As a hospitalist, I may be called by an emergency department physician today with the following scenario.
“Hey, Steve, I’ve got an admission for you. The patient just got off the plane at Sky Harbor and drove straight here with flu-like symptoms. He was in Liberia 10 days ago. This might be Ebola.”
My first inclination might be to run in the opposite direction from the ER and leave the hospital. But I probably won’t.
I’ve never seen a case of Ebola. At this point, very few U.S. doctors and hospitals have experience with it. I don’t remember anything about Ebola from medical school—for all I know it didn’t even existed back then.
In preparation for that call from the emergency department, here are some links for pertinent info, until I can memorize it all. Many of these links are to the U.S. Centers for Disease Control and Prevention and should be (better be) updated soon.
World Health Organization Guidelines on Personal Protective Equipment (October, 2014). This document is more detailed and probably a bit more stringent than the CDC’s advice, although the two have much overlap. A few points to remember:
- use nitrile gloves instead of latex
- medical/surgical mask must be fluid-resistant (e.g, “surgical N95 respirator”; if not surgical, it may not be water-resistant
- either fluid-resistant gown or coveralls, covered by a waterproof apron
- wear waterproof boots
World Health Organization Guidelines on Both Direct and Non-direct Care to Ebola Patients (September, 2014). Non-Direct care includes waste management, lab activities, movement and burial of human remains, etc.
The Nebraska Ebola Method: This dynamic and evolving course will provide videos, media, and guidelines as used in Nebraska to care for Ebola patients. The materials share current processes being used to safely care for patients with this dangerous, highly infectious disease. The course will be updated frequently to disseminate lessons learned.
A Detailed Ebola Case Report From Germany Published in NEJM. “Staff members…were protected by pressurized suits…that were equipped with ventilators with high-efficiency particulate air filters to provide fresh air supply with a maximum airflow of 160 liters per minute….” Does your hospital have these? “Decontamination [of healthcare workers] in the airlock is performed by two shower-cycles with 2% perchloric acid for 2 minutes and a residence time of 7 minutes. Finally acid residues are rinsed by showering with water.”
Lessons Learned Treating Ebola Patients at Emory University Hospital (pdf). Video of same presentation (didn’t work on my Mac).
An Emergency Physician Ponders the Reality of a Serious Infectious Pandemic and Suggests Management Outside of Traditional Healthcare Facilities
New York Times Oct. 15, 2014, article on CDC intensifying (Oct. 4) their initially lax healthcare worker infection control guidelines
Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals (I’m not sure these are adequate as of Oct. 15, 2014)
Generic 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
Donning and Removing Personal Protective Equipment
Personal Protective Equipment Training Demonstration Video from GNYHA. One way to do it, which may or may not be adequate.
Ebola Overview for Clinicians in U.S. Healthcare Settings
Algorithm for Evaluation of the Traveler Returned From Ebola-Affected Areas
Checklist for Patients Being Evaluated For Ebola in the U.S.
2008 Doctors Without Borders Practical Guidelines on Ebola and other Filoviruses
University of Nebraska Medical Center’s Biosafety Level 4 Facility Guidelines for Donning and Doffing Personal Protective Equipment Around Viral Hemorrhagic Fever Patients (these took 30-60 seconds to load on my computer)
Updated: November 3, 2104, 2345 hrs
I’m not sure I’d trust the guidelines as I don’t think they know what they’re doing. First thing I’d do is accumulate AS MUCH bleach as I could. Then I’d call an ID guy. This virus is not to be trifled with and I’m not sure the average hospital, or even the Tier 3 centers are capable of handling this yet as the Dallas situation is proving.
Vanslix, I very much agree. If this “outbreak” spreads in the U.S., I’m attracted to the idea of designating one hospital in major urban centers to be “the Ebola hospital.” Concentrate the expertise and experience in one place. Might be hard to staff it, however.
For myself, I’m leaning towards a Tyvex hazmat suit with boots and hood. I don’t even know yet if my hospitals have those in stock. After leaving the pt’s bedside, how about spraying down the protective gear with a bleach solution before doffing it? No one’s talking about that.
At this point, the ID guys probably don’t know any more about it than the average internist, FP, or hospitalist who’s done a few hours of targeted reading.
You just described what the personnel did with the anthrax scare in Congress. Funny how their lives seem worth it but the poor nurses are being blamed for poor protocol adherence. Maybe the protocols are wrong.
Oh, here’s a reference to chlorine mist as part of decontamination protocol: http://www.nytimes.com/2014/10/16/us/lax-us-guidelines-on-ebola-led-to-poor-hospital-training-experts-say.html?hp&action=click&pgtype=Homepage&version=LargeMediaHeadlineSum&module=b-lede-package-region®ion=top-news&WT.nav=top-news&_r=1