In May of 2018, DFW area infection preventionists were invited to a situation update regarding an Ebola outbreak in the Democratic Republic of Congo (DRC) by public health authorities. At the time, the cases identified in the DRC were limited to a remote area with limited international connectivity. Nonetheless, the recommendation was to remain vigilant and prepared to respond in the case a patient at risk for a high consequence infectious disease presented to one of the area facilities.
Following this guidance, our local community standards of practice (CSOP) special interest group met to discuss how area facilities prepare for emerging infectious diseases. We had turnout from three major healthcare systems in our area in addition to state and county epidemiologists. Recommendations listed below summary the decision of this meeting and guidance from public health authorities. For additional questions or concerns about this information, please contact CSOP Chair – Marie Wilson via email @ MarieWilson@mhd.com.
Disclaimer: A variety of factors impact individual facility responses and the below summarization should not be taken as a gold standard of care. Instead this information represents common interventions and resources used in our community to prepare to safeguard our public’s health.
1. “Lack of preparation on your part, does not constitute an emergency on mine.” THINK AGAIN!
Prepare by setting policies and procedures for the below activities:
a. Know the terminology and be prepared to answer the question of what HCIDs or EIDs are:
1. Definition from CDC’s Emerging Infectious Diseases https://wwwnc.cdc.gov/eid/page/high-consequence-pathogens-2018
2. Epi Case Criteria (2018) for Ebola: https://www.dshs.texas.gov/IDCU/investigation/electronic/Ebola-May-2018.pdf
a. Additional infectious disease control unit (IDCU) information available here: https://www.dshs.texas.gov/IDCU/investigation/Investigation-Guidance/
i. What are screening expectations for EID preparedness?
1. Resources to help answer this question:
a. https://www.cdc.gov/vhf/ebola/clinicians/evd/infection-control.html – Overall IP&C considerations
b. https://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.pdf (ARCHIVED Identify, Isolate and Inform infographic from CDC)
c. Care for the patient under investigation (PUI)
i. Understand the role your facility plays in HCID response. Are you a frontline, assessment or treatment facility?
1. Resources to help answer this question:
a. CDC differentiation of frontline, assessment and treatment facilities: https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html
2. Based on that designation, what is expected of your facility related to care for the PUI for an HCID?
a. Resources to help answer this question:
i. ASPR TRACIE develops resources (toolkits, templates and fact sheets) to address current and emerging infectious disease threats: https://asprtracie.hhs.gov/infectious-disease
ii. Specifically, their EMS Playbook may help guide frontline facilities on what care is expected for the PUI outside of treatment facilities: https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf
ii. Protecting employee health and wellness while caring for the PUI
d. How to safely transfer the PUI to a higher-level of care?
i. Resources to help answer this question:
1. Interfacility transport of PUI from CDC https://www.cdc.gov/vhf/ebola/clinicians/emergency-services/interfacility-transport.html
2. North Central Texas Trauma Regional Advisory Council: https://ncttrac.org/programs/healthcare-coalition-hpp/tsa-e/hcid/
2. “Practice makes perfect!”
Measuring the effectiveness and staff comfort with interventions designed to help identify and care for the patient at risk for an HCID.
a. Exercises – Work with your hospital’s emergency preparedness officer to plan and execute exercises
i. Planning – Allow ample time to plan your exercise and inform those that need-to-know
ii. Implementing – Be flexible and remember, “This is only a drill!”
iii. Reviewing – Include key stakeholders in after-action discussions and improvements
1. Mystery patient toolkit: https://asprtracie.hhs.gov/technical-resources/resource/3989/mystery-patient-drill-toolkit
b. Personal Protective Equipment donning and doffing procedures:
i. Resources for guiding PPE practice:
1. Training: https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/index.html
2. PPE calculator: https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/calculator.html
3. “The only true wisdom is knowing you know nothing.” -Socrates
Many recommendations have emerged since 2014 on the topic of emerging infectious diseases and will continue to. Its imperative infection Preventionists stay in-the-know and continue to collaborate among each other and with our public health colleagues. Only when we remain up-to-date will we be able to keep our facilities up-to-date and thus provide the highest level of care while minimizing the risk of exposure to staff and the public.
i. Sample Emergency Preparedness Plan from the University of Texas: https://preparedness.utexas.edu/sites/preparedness.utexas.edu/files/infectious-disease-plan.pdf
ii. Communication resources from the CDC:
1. Please note, some of this information has not been updated since 2015. Carefully review information prior to dissemination as it may not all continue to be accurate. For example, as of this posting there are no known PUIs in the United States.
iii. EVD information for clinicians (helpful guidance for IPs located here as well): https://www.cdc.gov/vhf/ebola/clinicians/index.html
iv. Ongoing training from CDC and SHEA: http://ortp.shea-online.org/online-training/
v. National Ebola Training and Education Center: https://netec.org/training/