CENTRAL MISSOURI CHAPTER ENA
Meeting Minutes, Thursday, October 16, 2014
Shakespeare’s Pizza South, Columbia, Missouri
Attendance: Carol Nierling, Linda Cockrell, Karen Neuman, Darlene Grosvenor, Amy Harrell,
Ashley LePage, Donna Pond and Gordon Rogers.
1) The meeting was called to order by Carol Nierling. Pizza and drinks bought by the chapter
were freely available throughout the meeting.
2) The minutes of the September meeting were approved.
3) The chapter financial report was reviewed and expenditures approved. The Treasurer’s
report was given by Gordon Rogers. The Chapter has a balance of $9,693.74. This includes
all Emergency Nursing Update seminar expenses and inflows with the exception of $100
which is expected but has not yet come in. It also includes a check for $150 which was
written to ENA for a group of five new chapter nurses who joined as a group and are to get a
discount from the state and National. $100 of this is due to be reimbursed to us.
4) Gordon reported that the seminar registration receipts totaled $1,810.00 (plus $20 from sale
of excess snacks). Total expenditures were $702.67, so we came out $1,127.33 ahead. Three
speakers accepted their honoraria and three donated theirs back to the Chapter.
5) It was announced that Donna Pond will put on an ENPC course March 12-13 at Boone
Hospital. It was decided that we will not have a December meeting. Gordon and Amy
agreed to give an educational summary of things learned at the National Scientific Assembly
at the November meeting and the January meeting, and Linda volunteered to give the
February educational presentation. Gordon also stands ready to give his prepared
presentation in March or whenever it is desired.
6) There was discussion about Ebola. Linda gave a summary of information presented at a
webinar at the University Hospital. (See attached notes).
7) Carol Nierling drew names for door prizes. Gordon and Linda won a bottle of wine apiece
and Darlene won a deck of cards.
8) There was discussion about plans for next year. It was decided, under Amy’s leadership, that
we would pursue having CEN Review class targeted for April 17-18 or April 24-25, 2015
and also having another Emergency Nursing Update targeted for September 2015. Gordon
will contact Pat Clutter to determine her availability for the CEN Review and Amy will
contact Boone Hospital about room availability. Gordon will also check with Beth Eidson on
whether any Boone Hospital nurses will be supported in attending.
9) The meeting was adjourned by Carol Nierling. The next meeting will be November 20th at
5:30 PM at the Copper Kettle Restaurant in Ashland.
Respectfully submitted,
Gordon Rogers, Secretary
UHC Webinar: Treating Patients with Ebola Virus Infection – Emory University Lessons
Learned (recording available on UHC https://www.uhc.edu/ ~ 10-21-14)
Dr. Bruce Ribner
Pt Bio-containment Units:
 A level of containment sufficient to safely care for pts with any known or anticipated
communicable disease
 Ante-room with lab (or contained lab with in hospital laboratory only to prevent the shutdown of the entire lab in case of a spill needing containment)
Planning the care:
 Medical staff ID, critical care, anesthesiology and subspecialties
 Nursing (possibly other: respiratory, dialysis) Ebola = 2 nurses per pt. one at bedside at
all times and an auxiliary nurse to assist
 Environmental management
 Facilities
 Security
 Media relations
Ebola epidemiology:
 Filoviriae family
 Enveloped RNA virus = susceptible to common hospital disinfectants, no vaccines or txs
approved, fatality up to 90%
 Outbreaks of Ebola have occurred for ~ 40 yrs
o First noted in 1970s:
 Zaire 88% mortality
 Sudan 53% mortality
 Symptoms: Flu like systems- extreme vomiting, diarrhea possible hemorrhage (NOT
Airborne) requires Enhanced Body Substance Precautions to prevent contact with body
fluids.
o A person is contagious if he/she has active symptoms. Ebola virus is transmitted
by direct contact with body fluids.
 Ebola denigrates blood vessels leading to multi-system failure~ 2nd week may develop
hemorrhage
Ebola clinical management:
 Clinical Pearls:
 3rd space- low albumin and vascular damage, large volume losses 5-10 liters/day via
diarrhea and vomiting
 Over a week into course marked electrolyte abnormalities and nutritional deficiency- Lab
testing for chemistries was critical for pt care, hypokalemia, hypocalcemia and
hyponatremia requiring both iv and oral replacement
 Viral RNA on skin, blood, urine, semen, oral and lung secretions, vomit and stool- all
carry a high viral load; did Not find viral RNA in dialysate nor multiple pt room and
bathroom samplings- all carry a high viral load
 24/7 one-on-one nurses allowed for rapid response to changes and adjustment of care
(nutritional, self-care, emotional care- depression with the knowledge that they may die)
 WHO states the use of experimental medicines and vaccines is ethically acceptable. Side
effects may exceed therapeutic benefit.
