Given the current concerns over the possibility of having another Ebola patient walk into a hospital Emergency room, Clinic, or Doctor’s office the CDC has been working on various types of guidance, and we expect updated advice on PPEs to be released in the next few days (see NIH: `More Stringent’ PPE Standards For Ebola On The Way).
While clinicians have been asked to be alert for the signs of Ebola in anyone with recent travel history to West Africa, there hasn’t been a set of coordinated guidelines telling healthcare workers what to do next.
Yesterday, in an attempt to provide some `first steps’ for front line workers confronted with a possible Ebola patient, the CDC released the following infographic and advice, outlining what steps `should’ and `should not’ be done for a patient under investigation (PUI) for Ebola.
- Activate the hospital preparedness plan for Ebola, which should include
- Initiate the notification plan for suspect or confirmed Ebola patient immediately.
- Ensure hospital infection control is notified.
- Create a clinical care team led by a senior level experienced clinician that includes at a minimum a hospital infection control specialist, a senior nurse, an infectious disease specialist, and critical care consultants.
- Assign a senior staff member from the clinical care team to coordinate testing and reporting of results from the hospital laboratory, state health department laboratory, CDC, and local and state public health. For a list of state and local health department phone numbers, see http://www.cdc.gov/vhf/ebola/outbreaks/state-local-health-department-contacts.html.
- Isolate the patient in a separate room with a private bathroom.
- Ensure a standardized protocol is in place for how and where to remove and dispose of personal protective equipment (PPE) properly and that this information is posted in the patient care area.
- When interviewing the patient, collect data on:
- Earliest date of symptom onset and the sequence of sign/symptom development preceding presentation to an emergency department.
- Detailed and precise travel history (e.g., dates, times, locations).
- Names of any persons with whom the patient may have had contact during and any time after the earliest date of symptom onset.
- Consider and evaluate for all potential alternative diagnoses (e.g. malaria, typhoid fever).
- Reassure patient and family that appropriate care will be provided.
- Ensure patient has the ability to communicate with family.
What SHOULD NOT be done for a patient under investigation for Ebola virus disease?
- Don’t have any physical contact with the patient (e.g., perform examination, collect clinical samples, position for x-rays) without first putting on appropriate PPE and using recommended infection control practices necessary to prevent Ebola virus transmission.
- Don’t neglect the patient’s medical needs; assess and treat patient’s other medical conditions as indicated (e.g., diabetes, hypertension).
- Don’t forget to evaluate for all potential alternative diagnoses (e.g. malaria, typhoid fever).
- Don’t perform elective tests or procedures; minimize sample collection, laboratory testing, and diagnostic imaging (e.g., blood draws, X-rays) to those procedures necessary to provide acute care.
- Don’t allow family members to visit without putting on appropriate PPE; provide a telephone for family to communicate with patient.
Don’t judge or snub the patient; maintain a professional and compassionate atmosphere.
- Ebola virus disease Information for Clinicians in U.S. Healthcare Settings
- Safe Management of Patients with Ebola Virus Disease (EVD) in U.S. Hospitals