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Providence Alaska Medical Center’s highly infectious disease planning journey to designation Hale Borealis – October 18, 2016 Pat Reynaga, RN PAMC Director of Communications and Emergency Preparedness Rebecca Hamel, RN PAMC Infection Preventionist Describe a strategy for evaluating infectious disease readiness and preparedness. List three local/national resources for enhancing their emergency preparedness/infection prevention programs. Define the level of Ebola readiness designation PAMC has achieved. March 2014 – Emergence of outbreak in West Africa ◦ projected 20,000 infected people by year end 2014 July 2014 – CDC Health Advisories – rapid changes ◦ Disease information, Clinical recognition, PPE, Recommendations October 2014 Status of Epidemic in West Africa (Guinea, Sierra Leone, Liberia) ◦ 9935 cases ◦ 4877 deaths 4 treated after abroad (Atlanta, Omaha) 1 traveler who developed symptoms in US (Liberia to Dallas, Sept 30) 2 nurses acquired the infection in the US (Dallas, early Oct) 1 MD acquired infection 10 days after return to US (Guinea to NYC, Oct 23) Mr. Duncan, 42, grew up next to a leper colony in Liberia and fled years of war before later returning to his country to find it ravaged by the disease that ultimately took his life. Duncan arrived in Dallas in late September, realizing a long-held ambition to join relatives. He came to attend the high-school graduation of his son, who was born in a refugee camp in Ivory Coast and was brought to the U.S. as a toddler when the boy's mother successfully applied for resettlement. The trip was the culmination of decades of effort, friends and family members said. But when Duncan arrived in Dallas, though he showed no symptoms, he had already been exposed to Ebola. His neighbors in Liberia believe Duncan become infected when he helped a pregnant neighbor who later died from it. It was unclear if he knew about her diagnosis before traveling. Duncan had arrived at a friend's Dallas apartment on Sept. 20 -less than a week after helping his sick neighbor. CDC Support - Dallas Hospital Investigation Immediate Actions in Response to the Investigation ◦ ◦ ◦ ◦ ◦ Personal Protective Equipment Oversight and Monitoring Enhanced Training Establishing a Dedicated CDC Response Team Ensuring Healthcare Workers and Facilities are Prepared Recommendations Complete skin coverage Use of buddy system to oversee and monitor donning/doffing of PPE Training and drills Summer 2014 ◦ CDC Health Advisories August 2014 ◦ Alaska Interagency Outbreak Readiness Team October 2014 ◦ Interdisciplinary meetings and town hall meetings ◦ Providence System – resource documents ◦ Rapid Ebola Preparedness Tool for Hospitals (11 domains) ◦ Determination and acquisition of PPE ◦ Enhanced PPE Training ◦ Regional training and supplies Inventory EMS including PAMC Off-campus Room 8&9 Incident Command TRIAGE or PAMC On-campus October 20, 2014 – November 14, 2014 ◦ 13 training sessions ◦ Over 100 staff trained ◦ Multidisciplinary staff First full scale drill planned for November 17, 2014 ◦ Emergency Department entry point to Intensive Care Unit ◦ Multiple department involvement ◦ Containment walls, decontamination shower, supplies, don/doff Competency ◦ Enhanced PPE and supplies ◦ Observer checklists ◦ PAPR training Points of entry and workflow Incident Command support processes ◦ Phone trees ◦ Department readiness ◦ Supplies prepped and ready Isolation, Containment, Safety ◦ Walls ◦ Decontamination November 14, 2014 ◦ Presented with fever, diarrhea, nausea – not wet ◦ Recent travel from Mali Few cases being monitored, not yet declared ◦ Language barrier ◦ Phone trees ◦ ID MD and IP support in-house within 45 minutes from presentation ◦ Lessons learned Processes Roles Workflow Strong partnership with State Public Health Certain roles are critical throughout process and required on-site Lab collecting, processing and transport ◦ Rote processes (ordering, collecting) ◦ Staff safety Phone trees Training Next steps ◦ CDC Recommendations June 2015 ◦ Create an environment in which infection prevention is a component of best practice and strive in daily practice for infectious disease incident and outbreak preparedness. ◦ Promote a culture committed to infectious