Ebola Virus FAQs. How will the waste be handled for urine and stool of infected patients? Waste disposal will be via the sanitary sewer system.

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1 Ebola Virus FAQs The FAQs below are from questions received during town hall meetings and from the Premier Health They are arranged in categories of general questions, transmission, signs and symptoms, diagnosis, prevention, personal protective equipment, treatment, and travel. This listing is intended to be a living document. As questions are added they will be indicated by date within each category to make it easier to see if new information has been posted. GENERAL Where is the paperwork for staff reference? Because the Ebola virus is new to the United States, there are frequent updates to information and checklists. In order to assure that staff has the most accurate information, links are being posted to the Premier Health intranet, in order to assure that staff caring for a patient are not using outdated protocols. Who will be educated, what is the target audience? Only nurses? Information posted on the Premier Health intranet is available to all employees and physicians. Additional hands-on training will be provided to those who directly care for patients, including ancillary departments, such as imaging, lab, environmental services, etc. How will the waste be handled for urine and stool of infected patients? Waste disposal will be via the sanitary sewer system. Is there a designated unit/floor where infected patients will be placed? Each facility will place patients in a designated unit. Please contact your local infection preventionist for information specific to your facility. How will pertinent information be communicated to the front line care givers (nurses, therapists, techs)? A variety of mechanisms will be used, including additional hands-on training; the Premier Health intranet; daily check-ins; and through managers and directors, additional town halls, communication, and newsletters. Also, drills will be conducted. Will education be provided to our community? Yes, though local and state health departments and state and regional hospital associations.

2 Will PCP offices be provided with education? How are they to send potentially infected patients from the office to the hospital? Yes. Signs are now posted in physician offices, alerting patients to immediately inform staff if they have traveled to epidemic areas within the last 21 days AND have symptoms. Protocols for transfer are available on the intranet. How will having an Ebola patient here affect our census? Currently, there is a tremendous amount of fear associated with the Ebola virus. It is likely that patients will avoid facilities caring for known Ebola patients. Health departments have established hotlines and are assisting in the education of the community. Are there any protocols for handling specimens going to the lab? Yes, there are specific protocols for handling lab specimens, which are posted on the intranet. Plastic collection tubes and leak-proof containers are required. NO specimens of any kind from a suspected Ebola patient should be sent through the pneumatic tube system. Premier Health is exploring Point of Care testing in isolation units in order to minimize lab exposure. What is the proper protocol to follow for family or friends who bring in a patient with Ebola symptoms? If asymptomatic, contact information should be obtained from the family or friend, in order to allow local and state health departments to perform contact tracing. The Ohio Department of Health recently updated Quarantine Requirements. The document can be found on our website for further details. How do we screen direct admits from a physician s office? Offices will also be querying travel history. We have modified the EPIC screens to make travel history more easily visible. Any transfer from one location to another within the hospital should include isolation precautions as part of the hand-off, as is recommended currently. How do we handle/address questions being asked by the public? Local and state health departments are developing hotlines. Calls can be referred to the health departments. Where is the video to watch for putting on/removing PPE? When will the mandatory HealthStream module be available? The video is currently in production. Staff will be notified as soon as the video is available. The video will be available on our intranet as well as youtube. For physician offices, where should the poster be hung? Will it just be in the lobby of the buildings, in each physician office, in each patient room? To be most effective, the poster should be visible in the triage areas and at entrances to the facility.

3 Will staffing increase if we start to see an increase in patients presenting with symptoms? Patients with Ebola require one-on-one nursing care. As the needs increase, so will staffing. Teams will work in short shifts, as the personal protective equipment is hot. Team members need to change out approximately every four hours. Only members of the Ebola Rapid Response Team (ERRT) will care for such patients once transferred from the Emergency Department. Will there be information that can be given to the EMS education department, so that they can educate paramedics? Should paramedics call ahead if they have a patient who meets the case definition? Health departments and hospital associations are collaborating to train first responders. Our local EMS have developed internal communication mechanism as well as protocols. If known, a patient with the status of suspected Ebola will be transmitted before arrival to the receiving facility. See CDC.gov for transport protocols. Will the signs that are going to be put up at the entry points be in languages other than English? Emoticons on signs are universal. Translation services are available if needed. How will we communicate to the other patients that the hospital has a current patient with Ebola? Patients will not want to come if they hear we have someone with Ebola, so how will we manage that financial loss? We will not communicate any patient specific information, as doing so is a HIPAA violation. It is likely that the media will learn of a case. Any and all media inquiries should be referred to media relations. What are some ways that Premier System Support employees can provide support to our caregiver colleagues? There are a couple things Premier System Support can do: Do not use mainstream media as your source of information regarding Ebola. We should always refer to professional organization when dealing with a health crisis. Using mainstream media only foster panic which is counter productive. Let caregivers know that we care, that we re all in this together, and that we support their efforts. Get the word out to colleagues about Ebola information on the Premier Health intranet (information may be accessed from by clicking Ebola Awareness ). Information will be updated regularly, so that we continue to communicate effectively, accurately, and quickly. Get the word out to colleagues that they can submit questions to ebolaquestions@premierhealth.com. The address will be monitored daily, and frequently asked questions received will be posted on the Premier Health intranet. Consider the fact that information shared by the media is, at best, a personal and/or professional opinion, which is the reason that caregivers rely on evidence-based practices, shared via professional organizations.transmission

