EBOLA RESPONSE

IN THE

HEALTHCARE SECTOR

Elizabeth Corneliuson RN, MS, CHECRegional Program Manager – SEWHERC

Kelcie Chyla, Katie Wrobel, Bianca Behm, Jeremy Weaver

Learning Objectives● Review local and state response to Ebola in Wisconsin● Define ICS structure and apply to nursing roles● Discuss epidemiology and outbreak investigation● Identify aspects of hospital planning● Review PPE and waste protocols to contain Ebola virus

Department of Health Services Response

• Incident Command Activated

• Ebola Webinars

• Ebola Survey sent to hospitals via Wi-Trac.

• Working with Local Public Health to monitor persons returning impacted from

West African Counties.

• Designated Ebola Hospitals.

• DHS has partnered with 2-1-1 Wisconsin to establish the information line.

A toll free line is now available for state residents with questions about the Ebola virus.

Residents can dial 1-844-684-1064, 24 hours a day, 7 days a week. The calls are free, confidential, and multi-lingual

Governor's Response• Training of WI National Guard back-up teams to be completed this

week • Governor’s office has selected Ebola Clinical Advisory Panel, meeting

weekly • Karen McKeown, State Health Officer (WI Dept. of Health Services)

and General Donald Dunbar, State Adjutant General (WI Dept. of Military Affairs) state leads for Ebola issues

DHS Resources for Responders

• DHS webcasts and teleconferences• DHS Situation updates via Teleconferences• Wide dissemination of Ebola information and tools via emails and

WiTracIf you have questions, please email:

DHSResponse@wisconsin.gov

Southeast Wisconsin Healthcare Emergency Readiness Coalition

Response• Healthcare using guidance from CDC, University of

Nebraska Medical Center, and Emery University Medical

Center

• Ebola Symposiums and education outreach

• Enlisting Public Health and Healthcare Subject Matter

Experts to coordinate efforts

• Incorporating lessons learned in Dallas

• Written Plans are fluid

• Designated area for patient care

• Assessing resources (staff and equipment)

Southeast Wisconsin Healthcare Emergency Readiness Coalition

Response

• Using buddy system to Don and Duff PPE• Conducting tabletop exercises with staff and other

partners• Hands-On Drills in the ED and with hospital staff• Training teams for point-of-care for suspect and

confirmed cases• Early reporting and surveillance for suspect cases• Town hall meetings to alleviate staff concerns• Waste Management protocols in place

SEWHERC Resources

• SEWHERC Situation Reports

• Sertacwi.org

• Wi-Trac

• Presentations/ Webinars

• Tabletop exercises

• Teleconferences

Questions• How do we get this information to you?

• Do you have the resources that you need?

• How do we coordinate patient transfers, decon issues and waste handling with your local hospital

• As a nursing student what is you role?

Incident Command System

The Incident Command System (ICS) is a standardized method for managing emergency situations.

• Coordinated Response• Common Processes• Common Organizational Structures

Uses for ICSFlexibility of the system allows ICS to be applied to any incident,

regardless of the severity.

● Natural Hazards● Technological Hazards● Human-Caused Hazards

Features of ICS● Common Terminology

● Establishment and Transfer of Command

● Chain of Command and Unity of Command

● Unified Command

● Management by Objectives

● Incident Action Planning

● Modular Organization

Features of ICS● Manageable Span of Control

● Comprehensive Resource Management

● Incident Facilities and Locations

● Integrated Communications

● Information and Intelligence Management

● Accountability

● Dispatch/Deployment

Command & General Staff

Applying ICS to Ebola ● Wisconsin’s preparation:

o ICS initiated October 1sto Daily situational report meetingso Current necessary positions:

● Incident Commander● Public Information Officer● Safety Officer● Liaison Officer● Operations Chief

● Planning Chief● Logistics Chief● Financial Chief● Policy Chief● Legal Chief

ICS for Nurses“It is imperative that all voluntary healthcare professionals learn

the chain of command within the disaster response system. Each disaster response begins with the individual’s preparedness at the local level and all disaster preparedness must incorporate training of health professionals, citizens, and families in local disaster drills.”

Ebola Outbreaks2014: Ebola Outbreak in Democratic Republic of the Congo

On August 26, 2014, the Democratic Republic of the Congo (DRC) Ministry of Health notified the World Health Organization of an outbreak of Ebola virus disease (EVD) in Equateur Province. The index case was a pregnant woman from Ikanamongo Village who butchered a bush animal. She became ill with symptoms of EVD, reported to a private clinic in Isaka Village, and died on August 11, 2014. Local customs and rituals associated with death meant that several healthcare workers were exposed to Ebola virus. (CDC)

