Holy Cross Health
Update on Ebola
October 16, 2014
Our Goals:
• Provide staff with a basic understanding of Ebola virus
disease
• Communicate the state and federal role in testing for and
communicating about Ebola
• Define the current Center for Disease Control (CDC)
recommendations for personal protective equipment (PPE)
and the Holy Cross Health plan
• Assure that staff understand what personal protective
equipment (PPE) is needed and how to put on and take off
safely
Ebola Virus Disease (EVD)-The Basics
• First outbreak recognized in 1976 in Democratic
Republic Congo (DRC)
• Infection caused by a virus in the Filoviridae family
(RNA)
• Is one of numerous viral hemorrhagic fevers
• Many outbreaks in last decades confined to West
Africa have been contained by basic public health
measures
• 2014 outbreak has been widespread
Ebola Virus Disease (EVD)-The Basics
Incubation period is 2 to 21 days after exposure
Symptoms are non-specific at first (flu-like) with fever
Mortality rate > 50% in West Africa
Spread from human to human by unprotected contact
with body fluids
• People are not contagious before the fever
• Treatment is supportive—fluids, nutrition, oxygen
•
•
•
•
When should Ebola be considered?
• Symptom onset within 21 days of return from affected
countries in West Africa
– Most affected--Senegal, Guinea, Sierra Leone, Liberia
– See CDC website for most recent information
– It is about travel history, not ethnicity
• Risk of exposure to Ebola when in affected area (see
CDC risk categories)
• Close contact of individual with symptomatic Ebola virus
disease (including healthcare workers)
• No other reason for illness—like malaria
Africa is
very big
and
concerns
are
localized
Senegal
Guinea
Sierra Leone
Liberia
CDC Ebola Virus Disease (EVD)
Risk Categories
• High Risk Activities:
– Direct care of EVD patient
without PPEs
– Needle stick or mucus
membrane contact with
EVD blood/body fluids
– Lab worker processing
EVD body fluids without
PPEs
– Participation in funeral
rites of EVD patient
– (Maryland Department of
Health and Mental
Hygiene also included
eating bush meat)
• Low Risk Activities:
– Household member or
other casual contact with
EVD patient
– Providing patient care or
casual contact without
high-risk exposure to EVD
patients in healthcare
facilities in outbreak
countries
• No Known Exposure
– In affected countries
– No high or low risk
exposure
Not all Travelers’ Fevers are Ebola
• Febrile illnesses are very common
• Ebola presents with flu-like symptoms
• Common infections are more likely
– Influenza
– Sepsis from urinary tract, pneumonia, etc.
• Some infections are more common in West
Africa
– Malaria or Dengue fever
Testing for Ebola
• Montgomery County hospitals have already evaluated
a number of patients, none of whom had Ebola
• When Ebola is a consideration in an ill patient—based
primarily on travel history—physicians will consult with
Maryland authorities and the CDC
• Only the state and CDC can run the Ebola test and
they will approve testing only with strong suspicion
Talking about Ebola
• The Montgomery County Health Department has directed that
no information be released about whether a patient is being
evaluated for Ebola
• This respects the individual’s rights and minimizes public
misinformation about the safety of the hospital
• Please be mindful of conversations with family and friends
who might share protected information with others
• The state, CDC and involved hospital will jointly announce any
confirmed case
• If you are contacted by members of the public or the press,
please direct queries to Yolanda Gaskins, director, media
relations (202-550-0454)
Protecting Caregivers from Ebola
• It is transmitted by direct contact with body
fluids on mucous membranes or skin breaks
• Can’t transmit it before fever
• Not transmitted through the air (like TB or
chickenpox)
• Viral hemorrhagic patients have been safely
cared for in the U.S. since 1976, using
Standard Precautions
Proper Use of PPE is Key
• Study the recommended sequence and technique for
donning PPE
1. Boot covers (if needed)
2. Gown
3. N-95 Mask
4. Head cover (if needed)
5. Face shield
6. Gloves
• Practice with someone watching
• Be observed by an assigned monitor or trained
“buddy” when caring for a patient
Protecting Caregivers from Ebola
• As of October 15, CDC recommends contact isolation
with droplet precautions when body fluids may be
aerosolized
• Holy Cross Health has simplified and standardized by
designating a single higher level of protection for all
patients
• Holy Cross Health will continue to monitor the latest
recommendations for personal protection and will
provide any necessary equipment and training
Holy Cross Health Will Provide a Uniform,
Higher Level of Protection
CDC Recommendations
• Contact isolation
– Gloves, fluid resistant
gowns, face shield, shoe
covers (for body fluids)
• Droplet isolation
– Airborne isolation for
aerosolization procedures
• Private room-door closed
– With bathroom
– Negative pressure room
• For aerosolization
procedures
Holy Cross Health Plan
• Contact isolation
– Gloves, fluid resistant
gowns, face shield
– boot covers and head
covers (for body fluids)
– All Disposable
• Airborne isolation
– N95 mask (disposable)
• Private Negative pressure
room
– Private room with toilet
Removing PPE Properly
• Risk of healthcare worker exposure is greatest when removing PPE,
particularly if visibly soiled
• Remove in proper sequence
1.
