Transcript Document

EBOLA RESPONSE
IN THE
HEALTHCARE SECTOR
Elizabeth Corneliuson RN, MS, CHEC
Regional Program Manager – SEWHERC
Kelcie Chyla, Katie Wrobel, Bianca Behm, Jeremy Weaver
Learning Objectives
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Review local and state response to Ebola in Wisconsin
Define ICS structure and apply to nursing roles
Discuss epidemiology and outbreak investigation
Identify aspects of hospital planning
Review PPE and waste protocols to contain Ebola virus
Department of Health
Services Response
• Incident Command Activated
• Ebola Webinars
• Ebola Survey sent to hospitals via Wi-Trac.
• Working with Local Public Health to monitor persons returning impacted
from West African Counties.
• Designated Ebola Hospitals.
• DHS has partnered with 2-1-1 Wisconsin to establish the information line.
A toll free line is now available for state residents with questions about the Ebola
virus.
Residents can dial 1-844-684-1064, 24 hours a day, 7 days a week.
The calls are free, confidential, and multi-lingual
Governor's Response
• Training of WI National Guard back-up teams to be completed this
week
• Governor’s office has selected Ebola Clinical Advisory Panel, meeting
weekly
• Karen McKeown, State Health Officer (WI Dept. of Health Services)
and General Donald Dunbar, State Adjutant General (WI Dept. of
Military Affairs) state leads for Ebola issues
DHS Resources for
Responders
• DHS webcasts and teleconferences
• DHS Situation updates via Teleconferences
• Wide dissemination of Ebola information and tools via emails and
WiTrac
If you have questions, please email:
[email protected]
Southeast Wisconsin Healthcare
Emergency Readiness Coalition
Response
• Healthcare using guidance from CDC, University of
Nebraska Medical Center, and Emery University Medical
Center
• Ebola Symposiums and education outreach
• Enlisting Public Health and Healthcare Subject Matter
Experts to coordinate efforts
• Incorporating lessons learned in Dallas
• Written Plans are fluid
• Designated area for patient care
• Assessing resources (staff and equipment)
Southeast Wisconsin Healthcare
Emergency Readiness Coalition
Response
• Using buddy system to Don and Duff PPE
• Conducting tabletop exercises with staff and other
partners
• Hands-On Drills in the ED and with hospital staff
• Training teams for point-of-care for suspect and
confirmed cases
• Early reporting and surveillance for suspect cases
• Town hall meetings to alleviate staff concerns
• Waste Management protocols in place
SEWHERC Resources
• SEWHERC Situation Reports
• Sertacwi.org
• Wi-Trac
• Presentations/ Webinars
• Tabletop exercises
• Teleconferences
Questions
• How do we get this information to you?
• Do you have the resources that you need?
• How do we coordinate patient transfers, decon issues and waste handling with
your local hospital
• As a nursing student what is you role?
Incident Command
System
The Incident Command System (ICS) is a standardized method
for managing emergency situations.
• Coordinated Response
• Common Processes
• Common Organizational Structures
Uses for ICS
Flexibility of the system allows ICS to be applied to any incident,
regardless of the severity.
● Natural Hazards
● Technological Hazards
● Human-Caused Hazards
Features of ICS
● Common Terminology
● Establishment and Transfer of Command
● Chain of Command and Unity of Command
● Unified Command
● Management by Objectives
● Incident Action Planning
● Modular Organization
Features of ICS
● Manageable Span of Control
● Comprehensive Resource Management
● Incident Facilities and Locations
● Integrated Communications
● Information and Intelligence Management
● Accountability
● Dispatch/Deployment
Command & General
Staff
Applying ICS to
Ebola
● Wisconsin’s preparation:
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ICS initiated October 1st
Daily situational report meetings
Current necessary positions:
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Incident Commander
Public Information Officer
Safety Officer
Liaison Officer
Operations Chief
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Planning Chief
Logistics Chief
Financial Chief
Policy Chief
Legal Chief
ICS for Nurses
“It is imperative that all voluntary healthcare professionals learn
the chain of command within the disaster response system.
Each disaster response begins with the individual’s
preparedness at the local level and all disaster preparedness
must incorporate training of health professionals, citizens, and
families in local disaster drills.”
Ebola Outbreaks
2014: Ebola Outbreak in Democratic Republic of the Congo
On August 26, 2014, the Democratic Republic of the Congo (DRC) Ministry of Health notified the World Health Organization
of an outbreak of Ebola virus disease (EVD) in Equateur Province. The index case was a pregnant woman from
Ikanamongo Village who butchered a bush animal. She became ill with symptoms of EVD, reported to a private clinic in
Isaka Village, and died on August 11, 2014. Local customs and rituals associated with death meant that several healthcare
workers were exposed to Ebola virus. (CDC)
2014: Ebola Outbreak in West Africa
The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. Two imported cases, including
one death, and two locally acquired cases in healthcare workers have been reported in the United States. CDC and
partners are taking precautions to prevent the further spread of Ebola within the United States. CDC is working with other
U.S. government agencies, the World Health Organization, and other domestic and international partners and has
activated its Emergency Operations Center (EOC) to help coordinate technical assistance and control activities with
partners. CDC has deployed teams of public health experts to West Africa and will continue to send experts to the
affected countries. (CDC)
Signs and Symptoms
Symptoms of Ebola include:
● Fever
● Severe headache
● Muscle pain
● Weakness
● Fatigue
● Diarrhea
● Vomiting
● Abdominal (stomach) pain
● Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average
is 8 to 10 days.
