The reality of a suspected Ebola case

Hospital Safety Insider, October 8, 2015

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If your hospital is like most in the U.S., you've taken the lessons learned since last year's Ebola scare in Dallas and applied some new protocols to your infectious disease response plan. Most places have updated their PPE stores and conducted training with their staff.

But like most things, the real teaching doesn't start until the real thing happens. It's one thing to plan for an Ebola response on paper; it's quite another when a patient suspected to have the disease enters your facility's ED.

That's what happened to two large Virginia hospitals last year. The University of Virginia (UVA) Medical Center in Charlottesville and Virginia Commonwealth University (VCU) Medical Center in Richmond both had their emergency planning tested last fall when two separate patients who had been traveling in Africa fell ill and were brought into their facility, suspected of having the Ebola virus.

Rockwell and his VCU counterpart, Joe Aurrichio, BS, CHFM, assistant director of plant operations for VCU Healthcare System, spoke about their experiences in a well-attended session at the annual conference of the American Society of Healthcare Engineers in July.

Identify a separate unit now.
The moment an Ebola patient is wheeled in the doors of the hospital is not the moment you want to be deciding where to treat him or her. If you haven't already, you need to have in your plans a place in your building that can be completely isolated, locked down, and operational while separate from the rest of the hospital. Ebola is such an infectious disease that just a tiny speck of blood can be enough to transmit the virus. For that reason, the Ebola ward needs to operate as a self-contained unit, with access tightly restricted. If surgery, dialysis, or other procedures need to be done, they will happen right there in the ward. Identify where your "hot zone" will be, as well as cold zones where staff will be able to don and doff PPE, consult on the patient's progress, and rest without worry about contaminating anyone else.

Plan to care for your staff. This is a big one that isn't thought about enough. Your staff members who work on an Ebola patient will essentially live in the ward until the all-clear is sounded, and they will develop an emotional bond to the case. It's a good idea to plan for a break room where staff will be able to completely get away from what is going on in the other room. They will also be scared and stressed, and need a place to relax, eat, and take a nap. Also, remember that their experiences may take a toll on their lives outside of work, and they will need lots of emotional support.

You haven't done anywhere near enough PPE training. You may have seen the training videos from the CDC or practiced with your staff to don and doff the proper PPE when working with an Ebola patient, but the reality is that there can never be enough training. Those who have lived through treating an actual Ebola patient say the training is daunting; there are a large number of steps, and intense peer supervision is required to ensure that absolutely no trace of body fluid gets on someone's skin. Aurrichio said his staff was trained on the more than 38 steps required to properly put on and take off an entire body suit to work with a patient with only about 30 minutes' notice, as well as fitting them properly for respirators, working in an enclosed environment for hours at a time, and making sure they recognize when it's time for someone to take a break.

Be ready for an insane amount of waste. All patients generate medical waste, but for the most part it can be separated into categories, with some of it allowed to go into the regular trash. But because of the highly infectious nature of Ebola, all materials that come into contact with the patient must be treated as potentially infectious. Officials at the Virginia hospitals that worked on Ebola patients say each patient generated about 1,000 pounds of waste per day. That includes any disposable underwear, socks, towels, and extra toothbrushes that the patient uses. What's more, it's not easy to get rid of. Waste generated from an Ebola patient is considered Class A medical waste, some of the most infectious, and many trash haulers will not even touch it. It cannot go to regular landfills, and it has to be disposed of in a special incinerator that is designed to prevent smoke and other vapors from contaminating the environment.
Maintenance on the fly
. For most of us, something as seemingly simple as replacing a light bulb is a commonplace event that we leave to maintenance workers. An Ebola ward will not have that luxury. The folks at VCU faced this problem when a nurse call button in the room housing the Ebola patient failed. No one from plant operations or maintenance had been trained in proper PPE, so they were not cleared to be in the room. Instead, four nearby rooms were emptied, and engineers trained a nurse on how to replace the call button herself.

This is an excerpt from the monthly hospital safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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