Transcript Screening for Ebola - ExcelaHealth DrWeb

Ebola
Ebola Virus
Disease (EVD)
Prevention
Guidelines
All content based on available data from the
CDC as of 10/17/14
Acknowledgements
Presented By:
Debbie Territ RN,BSN
In Cooperation With:
Kathleen Rosatti RN, BSN
Mary Jo Bellush MSN,CIC
Joan Grote, BS, MT(ASCP)
Suzanne Mamrose-Hunt, MPH, MT (ASCP)
Debbie Schotting, RN, MSN
Menu
Click the links below to jump to selected “chapters” in the course.
Introduction
Objectives
What is Ebola
Ebola Exposure
Components for Prevention of Ebola
PPE Recommendations
Aerosol Generating Procedures
Summary
References
Introduction
The Centers for Disease Control and Prevention (CDC)
has released Infection Prevention and Control
Recommendations for Hospitalized Patients with Known
or Suspected Ebola Hemorrhagic Fever in U.S.
Hospitals.
Standard, Contact and Droplet Precautions are
recommended for any patients with known or suspected
Ebola hemorrhagic fever.
Objectives
 Healthcare workers are able to recognize the signs and
symptoms of Ebola Virus Disease (EVD).
 Define the key components of Standard, Contact and
Droplet precautions recommended for Prevention of EVD
Transmission.
 Describe how EVD is transmitted and the Personal
Protective Equipment (PPE) that needs to be used when
caring for patients infected with EVD.
 Healthcare workers will be able to identify key POINTS OF
CONTACT for any suspect case of EVD.
What is Ebola
Ebola virus is the cause of a viral hemorrhagic fever disease:
Symptoms of Ebola include:
- Fever (greater than 38.6 C or 101.5 F)
- Severe Headache
- Muscle pain
- Weakness
- Diarrhea
- Nausea and vomiting
- Abdominal pain
- Unexplained hemorrhage
(bleeding or bruising)
 Symptoms may appear anywhere from 2 to 21 days after
exposure to Ebola, although 8-10 days is most common.
Transmission of Ebola
 Ebola is transmitted through direct contact with the blood or
bodily fluids of an infected symptomatic person. (Body fluids
include saliva, mucus, vomit, feces, sweat, tears, breast
milk, urine, and semen.)
 It can also be transmitted through exposure to objects (such
as needles) that have been contaminated with infected
secretions.
 Individuals who are not symptomatic are not contagious. In
order for the virus to be transmitted, an individual would
have to have direct contact with an individual who is
experiencing symptoms.
Ebola Exposure
The level of exposure for EVD is important to know:
High Risk Exposure
 Percutaneous or mucous membrane exposure to fluids of affected patients.
 Direct care of affected patient without PPE.
 Handling lab specimens of affected patient without PPE.
 Exposure to remains of affected patient without PPE.
Low Risk
 Household member or **casual contact with affected patient (no contact with body fluids).
 Patient care or **casual contact without high risk exposure with affected patient in
healthcare facilities.
 Healthcare personnel in facilities with confirmed or probable EVD patients who have been
in the care area for a prolonged period of time while not wearing recommended PPE.
**Casual contact is defined as >3 feet from patient and no exposure to body fluids.
Screening for Ebola
Screening all patients at any entry point within Excela
Health is key! All clinicians are to screen patients when
they present for services.
EVD should be suspected in persons who have BOTH
consistent symptoms AND risk factors within 21 days of
symptom onset as follows.
Screening consists of two key components:
Symptoms
Travel History / Risk Factors
Screening for Ebola
Patients should be screened for symptoms associated with
EVD.
SYMPTOMS INCLUDE:
Fever (subjective or > 101.5 degrees F or 38.6 degrees C)
Severe headache
Muscle pain
Vomiting
Diarrhea
Stomach pain
Unexplained bleeding or bruising
Screening for Ebola
If a patient presents with ANY of the aforementioned symptoms,
a travel history should be obtained, particularly as it relates to
travel to West Africa in the last three weeks (21days) or if the
patient has had direct contact with blood, other body fluids,
secretions, or excretions of a person with EVD or who has
traveled to one of the areas listed below:
 Guinea
 Sierra Leone
 Liberia
 Nigeria
 Democratic Republic of the Congo
Areas of concern will be updated/included as recommended by the CDC
Screening for Ebola
Screening tools have
been created. Whenever
possible, the screening
information is being
added to the electronic
medical record.
 Outpatient settings will
use a paper tool
 Inpatient settings will
use the EMR
Screening for Ebola
For ANY suspect case of Ebola Virus Disease (EVD), staff
must follow these very important steps:
 Isolate the patient in a single room with a private bathroom and negative airflow
(if possible).
 Immediately suspend any further physical exam and/or diagnostic testing at this
time.
 Implement standard, contact and droplet precautions for any individuals who
have contact with the patient.
 Contact the Infection Control Preventionist ON CALL for Excela Health.
• Call the Excela Health Switchboard Operator at 724-832-4000.
• Request the On-Call Infection Control Preventionist.
