|Preparing for Ebola: Essential Elements for Health Care Facilities|
|Richard Giardina RN, MPH, CIC|
The past few months have presented the US health care system with new and perhaps daunting challenges when faced with the emergence of an often fatal infectious disease. This is not the first outbreak of Ebola in history; however, it is the first time its impact has reached the dinner table with such fervor. As of December 6, 2014, the CDC and WHO case count is 17,834 reported cases, 11,214 of which were confirmed by laboratory tests, with 6346 deaths (case fatality rate = 35%). The majority of cases remains confined to Guinea (2283), Liberia (7719), and Sierra Leone (7798). Four cases have been identified in the United States with 1 fatality.1
Ebola Virus Disease (EVD), previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees).2 It is highly transmissible from blood and body fluids of sick individuals. Exposed persons with no signs and symptoms (at least a fever) have not been reported to transmit EVD to others.
According to the CDC, if a patient in a U.S. hospital is suspected or known to have Ebola virus disease, healthcare teams should follow standard, contact, and droplet precautions, including the following recommendations:
Implement environmental infection control measures: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is of paramount importance, as blood, sweat, vomit, feces, urine and other body secretions represent potentially infectious materials should be done following hospital protocols.3
The primary concern of the CDC is to resolve the epidemic in West Africa in order to prevent further cases from occurring and thusly keeping ourselves safe in the US. This is accomplished through good preparedness and response riding on the backs of strong day-to-day systems. It will add demands to our public health agencies and health care system. We have been asked by the CDC to be prepared to recognize a case of EVD, isolate the suspected person, use highest available PPE available at that time, and contact the health department. These interventions require practice and revision of existing procedures to ensure compliance with the CDC requirements and ultimately the safety of the hospital staff and the public.
Most importantly is the speedy acquisition of necessary PPE. Not every hospital needs to maintain a stockpile of PPE. Firstly, only designated hospitals will be approved to accept suspect or known EVD patients and even then, there should be a designated cadre of necessary health care workers who will provide care. This will allow for rational purchasing decisions. The Hawai‘i Association of Hospitals has worked with the CDC to provide necessary equipment to designated facilities. The HAH has an overstock of supplies on hold in the event that each facility’s supply becomes depleted. Stockpiling hundreds of supplies is not the best use of resources.
The challenge we face is the decision of what PPE to use. We know the science on how the ebola virus is spread--through contact with blood and body fluids. Administrators must work with facility Infection Control, Employee Health, Safety, and Nursing departments to weigh the delicate balance of actual measurable risk and perceived risk by staff. When staff is presented with two different tiers of protection, odds are they will choose the higher level. That is human nature.
The ebola crisis is an evolving situation due to the learnings from each micro-event or “mistake” that occurs. The CDC acknowledges that they cannot provide initial guidance for every situation that occurs. They will, however, provide current guidance based on science and current situations to eliminate risk. The best advice is to assign a designated leader in your institution to keep close to the CDC and health department websites and update administration at least weekly.
1 CDC Website. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. Last accessed December 10, 2014.
2 CDC Website . Centers for Disease Control and Prevention Division of High-Consequence Pathogens and Pathology (DHCPP) Viral Special Pathogens Branch (VSPB). Last accessed November 18, 2014.
3 CDC Website. http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html. Last accessed November 18, 2014