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This document is provided as a courtesy to those interested in Emory Healthcare and does not constitute medical or any other advice and does not create any physician-patient relationship. Also, Emory Healthcare does not endorse or recommend any specific commercial product or service. This document is provided solely for informational purposes only and no part of it may be used for any other purpose. The Emory Healthcare Ebola Preparedness Protocols full site/materials Disclaimer is available at www.emoryhealthcare.org/ebolaprep. These documents are subject to change based on
developing epidemiology in the country. Updated 11/10/2014 10:34 AM Copyright© Emory Healthcare 2014 – All Rights Reserved.
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Organizational Structure
& Logistics
Bryce Gartland, MD, FHM
Vice President of Operations, EUH
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OPERATIONS & ORGANIZATIONAL
STRUCTURE • Established early multidisciplinary leadership structure
• Leadership Team formed by hospital administration 72°prior to arrival of 1st patient
• Met 2x per day the first week
• Team composition:
• Administration
• Nursing leadership
• Physician leadership
• Direct support staff (e.g., Lab, EVS, Facilities, OIM, Biosafety, Infection Prevention, Security, HR)
• Communications (Internal & External)
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OPERATIONS & ORGANIZATIONAL
STRUCTURE
• Careful coordination and communication with involved organizations and groups • Internal
• Associated parties
• State and federal government
• Established formal review and approval process for key decisions
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Operations
• OSHA Bloodborne Pathogens Standard (29 CFR 1910)
• CDC/NIH Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Ed.
• Department of Transportation (DOT) Hazardous Materials Regulations (Division 6.2 Biological Agents)
• National Science Foundation (NSF)/ American National Standards Institute (ANSI) 49 (Biosafety Cabinetry Certification)
• Georgia Environmental Protection Division (EPD)
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SITE ASSESSMENT
AND TRAINING
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SITE RISK ASSESSMENTS
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SITE RISK ASSESSMENTS
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SITE ASSESSMENT AND TRAINING
SCHEDULE
• Site assessment process
– Site assessments complete in all hospitals and high risk clinics
• Three tiers of training
– SCDU
– Point of Entry Staff
– Broader EHC staff, faculty and students
• Training of ED and L&D staff and points of potential patient access are priorities
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PREPARING THE WORKFORCE – GOING FORWARD
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PPE FOR STAFF
• Impervious hair cover
• Impervious gown
• Double gloves
• Impervious booties
• Surgical mask
• Face shield
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Occupational Health
Paula DesRoches, ANP-BC, COHN-S
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THE ROLE OF OCCUPATIONAL HEALTH
• Management of EVD Providers: Temperature and
Symptom Monitoring
• Guidance to staff and faculty returning from travel
to West Africa (Liberia, Guinea and Sierra Leone)
• Management of staff potentially exposed to EVD
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MANAGEMENT OF EVD PROVIDERS
PROTOCOL • EVD Response Plan: Protocol for employees providing direct patient care (including lab personnel and anyone managing the waste
stream)
• All health care providers, including lab personnel and anyone managing the waste stream, are required to measure their temperature and
complete the symptom questionnaire twice daily.
• If you have a fever of > 37.8 degrees C, 100 degrees F.
• OR
• If you have any of the following symptoms: chills, malaise, headache, joint/muscle aches, weakness, diarrhea, nausea/vomiting, stomach
pain, or lack of appetite.
• Call the Occupational Injury Management Director or the Occupational Injury Management Clinical Lead for personal consultation/triage,
prior to leaving the Unit.
• Complete an Employee Incident Report
• If you are symptomatic, do not leave the Unit until consultation with Occupational Injury Management.
• If you are unable to work an assigned shift, you are required to notify the unit director of the Unit as well as Occupational Injury
Management.
• You are required to report any fever of > 37.8 degrees C, 100 degrees F for any of the following symptoms (headache, joint/muscle aches,
weakness, diarrhea, vomiting, stomach pain, or lack of appetite) for 21 days from the last shift worked on the Unit.
• Any health care provider (including lab and waste handlers) is required to monitor their temperature twice daily and monitor for any
symptoms (listed above) on days not worked on the Unit. Report these symptoms immediately to Occupational Injury
Management.
• Compliance Statement
Occupational Injury Management nurses will manage the symptom monitoring data, and the Corporate Director of Occupational Injury
Management will audit the data on a daily basis.
– The Occupational Injury Management nurse will review data on daily basis and make contact with any direct care provider that
does not have a temperature and symptom review documented two times in a day for 21 days from the last day worked on the
unit.
– Once contact is made with noncompliant providers, the OIM nurse will review symptoms with the provider and log the results on
their behalf.
– Executive leadership will be provided the names of any provider that has three instances of noncompliance.
