Ebola: Are we higher prepared today?

The 2014 outbreak of Ebola virus disease (EVD) in West Africa was a wake-up call for healthcare administrators and physicians within the United States. EVD was seen as a third-world problem, a crisis that may likely never hit America. However, last October, we witnessed the primary patient diagnosed with EVD within the United States, a Liberian man who ultimately died in a Dallas hospital after infecting two of his nurses, who fully recovered. At the time, healthcare staff faced with the potential spread of the infectious disease needed to develop protocols based on limited knowledge and standards of look after patients infected with EVD. Most hospitals weren’t prepared for an infected patient to reach within the emergency department (ED). Most didn’t have adequate isolation rooms, personal protective equipment (PPE), or sufficient staff to securely look after these patients.

According to the World Health Organization (WHO), EVD stays a public health emergency of international concern (PHEIC)¹. There are still two lively EVD transmission chains, one in New Guinea and one in Sierra Leone, leading to about 5 recent cases per week¹. Are U.S. hospitals higher prepared, and are nurses safer, in caring for patients with highly contagious diseases than they were a yr ago? The answer could also be yes for a handful of facilities which have received advanced training, education, and government funding, but that just isn’t the case for greater than 5,000 hospital facilities nationwide.

In response to the outbreak, the Centers for Disease Control and Prevention (CDC) established a three-step approach to assist hospitals and other acute care clinics develop preparedness plans for patients under investigation (PUI) or with confirmed Ebola virus infection²Under this plan, hospitals can serve in one in all three roles: a front-line healthcare facility, an Ebola case assessment hospital, or an Ebola treatment hospital.

All hospitals are considered, and every plays a key role in identifying, isolating, and assessing PUI for EVD. Once identified, the institution is liable for notifying the ability’s infection control department, in addition to the state and native public health agency, and immediately placing the patient in isolation. The frontline hospital just isn’t expected to supply long-term look after the patient beyond 12 to 24 hours and may coordinate immediate transfer of the patient to an Ebola assessment hospital or an Ebola treatment hospital.³

are facilities which might be prepared to receive and isolate PUI and look after the patient until the diagnosis of EVD is ruled out or confirmed and until discharge or transfer is accomplished. They ought to be prepared to look after PUI for as much as 96 hours, ought to be equipped with adequate personal protective equipment for 4 to 5 days, and may be certain that staff members involved in or supporting the care of the patient are appropriately trained to perform their roles. This includes demonstrated proficiency in donning and doffing PPE, proper waste management, infection control practices, and packaging and transporting specimens.³

are facilities that plan for the care and management of a patient with confirmed EVD throughout the course of the patient’s illness. These facilities must meet minimum criteria set forth by the CDC, including infection control capability, physical infrastructure, staffing resources, PPE supplies, waste management processes, worker safety training, environmental services, and laboratory equipment.³ Staff have to be trained and expert in donning and doffing PPE for Ebola, in addition to providing clinical care using PPE. CDC Ebola Response Teams (CERTs) are able to deploy to every Ebola treatment center to supply technical assistance with infection control procedures, clinical care, and logistics for managing Ebola patients when a health department or hospital requests assistance.³

Fifty-five hospitals have been identified as Ebola assessment centers. Of these, nine hospitals have been designated as regional Ebola treatment centers and have received government support and advanced training to fulfill minimum CDC criteria. The Department of Health and Human Services (HHS) doesn’t mandate that each state adopt this approach, but all are encouraged to discover Ebola assessment hospitals that may effectively manage PUI or confirmed EVD cases.²

CDC published comprehensive guidelines for frontline hospitals within the management of patients with EVD from identification to treatment. The recommendations aren’t government mandated and may be expensive to implement, so most facilities haven’t implemented these secure practices or provided training to their frontline nurses. The responsibility for ensuring implementation of those guidelines rests with health care administrators, local state health departments, and the Occupational Safety and Health Administration (OSHA).

