or face
shield) Facemask
Additional PPE might be required in certain situations depending on patient and environment, including but not limited to: Double gloving Disposable shoe covers Leg coverings
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
ProtectingHealthCareWorkers
AlthoughPPEiseffectiveatdecreasingexposuretoinfectedbodilyfluidsamonghealthcareworkers,itspresenceissimplynotenough
PPEitselfcanintroducerisk PropertrainingandcompetencyindonninganddoffingofPPEkeyforsafety
http://annals.org/article.aspx?articleid=1900481
ConsiderationsforPPEinourUnit
Dedicatedstaffwithyearsoftraining Werequiredallstafftoundergorefreshertrainingfromqualifiedinstructors
RemovingPPEproperlykeytopreventingcontamination
AlldonninganddoffingofPPEwasobservedbyanotherteammember Placedchecklistsinroomstoremindstaffofproperprotocols
UnexpectedAdventuresinWasteManagement
CDC:Sanitarysewersmaybeusedforthesafedisposalofpatientwaste.
CountyWatershedDepartment:ifebola virusisplacedinthesanitarysewerstheywoulddisconnectourservice
Result:Allpatientsliquidwastesweredisinfectedwithbleachorquaternarydisinfectingdetergentsfor>5minutespriortoflushing
UnexpectedAdventuresinWasteManagement(2)
CDC:disposablematerialsandlinensshouldbeplacedinleakproofcontainmentanddiscardedasregulatedmedicalwaste
Ourcontractor:allwasteneededtobecertifiedasfreeofebola virusbeforetheywouldtransporttotheirincinerator
Result:weautoclavedallregulatedmedicalwastebeforecontractorpickeditup
Communications
Primarygoal:toeducateandtoallayfears Keymessages
Wehaveexpertiseintreatingpatientswithseriousinfectiousdiseases
Wearetrainedandpreparedforthesepatients Wewillprotectourpatients,ourstaffandourcommunities
Patientconfidentiallyandrespectisparamount Toactinthebestinterestsofourpatients
Communications(2)
Hospitalstaff: Townhallmeetingswiththehospitalstaff Emailupdatestoallstaff
Maintainingconfidenceandhonestywithourotherpatients Lettergiventoeachinpatientandallnewadmissionexplainingthesituationandourkeymessages
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Centers for Disease Control and Prevention Atlanta, Georgia
Clinician Outreach and Communication Activity (COCA)
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