DATE REVIEWED/REVISED Plan developed based on CDC recommendations and guidelines and may be modified as recommendations and guidelines change. I. PREPARATION A. Employee Training 1. All employees will receive annual basic training in Ebola awareness provided through the organization s online training software, to include signs and symptoms and exposure risks. 2. Employees involved with patient triage or patient admission will be trained on the recognition of signs and symptoms of Ebola and risks of exposure. Employees should be familiar with the current Ebola screening criteria, notification procedures, specimen collection, transport, testing and submission. 3. Those employees identified as primary care givers of potential Ebola victims will receive initial training in the proper donning and doffing of PPE and subsequent quarterly refresher training. B. Screening Procedures 1. Emergency Room Charge Nurses will confirm that triage staff are aware of and practicing the current procedures. 2. Screening and notification procedures will be reviewed at least annually by the Emergency Preparedness Committee to ensure they are consistent with the current CDC and Florida Department of Health (FDOH) guidance. Clarifications of or questions regarding current guidance should be directed to UF Health Shands Epidemiologist and infection control team, in collaboration with SHANDS Emergency Preparedness Committee Co-Chairs. 3. The FDOH Decision Algorithm to Assist with Identifying Patients with Suspected Ebola Virus Disease (EVD), (see TAB A) will be distributed to all patient intake areas. C. Logistics 1. Cart(s) identified for pre-stocking of critical supplies necessary for the care and treatment of Ebola patient will be staged in Emergency Rooms
and CDC. Upon identification of suspected patient, the cart(s) will be immediately positioned near the patient care area(s) for ready availability. 2. Supplies and PPE to be used in the treatment of suspected or confirmed Ebola-infected patients will be established by the Ebola response committee (a sub-committee of the Emergency Preparedness Committee). All required PPE and supplies will be located on pre-built supply carts, including sufficient par levels of filters, batteries, and other key components of protective equipment. 3. Disposable products will be used to the greatest extent to minimize the need for decontamination and handling process. 4. Monthly inventories and inspections will be conducted to ensure a ready state for key supplies and PPE. 5. If additional supplies or PPE are required, Safety, Security, and External Transportation Director or designee will communicate need to local, county and state resources immediately. II. NOTIFICATION A. Suspected Ebola Reporting 1. Suspected cases of any viral hemorrhagic fever, including Ebola, must be reported immediately to the Alachua County Department of Health and is required under Florida Administrative Code Title XXIX Chapter 381.0031. THE Alachua County department of Health will determine if a patient should be tested for Ebola. No testing will occur without their approval and coordination. 2. The person(s) responsible for immediately reporting to the local health agency: Hospital Epidemiologist or designee 3. The Alachua County Health Department Epidemiology contact numbers are: Routine hours (352.334.7981 or 352.334.8842), After-Hours (352.334.7900), Fax (352.955.6464).
B. Hospital Notification Once a suspected EBOLA patient is identified, the following individuals will be notified: Charge Nurse Team Coordinator Director on Call Additional key individuals will be subsequently contacted in order to fully activate the response mechanisms. These individuals and contact information are located in the Ebola Call tree document, located in all emergency rooms and DOC (director on call) resources (see TAB 2). III. RESPONSE A. Patient Location 1. Evaluation a) A suspected Ebola patient in the ED must be isolated in a private room with a private bathroom or bedside toilet and closed door. Use only a mattress and pillow with plastic or other covering that fluids cannot get through. Remove all upholstered furniture and decorative curtains from patient room before use. A restricted entry sign indicating isolation status will be placed on the door of the room in which a suspected Ebola patient is located. Appropriate locations will be identified by charge nurse and ED attending. Suspected Ebola patients identified in other triage locations (e.g. MD office, ambulatory location, etc.) will be placed in a private room (eg. Exam room). If located within the facility, the Ebola phone tree will be activated. If located outside of the hospital (e.g. MD office), hospital staff will call 911 and relay suspicion of Ebola to the EMS staff. b) Staff access to the room will be restricted to those designated staff who have completed PPE doffing and donning training. In addition, access into the room and surrounding support areas will
be restricted to minimum number of staff necessary to safely care for the patient. c) Visitation will not be allowed. If visitors are accompanying patient, they will be asked to wait in a separate private room. ACHA will be consulted to determine if accompanying staff should be held for screening. d) If test results positively confirm the presence of Ebola, patient will be transported to designated treatment/stabilization room as soon as appropriate (currently Unit 94 room#). Patient will be transported using appropriate PPE. e) Suspected and/or confirmed Ebola patient will be identified by physical precaution signage, Epic banner and notations placed in patient chart. 2. Treatment/stabilization a) Confirmed Ebola patient will be located in isolation rooms on unit 94 and restricted access signage will be placed. b) Security or other personnel will be placed outside the restricted area to assist with area restrictions. c) The Ebola supply cart will be retrieved from CDC and emplace outside the patient room. d) A trained observer will be posted outside the door to the patient s room to ensure all persons entering the room are properly wearing appropriate PPE prior to entering the room and that PPE has been properly removed and hand hygiene performed upon exiting as per the CDC guidelines. A log of personnel entering and exiting the patient s room must be maintained and will be reviewed daily and maintained by Infection Control staff. e) Breaches of access policy or procedure, infection control or other issues of non-compliance will be immediately reported to Nurse Manager/Clinical Coordinator, Occupational Health, CNO, DOC and Infection Control.
