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Preparing for Ebola: What U.S. Hospitals Can Learn From Emory
Healthcare and Nebraska
Medical Center
Clinician Outreach and
Communication Activity (COCA)
Webinar
October 14, 2014
Office of Public Health Preparedness and Response
Division of Strategic National Stockpile
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TODAYS PRESENTER
RADM Steve ReddSenior Advisor
CDC Ebola Response
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TODAYS PRESENTER (2)
Bruce S. Ribner, MD, MPHDirector
Emorys Serious Communicable Disease UnitEmory Healthcare
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TODAYS PRESENTER (3)
Alexander P. Isakov, MD, MPHDirector
Section of Prehospital and Disaster MedicineEmory Healthcare
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TODAYS PRESENTER (4)
Phillip W. Smith, MDMedical Director
Biocontainment UnitUniversity of Nebraska Medical Center
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TODAYS PRESENTER (5)
Angela Hewlett, MDAssociate Director
Biocontainment UnitUniversity of Nebraska Medical Center
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PlanningtoTransportPatientswithEbolaVirus
InfectionintheU.S.
AlexanderP.Isakov,MD,MPHDirectorSectionof
Prehospital andDisasterMedicineEmoryHealthcare
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MybrotherjustreturnedfromLiberiaandhasfeveranddiarrhea
Screening PSAP HCWs
Safety Destination Missionrecovery
Disinfection,infectiouswaste,followup
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PPE/Infectioncontrol
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AmbulanceDisinfectionMissionrecovery
Drivercompartmentisolationandpatientcompartmentbarrierdrapes
Decon,disinfectionofambulance,PPEdoffingandwasteremovalALLSUPERVISED
Surveillance
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PlanningtoTreatPatientswithEbolaVirusInfection
intheU.S.
BruceS.Ribner,MD,M.P.H.
OnbehalfoftheEmorySeriousCommunicableDiseasesUnit
team
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Planning
InvolveseverydepartmentinyourfacilityEmergencyMedicalServices(AIM9/23/14)Medicalstaff
ID,criticalcare,anesthesiology,
medicalsubspecialtiesNursingEnvironmentalmanagementFacilitiesSecurityMediarelations
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LaboratoryTesting
CDC:Recommendationsforlaboratorytestingbystaff:
AnypersontestingspecimensfromapatientwithasuspectedcaseofEbolavirusdiseaseshouldweargloves,waterresistantgowns,fullfaceshieldorgoggles,andmaskstocoverallofnoseandmouth,andasanaddedprecautionuseacertifiedclassIIBiosafetycabinetorPlexiglass
splashguardwithPPEtoprotectskinandmucousmembranes.Allmanufacturerinstalledsafetyfeaturesforlaboratoryinstrumentsshouldbeused.
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LaboratoryTesting(2)
ASM:TestingshouldbelimitedtoiSTAT
orequivalentPOCtestingsystemsandperformedinthepatientsroom
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LaboratoryTesting(3)
Realitycheck:ifalabspecimenspillsinthemainlabwe
wouldhavetoclosethelabdownforhourstodecontaminate
ifalabspecimenfromapatientwithEVDcomestothemainlab,fewtechnologists
wouldprocessit
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ADedicatedLabSpace
TheSCDunitestablishedasmallpointofcarelabwithintheunit
Dedicatedlabequipmentforourpatients
Staffedbylaboratoryvolunteers
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LaboratoryTestSupport
Chemistryanalyzer
Hematologyanalyzer
Bloodgasanalyzer
Automatedurinalysisanalyzer
Coagulationanalyzer
MalariaPOCdevice
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SurprisesinShipping
WehadlabstafftrainedinCategoryAshipping
Commercialcouriers,eventhosecertifiedinCategoryAshipping,refusedtopickupanythingfromEmorylabelledascontainingebola
virusanddestinedforCDC
Category A Shipping Containment
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ListofRegulationsAssociatedwiththeEbolaResponse
OSHABloodbornePathogensStandard(29CFR1910)
CDC/NIHBiosafetyinMicrobiologicalandBiomedicalLaboratories(BMBL)5th
Ed.
DepartmentofTransportation(DOT)HazardousMaterialsRegulations(Division6.2BiologicalAgents)
NationalScienceFoundation(NSF)/AmericanNationalStandardsInstitute(ANSI)49(BiosafetyCabinetryCertification)
GeorgiaEnvironmentalProtectionDivision(EPD)
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PersonalProtectiveEquipment
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FollowedCDCRecommendationsforPrecautionsforPreventionofEbolaTransmission
PersonalProtectiveEquipment(PPE) All persons entering the
patient
room should wear at least: Gloves Gown (fluid resistant or
impermeable) Eye protection (goggles or face
shield) Facemask
Additional PPE might be required in certain situations depending
on patient and environment, including but not limited to: Double
gloving Disposable shoe covers Leg coverings
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
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ProtectingHealthCareWorkers
AlthoughPPEiseffectiveatdecreasingexposuretoinfectedbodilyfluidsamonghealthcareworkers,itspresenceissimplynotenough
PPEitselfcanintroducerisk
PropertrainingandcompetencyindonninganddoffingofPPEkeyforsafety
http://annals.org/article.aspx?articleid=1900481
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ConsiderationsforPPEinourUnit
Dedicatedstaffwithyearsoftraining
Werequiredallstafftoundergorefreshertrainingfromqualifiedinstructors
RemovingPPEproperlykeytopreventingcontamination
AlldonninganddoffingofPPEwasobservedbyanotherteammember
Placedchecklistsinroomstoremindstaffofproperprotocols
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UnexpectedAdventuresinWasteManagement
CDC:Sanitarysewersmaybeusedforthesafedisposalofpatientwaste.
CountyWatershedDepartment:ifebola
virusisplacedinthesanitarysewerstheywoulddisconnectourservice
Result:Allpatientsliquidwastesweredisinfectedwithbleachorquaternarydisinfectingdetergentsfor>5minutespriortoflushing
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UnexpectedAdventuresinWasteManagement(2)
CDC:disposablematerialsandlinensshouldbeplacedinleakproofcontainmentanddiscardedasregulatedmedicalwaste
Ourcontractor:allwasteneededtobecertifiedasfreeofebola
virusbeforetheywouldtransporttotheirincinerator
Result:weautoclavedallregulatedmedicalwastebeforecontractorpickeditup
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Communications
Primarygoal:toeducateandtoallayfears Keymessages
Wehaveexpertiseintreatingpatientswithseriousinfectiousdiseases
Wearetrainedandpreparedforthesepatients
Wewillprotectourpatients,ourstaffandourcommunities
Patientconfidentiallyandrespectisparamount
Toactinthebestinterestsofourpatients
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Communications(2)
Hospitalstaff: Townhallmeetingswiththehospitalstaff
Emailupdatestoallstaff
Maintainingconfidenceandhonestywithourotherpatients
Lettergiventoeachinpatientandallnewadmissionexplainingthesituationandourkeymessages
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To Ask a Question
On the Phone Press Star (*) 1 to enter in the queue to ask a
question State your name Listen for the operator to call your name
State your organization and then ask your question
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Thank you for joining!Please email us questions at
[email protected]
Centers for Disease Control and Prevention Atlanta, Georgia
Clinician Outreach and Communication Activity (COCA)
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