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From: McGovern, Fran On Behalf Of Hupp, Diane Sent: Friday, October 17, 2014 4:02 PM To: Roth, Kimberly; Moody, Shawn; Roberts, Terri; Green, Michael; Aumer, Meredith; Clark, Robert (Anes/CCM); Aneja, Rajesh; Silva, Ismael; Cassese, Patrick; Munsch, Elizabeth; Rasmussen, Jayne; Hariri, Rahman (Mercy); Coffman, Leslie; Teears, Jason L; Majsak, James; Kapsin, Kathleen; Cancilla, Diane; Hecht, Lynn; Sears, Maryann; Croyle, Karen S.; Fagan (Holland), Julie; Kuch, Bradley A; Pritchard, Nancy S.; O'Hern, Mark A; Brozanski, Beverly; Gaines, Barbara; McKenna, Chris (CHP); Capan (Arnold), Michelle; Dewar, Stephanie; Hart, Stephen; Fox, Michael; Rometo, Allison B; Docimo, Steven; Ali, Bernadette; Ambrose, Heather; Basille, Donna; Belenis, Elaine; Eddy, Sandra A; Eicker, Paula; Iagnemma, Jennifer; Kovac, Victoria; Lesniak, Deborah; Madden, Christina; Scanlon (Lucero), Terri L; Straka, Kristen; Valenta, Cynthia; Vincze, Durae L; Waltenbaugh, Hope; Zoller, Kayla; Ankney, Diane; Aumer, Meredith; Carlson, Michele; Chaplik, Annette; Cote, Stacey; Dickman, Jennifer; DiLucente, Michele; Guthrie, Charles E; Kuch, Bradley A; Lamouree, Margaret; Manuel, Grace; Mastrangelo, Beth; Opalko, Darcie; Rausch, David; Ricci, Frank G; Spence, Ann; Tharp, Marcie M; Thomas, Dawn (CHP); Vincett, Carrie; VonHofen, Geraldine; Wible, Susan R; Cooper, Heather-Dawn; Kaminski, Marnie; Landgraf, Bonnie; Lipinski, Kimberly D; Mcintyre, Melissa J; Wilson, Melissa Cc: Anderson, Karen; Tennies, Kylen Subject: Ebola Preparedness Educational Meeting - Wednesday, 10/22/14, @ 3 pm Importance: High An Ebola preparedness educational meeting has been scheduled for Wednesday, October 22, at 3 pm in Rangos Conference Rooms B and C. If you are unable to attend, please send a designee to represent your area and let my office know who your representative will be. Thank you, Diane S. Hupp, MSN, RN, NEA-BC Vice President Patient Care Services and Chief Nursing Officer Children's Hospital of Pittsburgh of UPMC 4401 Penn Avenue Pittsburgh, PA 15224 Phone: 412-692-5122 Fax: 412-692-5800
From: Hupp, Diane Sent: Friday, October 17, 2014 11:35 AM To: Roth, Kimberly; Green, Michael; Docimo, Steven; Moody, Shawn; Roberts, Terri Subject: Draft for Power Point Education to Staff/Faculty Attached is a draft outline for the power point education for all staff and faculty. I am happy to fill in some of the info for the slides but wanted to send off the overview for you to comment, edit and add as you see appropriate before we begin to add comment. Thanks, Diane Diane S. Hupp, MSN, RN, NEA-BC Vice President Patient Care Services & Chief Nursing Officer Children’s Hospital of Pittsburgh of UPMC 4401 Penn Avenue Pittsburgh, PA 15224 Phone: 412-692-5122 Fax: 412-692-5800 This e-mail may contain confidential information of the sending organization. Any unauthorized or improper disclosure, copying, distribution, or use of the contents of this e-mail and attached document(s) is prohibited. The information contained in this e-mail and attached document(s) is intended only for the personal and confidential use of the recipient(s) named above. If you have received this communication in error, please notify the sender immediately by e-mail and delete the original e-mail and attached document(s).
Ebola Preparedness at Children’s Hospital of Pittsburgh of UPMC
October 2014
What is Ebola Virus?
Background/Key Facts
Significant Timeline
Transmission of Virus
Clinical Symptoms
Diagnosis
Treatment
CHP Preparedness to Date
Our Primary Roles
1. Screening for infection 2. Controlling infection in the health care
setting
CHP Screening Tool
• Insert Tool
UPMC System Target Hospitals for Ebola Patients
• Children’s • Presby • Shadyside • Altoona • Mercy • Hamot
PPE – Two Levels with Buddy System
• Level 1 • Level 2
Donning and Doffing Procedure
• Insert video if ok
Patient Placement for Identified Ebola Patients at CHP
• Emergency Department – Room 38
• PICU – Rooms 1 and 2
Supplies
• Cart
Staffing – Limited Ebola Response Team
Visitation - Restricted
Linen/Waste Disposal
Environmental Room/Corridor Procedures
CHP Communication Process for Positive Ebola Patient
QUESTIONS
Ebola Preparedness Children’s Hospital of Pittsburgh of UPMC
Presented by: CHP Emergency Preparedness Program Leadership
October 2014
Objectives
Provide an overview of the disease
Review the outbreak timeline
Review CHP preparedness activities
Discuss where we go from here
Outline key management principles
Background
Ebola is one of several organisms that causes the disease Viral Hemorrhagic Fever (VHF)
Ebola is not new. Discovered in 1976.
34 outbreaks of Ebola virus previously documented
Current outbreak represents first time this virus is in an urban area
How Is Ebola Transmitted? Direct contact with bodily fluids from an
infected and symptomatic person Blood Urine Vomit Stool Saliva Sweat Breastmilk Semen
What Are The Symptoms of Ebola?
