This video includes simulations of preparing and responding to patients who may have a
high consequence infectious disease.
Try to identify areas of improvement in the first scenario.
[Coughing] Can I help you?
I have this cough that is getting worse.
My nose keeps running and my eyes are red.
I think I might have a fever.
Have you traveled internationally in the last 30 days?
Yeah, I recently just got back from Paris, France.
France, huh?
Okay, well you’re probably all right.
Why don’t you just go take a seat over there with those people?
We’re very busy, and it might be a while.
Okay.
[Coughing] The receptionist should have taken several
precautions in this scenario.
Seth has measles, which is prevalent in France.
This scenario could result in a measles outbreak.
Something like this could happen in any health care facility.
Watch the scenario again, this time following the high consequence infectious disease screening
guidance.
[Coughing] What brings you in?
I have this cough.
I think it’s getting worse.
My nose keeps running.
I think I might also have a fever.
Okay.
Could I ask you to put this mask on?
This mask?
Yeah, just to cover your cough.
Okay.
Can you also use the alcohol hand sanitizer?
Yeah, thanks.
Thank you.
Have you traveled outside of the U.S. in the last 30 days?
Actually yeah.
I just got back from Saudi Arabia recently.
Okay.
Do you have any type of a rash?
I don’t think so, no.
Okay, well I’m going to room you right away, so follow me.
Okay, thank you.
Per the High Consequence Infectious Disease Screening Guidance, the receptionist asks
Seth about travel and rash.
The HCID screening guidance screens all patients for four things: cough or respiratory symptoms,
fever, rash, and travel outside of the country in the last 30 days.
If the patient answers yes to any of these four questions, follow the screening guidance
for next steps.
Oh hi, Heather.
I just wanted to let you know that I roomed a patient in room 8.
He came in and he had respiratory symptoms, and he said he had a fever, and he has traveled.
He set off a flag in the admission screening, and so I did what it told me to.
I put a mask on him, and put him in his room.
Okay thanks, Mary Ellen.
I’m going to use the HCID Binder here to help us along until we get more information.
There are great tools in here, like a great checklist for all the things I need to remember
to do.
There’s a log I can use to document anyone going in and out of this room, and a list
that the hospital created to tell me where I can find more PPE if we need it, and a lot
of other things to consider if we end up deciding to fully activate our HCID plans.
But now, I wonder what kind of isolation sign I should put on his door.
Let me look at the pathogen-specific isolation guide in the Readiness Binder.
And it looks like it’s level one, so I’ll go put this on the door.
Okay Angie, will you help me don this PPE?
It’s kind of confusing with a lot of steps.
Yeah, of course.
Heather and Angie are following the level one full barrier isolation sign outside of
the patient’s room to don the appropriate personal protective equipment.
Heather will use a fit-tested N95 respirator and only one pair of extended cuff gloves
because she suspects a viral respiratory pathogen.
Heather enters the airborne infection isolation room to ask Seth about his recent travel.
She gets more information and explains why she is wearing additional personal protective
equipment.
She assures Seth that he is fine and he will be well taken care of.
After Heather leaves the room, she will start doffing the level one PPE.
For more information, see the step-by-step instructions for donning and doffing PPE in
the HCID Readiness Binder.
Oh hey Doctor, I wanted to talk to you about a patient that came in this morning.
Yeah, sure.
What’s up?
He’s a gentlemen here, he was in Saudi Arabia about eight days ago.
He’s having some respiratory symptoms, so we put him in bed eight, which is an airborne
isolation room.
Good.
He was visiting multiple hospitals in the area in Saudi Arabia because he works in pharmaceutical
sales.
He doesn’t know anybody else who has been sick, or friends or family around him.
He is coughing pretty bad, he’s got a temp of 101, but other than that, he’s doing
pretty good.
And it looks like the rest of his vitals are normal.
Okay.
Thanks, Heather.
Looks like we should probably go to our screening tool, just to get an idea of what we should
do.
So looking at this, based on his cough, fever, and recent travel, he falls into the yellow
box.
So this tells us that we should move the patient to a private or isolation room, and you’ve
already done that so great job.
Next, it says we should probably assess possible infections based on travel history, clinical
presentation, and it looks like there are some resources here, so let’s use that.
I’ll go to the first one: Travel Clinical Assistant from the state of Georgia, so let’s
do that.
Okay.
And you said he went to Saudi Arabia, right?
Yep.
[Typing] Okay, let’s see what comes up.
It looks like it organizes it based on recent outbreaks first, so let’s start there.
It doesn’t sound like cholera or measles really fit his picture, but the MERS coronavirus
infection definitely sounds like a possibility.
Incubation 3 to 15 days, cough, fever, respiratory symptoms.
And this says to use standard, contact, and airborne precautions.
We’ve already done that, which is great.
Let me click for some more information here.
This takes me to the CDC website for MERS.
Let’s scroll down and click on information for health care providers.
So reading through this, looking through it, looks like he definitely could be a patient
under investigation.
And that sounds like it leads us to the red box over here.
So let’s go back over here and see.
And it looks like going through the steps, we’ve already done the first two steps – airborne
and PPE – so good job doing that.
We should probably move on to the next step.
Heather, do you want to contact infection prevention, and I’ll contact the Minnesota
Department of Health?
Okay, will do.
I’ve already been looking over the checklist, and it mentions other key people that we should
notify, such as our clinical laboratory, too.
That’s a great point.
Yeah, he’s probably going to need a chest x-ray too, so I’ll talk to the radiology
department and say that we have a possible MERS case right now.
Okay.
Thank you.
Yep.
HCIDs could present to any facility at any time, and being prepared can reduce negative
consequences.
It is important to be able to identify and isolate possible HCIDs and inform key response
partners.
Integrate HCID preparedness into routine infection control practices by using the MDH HCID Toolbox
for Frontline Health Care Facilities.