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Ebola Information

Updated PPE Guidance (8.27.2015)

 

DHQP/CDC Update as of 2/8/19

Initial Triage of Patients

Here are the steps that facilities should implement as a routine part of triage to quickly identify, isolate, and inform public health authorities about patients who may have communicable infections:

  • Ask about and document international travel histories at initial triage. This information can alert healthcare personnel to the possibility of communicable infections, such as viral hemorrhagic fevers or emerging respiratory viruses, and other health conditions, such as malaria, that need specific treatment.
  • Identify patients who have fever and other signs and symptoms of infection and might warrant isolation pending further evaluation.
  • Post contact information in easily visible locations for infection control personnel and the local public health jurisdiction for reporting of communicable diseases.

 

Current Infection Prevention and Control Recommendations for Ebola Virus Disease in U.S. Healthcare Facilities

CDC recommendations for infection prevention and control for patients with confirmed EVD or persons under investigation (PUIs) for EVD in U.S. healthcare facilities have been recently reviewed and are considered up to date: https://www.cdc.gov/vhf/ebola/clinicians/index.html. To clarify,

 

 

The Regional Treatment Network for Ebola and Other Special Pathogens

Healthcare facilities and public health officials should be familiar with the U.S.Regional Treatment Network for Ebola and other special pathogens. This includes facilities understanding their designated role as part of the network, continuing to be willing to serve in that capacity, and maintaining preparedness as a Frontline facility, State-designated Assessment Hospital, State-designated Treatment Center, or HHS Assistant Secretary for Preparedness and Response (ASPR)-designated Regional Treatment Center.

  • Healthcare facilities and public health officials should have established plans for how PUIs or EVD patients are to be managed and referred.
  • Officials with responsibility for infectious diseases epidemiology and healthcare infection control should be in communication with their preparedness counterparts to ensure mutual understanding of the designations and preparedness status of assessment and treatment centers in their jurisdictions.
  • The National Ebola Training and Education Center (NETEC) is co-funded by ASPR and CDC. NETEC has additional online resources and a blog, and remains available to provide on-site readiness assessments to hospitals for Ebola and other special pathogens.

 

Additional Resources

This information was disseminated 2/8/19 by the Division of Healthcare Quality Promotion (DHQP), Centers for Disease Control and Prevention (CDC).

Ebola: What Nurses Need to Know

Preparedness Plan

Develop a preparedness plan that provides specific information on procedures and protocols to be used in your hospital or healthcare setting for identifying and caring for a patient with Ebola Virus Disease (EVD).  A preparedness plan should include:

  • Inpatient and ambulatory organizational policies and procedures that are in line with current CDC guidelines.
  • Incorporation of appropriate screening criteria to be used during patient registration and triage.
  • Rigorous training of all staff in screening procedures and what to do if a patient screens  positive for suspected EVD.
  • Isolation procedures to be used for patients in the ambulatory setting until transportation to an Emergency Department is facilitated, and isolation procedures to be used in the Emergency Department and inpatient setting if the patient is admitted to the hospital.
  • Initial and ongoing face-to-face training plans for staff who may provide direct care to a patient with a confirmed diagnosis of EVD.
  • Identification of appropriate isolation rooms and staffing plans to facilitate the care of a patient with EVD.
  • Appropriate use of PPE in all health care settings when caring for a patient with a suspected or confirmed diagnosis of EVD emphasizing the importance of proper hand hygiene.
  • Environmental cleaning procedures.
  • Mechanism to ensure timely reporting to local and public health officials.

The following resources can be used to develop a preparedness plan at your facility:
When using the following resources, please be aware that the CDC issued new Ebola and PPE guidelines on October 20, 2014 and some resources may not yet have been updated with that information.

 

Early Identification of EVD and Transfer to a Higher Level of Care

Early identification of Ebola Virus Disease through effective triage is critical to preventing the spread of infection. Paramedics, RNs, physicians and other personnel employed at health clinics and medical offices may be the first health care professionals to come in contact with patients with suspected Ebola Virus Disease (EVD).  The CDC provides the following guidance regarding identification and management of patients with suspected EVD:

 

Hospitalization

Hospitals may encounter patients with suspected and/or confirmed Ebola Virus Disease (EVD) at any time.  Updated CDC guidelines released on October 20th, 2014 remind all health care facilities that a preparedness plan that includes rigorous education, drilling and practice of any staff that directly interact with or care for patients is critical to ensure safe management of patients with EVD, particularly with PPE donning and doffing procedures.  No skin, hair or other body parts should be exposed when caring for patient with a suspected or confirmed diagnosis of EVD.  In addition, a trained monitor should oversee all PPE donning and doffing procedures.  ANA encourages all nurses to use the highest level of PPE recommended by the CDC at all times when in contact with a suspected/confirmed Ebola patient.

  • US Hospitals With Established Biocontainment Units
      • Emory University Hospital, Atlanta, Georgia
      • National Institutes of Health in Bethesda, Maryland
      • Saint Patrick Hospital, Missoula, Montana
      • University of Nebraska Medical Center, Omaha, Nebraska

 

Community Interaction

As trusted members of the community, people look to nurses for information about Ebola.  The six things nurses should communicate to family, friends and members of the community are:

  1. Ebola Virus Disease (EVD) is spread through direct contact with the blood and body fluids of someone who has EVD. 
  2. EVD is not spread through casual contact, or through the air, food or water.
  3. A person infected with EVD can’t spread the disease until symptoms appear.
  4. Early symptoms of EVD include fever (usually higher than 101.5F), muscle pain, headache, sore throat and abdominal pain.
  5. If you or someone you know has been to an area known to have confirmed cases of EVD and develops symptoms within 21 days of travel, seek medical care immediately.
  6. There is no vaccine against Ebola, However, you can protect yourself by washing your hands frequently and avoiding contact with blood, urine and other body fluids of someone who is at risk for, or sick with Ebola.

