Maine Medical Center NECOEM Ebola and Other Emerging Infectious Diseases May 14, 2015

Transcription

1 Maine Medical Center NECOEM Ebola and Other Emerging Infectious Diseases May 14, 2015

2 NECOEM 5/14/2015 WELCOME AND INTRODUCTIONS David W. Dickison, DO, MPH Carole Duperre, RN, BSN, CIC John Swiger, BS, CHMM Paul Weiss, MS, BS 2

3 Agenda Rule out EVD case - Infection Control - Shot Across the Bow PPE Selection - Donning and Doffing Demonstration Employee Health Services Role - Employee Health Protocols Emergency Preparedness - State Plan Lessons Learning 3

4 Disclaimer We are not speaking to you from the perspective of a group that has treated Ebola patients. Much of what we will present is based on our current state of readiness. Our policies and procedures are not final and remain in flux. Hopefully the information provided will be of assistance to you. Of course you should consult other sources such as local, state and federal public health and infectious disease experts. 4

5 MaineHealth Multi-facility Healthcare System Total employees 17, Member Organizations: Tertiary and Intermediate Care Facilities Several rural access hospitals Diagnostic Lab Psychiatric hospital and outpatient psychiatric services Long-term care and assisted living facilities 5

6 Emerging and re-emerging infectious diseases/agents K.L. Koenig and C.H. Schultz. 2014

7 EVD/Emerging Infectious Disease Health-care providers develop awareness of Ebola and other emerging infectious diseases especially front line providers Outbreaks/Cases in US and other countries?? When/where Increase and maintain vigilance in application of infection control practices 7

8 MMC EVD Response Plan Working DRAFT- living document- continue to refine Multiple teams intense effort; ongoing Focus areas (examples)» ED/EMS triage, identification, isolation, EE protection, transfer (internal/external)» Other points of entry: outpatient clinics/offices, diagnostic centers etc. 8

9 MMC EVD Response Focus Areas (continued) - Identified location to hold/care for person under investigation (PUI), probable or confirmed case» 6 Bed Unit with Isolation Room Capacity» Dedicated Air Handling - Isolation Chamber for patient transport - Development of a Special Infectious Disease Team - Employee Health Protocols 9

10 MMC Ebola Response Plan Review Focus Areas (continued) Integration with: - Emergency Management Plan and Hospital Incident Command (HICS)system - Infection Prevention policies - Safety, PPE and Respiratory Protection Programs» Training, drills etc.. 10

11 MMC EVD Planning Assumptions Maine: tiered response to Ebola care Frontline Healthcare Facilities all - Rapidly identify, triage, isolate and transfer - Notify infection control, local/state public health Assessment hospitals four regional facilities - Rapidly identify, triage, isolate patients - treat up to 96 hours - Notify infection control, local/state public health - If confirmed possible transport to Treatment Center Both- Protect employees - training and PPE 11

12 OSHA Visit March 11, 2015 Marianne Medeiros Area Director U.S. Department of Labor Occupational Safety and Health Administration 12

13 EVD Care and OSHA Standards Blood borne pathogens ( ) Personal Protective equipment ( ) Respiratory Protection ( ) Hazard Communications ( ) Access to medical records ( ) General Duty Clause 13

14 Employee Health Exposure to EVD Policy Content Policy statement Appendices Exposure Assessment Form EE and source information, exposure description, assessment, plan Healthcare Personnel Guidelines pertinent contacts, symptom monitoring and compliance Monitoring log Exposure worksheet - logs all personnel with reported exposure 14

15 Employee Health EVD Protocol Appendices(cont.) Monitoring period exit review form Biohazard monitoring form during care Contact list internal infection control, Maine and National CDC Employee travel review form Special Infectious Disease Team Medical History and Physical Reference List 15

16 Special Infectious Disease Team (SIDT) Modification of Hospital Emergency Response Team model Experienced staff meet complex patient care needs and able to meet functional demands Receive competency based, team oriented training - Focused training on PPE and specialized care of EVD and other infectious diseases Continuing education requirements and required participation in biannual drills 16

17 Special Infectious Disease Team (SIDT) Issue Operational Workflow of Team Identification of Team Action Pending 1. Discussion of length of work shift, separation of duties and demands on staff in the isolation environment. Clinician, Monitor/Buddy 1. Drafting of Job Description 2. Creation of Functional Demands 3. Compensation for Position 4. Posting of Position 5. Candidate Screening and Selection 6. Non-Nursing PPE Team

18 Respiratory Protection Program Medical Surveillance Administered by Employee Health Services Respiratory Protection Program Administered by Safety Department Initial Training and Fit Testing Conducted by Safety Dept. or Authorized Trainers Annual Fit Testing Conducted by Safety Dept., Authorized Trainers or Authorized Fit Testers 18

19 EVD and Laboratory Services No lab testing is to be ordered or performed until the patient s risk status has been determined If low risk; lab testing as usual If not low risk; - All testing by POCT methods - No testing in the Core laboratory. Specimens for EVD testing will be brought to lab to be packaged for transportation (hand carried - no use of vacuum tubes) Must consult with State CDC if EVD test requested - Federal CDC invited by state 19

20 Lab Services Pending/in Process Action pending: Test menu, staff training, drills, competency testing Training program - account for testing in PPE Confirm process for decontamination vs disposal of equipment Establish process for source testing for exposed HCP 20

21 LESSONS LEARNING Intense focus on logistics for patient care Employee health services - voice for employees Employee concerns: going home to families after work shift?? designated housing family risk if exposed? voluntary versus mandatory SIDT selection representatives from multiple disciplines ICU, Peds, OB enough?? Media/Public Perception - prepare ahead, prep front line employees 21

22 LESSONS Standardized PPE for healthcare workers PPE Availability- some have become creative with alternatives, but this may pose a risk to providers Understand level of coordination and assistance between National and State Public Health Agencies and front line medical facilities 22

23 LESSONS Other personnel that require PPE training: Bio medical engineering and facilities engineering may need to enter patient care areas Lab Environmental Services Radiology Others 23

24 LESSONS Training and Education - pillars to an effective response Must train the most for the things we will use the least - i.e. Low probability, High Risk Practice donning/doffing and patient care skills while in PPE All Hazard Approach- not just Ebola- could be SARS, etc. Tabletop and functional drills assist with identifying gaps and testing plans 24

25 LESSONS EVD IMPACT need for planning Suspected or confirmed Ebola patients have a huge impact on the healthcare system Local/Regional: lack of staff or bed availability due to resources dedicated to EVD Altered patient transfers or referrals from/to other facilities Staff shortage due to staff that may be required to self quarantine 25

26 LESSONS $$$$$$ Costs Facilities Upgrade Dedicated and adequate negative pressure rooms Dedicated equipment Ports for external location remote control of equipment outside patient care areas Upgrade room areas to increase space for ante room and supplies Employee on-site shower/dressing room/meals/lodging 26

27 References and Links MMC PPE Training Video Link CDC 1. General information and links 2. Decision Guide for CDC Consultation and Ebola Virus Testing 3. Updates regarding African Outbreak 27

28 References and Links US Department of Health and Human Services Information for Hospitals and Healthcare Facilities OSHA Safety and Health Topics Ebola NIOSH/OSHA PPE Matrix and Fatigue pdf 28

29 References and Links Emory University Ebola Preparedness Protocols University of Nebraska Ebola site 29

30 Questions? 30