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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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Environmental
Services Response
Robert Jackson
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Waste Management for Ebola Care
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•All EVD patient waste entered waste stream after
treatment
•All patients’ liquid wastes were disinfected with
bleach or quaternary disinfecting detergents for >
5 minutes prior to flushing
•All room waste was meticulously handled with
onsite processing
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Onsite Processing
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• Sterilizer room self contained within SCDU
• Autoclave up to 5 bags per-load
• Average 10-12 boxes medical waste
processed per day
• Spore testing pack placed in every
load for validation
• Preparation of waste for shipping and
exchange to contractor according to
established protocols
• 800 -1,000 sq. feet dedicated space for
all waste management processes
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Equipment Needed
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• 50 waste contractor boxes
• 3 cases of red biohazard bags
• 1 case autoclave bags
• 1 bag of autoclave bag rubber bands
• 1 incubator
• 1 case spore testing pack • 2 cart covers
• 1 spill kit
• 1 pair heat resistant gloves
• 12 Rubbermaid barrels with lids and casters
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Waste Generation
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•Patient 1: Admitted for 19 days
•Patient 2: Admitted for 14 days
•Autoclaved 350 bags of regulated medical waste
•Total weight: 3,058 lbs
•Packaged 218 boxes of regulated medical waste
•6 shipments of regulated medical waste were
transported for incineration
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SCDU EVS Team
• Staffing – coverage for day, night and weekend
shifts
• 5 EVS staff trained to manage waste
• Strong partnership with clinical and lab team
• Waste Management Issues
– Amount of waste generation
– Expanded autoclave capacity
– Coordinated disposal with waste contractors
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Facilities
Management
Response
Jerry Lewis
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Physical Infrastructure Needs
for Ebola Care
• Dedicated exhaust system
• HEPA filters
• Neg Pressure Alarm panels
• Scrub sink in anteroom
• Locker room with shower
• Vinyl coated ceiling tiles
• Epoxy wall paint
• Solid sheet flooring
• Dedicated family room and conference room
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SCDU Design
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This type of facility is NOT necessary for the care of patients with Ebola
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SCDU
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Main Entrance into
SCDU Anteroom
Patient Room
Staff Shower in
Anti-Room
HEPA Filtration & Solid
Surface Ceiling Tiles
Patient
Restroom
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SCDU Facilities Management • Staffing – available 24/7 by phone
• 4 staff trained to work in SCDU
• Responsiveness and close working relationship with
clinical team
• Facilities Management Issues
– Toilet seats
– Touchless fixtures
– Flooring
– Doors
– Lighting
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Laboratory Response
Charlie Hill, MD, PhD
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External Industry Relationships * Company Name Role
Equity, stock, or options in biomedical
industry companies or publishers
None
Board of Directors or officer None
Royalties from Emory or from external entity None
Industry funds to Emory for my research None
Other None
Charles E. Hill, MD, PhD
Personal/Professional Financial Relationships with Industry
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Laboratory for Ebola Care
• Known positive Ebola specimens do not leave the
SCDU (except to go to CDC)
– Cannot shut down automated line for a possible
spill
– Positive custody for category A pathogen
samples
• Limited test menu is sufficient to care for critically ill
Ebola patients
• SCDU lab capable of handling aerosol transmitted
organisms, even though not the case for Ebola
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The SCDU Laboratory
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Test Equipment
• Blood Gas Analyzer – GEM 4000
• Chemistries and Enzymes – Abaxis Piccolo
• CBC – Sysmex pocH 100i
• UA – Clinitek Status
• PCR – Biofire FilmArray
• EIA – Binax Now, OraQuick Advance
• In patient room(s) – CoaguCheck, AccuCheck
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Test Menu in the SCDU Lab
• pH, pCO2, pO2, Na+, K+, Ca++, Glu, Lac, Hct, tHgb,
O2Hgb, COHgb, MetHgb, HHgb, T Bili
• ALB, ALP, ALT, AST, BUN, Ca, Cl-, CRE, GLU, LDH, K+,
Mg, Na+, Phos, T Bili, tCO2, TP
• WBC, RBC, Hgb, Hct, MCV, MCH, MCHC, Plt, MPV
• UA – Alb, Bili, Cre, Glu, Ket, Leu, Nit, pH, Pro, SP, Ubg
• GI Panel PCR, Respiratory Panel PCR, Blood Culture
Identification PCR, Ebola PCR (BT Panel, now BT-E
under EUA)
• Malaria EIA, HIV EIA
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The SCDU Laboratory
• Staffing – assigned for 6 hour blocks, 24/7
• 10 Medical Technologists trained to work in lab
• Extremely close working relationship with clinical
team (part of the care family)
• Lab Issues
– Instrument maintenance and repair
– Waste management
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Materials
Management
Response
Catherine Maloney
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Equipment Needed
• PPE
• Disposable clinical items
• Cleaning supplies
• Waste management supplies
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SCDU PPE
• Coverall
• Gloves regular
• Gloves extended cuff
• Booties
• PAPR Hood
• Apron
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Managing PPE Resources
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Insure adequate PPE supply for training & reuse
items as appropriate
Limit PAPR training to specific personnel with high
potential for exposure
Develop standard pre-packaged kit for
ambulatory settings and points of entry
Constantly source alternate vendors
Constantly source alternate products and validate
with clinical team & biosafety
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Materials Management
• Staffing – available 24/7
• Dedicated personnel stocked SCDU daily
• Materials Management Issues
– Sourcing enough PPE supplies
– Evaluating alternate products
– Adjusting supply based on acuity of patient
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QUESTIONS
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