Use these resources to educate, dispel myths, and address concerns:

 

Right to Refuse

ANA believes nurses are obligated to care for patients in a non-discriminatory manner, with respect for all individuals, yet ANA also recognizes there may be limits to the personal risk of harm nurses can be expected to accept as an ethical duty.

ANA strongly encourages nurses to speak up if they believe there is inadequate planning, education or treatment related to providing care to these or any patients, and seek to resolve any conflicts of risk and responsibility swiftly. Nurses should have the right to refuse an assignment if they do not feel adequately prepared or do not have the necessary equipment to care for Ebola patients. .

 

Isolation, Monitoring, and Quarantine

Summary of CDC’s Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure

Isolation and Active Monitoring
The Centers for Disease Control and Prevention defines isolation as “the separation of an individual or group who is reasonable believe to be infected with a quarantinable communicable disease” from those who are not infected.

  • CDC has released detailed guidance based on different levels of risk. See table.
  • CDC recommends that people at risk for developing Ebola isolate themselves from others for 21 days. This includes restriction from traveling on airplanes and avoidance of public transportation and places where people congregate.
  • CDC is also recommending a 21-day active monitoring period for all people with any level of potential exposure to Ebola. Through active monitoring, public health workers check-in with people at least once a day to monitor for fevers or other symptoms of Ebola. In addition, those being monitored must take their temperature two times each day and watch for symptoms.
    • Direct active monitoring, which involves in-person observation, may be recommended for people with higher risks of exposure.
  • Public health orders for mandatory direct active monitoring and restrictions on movement may be used to ensure compliance.  

Quarantine 
CDC defines quarantine as the “separation of an individual or group reasonably believed to have been exposed to a quarantinable communicable disease, but who is not yet ill, from others who have not been so exposed, to prevent the possible spread of the quarantinable communicable disease.”

Some states have issued mandatory quarantine of health care workers returning from West Africa. In these instances individuals are required, sometimes forcibly, to remain in their homes or a medical setting for 21 days. ANA asserts that the decision to restrict the movement of person potentially exposed to Ebola should be left to public health officials. Mandatory quarantine of all health care workers returning from Africa will only increase the level of fear and misinformation that currently exists.

Highlights from Partner Organizations

Washington State Nurses Association

Texas Nurses Association

Ohio Nurses Association

American Association of Critical Care Nurses

Emergency Nurses Association

AORN Ebola FAQs, Resources and Multisociety Statement On Processing Biohazardous Medical Waste

Association of Professionals in Infection Control and Epidemiology

Best Practice Resources

CDC Ebola Key Messages (2.25.15)

Emergency Department Training Videos (2.17.15)

State Ebola Protocols (12.18.14)

Interim Guidance for U.S. Hospital Preparedness for Patients with Possible or Confirmed EVD (12.2.14)

Why Ebola is Not Likely to Become Airborne (12.2.14)

CDC's Ebola Response Team (12.2.14)

CDC Video on Respiratory Protection (11.12.14)

OSHA Standards for Protecting Workers from Ebola Virus

Web-Based PPE Training (10.31.14)

University of Nebraska Medical Center Best Practices Update (10.27.2014)

Emory Healthcare

Doctors Without Borders

Cal/OSHA Interim Guidance on Ebola Virus in Inpatient Hospital Settings (11.14.14)

NIOSH Training for Emergency Responders (12.8.14)

Additional Resources

Blueprint for 21st Century Nursing Ethics

CDC: Interim Guidance for Survivor Management

CDC Key Messages and Updates (11.19.2014)

CDC Infographic – Is it Flu or Ebola? (10.29.14)

CDC Updated Guidelines for Interim Monitoring and Movement of Persons with Potential Ebola Virus Exposure (10.27.2014)

CDC Fact Sheet: Monitoring Symptoms and Controlling Movement to Stop Spread of Ebola (10.27.14)

Patient Evaluation Checklist

WHO Fact Sheet

WHO Protective Measures for Medical Staff

Joint Commission Standards - Safely and Effectively Managing the Infectious Ebola Patient

 

References

Decker, D., Sevransky, J., Barrett, K. Davey, R. & Chertow, D. (2014). Preparing for critical care services to patients with ebola. Retrieved from http://annals.org/article.aspx?articleid=1910124

Fishcer, W., Hynes, N. & Perl, T. (2014). Protecting health care workers form ebola: personal protective equipment is critical but is not enough.  Retrieved from http://annals.org/article.aspx?articleid=1900481

Isakov, A., Jamison, A., Miles, W., Ribner, B. Safe management of patients with serious communicable diseases: Recent experience with ebola virus.   Retrieved from http://annals.org/article.aspx?articleid=1906849

Preston, R. (2014, October 27th).  The ebola wars. The New Yorker. Retrieved from
http://www.newyorker.com/magazine/2014/10/27/ebola-wars

Wolz, A. (2014). Face-to-face with ebola—an emergency care center in Sierra Leone. Retrieved from http://www.nejm.org/doi/full/10.1056/nejmp1410179.

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