Recovery from Ebola depends on good supportive clinical care and the patient’s immune
response. People who recover from Ebola infection develop antibodies that last for at
least 10 years. (CDC)
Transmission of
Ebola
Scientists believe that the first patient becomes infected through contact with an infected animal, such as a
fruit bat or primate (apes and monkeys), which is called a spillover event. Person-to-person transmission
follows and can lead to large numbers of affected people. In some past Ebola outbreaks, primates were
also affected by Ebola and multiple spillover events occurred when people touched or ate infected
primates.
When an infection occurs in humans, the virus can be spread to others through direct contact (through
broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with
● blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and
semen) of a person who is sick with Ebola
● objects (like needles and syringes) that have been contaminated with the virus
● infected fruit bats or primates (apes and monkeys)
Ebola is not spread through the air, by water, or in general, by food. However, in Africa, Ebola may be
spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats.
There is no evidence that mosquitos or other insects can transmit Ebola virus. Only a few species of
mammals (e.g., humans, bats, monkeys, and apes) have shown the ability to become infected with and
spread Ebola virus. (CDC)
Preventing the
spread of Ebola
• Contact tracing
can stop Ebola
in its tracks
(CDC)
http://www.youtube.com/watch?v=rwd
kVenedZQ&feature=player_embed
ded
Ebola Videos
http://www.youtube.com/watch?v=LleznZCviBM&feature=player_embedde
d
http://www.cnn.com/2014/03/27/world/ebola-virus-explainer/
http://www.cnn.com/video/data/2.0/video/health/2014/11/07/ctn-intv-nursevinson-on-ebola.cnn.html
Before the Hospital
• First Responders
• EMS, firefighters, law enforcement
• Public Safety Answering Points (PSAPs)
• Questions asked
• If brought by airplane
EMS
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Address for scene safety
Assessment and management
Exposure
Transporting
Cleaning the vehicle and other patientcare surfaces
Hospital Planning
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Incubation period
Triage
Urgent care and infection control
Communication
Background knowledge
Reduce risk of
transmission
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Safety procedures
Work in pairs
Adequate amount of space
High risk areas
Algorithm for Emergency
Departments
http://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-managementpatients-possible-ebola.pdf
https://www.youtube.com/watch?v=isQCCWq7RVw
PPE Rules
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All exposed skin covered
Training
Observers
Hands away from face
Do not adjust PPE during cares
PPE donning/doffing area
CDC (2014, October 20)
Donning PPE
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Must be labeled
Observer
Hand hygiene (before and after)
Separate from doffing area and patient
room
• No storage of contaminated items or
waste products
CDC (2014, October 20)
PPE Equipment &
Donning Steps
1.
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4.
5.
6.
7.
8.
1st pair of gloves
Boot/Shoe covers
Fluid resistant/impermeable gown
2nd pair of gloves
PAPR or N95 Respirator
Face shield, helmet or headpiece
Fluid resistant/impermeable apron
Disinfect gloves
*NO jewelry or personal items in patient room!
October 20)
CDC (2014,
Patient Room
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Limit contact with people
Door closed
Own bathroom
Disinfected regularly & when soiled
CDC (2014, October 20)
Doffing PPE
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Must be labeled
Observer
Slowly to prevent contamination
Disinfect gloves/hands between steps
Frequent disinfection of room and
equipment
CDC (2014, October 20)
Doffing Steps
1.
2.
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4.
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6.
7.
8.
Observer
Inspect PPE/Equipment
Disinfect gloves
Apron
Inspect
Disinfect gloves
Boot/Shoe covers
Disinfect/remove outer
gloves
9. Inspect/disinfect inner
gloves
10.Respirator
11.Gown
12.Disinfect gloves
13.Disinfect washable shoes
14.Disinfect/remove inner
gloves
15.Inspect
16.Scrubs
17.Shower
18.Evaluation
CDC (2014, October 20)
Waste
• “leak proof infectious waste containers”
• Disinfect regularly and when soiled
CDC (2014, October 20)
Lessons Learned
from Dallas
• Not prepared
• Need proper PPE
• Hospital lost 8 million dollars in revenue
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Patients/employees do not want to go there
References
• FEMA: Emergency Management Institute, (2013). National Incident
Management System: Independent Study Program. Accessed 10/2014.
Retrieved from http://training.fema.gov/IS/NIMS.aspx
• Shover, H. (2007). Understanding the chain of communication during a
disaster. Perspectives In Psychiatric Care, 43(1), 4-14.
• CDC (2014, October 20). Guidance on personal pertective equipment to
be used by healthcare workers during management of patients with ebola
virus disease in u.s. hospitals, including procedures for putting on
(donning) and removing (doffing). Retrieved from
http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html
• Sprinks, J. (2014). Healthcare staff advised to prepare for Ebola cases in
UK. Emergency Nurse, 22(5), 10-11. doi:10.7748/en.22.5.10.s10