Location, Location, Location: Managing Outbreaks in Ambulatory Care Settings

Transcription

1 Location, Location, Location: Managing Outbreaks in Ambulatory Care Settings Danielle Suminski BSN, RN Emerging Diseases Coordinator Department of Infection Prevention The MetroHealth System

2 Financial Disclosures Danielle Suminski BSN, RN I have no disclosures relevant to this presentation.

3 Learning Objectives Recognize the vital role that each team member plays in response to a public health emergency Identify unique challenges to infection control in each setting Formulate effective strategies to protect healthcare providers and staff

4 Goals Describe methods for early identification of potential outbreak scenarios in the ambulatory care setting Identify steps for initial management of the contaminated patient, including isolation and notification procedures Outline key education and prevention strategies for managing outbreaks in the ambulatory setting

5 Early Identification When will this patient be identified? Travel screening Waiting room signage Animal exposure and travel questioning should be routine Centers for Disease Control and Prevention. Ebola: U.S. healthcare workers and settings. Photos courtesy of Jen Conti.

6 Early Identification Have a plan in place Supply education/resources for staff Resource location simple and easy to find Drill/exercise plans to ensure readiness How long before identification/isolation? What is the risk to others in the waiting area?

7 Early Identification Plan for the most likely scenarios Use patient-facing as well as stafffacing signage Encourage patients to self-mask Is the patient with any family members? Are they symptomatic? Photo courtesy of Danielle Suminski.

8 Isolation Designate a single-patient room with a toilet/sink Negative pressure room = best choice Communicate and label the isolation room (eg, I sticker) Use minimal equipment Develop a quick, efficient transfer process Document staff in contact with the patient Minimize contact as much as possible Centers for Disease Control and Prevention. Ebola: U.S. healthcare workers and settings. Photos courtesy of Danielle Suminski.

9 Outpatient PPE Worn only if close contact with the patient is absolutely necessary before trained personnel arrive Surgical Mask Face Shield/ Eye Protection High-Level PPE Hair Cover Double Gloves (1 pair under gown, 1 pair over gown) Isolation Gown Shoe Covers Photos courtesy of Danielle Suminski.

10 Identifying an Isolation Room Single-patient room Private bathroom or covered commode Close to entry/exit Preferably with a window for staff Standard, contact, and droplet precautions Red bag trash Category A Special handling Centers for Disease Control and Prevention. Ebola: U.S. healthcare workers and settings. Photos courtesy of Danielle Suminski.

11 Outpatient Setting Limitations PPE stock What is available? No negative pressure rooms Management of body fluids Bedside commode versus toilet Treated versus untreated Proper disinfectants Photos courtesy of Danielle Suminski.

12 Notification Process The MetroHealth System. The MetroHealth information village (hospital intranet). Accessed February 27, 2017.

13 Communication Flow Sheet Outpatient triggers + travel screen at check-in Outpatient manager notified by PSR 2. Infection control & 3. Nursing supervisor FCO notifies Life Flight to deploy for patient pickup Life Flight notifies FCO of arrival to destination Life Flight communicates departure and ETA to FCO Notify EVS to send a supervisor to the SDCU for donning high-level PPE (1 supervisor to mop behind patient when traveling through hospital to SDCU 1. Notify SDCU physician on call of PUI 2. Notify local health department Nursing supervisor notifies FCO okay to deploy Life Flight ground FCO contacts SDCU RN facilitator of Life Flight ETA At est. 30 mins to patient arrival, instruct SDCU team (2 on-call RNs) to don PPE EDC notifies IC Team 2. Notify emerging diseases coordinator of PUI SDCU facilitator RN (EDC/IC/Quality) notifies nursing supervisor that SDCU is set up/ready SDCU Facilitator RN contacts Outpatient Manager ready to accept patient in SDCU Life Flight notifies FCO 10 mins out 1. Nursing supervisor 4. Nursing supervisor notifies 2 SDCU RNs & 1 MD on call Contact info located on Ebola Sharepoint Training Tracker (60 mins to arrive at MHMC) 3. Notify 4-East Stepdown charge RN to move patients out of rooms CP4-203 & 205 SDCU RN facilitator updates outpatient nurse manager and operations manager on conference call details Facilitator RN sends donned EVS supervisor/sdcu RNs (2) to designated entrance site for transfer of care FCO notifies SDCU Facilitator RN that Life Flight is 10 min out 1. Initiate code travel by notifying PBX operator Notify EVS supervisor STAT cleans needed for patients moved from rooms CP4-203/205 Conference Call Lead Options: 1. Attendance: Lead 2. Background patient information: ID Attending 3. Assign Tasks: Lead 4. Designate patient entrance: Lead/MHLF/MHPD 5. Plan/recap/questions/follow-up call needed: Lead and Group SDCU facilitator RN notifies MHPD and nursing supervisor of est. patient arrival time and location PBX operator sends CodeSpear template: Code Travel Inpatient with updated date/time as HIGH PRIORITY to CodeSpear Group: Code Travel Inpatient Response Team Life Flight arrives to designated entrance & transfer of care occurs to SDCU RNs (2) with MHPD/EVS escort Photo courtesy of Danielle Suminski.

14 Communication Flow Sheet SDCU physician Infection prevention Public health Nursing supervisor/senior leadership SDCU nursing Environmental services Transportation

15 Communication Flow Sheet Use a dedicated and secure conference line Ensure all parties are present Provide scenario background Discuss a plan Assign tasks/roles Arrange a follow-up call

16 Challenges Training space and time Creating staff buy-in long term Cleaning Transportation Photos courtesy of Danielle Suminski.

17 Education Use education opportunities to build rapport with staff Annual online learning Annual donning/doffing Resource/equipment location Tip sheets for EMAR changes Videos Photos courtesy of Danielle Suminski.

18 Prevention Working relationship with public health Strong employee health collaboration Solid exposure plan in place Employee vaccination/immunization Regular training/competency Photos courtesy of Danielle Suminski.

19 Questions? Photo courtesy of Jen Conti.

20 Additional Resources U.S. Healthcare Workers and Settings. Centers for Disease Control and Prevention. Healthcare Preparedness Capabilities National Guidance for Healthcare System Preparedness. Office of the Assistant Secretary for Preparedness and Response Hospital Preparedness Program. National Incident Management System (NIMS) Implementation for Healthcare Organizations Guidance. Assistant Secretary for Preparedness and Response Hospital Preparedness Program. Estimated Personal Protective Equipment (PPE) Needed for Healthcare Facilities. Centers for Disease Control and Prevention. Bellevue Hospital Ebola Virus Disease Incident Response Guide. National Ebola Training and Education Center (NETEC). netec.org/wp-content/uploads/2017/03/bellevue-evd-irg.pdf Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE. Centers for Disease Control and Prevention.