Download EXAMPLE OF SITE-SPECIFIC GUIDELINES FOR FRONT LINE

EXAMPLE OF SITE-SPECIFIC GUIDELINES FOR FRONT LINE STAFF
CARING FOR PATIENT WITH SUSPECTED EXOTIC INFECTIOUS DISEASE
Patient arrives to the nurse first window and complains of any of the following symptoms fever, cough, nausea, vomiting, diarrhea, influenza-like symptoms, headache, rash,
difficulty breathing, abnormal bleeding, and/or altered level of consciousness.
Yes
Nurse to ASK:
1. Have you traveled outside of the United States within the last 30 days?
2. Have you come into contact with anyone sick who has traveled outside of the
United States within last 30 days?
If Yes to either question – use handouts to investigate whether country visited is a
country of risk for Ebola or MERS
If yes-ACTIVATE ED RESPONSE PLAN FOR PATIENTS UNDER
ESI the
patient.
No
Patient to
appropriate
care and
room.
INVESTIGATION FOR INFECTIOUS DISEASE
Yes
1. Have patient don a surgical mask.
a. If family is present, have family/visitor(s) don a mask too.
2. Do Not touch the patient, do not obtain vital signs, do not continue with
completing the arrival process at the window.
3. Alert the CN and immediately request a negative pressure room (room 1 or 2) for the
patient.
a. CN/ PCRN will work collectively to clear Quiet Room (QR) & room 1 or 2 for the
patient and family/visitor(s).
b. If family is present with the patient, they will be placed in QR.
c. If room 1 or room 2 cannot be cleared immediately, have patient and family
stay in QR until alternate room(s) – room 3, room 4 (any single room with
door) is available.
d. Do not transfer the patient to the Rapid Care (RC) area prior to transport to
the treatment room.
e. Charge RN/PCRN will notify that QR is ready to receive patient and
family/visitor(s).
f. Charge RN/PCRN will notify that treatment room is ready to receive patients
4. Assign ESI 2 (high risk situation).
5. Assign Physician via PASS.
6. When notified by CN/PCRN that QR is ready - Don mask (for Ebola surgical maskDropet) (for MERS-N95 Airborne) and gloves at a minimum based on patient
presentation. Obtain key from CN desk, and return to waiting room towards QR door.
7. Triage Nurse to alert security to get the yellow tape/stanchions and secure the area
where the patient has entered including entryway. Remind security to close QR door.
8. Open Quiet Room. Motion and call for patient and family/visitor(s) to follow you.
9. Instruct visitors to remain in QR, and continue with patient to room 1 or 2. (Primary
RN will either go into negative pressure rooms or alternate single room with door).
Do not stop anywhere else along the way (including a bathroom).
10. Receptionist calls EVS worker to reception area for STAT clean of needed areas – e.g.
Counter, waiting room, front bathroom. Anything the patient touched – e.g.
wheelchair, etc. must be sequestered in the Quiet Room and not used until terminally
cleaned.
11. Surge Nurse will start triage of other waiting patients who have arrived to the ED from
RC 1 until front area cleaned. Clerk will assist RN in banding other arriving patients in
Rapid Care area, not at window, until front area has been cleaned.
12. The East side clerk will register the patient from arrival information and hand the ID
armband to the primary nurse who will band the patient.
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EXAMPLE OF SITE-SPECIFIC GUIDELINES FOR FRONT LINE STAFF
CARING FOR PATIENT WITH SUSPECTED EXOTIC INFECTIOUS DISEASE
Charge Nurse:
1. Notify assigned ED physician for rapid response to patient location.
2. Notify ED Physician if there is family or visitors for patient in QR.
3. Turn on alarm system for negative pressure room.
4. Review infection control precautions (droplet and contact).
5. Assign the primary nurse and staff member who will be monitoring the entrance
and exit from patient’s room. Log is found in binder.
6. Call engineering to set up ante-room.
7. Have Infection Control cart and needed supplies moved to outside patient’s room.
8. Page the EVS supervisor for APPROPRIATE BIOHAZARD waste and linen
containers AND to assign an EVS worker to monitor and dispose of the waste.
9. Alert ED Manager on-call of potential infectious patient who will notify TPMG
administrator on-call.
10. Alert the house supervisor to prepare for a potential transfer of the patient.
11. Assist and trouble shoot other needs as arise.
Triage Nurse Duties:
1. Give mask to patient and family/visitors if present.
2. Have the patient stand in front of window until notified that the QR is ready. In
the meantime ask patient if anyone else is present. Ask if patient has vomited on
the property or has used the restrooms in the entryway.
