Ebola concerns continue to grow this week as two nurses who cared for an Ebola patient in Texas test positive for the virus. Hospitals, physician offices, clinics, emergency medical services (“EMS”), physical therapy offices and other health care providers, regardless of location, need to prepare now for a possible Ebola patient. Care for an Ebola patient will require meticulous attention to detail, oversight and monitoring and enhanced training.

  • As the virus extends beyond West Africa, consider expanding the CDC questionnaire’s scope to address other travel destinations and possible routes of exposure. Reports indicate that individuals with transmissible exposure to Ebola may have traveled using commercial modes of transit.  While transmission during air travel is very unlikely, a high index of suspicion is advisable.
  • Note that updated guidelines for PPE have been issued, including full body suits and hoods. Check now to ensure that adequate stocks are available to staff. Doctors Without Borders advocates use of even stricter PPE requirements and modified processes for cleaning spills to minimize risk of viral exposure.
  • Although it is not known, it is suspected that challenges in using PPE and changes in protocol contributed to the transfer of the virus to nurses. The CDC recommends appointing a Site Manager who oversees the putting on and taking off of PPE and the care provided in the isolation unit at all times. If you have not already done so, appoint a Site Manager. Your goal now should be preparation and education.
  • Consider identifying teams of caregivers that will be primarily responsible for caring for Ebola patients and providing time for those teams to practice putting on and taking off PPE and performing job duties in the PPE. It is not easy to remove PPE; practice is critical. Personnel are typically very hot and tired when leaving patient care activities, and errors in removal of PPE are easily made. During practice, ‘contaminate’ the PPE with safe substances, including sprays, to facilitate identification of inadvertent exposure as a learning method. Others who might also provide care or be exposed to contaminated body fluids or materials should also be given time to practice these skills.
  • Several hospitals are running Ebola drills to help prepare their personnel. Consider expanding this beyond the hospital and involving EMS and other agencies that might be involved. Call in your local public health department. Walk through the process of imposing quarantine on both willing and unwilling contacts. Does your public health agency have the authority for immediate quarantine, or is a court order required? If required in your state, involve your court system in the process that would be required for quarantine orders.
  • The CDC is providing more opportunities for health care providers to receive additional training, disseminate critical information and  get their questions answered by CDC experts. Plan on participating in the October 20 CDC and HHS joint conference call to discuss health care preparedness. On October 21, CDC will host a live event in New York City with the Partnership for Quality Care to educate frontline health care workers on Ebola. This event will be streamed live to hospitals across the country. Further information is available at www.cdc.gov/ebola.
  • As employers, hospitals face unique concerns. Prudent hospital employers will start considering and planning for the following issues:
    • HIPAA - Remember to diligently maintain the privacy of patient health information. As mentioned in a previous Hall Render article, be prepared to audit the EMR for inappropriate access to medical records of Ebola patients (including “rule-out” patients). This is a great time for refresher training to remind employees that curiosity is not an acceptable reason for accessing patient information.
    • Americans with Disabilities Act - Remember the ADA imposes limitations on making medical inquiries of employees and that any employee medical information obtained must be kept confidential.  These and other concerns are addressed in a guidance document published several years ago by the U.S. Equal Employment Opportunity Commission entitled “Pandemic Preparedness In The Workplace And The Americans With Disabilities Act.”
    • Occupational Safety and Health Administration - Be prepared to deal with the possibility that some employees may refuse to treat certain patients or come to work at all.  Retaliating against employees who reasonably believe they are in imminent danger could violate OSHA.
    • National Labor Relations Act - Exercise caution before retaliating against employees who criticize the hospital or management for failing to provide safe working conditions.  Private employers covered by the NLRA must be aware that this could be considered protected activity by employees and could also be a rallying point for union organizing.
    • Constitutional Rights - Although governmental employers are not covered by the NLRA, their employees enjoy free speech protections under the First Amendment when they speak out about matters of public concern.  Be cautious before disciplining employees for this reason.