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DHQP/CDC Update as of March 2, 2021

Initial Triage of Patients

Currently, all U.S. healthcare settings are recommended to screen and triage everyone entering the facility for signs and symptoms of COVID-19.

Additionally, it is recommended that facilities

  • Ask about and document international travel histories to alert healthcare personnel to the possibility of other communicable infections, such as viral hemorrhagic fevers, that need specific infection control precautions and/or treatment.
  • Post contact information for infection control personnel and the local public health jurisdiction for reporting of communicable diseases, including EVD, in easily visible locations.

Current CDC infection prevention and control guidance for U.S. healthcare facilities is available on the CDC Ebola website for clinicians. Specific guidance and tools that may be of interest to facilities include

A healthcare facility evaluating a PUI or treating a patient with EVD should consult with public health authorities if they are unable to meet these recommendations due to PPE shortages caused by the COVID-19 pandemic. 

The Regional Treatment Network for Ebola and Other Special Pathogens

Healthcare facilities and public health officials should be familiar with the tiered U.S. Regional Treatment Network for Ebola and other special pathogens.

  • Healthcare facilities should understand their role in the tiered network as a Frontline facility, State-designated Assessment Hospital, State-designated Treatment Center, or HHS-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.
  • CDC continues to coordinate with the HHS Office of the Assistant Secretary for Preparedness and Response, Hospital Preparedness Program and the National Emerging Special Pathogens Training and Education Center (NETEC) to increase U.S. capability to safely manage patients with EVD and other special pathogens. NETEC maintains online resources at the link above, and remains available to provide consultation to hospitals for managing patients with EVD.

Additional Public Health Resources

This information was disseminated March 2, 2021 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.

Additional Resources

Blueprint for 21st Century Nursing Ethics

CDC: Interim Guidance for Survivor Management

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)

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 https://www.nejm.org/doi/full/10.1056/nejmp1410179.

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