4 Why are homes, cars, and airplanes being decontaminated? Ebola is spread through body fluids, which are copious, especially late in the disease. Vomiting and diarrhea can also be bloody, which poses a potential risk. The numbers of virus particles per teaspoon of body fluids is much higher than for other types of contagious diseases. Decontamination makes it safe for others who later come in contact with these surfaces. Is the hand sanitizer foam effective to use when exiting an Ebola patient s room? Hand hygiene is an important component to prevent spread of infection. A specific procedure to take off personal protective equipment in order to prevent selfcontamination will be taught in hand-on training. Videos and posters will be available on the intranet. Hand sanitizer is effective; however, soap and water should be used if hands are visibly contaminated. Can a patient get Ebola a second time? There are multiple strains of Ebola, so it could be possible for someone to develop Ebola a second time. Serum from patients who have recovered from the current Ebola strain is being used as a treatment, in some cases. What kind of loading dose do you need to get this infection? The amount of virus in the bodily fluids of a patient with late stage Ebola virus is in the billions per teaspoon of body fluid, as compared to HIV, where it is in the thousands. That is what makes body fluids so dangerous in Ebola, unless personal protection is used properly. The exact dose needed to transmit Ebola is not known. What is the family and visitor policy for Ebola patients? Will visitors be permitted to enter the room, and, if so, will they be required to wear the same PPE as staff? Family and outside visitors will not be allowed for suspected or confirmed Ebola patients. SIGNS AND SYMPTOMS Is a patient considered contagious with display of any one or combination of the symptoms? The hallmark of Ebola infection is fever. The symptoms mimic many other types of infection, so the constellation of symptoms plus travel history, or history of exposure to an Ebola patient, are key.

5 DIAGNOSIS How long does it take to get the results as to whether a patient has Ebola or not? ODH was approved as a testing facility for Ebola. The turnaround time for first testing is 4-6 hours. Final testing still needs to be confirmed by the CDC, including a 24 hour turnaround. PREVENTION How can we look ahead to be preventative in regard to Ebola? The most important way to keep everyone safe is to take a complete and accurate travel history. Signs will also be placed at entry points within Premier Health, to alert patients to let us know right away if they have been traveling in areas where Ebola is epidemic or have been exposed to an Ebola patient, so that we can immediately put them into isolation, to await further testing. Many of the emergency preparedness activities that hospitals have put in place since 9/11 have helped us be better prepared for ANY communicable disease, including Ebola. How long does it take before we are instructed to initiate isolation, etc? It was answered that staff should follow the proper procedures if any patient meets the definition. They should not wait to be told to follow protocol. As with current isolation policies, we ask that a patient be placed in isolation immediately. If Ebola is suspected, based on symptoms and history, isolation will be followed by a call to consult with infection control. The infection control call schedule can be located on the intranet. In addition, Premier is working to develop ebola rapid response teams (ERRT), in order to quickly get infectious diseases physicians involved with suspected cases. How many negative pressure rooms can actually be created? A negative pressure room is not required to care for a patient with Ebola, unless they are undergoing aerosol-generating procedures. Patients will be preferentially placed in negative pressure rooms in case intubation is needed, Are the wipes we use at the hospital effective on killing the Ebola virus? Current hospital disinfectants and bleach wipes are effective against Ebola.

