Ebola Viral Disease

October 21, 2014

Overview

Historical perspective Current epidemic update OSUWMC preparedness

Signage and marketing Screening Isolation activation Inpatient management Staff education and training; simulations

Challenges

Challenges

Balancing preparedness and informative education with alarmism

Forced isolation/treatment Global presence of our university community Dynamic nature of the epidemic

Changing protocols

Other problems to not forget…. Enterovirus D68, Influenza

Ebola Epidemiology

Acute infection starts as a non-specific febrile illness Fever (>100.4), severe headache, muscle pain, malaise;

progression to include GI symptoms (diarrhea and vomiting)

Symptoms may appear 2-21 days after exposure 8-10 day window the most common

Significant dehydration and electrolyte disturbances Small vessel involvement

Increased permeability due to cellular damage

Multi-organ system failure Hemorrhage may develop in the second week Poor prognosis associated with shock, encephalopathy,

extensive hemorrhage

Jay Varkey, MD; Emory University Hospital

Ebola Historical Perspective

Family Filoviridae Two genera: marburgvirus and ebolavirus

Enveloped RNA virus Five subtypes of Ebola virus

Zaire (EBOV) Sudan (SUDV) Tai Forest (TAFV) Bundibugyo (BDBV) Reston (RESTV)

No vaccines/treatments approved for humans Case-fatality rates of up to 90% in African settings

Jay Varkey, MD; Emory University Hospital

Ebola Historical Perspective

1976: Simultaneous outbreaks in Zaire (now DRC) & Sudan Zaire: 318 cases and 280 deaths (88% mortality) Sudan: 284 cases and 151 deaths (53% mortality)

1976 & 1979: Small-to-midsize outbreaks Central Africa 1995: Large outbreak in Kikwit (DRC)

315 cases (81% mortality)

Since 2000: Near-yearly outbreaks in Gabon, DRC or Republic of Congo

2000-2001: Largest outbreak on record (Sudan) 425 cases (53% mortality)

Jay Varkey, MD; Emory University Hospital

Current EVD Epidemic

West African outbreak limited to: Guinea: 1519 cases / 862 deaths Liberia: 4249 cases / 2484 deaths Sierra Leone: 3410 cases / 1200 deaths Total: 9178 cases / 4546 deaths

Senegal (8/29/14) and Nigeria (9/5/14) no longer considered at risk

Early August 2014 – first health care workers brought from West Africa to Emory University Hospital Other individuals brought from West Africa since then

September 30, 2014 – first case diagnosed in the US (Dallas) of a Liberian man traveling to the US Patient passed away October 8, 2014

www.cdc.gov and Fox News

Current EVD Epidemic

Two nurses at Dallas hospital have tested positive for Ebola (October 10th and October 14th) Second nurse traveled through NE Ohio from 10/10-

10/13 Over 100 people in NE Ohio on quarantine/isolation or

monitoring of temperatures

Risk points of when a health care worker can most commonly become infected: From exposure to body fluids during patient care From error during doffing of PPE From time when patient is intubated or during certain

procedures due to increased aerosolization of secretions

www.cdc.gov and Fox News

EVD Preparedness at OSUWMC

Both UH and UHE ED’s need to be prepared for walk-ins and EMS traffic

Volunteer team designated for inpatient care Medical Team Nursing RT/team

Six hours of training in three two-hour phases “Buddy System” for PPE

Point of Care testing equipment for in-room use for routine labs

EVS, solid and liquid waste plans developed

EVD Preparedness at OSUWMC All patients planned to be admitted to 5 Ross – this may

change after mid-December when old James available Will have a donning/doffing room adjacent to each room

Entry restricted to assigned care team with log 2 nurses per patient – one inside/one outside

If critically ill, consider two inside/one outside

Team huddle including Critical Event Officer and senior clinical leaders two times per day

No transport outside room unless approved by the Critical Event Officer

All deviations to SOP’s need to be approved by Critical Event Officer prior to implementation

EVD Preparedness at OSUWMC

Collaboration between the CMO’s of Franklin County Hospitals, Columbus Public Health and COTS

Outreach to regional hospital leadership and MedCare ambulance service

“Secret shopper” simulations Three+ have been completed

Screening questions in outpatient IHIS workflows with BPA that fires if screen positive to alert rest of care team

Working closely with University officials on how this will affect the rest of campus

Challenges

Balancing preparedness and informative education with alarmism

Forced isolation/treatment Global presence of our university community Dynamic nature of the epidemic

Changing protocols

Other problems to not forget…. Enterovirus D68, Influenza

Special thanks to Drs. Naeem Ali, Julie Mangino, and Christina Liscynesky for resources and data