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MANAGEMENT OF EVD PROVIDERS
SYMPTOM QUESTIONNAIRE • Direct Health Care Provider (including Lab Personnel and Anyone Managing the Waste Stream) Symptom Questionnaire
(EVD)
• Name_________________________________________
• Employee ID #__________________________________
• Date____________________ Time ____________
• Cell phone number (best contact #) __________________
• Temperature: ___________ degrees C/F If yes, onset and duration
• Nausea/Vomiting:
• Diarrhea:
• Headache:
• Joint or Muscle Aches, or both:
• Stomach Pain:
• Lack of Appetite:
• Weakness:
• All health care providers providing direct patient care (including lab personnel and anyone managing the waste stream) are required to complete this form at the beginning and at the end of their shift.
• If you have a fever of > 37.8 degrees C, 100 degrees F, or any of the symptoms listed above, please call the Occupational Injury Management Director or the Occupational Injury Clinical Lead NP for personal consultation, prior to leaving the Unit.
• Complete an Employee Incident Report.
• Refrain from leaving the Unit until consultation with Occupational Injury Management.
• If you are unable to work an assigned shift, you are required to notify the Unit director of the SCDU as well as Occupational Injury Management.
• You are required to report any fever of > 37.8 degrees C, 100 degrees F or any of the following symptoms (chills, malaise, headache, joint/muscle aches, weakness, diarrhea, nausea/vomiting, stomach pain, or lack of appetite) for 21 days from the last shift worked on the Unit.
• Any health care provider (including lab and anyone managing the waste stream) are required to monitor their temperature twice daily and monitor for any symptoms (listed above) on days not worked on the Unit. Report these symptoms immediately to Occupational Injury Management.
Signature: ____________________
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GUIDANCE TO STAFF RETURNING FROM
TRAVEL • Subject: Guidelines for staff and physicians traveling to West Africa
• This email is sent on behalf of Occupational Injury Management
• Dear Staff and Physicians,
• As the Ebola outbreak in West Africa continues, we want to remind you of the procedures Emory put in place in August to mitigate
exposure of those coming to our facilities. While the CDC considers Ebola to pose little risk to our country at this time, individuals traveling to
the countries where Ebola cases are occurring may be at risk for exposure. Therefore, Emory has put in place the following protocol for all
Emory faculty, staff and students who have recently traveled to or are planning to travel to Guinea, Liberia, Nigeria and Sierra Leone (Note: The at-risk regions listed has changed since the communication sent in August).
• Who to Contact Upon Return
• Emory Faculty and Staff: Prior to returning to work after travel, Emory faculty/staff should contact Paula Desroches, NP, Director of
Occupational Injury Management, at XXXXXX or Emily Beck, NP, Clinical Lead with Occupational Injury Management, at XXXXXXX, for counseling.
• Emory Students: Prior to returning to campus/classes, Emory students with recent travel to the countries listed above should contact Student
Health Services’ Michael Huey, M.D., Executive Director, at XXXXXXXXX, or Gertrude Thompson, RN, BSN, Director of Nursing, at
XXXXXXXXXX, for counseling.
• Procedures for 21 Days
• Emory faculty/staff and students should check their temperature and report any symptoms, including headache, joint/muscle aches,
weakness, diarrhea, vomiting, stomach pain or lack of appetite once daily from the first day of their return from travel and for 21 days
thereafter. For a complete list of Ebola symptoms, visit the CDC website.
• In the event of onset of a fever of 100 degrees or higher or any of the symptoms listed above, DO NOT REPORT TO WORK OR SCHOOL.
• Procedures if You Are Symptomatic
• Symptomatic faculty/staff should contact Paula Desroches, NP, or Emily Beck, NP, with Occupational Injury Management, immediately at
the phone numbers above for further guidance.
• Symptomatic Emory students should contact Student Health Services’ Michael Huey, M.D., or Gertrude Thompson, RN, BSN, immediately at
the phone numbers above for further guidance.
Thank you for your commitment to providing a safe environment and to your personal well-being.
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MANAGEMENT OF STAFF POTENTIALLY
EXPOSED TO EVD: PROTOCOL
Risk Assessment for Exposure to Ebola Virus • Percutaneous (e.g., needle stick) or mucous membrane exposure to
blood or body fluids from an EVD patient?
• Direct skin contact with skin, blood or body fluids from an EVD patient? • Processing blood or body fluids from an EVD patient without appropriate
PPE? • Healthcare personnel in facilities providing care to EVD patients without
recommended PPE?
• • If “Yes”, Alert Infectious Disease for counseling and consideration for work
furlough including twice daily temperature monitoring and symptom reviews until 21 days post this exposure. This exposed employee must submit an Incident Report in People Soft/eVantage
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Emergency Medical Services
Alexander Isakov, MD, MPH
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CONSIDERATIONS
• The Ebola epidemic is in Sierra Leone, Guinea and
Liberia
• Asymptomatic patients are not contagious
• Risk of transmission of EVD increases with severity of illness
• Primary infection control principle is preventing exposure
to blood and infectious bodily fluid
• PPE should reflect patient condition and operating
environment
• Supervised PPE doffing and disinfection is advisable
• Regionalization of care