Lab issues:

CDC recommendations for lab testing: testing in main lab acceptable with proper
enhanced body substance precautions: Wear gloves, water-resistant gowns, full face
shield or goggles and masks to cover mouth and [missing text]
 ADM : testing should be limited to POC testing in the pts room
 Emory chose POC testing in unit contained room near the Ebola rooms to prevent
potential spill/shut down of hospital wide lab
o Chemistry
o Hematology
o ABG
o Urinalysis
o Coagulation analyzer
o Malaria – these pts are high risk for malaria
 Specimen to CDC- many commercial couriers refused when labeled as Ebola
Managing health care personnel:
 Many federal and state agencies to regulate care, lab, waste etc. Need to have a resource
to guide.
 Emery used full coverage: CDC recommends enhanced Body Substance Precautionsmay need double gloving, disposable shoe covers and leg coverings.- due to the massive
fluid loss via vomit and diarrhea Emory chose full coverage. RNs were with pt 3-4 hrs at
a time, goggles fog. Papper with disposable hood was more comfortable without fog
allowing max protection and comfort to care for pts.
 Proper TRAINING and COMPETENCE of donning and doffing protective equipment is
essential with a buddy monitoring to prevent contamination during doffing of equipment.
 Daily team meeting to review plans and protocols, limited personnel to enter the room, no
auxiliary (EKG, housekeeping, CXR etc… RNs did all) All personnel entering pt room
were logged and monitored BID temps for 21 days.
Waste Management:
 CDC Sanitary sewers may be used for the safe disposal of pt waste. Us is designed to
inactivate infectious agents
 Bleach was placed in toilet, pt used toilet, wait 5 minutes then flush
 Disposable materials should be discarded as regulated waste- Our contractors were
unwilling accept any waste unless certified as free of Ebola virus. Therefore waste was
autoclaved prior to contractor removing the waste. Large amounts of waste.
Media: Media filled the campus with media tents and trucks
 Goal: EDUCATE and ALLAY FEARS
 WE have expertise, we are trained and prepared, we will protect our pts, staff and
communities- pts confidentiality and respect is paramount.
 Town meetings with staff, email updates
 Concerned with other pts. Gave each pt letter why it is important to care for pts, why it
was safe for all pts
What did Emory learn:
 Ebola can be safely care for in developed countries
 We do not expect a zero mortality rate, do expect a lower mortality
 Much was learned about pt management that can be shared to facilities with less
infrastructure
Why did we do it? Because that is what we do—care for sick patients.
Q &A:
 PPE: how long does it take to don? 5-10 minutes to place gear correctly
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How did you handle Health Care Workers (HCW) that refused to care for Ebola? All
were volunteers- did not have any volunteers HCW back out of caring for Ebola and had
more volunteers than needed.
Who provided PPE training and what was their credentials: BLS3 &4 laboratories and IC
personnel
Developed a website where all Emory P&P for Ebola will be available for
As long as HCW were symptom free they were free to care for patients- no restrictions as
long as HCW had no symptoms
All linens were autoclaved and disposed. Non-disposables machines were left in the room
and sterilized with the room.
Body suit was disposed. Papper and battery pack was disinfected with common hospital
disinfectant
Waste in pt room bagged closed at 2/3, double bagged, disinfected- bagged a 3rd time in
ante-room outside disinfected sent to auto clave. All by nursing.
Blood transfusion needs: platelet, RBC, and plasma- do plan for type and cross
Were staff paid differently? There was a premium for high level nursing not for caring
for Ebola.
Is virus in the sweat considered an exposure risk? yes we do consider the skin an
exposure risk
Spraying to decontaminate is high risk as it aerosolizes body fluids. All is wiped down.
Doffing must be meticulous for safety of HCW.
Disinfection of trash cans with the same disinfectant we use on all hospital surfaces.
Recommendations for flow of a pt from admit? Each hospital will have to analyze what
works best. These pts do need ICU with room to do procedures with an ante-room to don
and doff PPE
Can HCW take ibuprofen, aspirin, acetaminophen for aches and pains during monitoring?
Encourage not to take. Document if consuming.
Emory does not allow Pregnant or immunocompromised or lack of small pox vaccination
for any high risk infectious pts.
Decontaminate transport vehicles- train personnel and modify a truck to allow easy
disinfection for high risk transportations.
Lorilie Ann Hardy MEd, RRT
Performance Improvement Professional
Office of Clinical Effectiveness
MU Health Care
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