3. Give instructions to patient to wait at window until called to follow into QR.
4. Don mask, and gloves. DO NOT touch the patient.
5. Coordinate with Security to cordon off area. If there is a possibility that bodily
fluids have been left behind in entryway or restroom, have security post
themselves at entry doors. Remind security to close Quiet Room door.
6. Have family/visitors stay in quiet room. Have patient follow you to RM 1 or 2.
Have patient enter room. From the doorway instruct patient to undress, place
gown on, and place clothes in patient belonging bag. Inform the patient that the
nurse and MD will be into the room soon.
7. Accurately remove PPE and dispose in designated waste containers.
8. Wash your hands with soap and water and ensure door to room is closed.
9. Return to triage.
Surge Nurse Duties.
1. Open Rapid Care door, call patients will go through this door to continue triaging.
2. Surge nurse monitors for arrival of additional patients to the ED and triages those
waiting until relieved by returning assigned triage nurse.
PCRN Duties:
1. Work with CN to assign nurse and clear rooms, QR first.
2. Work in assisting set up of PPE and infection control measures (Droplet and
contact plus).
3. Place a STOP SIGN, Contact and Droplet isolation sign directly outside of door
leading into the patient’s room, as well as quiet room.
4. Ensure commode, and bucket with top are in room.
5. Anticipate additional assignment of personnel to support the assigned nurse.
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EXAMPLE OF SITE-SPECIFIC GUIDELINES FOR FRONT LINE STAFF
CARING FOR PATIENT WITH SUSPECTED EXOTIC INFECTIOUS DISEASE
Primary RN:
1. Implement stringent infection control precautions (Droplet and contact plus).
2. Ensure infection control cart with PAPRs are readily available.
3. Don PPE outside the room prior to entering (Mask, face shield, impervious gown,
shoe covers and gloves. Double gloving and shoe/leg covers for situations of
copious blood or body fluids in the environment. Respiratory protection (PAPR)
for use during aerosol-generating procedures. PPE must be put on prior to
entering patient’s room.
4. Place mayo stand near the door for placement of clean supplies for patient care.
5. Introduce yourself and relay to the patient that the physician will direct the
care.
6. Positively identify the patient using two patient identifiers, then armband the
patient.
7. Using disposable monitoring equipment, place on pulse oximetry and NBP to
obtain baseline VS.
8. DO NOT implement ESP or pre-orders, IV starts or lab draws.
9. If patient becomes unstable, work with the physician to implement condition
specific care. Once in the room, the patient should be attached to appropriate
cardiac and respiratory monitoring, as needed.
a. If patient requires immediate fluid resuscitation start IV under strict
contact & droplet precautions.
b. If endotracheal intubation/neb treatment is needed=negative pressure
room, N95, PAPR.
c. No portable x-ray equipment
10. Any laboratory specimens must remain in the patient’s room in a biohazard bag for
required processing. Do not use glass tubes; do not send specimens to
laboratory. Lab supervisor/director should be notified that specimens require
collecting & processing.
11. All disposable IV equipment (sharps, tubing, etc.) must be disposed of within the
patient’s room.
12. All disposable monitoring and examination equipment (monitor leads, ear
speculum, tongue depressors, etc.) must be disposed of within the patient’s room
in red bio- hazardous bin.
13. If patient uses commode or urinal, secure the top with tape. Leave in room until
further instructions.
14. Provide patient with comfort measures using the assigned staff member to collect
items and place on mayo stand.
15. Prior to exiting, ensure the patient’s immediate needs have been provided for.
16. Doff (remove) PPE at the doorway (or anteroom if available) accurately and place
in the designated waste container.
17. Wash hands with soap and water.
18. Prepare for possible admission.
19. If a piece of portable equipment is needed in the patient’s room (e.g. portable
ultrasound), this equipment must be carefully decontaminated in the patient’s
room prior to leaving the room. Whenever possible, use disposable covers for
equipment.
20. No visitors are allowed.
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EXAMPLE OF SITE-SPECIFIC GUIDELINES FOR FRONT LINE STAFF
CARING FOR PATIENT WITH SUSPECTED EXOTIC INFECTIOUS DISEASE
Monitoring RN: (stationed outside patient’s room)
1. Restrict entries to the minimum number of personnel.
2. Log all personnel entering and leaving the isolation room to ensure all persons who
come into contact with the patient are identified and to ensure appropriate PPE
protocol is followed.