California is one in all the states that has implemented mandatory safeguards to guard healthcare staff from Ebola, requiring hospitals to supply a full complement of private protective equipment and comprehensive training for employees caring for Ebola patients.⁴ Under the rules, California hospitals are required to supply staff with full-body protective suits that meet ASTM standard F1670 for blood penetration and F1671 for viral penetration, and leave no exposed or unprotected skin.⁴ Hospitals must also provide powered air-purifying respirators with a full hood or a hood covering the top, face, and neck to every registered nurse or other staff member who cares for a patient with suspected or confirmed Ebola virus infection. Hands-on training have to be provided to any staff member who’s susceptible to exposure.⁴ These regulations are mandatory in California and if hospitals don’t comply with the rules, they’ll face fines and penalties.

The precedent set by California ought to be adopted by every state and native health department nationwide. All nurses should be adequately informed and trained within the care of patients with EVD, and their safety and well-being must remain a top priority. Do you are feeling your institution is ready to look after a patient with EVD today? Do you are feeling you’ve got received adequate training and that your risk of contracting EVD or other highly contagious diseases could be minimal? (You can see how some nurses answered this query in this text.) Let us know what you’re thinking that by leaving a comment!

In-person Ebola training ought to be mandatory and include:⁵

• Learning to placed on and take off PPE – performed under direct remark, following detailed and standardised verbal instructions; practiced 4 to 6 times; nobody is allowed in the nice and cozy area (anteroom) or hot area (patient room) without wearing full PPE under close remark and supervision by trained nurses.
• Performing routine tasks while wearing multiple layers of private protective equipment
• Improving safety skills: slowing down; taking note of sharp objects, stopping and desirous about movements before starting a task; putting your immediate safety above the needs of the patient; at all times working in pairs – one nurse cares for the patient while the opposite nurse monitors PPE breaks, disinfects the realm, prepares trash for disposal, and assists with turnarounds or two-person procedures.
• Waste handling: crawl when handling chamber pots, containers and urinals, at all times covering the container; all liquid waste is disinfected for quarter-hour before flushing.
• Cleaning and disinfection of healthcare facilities

Bibliography:
1. Website of the World Health Organization (WHO) accessed October 21, 2015.
2. Department of Health and Social Care (HSS) website accessed October 21, 2015.
3. Centers for Disease Control and Prevention (CDC) website accessed October 21, 2015
4. Cable, J. (2014). Nurses urge OSHA to adopt California Ebola safety measures. EHS Today website. Retrieved October 21, 2015.
5. Johnson, S., Barranta, N., and Chertow, D. (2015). Ebola on the National Institutes of Health – Perspectives of critical care nurses.

More resources
What it’s worthwhile to know in regards to the Ebola virus
CDC Guidance: Preparing U.S. Hospitals for Ebola Outbreak
CDC Guidance: Hospital Preparedness: A Multi-Level Approach – Preparing Healthcare Facilities on the Front Lines
CDC Guidance: Hospital Preparedness: A Tiered Approach – Preparing Hospitals to Assess Ebola
CDC Guidance: Hospital Preparedness: A Tiered Approach – Preparing Ebola Treatment Centers
CDC tightens guidance for U.S. healthcare staff on personal protective equipment on account of Ebola virus. Fact sheet
OSHA Fact Sheet: Cleaning and Disinfecting Surfaces Infected with Ebola Virus
OSHA/NIOSH/EPA Fact Sheet: Safe Handling, Treatment, Transportation, and Disposal of Ebola Virus-Contaminated Wastes
OSHA Fact Sheet: Personal Protective Equipment Selection Matrix for Occupational Exposure to Ebola Virus
OSHA Bloodborne Pathogens Standard, which covers Ebola virus exposure
OSHA Personal Protective Equipment Standard (General Requirements)
OSHA Standard for Personal Protective Equipment (Respiratory Protection)
OSHA Fact Sheet: Protecting Workers During a Pandemic

Myrna B. Schnur, RN, MSN