 The Infection Control Preventionist will provide you with further guidance and
information.
 The Infection Control staff are accountable for immediately contacting the
Department of Health and CDC for direction and management of potential
patients.
Components for Prevention of Ebola
CDC Recommendations for Patient Placement:
 Single patient room (containing a private bathroom ) with
door closed.
 Standard, Contact and Droplet Precautions should be put in
place.
 Facilities should maintain logs of all persons entering the
patient’s room.
 Consider posting personnel at the patient door to ensure
appropriate and consistent use of PPE by all persons
entering the patient room.
PPE Recommendations
The CDC recommends: (The recommendations will be revised as new
information comes from the CDC)
 All persons entering the patient rooms should wear at
least:
- Double Gloves
- Gowns (fluid resistant or impermeable)
- Eye Protection (goggles or face shield)
- Facemask & Hood to include full neck coverage
- Disposable Leg/ Shoe coverings
 Additional PPE MAY be required in certain situations(e.g.,
copious amounts of blood, other body fluids, vomit or feces
present in the environment). Infection Control Practitioner
will provide guidance based the clinical presentation.
PPE Recommendations
Excela Health will begin:
 Training on the additional PPE requirements for EVD
including proper application and removal.
 In the case of a suspect EVD case, the buddy system will
be implemented and an Infection Control Preventionist or
designated individual will be assigned to the area to assist
and assure proper application and removal is occurring.
PPE Recommendations
 CDC recommends PPE should be worn by healthcare
providers upon entry into the patient rooms or care areas.
When exiting the patient room, PPE should be carefully
removed without contaminating one’s eyes, mucous
membranes, or clothing with potentially infectious materials
and discard it in the appropriate container in the room.
 Follow procedure for donning and removing PPE
as published by the CDC.
 Educational Materials found on:
EH Intranet/Featured News/Learn More About Ebola
 Hand Hygiene should be performed
immediately after removal of PPE.
Patient Care Equipment
 Dedicated equipment (preferably disposable, when
possible) should be used for the provision of patient care.
 All non-dedicated, non-disposable medical equipment used
for patient care should be cleaned and disinfected
according to the manufacturer’s instructions and hospital
policies.
 Use only a mattress and pillow with plastic or coverings that
fluids cannot get through.
Patient Care Considerations
CDC recommendations:
 Limit use of needles and other sharps as much as possible.
- Any injection equipment or parenteral medication
container that enters the patient treatment area should
be dedicated to that patient and disposed of at the
point of use.
 Phlebotomy, procedures and laboratory testing should be
limited to the minimum necessary for essential diagnostic
evaluation and medical care.
 All needles and sharps should be handled with extreme
care and disposed in puncture-proof, sealed containers.
Aerosol Generating Procedures
The CDC recommends avoiding Aerosol Generating Procedures
(AGP) for Ebola patients.
 AGPs are procedures that include use of BIPAP, open suctioning of
airways, bronchoscopy, intubation and extubation of patients.
 However, if APGs are needed, use a combination of measures to
reduce exposures.
- Limit number of healthcare providers (HCP’s) present
during the procedure.
- Conduct the procedure in an Airborne Infection Isolation
Room.
- Keep room doors closed during procedure and
minimize entry and exit during and shortly after the
procedure.
- HCP’s during the procedure should wear PPE
recommended by CDC with the addition of respiratory
protection (N95 respirator or higher filtering facepiece
respirator).
Hand Hygiene
 The healthcare provider must perform hand hygiene
frequently:
- Before and after all patient contact
- Contact with potentially infectious waste
- Before putting on and after removal of PPE
 Hand hygiene can be performed by washing with soap and
water or using alcohol-based handrubs. If hands are visibly
soiled use soap and water only.
Environmental Infection Control Measures
 Diligent environmental cleaning and disinfection and safe
handling of potentially contaminated material is of
paramount importance, as blood, sweat, vomit, feces, urine
and other body secretions represent potentially infectious
materials.
 Environmental service staff performing cleaning should
wear recommended PPE and consider additional barriers
such as shoe and leg coverings, if needed.
Additional Ebola Facts
On the Excela Health Intranet
Featured News at Excela Health Section
Learn More About Ebola
Click on links for additional information
Summary
 Key components of standard, contact and droplet
precautions are recommended by the CDC for prevention of
transmission of the Ebola virus.
 Appropriate PPE (i.e. gown, gloves, eye protection and
facemask) is essential in the care of Ebola patients.
 Aerosol Generating Procedures, if needed, require
additional measures to reduce exposure risks.
 Symptoms of Ebola include fever, headache, nausea,
vomiting, diarrhea, abdominal pain, weakness, muscle pain
and excessive bleeding and bruising.
References
• http://www.cdc.gov/vhf/ebola
Exit
Feel free to review the screens of this course until you are
confident about your knowledge of the material presented.
Click the Take Test button on the left side of the screen when
you are ready to complete the requirements for this course.
You must score 100% on the test before the module
will appear on your transcript.
•Choose the My Records button to view your transcript.
•Select Exit to close the Student Interface.