2014: Ebola Outbreak in West Africa

The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. Two imported cases, including one death, and two locally acquired cases in healthcare workers have been reported in the United States. CDC and partners are taking precautions to prevent the further spread of Ebola within the United States. CDC is working with other U.S. government agencies, the World Health Organization, and other domestic and international partners and has activated its Emergency Operations Center (EOC) to help coordinate technical assistance and control activities with partners. CDC has deployed teams of public health experts to West Africa and will continue to send experts to the affected countries. (CDC)

Signs and SymptomsSymptoms of Ebola include:

● Fever● Severe headache● Muscle pain● Weakness● Fatigue● Diarrhea● Vomiting● Abdominal (stomach) pain● Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years. (CDC)

Transmission of EbolaScientists believe that the first patient becomes infected through contact with an infected animal, such as a

fruit bat or primate (apes and monkeys), which is called a spillover event. Person-to-person transmission follows and can lead to large numbers of affected people. In some past Ebola outbreaks, primates were also affected by Ebola and multiple spillover events occurred when people touched or ate infected primates.

When an infection occurs in humans, the virus can be spread to others through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with

● blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola

● objects (like needles and syringes) that have been contaminated with the virus● infected fruit bats or primates (apes and monkeys)

Ebola is not spread through the air, by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bushmeat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitos or other insects can transmit Ebola virus. Only a few species of mammals (e.g., humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus. (CDC)

Preventing the spread of Ebola

• Contact tracing can stop Ebola in its tracks (CDC)

http://www.youtube.com/watch?v=rwdkVenedZQ&feature=player_embedded

Ebola Videos http://www.youtube.com/watch?v=LleznZCviBM&feature=player_embedded

http://www.cnn.com/2014/03/27/world/ebola-virus-explainer/

http://www.cnn.com/video/data/2.0/video/health/2014/11/07/ctn-intv-nurse-vinson-on-ebola.cnn.html

Before the Hospital • First Responders • EMS, firefighters, law enforcement

• Public Safety Answering Points (PSAPs)• Questions asked• If brought by airplane

EMS • Address for scene safety• Assessment and management• Exposure • Transporting• Cleaning the vehicle and other patient-

care surfaces

Hospital Planning • Incubation period• Triage • Urgent care and infection control• Communication• Background knowledge

Reduce risk of transmission

• Safety procedures• Work in pairs • Adequate amount of space• High risk areas

Algorithm for Emergency Departments

http://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.pdf

https://www.youtube.com/watch?v=isQCCWq7RVw

PPE Rules• All exposed skin covered• Training• Observers • Hands away from face• Do not adjust PPE during cares• PPE donning/doffing area

CDC (2014, October 20)

Donning PPE• Must be labeled • Observer• Hand hygiene (before and after)• Separate from doffing area and patient

room• No storage of contaminated items or

waste products CDC (2014, October 20)

PPE Equipment & Donning Steps

1. 1st pair of gloves2. Boot/Shoe covers 3. Fluid resistant/impermeable gown4. 2nd pair of gloves 5. PAPR or N95 Respirator6. Face shield, helmet or headpiece 7. Fluid resistant/impermeable apron 8. Disinfect gloves

*NO jewelry or personal items in patient room! CDC (2014, October 20)

Patient Room• Limit contact with people• Door closed• Own bathroom• Disinfected regularly & when soiled

CDC (2014, October 20)

Doffing PPE• Must be labeled • Observer • Slowly to prevent contamination • Disinfect gloves/hands between steps• Frequent disinfection of room and

equipmentCDC (2014, October 20)

Doffing Steps 1. Observer 2. Inspect PPE/Equipment 3. Disinfect gloves 4. Apron5. Inspect 6. Disinfect gloves 7. Boot/Shoe covers8. Disinfect/remove outer

gloves 9. Inspect/disinfect inner

gloves

10.Respirator 11.Gown12.Disinfect gloves13.Disinfect washable shoes14.Disinfect/remove inner

gloves15.Inspect16.Scrubs 17.Shower18.Evaluation

CDC (2014, October 20)

Waste

• “leak proof infectious waste containers”

• Disinfect regularly and when soiled CDC (2014, October 20)

Lessons Learned from Dallas

• Not prepared

• Need proper PPE

• Hospital lost 8 million dollars in revenue

• Patients/employees do not want to go there

References• FEMA: Emergency Management Institute, (2013). National Incident

Management System: Independent Study Program. Accessed 10/2014. Retrieved from http://training.fema.gov/IS/NIMS.aspx

• Shover, H. (2007). Understanding the chain of communication during a disaster. Perspectives In Psychiatric Care, 43(1), 4-14.

• CDC (2014, October 20). Guidance on personal pertective equipment to be used by healthcare workers during management of patients with ebola virus disease in u.s. hospitals, including procedures for putting on (donning) and removing (doffing). Retrieved from http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html

• Sprinks, J. (2014). Healthcare staff advised to prepare for Ebola cases in UK. Emergency Nurse, 22(5), 10-11. doi:10.7748/en.22.5.10.s10