As the first quarantine period in Texas passes without additional infections, the focus is on improving preparedness for Ebola while ensuring accurate information is made available to the public. To support preparedness efforts, the CDC and other health care organizations have taken steps to provide health care organizations and providers around the country with critical information to protect health care workers and prevent the spread of Ebola. The most significant takeaway from the livestream session, which was presented yesterday by the Greater New York Hospital Association, the Service Employees International Union and the Partnership for Quality Care, was the need to plan, prepare and practice caring for Ebola patients. It is critical that health care organizations and providers take step now to ensure the safe delivery of patient care in an environment that does not place health care workers at risk. With these goals in mind, health care organizations should consider the following:
- Implement prompt screening and triage of potential Ebola patients to prevent the spread of the disease. This includes taking a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain or unexplained hemorrhage. If the patient is under investigation for Ebola, health care workers should activate the hospital’s Ebola Preparedness Plan (“Plan”). The Plan should include quickly isolating the patient in a separate room and immediately implementing stringent infection control measures.
- On October 20, 2014, the CDC released more stringent guidance on personal protective equipment (“PPE”) for health care workers caring for patients with suspected or confirmed Ebola. The enhanced guidance, as well as the information provided during the livestream session, increases the level of protection offered to health care workers.
- Target rigorous education and training to those health care workers caring for potential Ebola patients. Training is critical to ensuring appropriate use of equipment, particularly putting on and taking off of PPE. Practice, practice, practice.
- Cover all skin areas – there should be no skin or hair exposure when PPE is worn correctly. This includes the use of disposable hoods and full-face shields. Although Ebola is not transmitted through airborne exposure, PPE recommendations now include use of N95 respirators or powered air purifying respirators whenever caring for an Ebola patient. Assess your current stock of high bio-hazard PPE and consider strategies for quickly replenishing your stock in the event it is needed.
- Goggles should not be worn. Goggles tend to trap perspiration and wearers tend to try to adjust goggles, leading to possible facial contact with contaminated gloves.
- Identify a trained observer to actively observe and supervise each worker putting on and taking off PPE. The trained observer must be available AT ALL TIMES. CDC recommends disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe or alcohol-based handrub. During removal of PPE, disinfectant must be applied by the trained observer as each layer of PPE is removed. Use a disinfectant that is effective for a non-enveloped virus. A disinfectant that is effective against norovirus will be effective against Ebola.
- Limit the number of caregivers providing care to an Ebola patient. Keep in mind that caring for Ebola is labor intensive and exhausting. Identify your care team in advance. Consider whether changes in staffing and hours will be necessary. Discuss such changes with union representatives, if appropriate.
- Performance of standard procedures, such as IVs, intubation and suctioning, can be difficult in high-biosafety PPE. Ebola care teams should be given time to practice these procedures in PPE before patients present.
- Effective environmental cleaning is critical, and in order to limit the number of individuals going into the patient’s room, consider having the physicians and nurses caring for the patient clean the patient’s room. Pay particular attention to high touch surfaces to reduce transmission. Infection Control and the environmental care team should work together to evaluate changes in cleaning procedures that will minimize spray, spread and aerosolization of liquids.
- Monitor health care personnel while they are caring for Ebola patients and for 21 days after last entry in the patient room or contact with the Ebola patient. This includes monitoring for fever and providing health care personnel with instructions on what to do and whom to contact in the event they have a fever or believe they are becoming ill.
- Health care personnel need the proper resources and support to do their jobs. Standardize and implement clear protocols and procedures. Personnel must know what to do in advance of caring for an Ebola patient. Oversight and practice are critical to ensuring that protocols are followed correctly, errors are identified and corrective actions are taken to prevent potential exposure and spread of the disease.
- As mentioned in our Ebola Preparedness Alert on October 17, understand the rules for waste disposal. Packaging and transporting Ebola waste is governed by federal Department of Transportation regulations, as well as state and local laws. Ebola waste that is incinerated or autoclaved is no longer infectious.
- Prepare a communications plan for use in the event an Ebola patient presents at your facility. Review the communications plan weekly to ensure that any changes in CDC protocols or local public health policies have been incorporated into the plan. Keep in mind that not every hospital will need to treat confirmed Ebola patients. However, hospital staff must be prepared to screen, isolate and transfer suspected Ebola patients.
Following the recommendations outlined above will help alleviate fear and increase the margin of safety for our nation’s health care workers. There are a myriad of potential employment issues related to Ebola; however, with advanced preparation, health care organizations and employers can ensure workplace safety. For additional guidance for employers on Ebola preparedness, click here.