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Preparing for Ebola: What U.S.

Hospitals Can
Learn From Emory Healthcare and Nebraska
Medical Center

Clinician Outreach and


Communication Activity (COCA)
Webinar
October 14, 2014

Office of Public Health Preparedness and Response


Division of Strategic National Stockpile

TODAYS PRESENTER

RADM Steve Redd


Senior Advisor
CDC Ebola Response

TODAYS PRESENTER (2)

Bruce S. Ribner, MD, MPH


Director
Emorys Serious Communicable Disease Unit
Emory Healthcare

TODAYS PRESENTER (3)

Alexander P. Isakov, MD, MPH


Director
Section of Prehospital and Disaster Medicine
Emory Healthcare

TODAYS PRESENTER (4)

Phillip W. Smith, MD
Medical Director
Biocontainment Unit
University of Nebraska Medical Center

TODAYS PRESENTER (5)

Angela Hewlett, MD
Associate Director
Biocontainment Unit
University of Nebraska Medical Center

PlanningtoTransport
PatientswithEbolaVirus
InfectionintheU.S.
AlexanderP.Isakov,MD,MPH
Director
Sectionof
Prehospital andDisasterMedicine
EmoryHealthcare

MybrotherjustreturnedfromLiberiaandhas
feveranddiarrhea
Screening
PSAP
HCWs

Safety
Destination
Missionrecovery
Disinfection,infectious
waste,followup

PPE/Infectioncontrol

AmbulanceDisinfection
Missionrecovery
Drivercompartment
isolationandpatient
compartmentbarrier
drapes
Decon,disinfectionof
ambulance,PPEdoffing
andwasteremovalALL
SUPERVISED
Surveillance

PlanningtoTreatPatients
withEbolaVirusInfection
intheU.S.
BruceS.Ribner,MD,M.P.H.
Onbehalfofthe
EmorySeriousCommunicableDiseasesUnit
team

Planning
Involveseverydepartmentinyourfacility
EmergencyMedicalServices(AIM9/23/14)
Medicalstaff ID,criticalcare,anesthesiology,
medicalsubspecialties
Nursing
Environmentalmanagement
Facilities
Security
Mediarelations

LaboratoryTesting
CDC:Recommendationsforlaboratorytestingby
staff: Anypersontestingspecimensfromapatient
withasuspectedcaseofEbolavirusdiseaseshould
weargloves,waterresistantgowns,fullfaceshield
orgoggles,andmaskstocoverallofnoseand
mouth,andasanaddedprecautionuseacertified
classIIBiosafetycabinetorPlexiglass splashguard
withPPEtoprotectskinandmucousmembranes.All
manufacturerinstalledsafetyfeaturesforlaboratory
instrumentsshouldbeused.

LaboratoryTesting(2)
ASM:TestingshouldbelimitedtoiSTAT or
equivalentPOCtestingsystemsandperformedin
thepatientsroom

LaboratoryTesting(3)
Realitycheck:
ifalabspecimenspillsinthemainlabwe
wouldhavetoclosethelabdownfor
hourstodecontaminate
ifalabspecimenfromapatientwithEVD
comestothemainlab,fewtechnologists
wouldprocessit

ADedicatedLabSpace
TheSCDunitestablishedasmallpointofcarelab
withintheunit
Dedicatedlabequipmentforourpatients
Staffedbylaboratoryvolunteers

LaboratoryTestSupport
Chemistryanalyzer
Hematologyanalyzer
Bloodgasanalyzer
Automatedurinalysis
analyzer
Coagulationanalyzer
MalariaPOCdevice

SurprisesinShipping
WehadlabstafftrainedinCategoryAshipping
Commercialcouriers,even
thosecertifiedinCategoryA
shipping,refusedtopickup
anythingfromEmorylabelled
ascontainingebola virus
anddestinedforCDC
Category A Shipping Containment

ListofRegulationsAssociated
withtheEbolaResponse
OSHABloodbornePathogensStandard(29CFR1910)
CDC/NIHBiosafetyinMicrobiologicaland
BiomedicalLaboratories(BMBL)5th Ed.
DepartmentofTransportation(DOT)Hazardous
MaterialsRegulations(Division6.2BiologicalAgents)
NationalScienceFoundation(NSF)/American
NationalStandardsInstitute(ANSI)49(Biosafety
CabinetryCertification)

GeorgiaEnvironmentalProtectionDivision(EPD)

PersonalProtectiveEquipment

FollowedCDCRecommendationsforPrecautionsfor
PreventionofEbolaTransmission

PersonalProtectiveEquipment(PPE)
All persons entering the patient
Additional PPE might be required
room should wear at least:
in certain situations depending on
Gloves
patient and environment, including
but not limited to:
Gown (fluid resistant or
impermeable)
Double gloving
Eye protection (goggles or face Disposable shoe covers
shield)
Leg coverings
Facemask

http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

ProtectingHealthCareWorkers
AlthoughPPEiseffectiveatdecreasing
exposuretoinfectedbodilyfluidsamong
healthcareworkers,itspresenceissimplynot
enough
PPEitselfcanintroducerisk
Propertrainingandcompetencyindonningand
doffingofPPEkeyforsafety

http://annals.org/article.aspx?articleid=190048
1

ConsiderationsforPPEinourUnit
Dedicatedstaffwithyearsoftraining
Werequiredallstafftoundergorefresher
trainingfromqualifiedinstructors
RemovingPPEproperlykeytopreventing
contamination
AlldonninganddoffingofPPEwasobservedby
anotherteammember
Placedchecklistsinroomstoremindstaffofproper
protocols

UnexpectedAdventuresinWaste
Management
CDC:Sanitarysewersmaybeusedforthesafe
disposalofpatientwaste.
CountyWatershedDepartment:ifebola virus
isplacedinthesanitarysewerstheywould
disconnectourservice
Result:Allpatientsliquidwasteswere
disinfectedwithbleachorquaternary
disinfectingdetergentsfor>5minutespriorto
flushing

UnexpectedAdventuresinWaste
Management(2)
CDC:disposablematerialsandlinensshouldbe
placedinleakproofcontainmentand
discardedasregulatedmedicalwaste
Ourcontractor:allwasteneededtobe
certifiedasfreeofebola virusbeforethey
wouldtransporttotheirincinerator
Result:weautoclavedallregulatedmedical
wastebeforecontractorpickeditup

Communications
Primarygoal:toeducateandtoallayfears
Keymessages
Wehaveexpertiseintreatingpatientswith
seriousinfectiousdiseases
Wearetrainedandpreparedforthesepatients
Wewillprotectourpatients,ourstaffandour
communities

Patientconfidentiallyandrespectisparamount
Toactinthebestinterestsofourpatients

Communications(2)
Hospitalstaff:
Townhallmeetingswiththehospitalstaff
Emailupdatestoallstaff

Maintainingconfidenceandhonestywithour
otherpatients
Lettergiventoeachinpatientandallnew
admissionexplainingthesituationandourkey
messages

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Centers for Disease Control and Prevention


Atlanta, Georgia
Clinician Outreach and Communication Activity (COCA)

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