Ebola Preparedness Protocols. Carole DuPerre, RN, BSN, CIC Maine Medical Center Department of Epidemiology and Infection Prevention May 14, 2014

Transcription

1 Ebola Preparedness Protocols Carole DuPerre, RN, BSN, CIC Maine Medical Center Department of Epidemiology and Infection Prevention May 14, 2014

2 The story of the origin of the Ebola Virus

3

4 Ebola Virus Disease (EVD) Viral Hemorrhagic Fever Transmitted via blood and body fluids and excreta of symptomatic EVD-infected patients Human to Human transmission direct contact w/infected body fluids Infectiousness of body fluids increases as patients become more ill Incubation: 2 to 21 days; typically 8 10 days after exposure Communicability: Not before febrile phase and continues to increase with stages of illness as the viral load increase Remains from deceased persons are highly infectious

5 Clinical Presentation Signs and symptoms: Fever >38.6 or Myalgias Malaise Anorexia Diarrhea Vomiting Abdominal pain

6 Emory/Nebraska Experience 3-4 days non-specific febrile illness w/chills, myalgias, malaise, anorexia GI symptoms (5-6 days) Diarrhea frequent/profuse (meas in liters) (1-3) days Vomiting several days 5-7 days macular papular rash Neurological: delirium (day 10), encephalopathy Hematological: thromobocytopenia, abn LFTs Multi-organ failure: dehydration, rapid AKI (dialysis) Lung injury requiring mechanical ventilation

7 Methods of Control No specific treatment Supportive clinical care No vaccine (Sierra Leone trials) STRIVE: Sierra Leone Trial to Introduce a Vaccine against Ebola Strict infection control protocols, PPE

8 Definitions Person under investigation (PUI) Clinical criteria, includes fever > 38.0 (100.4), and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND Epidemiologic risk factors within the past 21 days; travel to an area where EVD transmission is active, contact with BBF or human remains of a pt known to or suspected to have EVD or direct handling of bats or non-primates from disease-endemic areas Confirmed Case A case with LAB-ID diagnostic evidence of Ebola virus infection Probable Case - A PUI whose epidemiologic risk factors include high or low risk exposure(s)

9 Definitions (cont) High Risk exposure Percutaneous or mucous membrane exposure to BBF of EVD pt, direct skin contact w/o PPE, processing BBF of confirmed pt w/o appropriate PPE, direct contact with dead body w/o appropriate PPE Low Risk exposure Household contact with an EVD person, other close contact with EVD pt in HCF or community setting, being w/in 3ft of an EVD pt or w/in pts room or care area for prolonged period while not wearing PPE, direct brief contact (i.e., shaking hands) w/o appropriate PPE. No known exposure Having been in country in which an EVD outbreak occurred w/in the past 21 days and having had no high or low risk exposures.

10 R/O Ebola Patient in ED September 2015 Young man seeks medical care in ED after sustaining head laceration while bicycling Brought to ED by a friend Screening questions, + travel to W. Africa and fever Returned from Ghana, West Africa 17 days earlier R/O Ebola patient, placed in isolation HERT staff step up to plate, Safety & Emergency Preparedness Dept come to ensure staff donning/doffing appropriately Ebola playbook reflects lessons learned during this real live drill

11 Infection Control Methods WHO recommendations: (Enhanced Precautions) PPE; Tyvek suit, PAPR, no skin showing, double glove (severity of illness/perception) Isolation Room; negative pressure room, no carpet, upholstered furniture and decorative curtains removed Staffing; 1:1 nursing care, buddy system, check list Security; Logs coming and going of staff, visitors, etc. Special Infectious Disease Unit (SIDU); privacy protection for high profile infection control issues

12 IC Methods (cont) Transportation: ED walk in; travel questions, exposure history, triage Internal MMC clinic including OB triage clinic; travel questions, exposure history, triage External MMC; travel questions, exposure history, telephone conversation with Hospital Epidemiologist Ambulance; arrive at ED (wet/dry); decontamination bay, wrap pt or use iso-chamber

13 IC Methods (cont) Treating; Safe care will be delivered, treat empirically (i.e., malarial tx, blood transfusion) Testing; POCT, I-stat (limited labs), x-ray, ventilation, dialysis, conduits for remote technology methods Cleaning; Germicidal agents w/3 minute contact time (purple top wipes), daily cleaning high touch surfaces (bed rails, over bed table, equipment), virus shown to be viable up to 6 days in environment, discharge terminal clean, then bleach clean.

14 IC Methods (cont) Laundry/linen and disposable dishes; three bag system Clear trash bag w/in room (bag 1) Clear bag w/in anteroom (bag 2) no-touch technique, wipe outside of bag w/purple wipe Red bag w/in anteroom (bag 3) wipe w/purple wipe Waste; Red bag everything that leaves room, box at site for incineration Visitors/privacy issues; No visitors will be allowed in isolation room, Skype, face time, video conferencing, etc. Will be scheduled, controlled and screened. Compassionate exceptions may be made by the hospital epidemiologist.

15 IC Methods (cont) Patient care equipment; minimize dedicated equipment, know manufacturers recommendations Specimen collection; Category A, consult with MeCDC prior to specimen collection, primary container double bagged in two zip-locked biohazard specimen bags, transported in durable, leak-proof secondary containers, Discontinuation of precautions; Probable/confirmed cases only after receipt of negative Ebola PCR and approval from Epidemiology dept, duration of positive cases in conjunction w/state & federal authorities on case-by-case basis, Possible cases only when another diagnosis is ruled in

16 Dallas, Texas 9/19 Index case departs Liberia 9/20 Dallas/Fort Worth through Dulles airport 9/24 He begins having symptoms 9/25 Seeks medical care at Presbyterian Hsp for fever and abdominal pain. Tells nurse he had travelled from Africa but was sent home. 9/28 Returns to hsp by ambulance placed in isolation 9/30 He tests positive for Ebola

17 Dallas (cont) 10/2 His family confined to their home 10/8 Index dies 10/10 1 st nurse who provided care goes to hsp w/fever and tests positive for Ebola 10/13 2 nd nurse who helped care for index flies back to Dallas from Cleveland (visited mother on 10/8 in preparation for a wedding) 10/14 2 nd nurse reports Ebola sx and placed on precautions 10/15 2 nd nurse transferred to Emery Univ Hsp, 1 st nurse is improving

18 Countries with Widespread Transmission Country Total cases (suspected, probable, confirmed Laboratory confirmed cases Total deaths Guinea Liberia Sierra Leone Total United States 4 total cases, 4 Laboratory confirmed, 1 death

19 References Heymann, David L. MD. Control of Communicable Diseases Manual 20 th Edition. Washington, D.C. American Public Health Association. (2015): Print.