disease incident and outbreak readiness through proactive accountability for all staff being effectively trained, informed and protected at all times. ◦ Develop a comprehensive infectious disease incident response program that supports ongoing readiness through training, evaluation and implementation of best practices. Facility Infrastructure Private room with in-room dedicated bathroom with covered toilet or covered bedside commode Dedicated patient-care equipment Determined transfer routes Patient Transport Patients under investigation vs confirmed to an Ebola Assessment Hospital or Ebola Treatment Center ◦ Ground transport ◦ Air transport Transportation provider(s) safe transport training Identification of appropriate PPE Entry points to designated units Laboratory Safety and Capacity Diagnostic laboratory procedures and protocols are in place Specimen handoff and transport for routine clinical diagnostic testing at the facility ◦ iSTAT Lab personnel have been trained and have demonstrated proficiency in PPE Specimen transport to designated lab Staffing of Patient Care Team Readiness plans include input from a multidisciplinary team of all potentially affected hospital departments ◦ iDIRT Staffing plans have been developed and scheduled to support 96 consecutive hours of clinical care Training All staff involved in or supporting patient care are appropriately trained for their roles All staff involved in or supporting patient care and according to their roles have demonstrated proficiency in: ◦ ◦ ◦ ◦ Donning and doffing of PPE Proper waste management Infection control practice Specimen transport: Y N Retraining is provided as needed and to address observed gaps Personal Protective Equipment (PPE) Hospital has selected appropriate PPE for suspected or confirmed EVD patients ◦ High risk procedures ◦ Symptomatic Each step of every PPE donning/doffing procedure is supervised by a trained observer ◦ Buddy System Hospital has at least a 4–5-day supply of PPE in stock Worker Safety Worker safety programs and policies Hospital is in compliance with all federal or state occupational safety and health regulations Hospital has a program for assuring direct active monitoring ◦ monitoring for 21 days since the last known exposure Monitoring will be done in coordination with local and state public health agencies Environmental Services and Infection Control Hospital has a program in place to clean and disinfect patient care areas and equipment with Environmental Protection Agencyregistered hospital disinfectant Designated staff are: ◦ Trained in correct cleaning and disinfection of the patient room and equipment ◦ Trained in the correct use of PPE ◦ Directly supervised during all cleaning and disinfection Management of Waste Hospital has in place the services of a wastemanagement vendor capable of managing and transporting Category A infectious substances OR Hospital will sequester medical waste until the patient’s Ebola test result becomes known Hospital has appropriate containers for the safe temporary storage of Category A Clinical Management Staff who will be involved in managing the patient know the clinical protocols for management of PUIs Special populations ◦ Pediatric ◦ Obstetric Operations Coordination To ensure coordination of the response and communication regarding any PUIs for Ebola, the hospital has: ◦ An emergency management structure ◦ Plans and processes for routinely communicating with local and state public health agencies, emergency management authorities, coalitions ◦ Plans and processes for routinely communicating with hospital employees, patients, and community leadership Leadership (LD) 04.01.01 04.01.07 Environment of Care (EC) 02.02.01 03.01.01 Emergency Management (EM) 01.01.01 02.01.01 02.02.01 02.02.03 02.02.05 02.02.07 03.01.01 03.01.03 Human Resources (HR) 01.04.01 01.05.03 01.06.01 03.01.01 Infection Control (IC) 01.03.01 01.05.01 01.06.01 02.01.01 02.02.01 02.03.01 03.01.01 Nursing (NR) 01.01.01 02.03.01 NPSG 07.01.01 Local resources ◦ DHHS Emergency Programs ◦ CDC Quarantine Station Training – ongoing ◦ Drills ◦ Mini exercises Tools and Resources ◦ https://www.cdc.gov/vhf/ebola/ ◦ http://www.emoryhealthcare.org/ebolaprotocol/ehc-message.html ◦ http://www.nebraskamed.com/biocontainmentunit/ebola
