Hospital Negative Ebola Incident

Hospital Negative Ebola Incident

October 11, 20214

History

Patient called EMS reporting fever, abdominal pain and blood in vomitus. Also stated history of contact with someone from West Africa. EMS notified hospital of patient and reported symptoms and history. EMS used Level C PPE to pick up the patient.

Hospital Actions

Hospital set up isolation room in ED. Patients were moved from the adjoining rooms. Hospital staff dressed out in PPE as prescribed by CDC advisory to Healthcare providers.

The Infection Control Officer for the hospital and corporate level were notified as well as the Administrator on Call and Emergency Manager. The Corporate Level Infection Control Officer reviewed the CDC Guidelines with the staff per a conference call and then proceeded to the hospital. The CEO was notified and proceeded to the hospital.

Hospital notified the ADRC.

ADRC Actions

ADRC notified Dr. Davis, Region 1 OPH Medical Officer, the Region 1 PHERC, Dr. Prats and the Region 1 GOHSEP Coordinator.

ADRC proceed to the hospital. ADRC was able to answer questions and offer suggestions by referring to CDC guidelines and reassure that the proper notifications had occurred.

Patient treatment

Patient was placed in isolation room. History from patient reviewed that she was a “casual contact”. She was at Best Buy and talked with a friend there that reported to her that he had been with someone that had Ebola (not sure about the veracity of this statement from the friend).

The patient was examined and monitored in the ED for two hours for fever. No fever or vomiting occurred, however, she had other symptoms that warranted admission to the hospital.

At the end of the two hours, after consultation with Dr. Davis and the Epidemiological section of OPH, the use of the fluid precaution PPE was stopped and staff continued to use only gloves.

Staff

Hospital Infection Control MD conducted briefing with ED staff prior to patient’s arrival and once during the care and again at the “all clear”. The staff seemed calm throughout. The support shown by ID and Administration was greatly appreciated by the staff.

Patient

The patient was very upset by the activity using the PPE. She was afraid that the other person that lived in the house would leave and that her neighbors would shun her because of seeing the EMS in PPE and everything that was on the news. She was also upset by what was being said on the news that made it sound like she was a liar and just seeking attention. The hospital staff were attempting to call the other person that lived at the house at the patient’s request. The staff was also going to call the Chaplain on call for patient support.

Hotwash

Those present for the Hotwash were the Hospital CEO Infection Control Officers, Administration on Call, ED Director and Supervisor, ED physician in charge of patient’s treatment, Security Director, Emergency Manager and ADRC.

The physician stated that he was very nervous. He had read all the info coming out from CDC but was afraid that a lapse in technique with PPE could occur. He stated that even with all the preparations, when confronted with the situation, it caused him to be nervous.

Below, in no particular order, are the points from the Hotwash:

1.  Patients put in negative pressure not because of their disease but because of procedure that might aerosol secretions.

2.  Use a buddy system or “watcher” for donning and doffing PPE just like used for Hazmat Level C suit and to watch for time in PPE.

3.  Need to check EMS for heat exhaustion and use “watcher” for EMS removing PPE.

4.  Need to set up “kit” to use for these patients to contain impermeable gown, goggles, disposable stethoscope, shoe covers, gloves, face mask. This hospital found that these articles were in multiple places. The gowns available in ED were only semi-impermeable, goggles and disposable stethoscope were not available.

5.  One of healthcare providers had their glove “break” during care giving. Recommend “Watcher” supervise doffing of PPE and immediate cleaning of hands. Double gloving may be used if healthcare provider feels safer but still need strict doffing of PPE.

6.  Visitors to ED patients need to be kept out. Do not give time limit.

7.  Staff in other parts of the hospital must be keep informed to keep panic down.

8. 

9.  Need to verify that EMR has way to flag travel info for physician. Must stand out from other information that ED physician receives.

10.  Need to develop plan for:

1. Terminal cleaning for ED room and ambulance
2. Pediatric transfer if hospital does not have pediatric service and patient is confirmed.
3. Pregnancy transfer if hospital does not have high risk OB and patient is “confirmed”.