From: McGovern, Fran On Behalf Of Hupp, Diane Sent: Friday, October 17, 2014 4:02 PM To: Roth, Kimberly; Moody, Shawn; Roberts, Terri; Green, Michael; Aumer, Meredith; Clark, Robert (Anes/CCM); Aneja, Rajesh; Silva, Ismael; Cassese, Patrick; Munsch, Elizabeth; Rasmussen, Jayne; Hariri, Rahman (Mercy); Coffman, Leslie; Teears, Jason L; Majsak, James; Kapsin, Kathleen; Cancilla, Diane; Hecht, Lynn; Sears, Maryann; Croyle, Karen S.; Fagan (Holland), Julie; Kuch, Bradley A; Pritchard, Nancy S.; O'Hern, Mark A; Brozanski, Beverly; Gaines, Barbara; McKenna, Chris (CHP); Capan (Arnold), Michelle; Dewar, Stephanie; Hart, Stephen; Fox, Michael; Rometo, Allison B; Docimo, Steven; Ali, Bernadette; Ambrose, Heather; Basille, Donna; Belenis, Elaine; Eddy, Sandra A; Eicker, Paula; Iagnemma, Jennifer; Kovac, Victoria; Lesniak, Deborah; Madden, Christina; Scanlon (Lucero), Terri L; Straka, Kristen; Valenta, Cynthia; Vincze, Durae L; Waltenbaugh, Hope; Zoller, Kayla; Ankney, Diane; Aumer, Meredith; Carlson, Michele; Chaplik, Annette; Cote, Stacey; Dickman, Jennifer; DiLucente, Michele; Guthrie, Charles E; Kuch, Bradley A; Lamouree, Margaret; Manuel, Grace; Mastrangelo, Beth; Opalko, Darcie; Rausch, David; Ricci, Frank G; Spence, Ann; Tharp, Marcie M; Thomas, Dawn (CHP); Vincett, Carrie; VonHofen, Geraldine; Wible, Susan R; Cooper, Heather-Dawn; Kaminski, Marnie; Landgraf, Bonnie; Lipinski, Kimberly D; Mcintyre, Melissa J; Wilson, Melissa Cc: Anderson, Karen; Tennies, Kylen Subject: Ebola Preparedness Educational Meeting - Wednesday, 10/22/14, @ 3 pm Importance: High An Ebola preparedness educational meeting has been scheduled for Wednesday, October 22, at 3 pm in Rangos Conference Rooms B and C. If you are unable to attend, please send a designee to represent your area and let my office know who your representative will be. Thank you, Diane S. Hupp, MSN, RN, NEA-BC Vice President Patient Care Services and Chief Nursing Officer Children's Hospital of Pittsburgh of UPMC 4401 Penn Avenue Pittsburgh, PA 15224 Phone: 412-692-5122 Fax: 412-692-5800

From: Hupp, Diane Sent: Friday, October 17, 2014 11:35 AM To: Roth, Kimberly; Green, Michael; Docimo, Steven; Moody, Shawn; Roberts, Terri Subject: Draft for Power Point Education to Staff/Faculty Attached is a draft outline for the power point education for all staff and faculty. I am happy to fill in some of the info for the slides but wanted to send off the overview for you to comment, edit and add as you see appropriate before we begin to add comment. Thanks, Diane Diane S. Hupp, MSN, RN, NEA-BC Vice President Patient Care Services & Chief Nursing Officer Children’s Hospital of Pittsburgh of UPMC 4401 Penn Avenue Pittsburgh, PA 15224 Phone: 412-692-5122 Fax: 412-692-5800 This e-mail may contain confidential information of the sending organization. Any unauthorized or improper disclosure, copying, distribution, or use of the contents of this e-mail and attached document(s) is prohibited. The information contained in this e-mail and attached document(s) is intended only for the personal and confidential use of the recipient(s) named above. If you have received this communication in error, please notify the sender immediately by e-mail and delete the original e-mail and attached document(s).

Ebola Preparedness at Children’s Hospital of Pittsburgh of UPMC

October 2014

What is Ebola Virus?

Background/Key Facts

Significant Timeline

Transmission of Virus

Clinical Symptoms

Diagnosis

Treatment

CHP Preparedness to Date

Our Primary Roles

1. Screening for infection 2. Controlling infection in the health care

setting

CHP Screening Tool

• Insert Tool

UPMC System Target Hospitals for Ebola Patients

• Children’s • Presby • Shadyside • Altoona • Mercy • Hamot

PPE – Two Levels with Buddy System

• Level 1 • Level 2

Donning and Doffing Procedure

• Insert video if ok

Patient Placement for Identified Ebola Patients at CHP

• Emergency Department – Room 38

• PICU – Rooms 1 and 2

Supplies

• Cart

Staffing – Limited Ebola Response Team

Visitation - Restricted

Linen/Waste Disposal

Environmental Room/Corridor Procedures

CHP Communication Process for Positive Ebola Patient

QUESTIONS

Ebola Preparedness Children’s Hospital of Pittsburgh of UPMC

Presented by: CHP Emergency Preparedness Program Leadership

October 2014

Objectives

Provide an overview of the disease

Review the outbreak timeline

Review CHP preparedness activities

Discuss where we go from here

Outline key management principles

Background

Ebola is one of several organisms that causes the disease Viral Hemorrhagic Fever (VHF)

Ebola is not new. Discovered in 1976.

34 outbreaks of Ebola virus previously documented

Current outbreak represents first time this virus is in an urban area

How Is Ebola Transmitted? Direct contact with bodily fluids from an

infected and symptomatic person Blood Urine Vomit Stool Saliva Sweat Breastmilk Semen

What Are The Symptoms of Ebola?