Fever >100.6 Headache Chills, myalgias, fatigue, weakness Conjunctival injection Rash Abdominal pain, vomiting, diarrhea Unexplained bleeding (late in course)
Treatment of Ebola
No FDA approved vaccine or treatment
Supportive care is the mainstay
◦ Fluid resuscitation
◦ Electrolyte replacement
◦ Respiratory support
◦ Blood products
New treatments in the pipeline
2014 Timeline
March 2014 – report of 23 deaths in
Africa
July 27 – Diagnosis of 2 Americans in
Liberia
Aug 2 – Dr. Brantley transferred to Emory
Timeline Continued
Sept 20 – Duncan arrived in US
Sept 26 – Duncan seeks treatment at ED
Sept 28 – Duncan transported by EMS to
Texas hospital and admitted
Oct 8 – Duncan dies
Timeline Continued
Oct 10 – First Dallas RN tests positive
Oct 14 – Second Dallas RN tests positive
CHP Preparedness
July – planning meetings for MERS/Ebola August 8 – a case of interest in CHP ED ◦ HICS Team assembled
◦ Engaged with ACHD and State
August 13 – started screening in CHP ED ◦ “Travel-Illness Screening”
◦ Goal was to make this the “new norm”
Travel-Illness Screening Form
Initial screen is 2 questions
◦ Travel / exposure history
◦ Fever
“Positive hit” on initial screen prompts medical provider to ask additional questions to determine if this is a true case of interest
CHP Experience to Date
9 “positive hits” since August 13th
◦ 5 with concern for MERS
◦ 4 with concern for Ebola
Detailed history by physician was able to rule-out travel-
illness
Served as wonderful “drills” for us
◦ Communications tested
◦ PPE practiced
Where do we go from here?
Look closely at lessons learned ◦ CHP “positive screens”
◦ Texas experience
◦ Reports from recent drills across the nation
Continue to expand preparedness activities and engage all areas of the hospital and our medical community
The Steps to Success
Screen
Isolate
Call…..(and Communicate well!)
Evaluate
Partner with public health for appropriate
diagnosis and treatment of patient
Screen
Hold ourselves accountable to ensure the safety of all our patients and staff
Focus on point-of-entry locations ◦ Signage to promote self-reporting
◦ Must ask each patient, family and visitor
◦ Method that reflects to our colleagues that screening was done as expected
Isolate
Emergency Department ◦ ED Room 38 – now a dedicated isolation room
◦ Re-organized solely for this purpose
Inpatient location identified ◦ PICU Room 1
◦ Regardless of age, clinical status
Expand planning to ambulatory settings
Call Call the CHP ID Attending on call ◦ A key element in our CHP internal plan which
is in place to address specific issues encountered in a pediatric center ◦ CHP has five ID Attendings on staff ◦ The group has received in depth training ◦ Review history and determine if the individual
meets case definition for Ebola ◦ ID has been trained to then activate UPMC
and CHP teams to manage the situation
Call and Activate the Teams
ID Attending will call
◦ UPMC MedCall 647-7000
Activate Ebola Executive Team
◦ CHP Hospital Incident Commander
Activate the HICS Team (12 members + IP/ID)
Serves as support structure for all the “other layers”
Coordinates communications with external entities
(and communicate well) Practice communications for this scenario ◦ How would you address the family ◦ Who is designated to handle and document
communications (i.e. consider designating an emergency situation leader) ◦ Who will remain the point of contact and
communicate that information to important parties
Evaluate Safety is absolutely paramount to a
successful outcome Our community can not manage this if
the providers become the next victims Use of PPE is a skill that must be learned
and reinforced over time Understand that clinical management
may be very different from “everyday practice”
Clinical Management
Providers utilize PPE with buddy system
Treatment is supportive
◦ Istat machine in room with patient
◦ No labs are sent out of the room
◦ No radiology studies
◦ Un-crossmatched blood products only
◦ Empiric antibiotics when testing not available
Targeted Treatment Locations Facility level – identified locations and
internal “response” team members who have received a higher level of training
UPMC System level – CHP Presby/Shadyside Mercy Altoona Hamot
National level – CDC biocontainment unit
Benefit of Targeted Locations
Focus planning efforts and preparation for optimal outcome
Focus staff education and implement concept of “train and re-train”
Key resources and supplies can be concentrated and not spread too thinly across the region
Team Development
Need to work to identify staff who are willing to dedicate their time to more intensive training in how to care for patients diagnosed with Ebola ◦ ED and ICU background
◦ Primarily MDs and RNs will be needed
Visitation Policy
Visitation will be restricted
◦ CHP leadership will immediately review each
individual case to determine if an exception to
this rule is needed for optimal care of a young
pediatric patient and their family
◦ CHP leadership will determine if an approved
visitor must wear PPE
Waste and Linen Disposal
In initial hours ◦ Waste and linen will not leave the room
◦ Dietary should use disposable products only
◦ Determine need to pretreat waste products
◦ Linen will be red bagged
◦ PPE is doffed in the room and remains in the room
Environmental Cleaning
ALL cleaning practices will be determined by Hospital Incident Command in real time based on most current information available
CDC does recommend daily cleaning of room to reduce viral load on surfaces
Terminal cleaning is a multi-stage process that requires tremendous oversight
Travel Within Hall Corridors ALL patient travel will be managed by
Hospital Incident Command in real time Following steps are considered: ◦ Placing protective equipment on and around
the patient ◦ Public Safety establishing the travel corridor
and blocking passage of anyone besides the patient team ◦ Immediate environmental cleaning ◦ Ensuring privacy of patient, family and staff
Summary
Screen
Isolate
Call (CHP ID Attending)
Evaluate (safely!)
Call MedCall and CHP HICS Team
Communicate well along the way
QUESTIONS