6 After we take off our PPE in the patient room if they have Ebola, where do we wash our hands? The patient s sink or another wash station? What about the door handle? Can we beef up the disinfectant stations located throughout the hospital with additional PPE (e.g., masks)? These are the stands currently stocked with tissue and hand sanitizer for our flu pretention initiative. Appropriate equipment will be made available at the point of use, specifically for Ebola patients. Patients will be in private rooms, with adjacent rooms being used for donning and doffing protective equipment, separating clean from dirty. PERSONAL PROTECTIVE EQUIPMENT What is the plan for TB mask fit testing physicians? As with TB, personnel are available to perform just-in-time fit testing for physicians. Since Ebola virus is not transmitted via the airborne route, N-95 respirators are not required to care for patients with Ebola, unless aerosol-generating procedures are performed. Employee health offices should be contacted to schedule fit testing. A regular surgical mask or a full face shield should be worn when providing routine care, as a barrier to contaminating the face and mucous membranes. Once a patient has been confirmed to have Ebola and/or if the clinical judgment of the caregivers warrants Tier II equipment, a full gear including PAPRs will be available. Only members of the ERRT will be trained to don and diff such equipment. What about males with facial hair? See above. If aerosol generating procedures are performed, PAPRs would be utilized as for TB. A core group of caregivers and providers will be identified and trained re: the appropriate use of PAPRs (ERRT members). Why are all of the isolation precautions necessary, if the disease is spread through contact? Similar precautions are utilized for other bacteria and viruses spread through contact, such as MRSA, and droplet mechanisms, such as pertussis and influenza. Impervious gowns are used with Ebola, as the amount of secretions is copious. Patients can also have projectile vomiting and diarrhea, which can be bloody. How many Ebola carts will be available? Infection control at your local site should be contacted for the location and number of carts in your facility. At minimum each facility will have two carts in its ED, to allow for rapid response, as well as one cart in labor and delivery, and one cart in the designated inpatient setting. Additional protective equipment will be available throughout each facility.

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8 What exactly is on the Ebola cart? Ebola carts are meant for rapid response teams, mostly in the EDs, and will contain full personal protective equipment-masks, impermeable gowns, face mask/shield, gloves, head cover, and shoe and leg coverings. If an Ebola or suspected Ebola patient is admitted, protective equipment will be available in the immediate area. Are we expanding the questions we ask patients, since it is now not enough to just ask if you have recently traveled to certain countries in Africa? We will follow CDC guidance. An additional question is being added on potential exposure to a known Ebola patient, regardless of travel, per today s new CDC recommendation. It is anticipated that signage will be fluid, as the outbreak evolves and guidance changes. The most current sign will be posted on the intranet. How do we ensure that the PPE covers all exposed skin? Hands-on training will occur at every facility beginning October 17, 2014, with train-thetrainer sessions. Premier will use the buddy system when putting on and taking off personal protective equipment, in order to assure that skin is covered and contamination does not occur during removal. At what point will we get the haz-mat suits to wear as PPE? The CDC recommends using Tyvek suits, only when a facility has been extensively trained on their use (Emory and Nebraska facilities have trained in Tyvek suits since 9/11) and with a confirmed case of Ebola. Tyvek suits are difficult to remove without contaminating oneself. If we care for a patient who has extensive diarrhea, vomiting, and excess bodily fluids, Tyvek suits and PAPRs will be used by a group of trained Premier Health employees and providers (ERRT members). TREATMENT Will CDC assist facilities on site when an Ebola case is identified? The CDC has committed to deploying CDC-trained staff to any US location with a documented Ebola patient. Is there any treatment or vaccine for Ebola? Currently, the only treatments available other than supportive are experimental. A vaccine for Ebola is in the very early stages of testing. Do we have plans in place for a patient with symptoms who might need surgical services? Protocols are being developed and will be available on the intranet. The attempt will be to avoid any procedures that are not emergent.

9 TRAVEL Will travel be restricted for people traveling from West Africa? At the current time, there are not travel restrictions from West Africa. Temperature and symptom screening is occurring at departure points and at the five US airports that receive the over 95% of the air travel from affected West African nations. See CDC guidelines posted to obtain the latest information. Are there any concerns with staff travelling to Senegal? Senegal has had one travel-related case of Ebola. Since September 20, Senegal has been taken off the travel health notices list, and is no longer considered an Ebola epidemic area. Are there restrictions on US travel to Ebola endemic areas? The CDC has information for travelers going to endemic areas and coming from endemic areas. This information can be found at