Fever >100.6 Headache Chills, myalgias, fatigue, weakness Conjunctival injection Rash Abdominal pain, vomiting, diarrhea Unexplained bleeding (late in course)

Treatment of Ebola

No FDA approved vaccine or treatment

Supportive care is the mainstay

◦ Fluid resuscitation

◦ Electrolyte replacement

◦ Respiratory support

◦ Blood products

New treatments in the pipeline

2014 Timeline

March 2014 – report of 23 deaths in

Africa

July 27 – Diagnosis of 2 Americans in

Liberia

Aug 2 – Dr. Brantley transferred to Emory

Timeline Continued

Sept 20 – Duncan arrived in US

Sept 26 – Duncan seeks treatment at ED

Sept 28 – Duncan transported by EMS to

Texas hospital and admitted

Oct 8 – Duncan dies

Timeline Continued

Oct 10 – First Dallas RN tests positive

Oct 14 – Second Dallas RN tests positive

CHP Preparedness

July – planning meetings for MERS/Ebola August 8 – a case of interest in CHP ED ◦ HICS Team assembled

◦ Engaged with ACHD and State

August 13 – started screening in CHP ED ◦ “Travel-Illness Screening”

◦ Goal was to make this the “new norm”

Travel-Illness Screening Form

Initial screen is 2 questions

◦ Travel / exposure history

◦ Fever

“Positive hit” on initial screen prompts medical provider to ask additional questions to determine if this is a true case of interest

CHP Experience to Date

9 “positive hits” since August 13th

◦ 5 with concern for MERS

◦ 4 with concern for Ebola

Detailed history by physician was able to rule-out travel-

illness

Served as wonderful “drills” for us

◦ Communications tested

◦ PPE practiced

Where do we go from here?

Look closely at lessons learned ◦ CHP “positive screens”

◦ Texas experience

◦ Reports from recent drills across the nation

Continue to expand preparedness activities and engage all areas of the hospital and our medical community

The Steps to Success

Screen

Isolate

Call…..(and Communicate well!)

Evaluate

Partner with public health for appropriate

diagnosis and treatment of patient

Screen

Hold ourselves accountable to ensure the safety of all our patients and staff

Focus on point-of-entry locations ◦ Signage to promote self-reporting

◦ Must ask each patient, family and visitor

◦ Method that reflects to our colleagues that screening was done as expected

Isolate

Emergency Department ◦ ED Room 38 – now a dedicated isolation room

◦ Re-organized solely for this purpose

Inpatient location identified ◦ PICU Room 1

◦ Regardless of age, clinical status

Expand planning to ambulatory settings

Call Call the CHP ID Attending on call ◦ A key element in our CHP internal plan which

is in place to address specific issues encountered in a pediatric center ◦ CHP has five ID Attendings on staff ◦ The group has received in depth training ◦ Review history and determine if the individual

meets case definition for Ebola ◦ ID has been trained to then activate UPMC

and CHP teams to manage the situation

Call and Activate the Teams

ID Attending will call

◦ UPMC MedCall 647-7000

Activate Ebola Executive Team

◦ CHP Hospital Incident Commander

Activate the HICS Team (12 members + IP/ID)

Serves as support structure for all the “other layers”

Coordinates communications with external entities

(and communicate well) Practice communications for this scenario ◦ How would you address the family ◦ Who is designated to handle and document

communications (i.e. consider designating an emergency situation leader) ◦ Who will remain the point of contact and

communicate that information to important parties

Evaluate Safety is absolutely paramount to a

successful outcome Our community can not manage this if

the providers become the next victims Use of PPE is a skill that must be learned

and reinforced over time Understand that clinical management

may be very different from “everyday practice”

Clinical Management

Providers utilize PPE with buddy system

Treatment is supportive

◦ Istat machine in room with patient

◦ No labs are sent out of the room

◦ No radiology studies

◦ Un-crossmatched blood products only

◦ Empiric antibiotics when testing not available

Targeted Treatment Locations Facility level – identified locations and

internal “response” team members who have received a higher level of training

UPMC System level – CHP Presby/Shadyside Mercy Altoona Hamot

National level – CDC biocontainment unit

Benefit of Targeted Locations

Focus planning efforts and preparation for optimal outcome

Focus staff education and implement concept of “train and re-train”

Key resources and supplies can be concentrated and not spread too thinly across the region

Team Development

Need to work to identify staff who are willing to dedicate their time to more intensive training in how to care for patients diagnosed with Ebola ◦ ED and ICU background

◦ Primarily MDs and RNs will be needed

Visitation Policy

Visitation will be restricted

◦ CHP leadership will immediately review each

individual case to determine if an exception to

this rule is needed for optimal care of a young

pediatric patient and their family

◦ CHP leadership will determine if an approved

visitor must wear PPE

Waste and Linen Disposal

In initial hours ◦ Waste and linen will not leave the room

◦ Dietary should use disposable products only

◦ Determine need to pretreat waste products

◦ Linen will be red bagged

◦ PPE is doffed in the room and remains in the room

Environmental Cleaning

ALL cleaning practices will be determined by Hospital Incident Command in real time based on most current information available

CDC does recommend daily cleaning of room to reduce viral load on surfaces

Terminal cleaning is a multi-stage process that requires tremendous oversight

Travel Within Hall Corridors ALL patient travel will be managed by

Hospital Incident Command in real time Following steps are considered: ◦ Placing protective equipment on and around

the patient ◦ Public Safety establishing the travel corridor

and blocking passage of anyone besides the patient team ◦ Immediate environmental cleaning ◦ Ensuring privacy of patient, family and staff

Summary

Screen

Isolate

Call (CHP ID Attending)

Evaluate (safely!)

Call MedCall and CHP HICS Team

Communicate well along the way

QUESTIONS