f) Upon a confirmed diagnosis of Ebola, notification and arrangements will be made to FDOH/CDC transfer the patient as soon as possible to a designated Ebola treatment facility. B. Personal Protective Equipment (PPE) 1. PPE will be established according to current CDC guidelines. 2. Ebola PPE kits will each contain, at a minimum: a) Powered Air-Purifying Respirator (PAPRs) or (CAPRs)extending to shoulders and single-use (disposable) full face shield b) HEPA filter canisters (3ea per PAPR) or Organic Vapor canisters (with integrated HEPA filter). c) Single-use (disposable) fluid-resistant or impermeable gown d) Single-use (disposable) extended cuff nitrile examination gloves e) Single-use (disposable) fluid-resistant or impermeable high-top boot covers f) Single-use (disposable) fluid-resistant or impermeable apron g) Single-use (disposable) fluid-resistant or impermeable hoods. 1. Ebola PPE kits to be used upon identification of a suspected Ebola patient are located at: Adult ED/Trauma Center, Pediatric ED, Free- Standing ED, and CDC. 2. No less than 4 of Ebola PPE kits will be maintained at each location. The availability of Ebola PPE kits will be verified INTERVAL (DAILY, SHIFT,ETC.) by PERSON/POSITION RESPONSIBLE
3. Guidance demonstrating proper donning and removal of PPE for a patient with Ebola will be placed prominently in triage areas and on the door of the room in which the suspected Ebola patient is isolated. C. Environmental Services 1. Ensure that Environmental Services and cleaning personnel have been trained on appropriate PPE doffing and donning process. 2. Waste from a suspected Ebola patient is to be placed only in predesignated waste containers. Additionally, ensure staff training on protocols for safely bagging and packaging waste, storing waste, and transporting packaged waste. 3. A designated, secured area should be identified for waste storage pending a determination of whether the patient has Ebola or not. The storage space should meet all applicable fire codes and principles of maintaining a clutter-free, safe environment. 4. If a patient is confirmed with Ebola, waste should be labelled in accordance with CDC guidelines. Waste to be removed from facility by specially designated removal trucks. 5. Waste bags should never be over-filled. Bags should be closed when two thirds full. D. Transport and Transfer Services Transportation of the Ebola Patient to an alternate care facility will be coordinated through FDOH and CDC. E. Laboratory Personnel Laboratory personnel will be notified/alerted of lab samples associated with the potential/confirmed Ebola patient. Conduct only essential laboratory testing, and take appropriate precautions according to laboratory recommendations 1. Include malaria diagnostics in initial testing as it is the most common cause of febrile illness in persons with travel history to affected countries
2. Following consultation with FDOH and approval for EVD testing, collect two 4 ml whole blood specimens in plastic purple top tubes; do not use pneumatic tube system for transport; contact FDOH to determine the proper category for shipment. 3. Negative results will be reported with the following comment "If fever or symptoms have been present for less than 72 hours, a repeat test may be required to rule out Ebola virus infection. If Lassa fever is a consideration (e.g. recent travel to a West Africa), please refer the specimen to CDC for Lassa fever testing. F. Visitors Visitors who have been in contact with the suspected Ebola patient before and during hospitalization are a possible source of exposure for other patients, visitors and personnel; therefore, visitor access to patient s room will not be allowed while diagnosis is pending or after confirmed diagnosis of Ebola. Breaches of visitor policy or procedure, infection control or other issues of noncompliance will be immediately reported to: Nurse Manager, DOC and Infection Control. G. Handling of Human Remains 1. Only personnel trained in handling infected human remains and proper PPE should touch or move any Ebola-infected remains. 2. Handling of human remains should be kept to a minimum. 3. If an autopsy is necessary, request support from local or state public health department to provide service. 4. Ebola postmortem preparation supplies will contain, at a minimum: a) PPE - Prior to contact with body, postmortem care personnel must wear appropriate PPE. b) Plastic shroud for wrapping of the body. c) Chemical resistant and leak resistant body bag.
d) EPA-registered disinfectants which can kill a wide range of viruses. IV. RESOURCES Centers for Disease Control (CDC) http://www.cdc.gov/vhf/ebola/ Florida Department of Health (FDOH) http://www.floridahealth.gov/diseases-and-conditions/ebola/index.html TAB 1. Decision Algorithm to Assist with Identifying Patients with Suspected Ebola Virus Disease (EVD) TAB 2. UF Health-Shands Hospital Notification Call Tree