Ebola Viral Disease
October 21, 2014
Overview
 Historical perspective
 Current epidemic update
 OSUWMC preparedness
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Signage and marketing
Screening
Isolation activation
Inpatient management
Staff education and training; simulations
 Challenges
Challenges
 Balancing preparedness and informative education
with alarmism
 Forced isolation/treatment
 Global presence of our university community
 Dynamic nature of the epidemic
 Changing protocols
 Other problems to not forget….
 Enterovirus D68, Influenza
Ebola Epidemiology
 Acute infection starts as a non-specific febrile illness
 Fever (>100.4), severe headache, muscle pain, malaise;
progression to include GI symptoms (diarrhea and
vomiting)
 Symptoms may appear 2-21 days after exposure
 8-10 day window the most common
 Significant dehydration and electrolyte disturbances
 Small vessel involvement
 Increased permeability due to cellular damage
 Multi-organ system failure
 Hemorrhage may develop in the second week
 Poor prognosis associated with shock, encephalopathy,
extensive hemorrhage
Jay Varkey, MD; Emory University Hospital
Ebola Historical Perspective
 Family Filoviridae
 Two genera: marburgvirus and ebolavirus
 Enveloped RNA virus
 Five subtypes of Ebola virus
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Zaire (EBOV)
Sudan (SUDV)
Tai Forest (TAFV)
Bundibugyo (BDBV)
Reston (RESTV)
 No vaccines/treatments approved for humans
 Case-fatality rates of up to 90% in African settings
Jay Varkey, MD; Emory University Hospital
Ebola Historical Perspective
 1976: Simultaneous outbreaks in Zaire (now DRC) &
Sudan
 Zaire: 318 cases and 280 deaths (88% mortality)
 Sudan: 284 cases and 151 deaths (53% mortality)
 1976 & 1979: Small-to-midsize outbreaks Central
Africa
 1995: Large outbreak in Kikwit (DRC)
 315 cases (81% mortality)
 Since 2000: Near-yearly outbreaks in Gabon, DRC
or Republic of Congo
 2000-2001: Largest outbreak on record (Sudan)
 425 cases (53% mortality)
Jay Varkey, MD; Emory University Hospital
Current EVD Epidemic
 West African outbreak limited to:
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Guinea: 1519 cases / 862 deaths
Liberia: 4249 cases / 2484 deaths
Sierra Leone: 3410 cases / 1200 deaths
Total: 9178 cases / 4546 deaths
 Senegal (8/29/14) and Nigeria (9/5/14) no longer
considered at risk
 Early August 2014 – first health care workers brought
from West Africa to Emory University Hospital
 Other individuals brought from West Africa since then
 September 30, 2014 – first case diagnosed in the US
(Dallas) of a Liberian man traveling to the US
 Patient passed away October 8, 2014
www.cdc.gov and Fox News
Current EVD Epidemic
 Two nurses at Dallas hospital have tested positive
for Ebola (October 10th and October 14th)
 Second nurse traveled through NE Ohio from 10/1010/13
 Over 100 people in NE Ohio on quarantine/isolation
or monitoring of temperatures
 Risk points of when a health care worker can most
commonly become infected:
 From exposure to body fluids during patient care
 From error during doffing of PPE
 From time when patient is intubated or during certain
procedures due to increased aerosolization of
secretions
www.cdc.gov and Fox News
EVD Preparedness at OSUWMC
 Both UH and UHE ED’s need to be prepared for
walk-ins and EMS traffic
 Volunteer team designated for inpatient care
 Medical Team
 Nursing
 RT/team
 Six hours of training in three two-hour phases
 “Buddy System” for PPE
 Point of Care testing equipment for in-room use
for routine labs
 EVS, solid and liquid waste plans developed
EVD Preparedness at OSUWMC
 All patients planned to be admitted to 5 Ross – this may
change after mid-December when old James available
 Will have a donning/doffing room adjacent to each room
 Entry restricted to assigned care team with log
 2 nurses per patient – one inside/one outside
 If critically ill, consider two inside/one outside
 Team huddle including Critical Event Officer and senior
clinical leaders two times per day
 No transport outside room unless approved by the
Critical Event Officer
 All deviations to SOP’s need to be approved by Critical
Event Officer prior to implementation
EVD Preparedness at OSUWMC
 Collaboration between the CMO’s of Franklin County
Hospitals, Columbus Public Health and COTS
 Outreach to regional hospital leadership and
MedCare ambulance service
 “Secret shopper” simulations
 Three+ have been completed
 Screening questions in outpatient IHIS workflows
with BPA that fires if screen positive to alert rest of
care team
 Working closely with University officials on how this
will affect the rest of campus
Challenges
 Balancing preparedness and informative education
with alarmism
 Forced isolation/treatment
 Global presence of our university community
 Dynamic nature of the epidemic
 Changing protocols
 Other problems to not forget….
 Enterovirus D68, Influenza
 Special thanks to Drs. Naeem Ali, Julie Mangino,
and Christina Liscynesky for resources and data