Mobilizing to Respond to an Infectious Disease Emergency

Transcription

1 Mobilizing to Respond to an Infectious Disease Emergency John Lynch, MD, MPH Harborview Medical Center University of Washington Steven Mitchell, MD Harborview Medical Center University of Washington

2 HIGHLY INFECTIOUS DISEASE CARE Objectives: 1. Understand the complexity of safe and effective care 2. Understand the unique impacts on staff when caring for these patients 3. Understand the fundamental shift in institutional approach necessary for effective care

3 HMC was ready for. Traumaü Burnsü Shock/sepsisü Tuberculosis ü HIV ü Influenza (including HPAI) ü Hantavirus ü And many other diseases, we thought

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6 Comparison with Past Epidemics NY Times

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10 EVD in the United States

11 Source: New York Times

12 HIGHLY INFECTIOUS DISEASE CARE 9/30/14 Diagnosis of Thomas Duncan 10/6/14 Harborview Announcement 10/10/14 Nina Pham Diagnosed

13 HIGHLY INFECTIOUS DISEASE CARE

14 HIGHLY INFECTIOUS DISEASE CARE From CBS 60 Minutes Transcript 10/26/14: On September 28, Duncan was rushed by ambulance to Texas Health Presbyterian Hospital. He was isolated in a separate section of the ER and nurse Sidia Rose, starting the night shift, was briefed on the special precautions required for what they now suspected was a case of Ebola. Sidia Rose: I went over and met with a nurse who gave me a report. She also went over the protective gear that we would be wearing that night. She gave, you know, finished briefing me on what was going to happen, and I literally burst out in tears.

15 HIGHLY INFECTIOUS DISEASE CARE Risks Abound With Highly Infectious Diseases Transmission of EVD to staff Staff and Resource Impact of Single Patient Single staff member illness > substantial institutional risk Financial consequences

16 HIGHLY INFECTIOUS DISEASE CARE Can t Underestimate Fear Factor Medical Staff Support Staff Patient and Families

17 EVD in Healthcare Workers Cases Deaths Guinea Liberia Sierra Leone Total

18 HIGHLY INFECTIOUS DISEASE CARE From CBS 60 Minutes Transcript 10/26/14: Sidia Rose: The first time when I went in and he vomited, I was standing in front of him, he was sitting on the commode, and there was just so much it went over the bag, it was on the walls, on the floors. I had two pairs of gloves on and shoe covers. And I had my face shield on. I didn't have two masks on at the time, I had just one. No, we didn't have any head covers. But I wiped down the walls, wiped down the floor with some bleach wipes. Richard Townsend: He was having so much diarrhea and vomiting that he, you know, she was constantly having to give him the little bags that we have for people to vomit into.

19 HIGHLY INFECTIOUS DISEASE CARE From CBS 60 Minutes Transcript 10/26/14: Then the hospital moved out all of the patients in medical intensive care and reconfigured the 24-bed unit for just one patient. It was a strange scene for ICU nurse John Mulligan.

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21 HIGHLY INFECTIOUS DISEASE CARE

22 HIGHLY INFECTIOUS DISEASE CARE

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25 HIGHLY INFECTIOUS DISEASE CARE

26 HIGHLY INFECTIOUS DISEASE CARE Fundamental Shift In Organizational Approach is Required 10/15/14 Harborview Implements Incident Command System Implement command structure for rapid decision making and multi-disciplinary planning

27 SHIFT IN ORGANIZATIONAL APPROACH

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29 Specialty Clinic Community Off-site Clinic Front Door EMS/helicopters Pharmacy Radiology Morgue/M edical Examiner Laboratory Emergency Room

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34 23 gal HOT: Patient Room 23 gal COLD: Ante Room VEST. 1EH gal CORRIDOR 1EH-COR-K ISOLATION 1EH EH-C26 ACCESS PANEL Warm Room #1: Decontamination 23 gal 40 gal Warm Room # Doffing COLD: Breezeway CORRIDOR 1WH-COR-006 COLD: Shower DECON 1WH gal

35 T 2WH-72.1 PT. RM 279 2WH-75 CAUTION CAUTION 23 gal HOT: Patient Room Warm Room #1: Decontamination 23 gal CAUTION CAUTION WOW PT. RM 278 2WH-72 CART WOW 23 gal COLD: Ante Room 23 gal 23 gal EVS Warm Room #2:Doffing COLD: Hallway/ Barrier LOCKERS COLD: Shower EQUIP/SUP 2WH gal 40 gal WOW 40 gal CORRIDOR 2WH-COR-64 COLD: Exit to Hallway CONS 2WH-77 CAUTION CAUTION

36 HMC EBOLA DIRECT ADMIT TO 2WH PATIENT TRAVEL PATH HOT: 1WH-81.A TA5 VO OAV 1EH-C13.1 1EH-C12.1 1WH-C408 1WH-CE11 1WH-CE15 E19 1EH-C07 ROUTE KEY: DIRECT ADMIT TO 2WH PRIMARY ROUTE DIRECT ADMIT PRIMARY ROUTE: 1. BREEZEWAY (1WH-COR-006) THROUGH GARDENVIEW HALLWAY (1WH-COR-007> 1WH-COR-009> 1WH-COR-10) TO 1WH STAFF ELEVATORS. 2. UP TO 2WH. 3. LEFT INTO CORRIDOR (2WH-COR-02), RIGHT AT FOLLOWING CORRIDOR (2WH-COR-64) TO 2WH ISO ROOM (2WH-72, PAT RM 278). Warm Room #1: Decontamination 1 E D B L U E Patient Room ISOLATION 1EH-27.1 COLD: Shower DECON 1WH-427 SHOWR 1WH-426 COLD: Breezeway CORRIDOR 1WH-COR-006 COLD: Ante Room VEST. 1EH-27 R 1 CORRIDOR 1EH-COR-K 1EH-C26 Warm Room #2: Doffing DN UP R 5 CORRIDOR 1WH-COR-007 N S E S T N GREEN E D G R E E N R A D R M R A D WRK 1EH-C12.4 1EH-C24 E D E A S T 1EH-02.2.A ELEVATOR 1WH-ELV-11 ELEVATOR 1WH-ELV-12 2 CORRIDOR 1WH-COR-010 T 2WH-72.1 HOT: Patient Room Warm Room #1: Decontamination CORRIDOR 2WH-COR-02 CAUTION CAUTION ELEVATOR 2WH-ELV-11 ELEVATOR 2WH-ELV-12 3 CORRIDOR 2WH-COR-86 PT. RM 250-NP PT. RM 278 2WH-72 Warm Room #2:Doffing PT. RM 279 2WH-75 CAUTION 1WH-C241 1WH-C404 UP DN CO 1WH CAUTION CAUTION COLD: Ante Room COLD: Hallway/ Barrier COLD: Shower EQUIP/SUP 2WH-83 CORRIDOR 2WH-COR-64 COLD: Exit to Hallway CONS 2WH-77 CAUTION CAUTION NEUROSCIENCE CLEAN UTIL 1 1EH-/ 1WH ED DEPT 2 1WH 3 2WH- ICU CORRIDOR 2WH-COR-76 MAP E

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40 And more work. Dialysis Handling of dead bodies Monitoring of laboratory workers Standardization of PPE Maintenance of training

41 CDC/State Designations CDC arrived the next day to evaluate HMC s response readiness Response tiers (November 2014): Ebola treatment Ebola assessment Frontline facilities

42 Key actions Rapid development of safe, effective protocols Communication/education misinformation corrects Training normalizes the work Be ready to modify all of the above on a daily basis Preparing for the long-haul and the next epidemic