This module will provide guidance to Emergency
Departments for the development of hospital specific plans and procedures
to ensure the safety of staff, patients and visitors
as well as to inform and coordinate with local health authorities.
"Hi, can I help you?" "Um, yeah I don't know what's wrong with me but
"I really don't feel well." If a patient reports recent travel to countries
with widespread Ebola transmission or exposure to someone known to have Ebola
virus disease, and also exhibits or reports symptoms consistent
with Ebola, isolation precautions must be implemented
and further evaluation should occur in a designated private room or separate
enclosed area with private bathroom, or covered, bedside commode.
"Could you follow me to this room please? We're just going to
"put you here temporarily and ask you a few more questions." Adherence to procedures and precautions designed to prevent
transmission by direct or indirect contact is vital.
For patients under investigation for Ebola, hand hygiene,
appropriate precautions, dedicated equipment, and restricted
patient movement are important to protect other patients, visitors and staff.
Once notification is received that a patient is under
investigation for Ebola is identified, ensure the designated isolation
room is prepared. If available, you may decide to put the patient in an isolation room
with negative pressure in anticipation of needing to perform any
aerosol generating procedures. All unnecessary medical equipment should be removed
from the room prior to the patient arriving. There should be separate
adjacent to the isolation room to be used for donning and doffing PPE.
Ensure all appropriate PPE is available and staff have been trained
to properly don and off PPE. Post a do not enter
room sign on the door and a sign in log on the door to document
who enters the room. Consider providing a phone or call device
so the clinical staff can communicate with the patient from outside the room
to limit the number of staff who must enter the room and to limit potential exposure.
When the isolation room is prepared, the triage or charge nurse
will escort the patient to the isolation room, avoiding physical contact
and keeping a distance of at least 3 feet from the patient. "Come this way please."
No PPE is required if the patient is able to ambulate to the isolation room
in this way. While the patient is being escorted into the
room and given instructions, the health care worker should be donning appropriate
PPE. Please refer to the section of the CDC
website, illustrating procedures for proper donning and doffing of PPE.
If the patient is not able to ambulate,
the triage or charge nurse should don PPE
to transport the patient to the isolation room. While escorting the patient to the isolation room,
tell the patient the reason for the isolation precautions, what
to expect, and to assure that someone will be in contact with them throughout the process.
At this point, the patient will likely be concerned and unsure of what
is happening around them, so it is important to communicate with them and let them know what to expect.
If you choose to use a phone or other communication device, explain to the patient
that someone will speaking will be speaking with them on the communication device in the room
and asking them further questions about their symptoms and risk factors.
As the patient is being isolated and further risk factors and symptoms
are assessed by the health care team, activate your institution's Ebola preparedness plan
and notify infection control or the appropriate designated staff.
Notify your local public health authorities immediately
that your facility is evaluating your a patient with relevant travel and/or
exposure history or symptoms that might be consistent with Ebola.
To minimize transmission risk, only essential health care workers with designated roles
should provide patient care. A log should be maintained
of all personnel who enter the patient's room.
All health care workers who have contacted with the patient should put on appropriate PPE based on the
patient's clinical status. If the patient is not exhibiting obvious vomitng,
bleeding or other discharge of bodily fluids, PPE
recommended for patients without obvious vomiting, bleeding or other discharge
of bodily fluids should be used. If the patient is exhibiting obvious
vomiting, bleeding or other discharge of bodily fluids,
then PPE recommended for hospitalized patients with Ebola should be used.
Once the patient is safely isolated, continue the patient assessment,
obtain additional history, perform a physical examination
and provide medical care as necessary.
Remember, most patients who are screened do not have Ebola. Ensure there
is no delay in these patients' care by being prepared to evaluate, manage
and treat alternative etiologies of febrile illness as
clinically indicated. Frontline hospitals
will identify, isolate, stabilize, and notify the local public health
authorities and prepare to transfer the patient to an Ebola assessment hosptial
or treatment center. Ebola assessment hospitals will
continue to care for the patient for up to 96 hours until the diagnosis
is confirmed or ruled out. Each facility's role is to
safely provide care for the patient, and to inform the public health authorities
who will help to ensure that the patient can be evaluated safely and/or
transferred to another type of facility as appropriate.
In this module we have provided guidance to Emergency Departments for the
development of hospital specific plans and procedures to ensure the safety
of staff, patients and visitors, as well as to inform and coordinate
with local health authorities. Please continue with the next
module, which outlines steps to evaluate and briefly manage patients
under investigation for Ebola.