2.
3.
4.
5.
6.
Boot covers
Gloves
Face shield
Head cover
Gown
N-95 mask
• Alcohol hand hygiene between each step after removing gloves
• Be observed by an assigned monitor or trained “buddy”
• Ask for help if PPE is contaminated
– Helper must wear full PPE
• Practice with someone watching
First Steps
• An ill patient with a relevant travel and/or exposure
history will be masked and moved as quickly as
possible to an isolation room minimizing contact with
other people
• Precautions will be instituted until the diagnosis is
ruled out or confirmed
• Check with your unit manager for specifics for likely
first contact areas—Emergency Department,
Obstetrics, Health Centers
Patient Companions/Visitors
• Companions of a suspected Ebola case will be screened for
evidence of active infection and triaged appropriately
• Visitors will not be allowed in the room with the patient
• Critical caregivers (parent-child) who remain with a
suspected case must wear PPE under staff supervision
• Companions should be advised to return home after
obtaining contact information
• Companions without evidence of infection who stay at the
hospital should be directed to a private area until the
patient’s disposition is determined
• If Ebola diagnosis is established, we will follow CDC visit
guidelines and contacts will be followed by public health
officials
Limiting Contact with Suspected Ebola
• No visitors in the patient room
• Nursing assignments will be 1:1
• A monitor will be stationed outside the isolation
room to observe PPE use, limit access and
maintain log of all entering room
• Blood draws will be minimized
• Disposable equipment will be used where
possible
Disposing of Waste and Cleaning
• All PPE and linens from an established patient
will be kept in sealed double red bag until
transferred to a central site
• Clean hard surface or re-useable equipment
with bleach wipes and allow to dry
• Solidify liquid spills with granules
Caring for Our Community
• Many of our neighbors and colleagues come from West Africa
and many have family there and, consistent with our guiding
behaviors, we need to be sensitive to their anxiety
• The Washington area has a large number of international
travelers and some will have spent time in Ebola affected areas
• We can expect that Ebola will be a consideration in a few
acutely ill patients in the days, weeks and months ahead. This
has already occurred several times in Montgomery County
hospitals including both Holy Cross Health hospitals. All cases
had other explanations for their symptoms
• We need to be prepared to provide care for all who come to us
and to provide that care in a way that keeps our colleagues
safe
Recommendations Are Evolving
• On October 15, we all learned of a second healthcare
worker in Texas who became infected with Ebola while
caring for a dying patient
• The CDC and public health officials are evaluating the
procedures and recommendations for protecting
caregivers
• Holy Cross Health is monitoring the situation and will
provide the equipment and training necessary to keep
our staff and doctors safe
Next Steps
• Discuss this material with your manager
• Review materials on HCnet and other credible websites
like CDC
• Be alert to risk factors for Ebola in all clinical settings
• Practice using the PPE that is appropriate to your unit
and job
• Participate in scenario-based training in your unit
• Refer questions to Infection Control 301-754-7480 or
301-557-5969
Thank you for completing
this course.
• Please return to your ‘My Learning’ page to
complete a quiz.
• After completing the quiz, you will have an
opportunity to submit questions or comments.