As American hospitals admit the first confirmed Ebola patient diagnosed in the U.S., and a second possible patient, providers and counsel should prepare for the possibility of a patient presenting at their facility. Here are some considerations for initial steps:
- Update contact information for your local public health officer and legal counsel. While your infectious disease staff probably have good contacts at the local level, this is a good time for the lawyers to re-establish contacts with emergency preparedness staff.
- Review your medical waste disposal agreement. Is your contracted company licensed to handle regulated medical waste? Unless pre-treated, Ebola waste is considered to be a Category A infectious substance, capable of causing a life-threatening or fatal disease to otherwise healthy persons or animals upon exposure. Category A waste products must also be packed and transported in compliance with regulations.
- Consider if you have sufficient isolation and protective garments. If you have an Ebola admission, proper use of personal protective equipment and other supplies that may not be customarily treated as disposable, such as sheets, will increase. Do your supply chain contracts have a clause that permits immediate increases in deliveries without delays for payment? If not, consider establishing those abilities now.
- Consider necessary changes to policies and procedures for triage and intake of patients with complaints consistent with Ebola (i.e., fever, headache, body aches, nausea and vomiting). Implement a process that ensures questions regarding travel, and exposure to returned travelers, are asked early in the process. If the answer indicates possible exposure to Ebola or an Ebola carrier, a procedure should be in place to ensure clear and prompt communication to everyone who might come in contact with the patient. Consider the use of an armband or other visible indicator rather than merely an entry into the medical record. Immediate and uniform use of universal precautions should be mandatory.
- Work with media relations to develop a communications plan to be used in the event a possible Ebola patient presents at your facility. Ensure that all staff know who is permitted to communicate with the media. All media contacts should be coordinated through media relations.
- Review audit trails for inappropriate access to the patient's EHR if a possible Ebola patient does present.
- Consider whether changes to shifts or staffing will be necessary to accommodate the discomfort if your infectious disease staff recommends use of full isolation gear. If appropriate, work with your union steward regarding the needed changes in work practices.
- Pull out the pandemic preparedness plan, and refresh your memory on preparedness for increased infectious disease patients, including procedures for increasing capacity for patients on isolation precautions.
- Train all staff who might encounter a patient on the screening steps recommended by CDC and how to handle patients that meet the criteria for possible Ebola exposure. Those staff should include the ER triage area, ER registration, outpatient clinics and other community-facing locations. Post the CDC checklist in high-visibility locations.