3. Observe personnel putting on PPE and ensure all required items are in place.
4. Observe personnel doffing (taking off) PPE and stop the action if self contamination
noted and have person wash hands with soap and water and then continue.
5. Ensure all equipment/supplies remain in the isolation room until appropriate
disinfection.
6. Wheelchair and equipment such as ultra sound machine, ekg machine after initial
wipe down by bleach should be placed in Quiet Room for terminal clean.
ED Physician:
1. Don surgical mask, face shield, gloves, impervious gown, shoe covers. Double
gloving and shoe/leg cover for situations of copious blood or body fluids in the
environment. Respiratory precaution (PAPR) for use during aerosol generating
procedures.
2. Evaluate patient’s travel history, complete examination to determine if the patient
should be considered for possible Ebola or MERS case.
3. Routine labs or X-rays should not be ordered.
4. Anticipate the need for airway management and alert the nurse if suspected.
(PAPR) – airborne isolation protection will be placed by the room in the event of a
procedure on the airway that may aerosolize the organism.
5. Accurately take off PPE at the doorway (or anteroom if available) and place PPE in
designate receptacles.
6. Wash hands with soap and water.
7. Go to Quiet Room -Don surgical mask, face shield, gloves, impervious gown, shoe
covers.
8. Evaluate family and visitor’s travel history, complete examination to determine if
they also should be considered for possible Ebola or MERS case. If this is the case,
they will need to be registered as well and placed in an available room.
9. If there is a potential for Ebola or MERS, or any question, the ED physician contacts
the on-call infectious disease physician.
10. Assists with expediting admission of patient to negative pressure room in ICU.
Infectious Disease Physician:
1. If determined possible Ebola or MERS case, he/she contacts hospital administrator
on-call to activate emergency command center.
2. Contacts Infection Control.
3. Review with ED physician what labs and procedures should be done.
4. Review case with HBS physician and expedite admission of patient to negative
pressure room in ICU.
5. ID specialist contacts County Department of Public Health (DPH).
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EXAMPLE OF SITE-SPECIFIC GUIDELINES FOR FRONT LINE STAFF
CARING FOR PATIENT WITH SUSPECTED EXOTIC INFECTIOUS DISEASE
Security responsibilities:
1. Alerted by triage nurse to secure the area. Calls security supervisor for additional
security needs.
2. Walk over to the patients in line, open stanchions with gloved hand. Have them line
up in front of rapid care door. Contain them in line until the flow nurse comes out to
assist them.
3. If there is a possibility that bodily fluids have been left behind in the
entryway, ensure an officer is posted at the temporarily closed doors.
4. Close off window area with caution tape/stanchions from window 3 to security desk
to front door until cleared. Deactivate alarm on Emergency door. Ensure Security
officer is assigned to direct patients through temporary new entryway into the ED.
5. Ensure door to Quiet Room has been closed.
EVS responsibilities:
1. Immediately respond to clean and decontaminate areas touched by patient, e.g. in
waiting room, bathroom.
2. Set up infectious specific waste containers as directed by the EVS supervisor.
3. Continually monitor the waste containers and resupply to ensure no transmission of
infectious waste occurs. Manage process for disposal of lines and trash.
4. Monitor the exit from the room and clean with approved cleaner on the exit of ALL
staff from the room.
5. Clean and decontaminate surface areas and equipment, as needed.
6. Monitor the transfer of the patient from the ED and alert the EVS supervisor of the
transfer to ensure infection control procedures are initiated on the floor.
7. Terminal clean ALL areas of the ED with approved cleaning agents.
Patients that arrive to the ED by EMS or/ through Ambulance
Bay:
When medics call report, and suspect that the patient may be a candidate for categorization
as a “Patient Under Investigation for Infectious Disease”, inform medics that staff will be
outside in the ambulance bay to meet them. Clear out room 2. Staff that has been called
to ambulance bay to assist patient or direct ambulance must be in full PPE. Patients arriving
in this manner should enter into room 2 via the outside door directly into room 2. Key
is the same as QR door key @ the CN desk
Patients that want to sign out AMA:
1. Inform County Public Health
2. Inform the U.S. Centers for Disease Control and Prevention (CDC), available
24/7 at 770-488-7100, or via the CDC Emergency Operations Center (EOC) or
via email at [email protected]
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