Ebola Preparedness Q&A

The topic of the Ebola virus and hospital/health care system preparedness is a rapidly moving target; Centers for
Disease Control and Prevention (CDC) guidelines and recommendations change frequently. Cooley Dickinsons
Infection Prevention Dept. is working to protect patients, their families and staff and we are fortunate to be working
with staff from Massachusetts General Hospital and Partners HealthCare to implement the safest processes we can.
Q: How likely is it that we might see a patient with Ebola at CDHC?
A: The chances are very small, but real, and we need to be prepared. There are students in our local schools and
colleges who are from Western Africa; and when it comes to airplane travel, its a very small world. The local Public
Health Department will immediately follow and monitor the health status of anyone suspected of having the virus, and
if necessary, public health will quarantine those people and others with whom they have come in contact.
Q: Is the Emergency Department staff asking patients about travel history and symptoms?
A: Yes. The Emergency Department receptionist and the triage nurse are asking all patients about travel both to the
West African countries where Ebola is present and to the Middle Eastern countries where MERS (Middle East
Respiratory Syndrome) is present. If there is a travel history, then staff use a screening tool to ask specifc questions
related to contacts and symptoms.
Q: How can we be sure communication is facilitated at CDHC?
A: At CDH, the ED triage note that the nurse writes is in the record in real time and all providers have access to that
record. In addition, the triage nurse gives a verbal report to the receiving nurse. Prior to seeing the patient, the
doctors/physician assistants read all the nurses notes, lab values, and any other information in the chart.
Q: Is there a specifc place in the Emergency Department where patients suspected of having Ebola
would be placed?
A: Yes. Patients would be placed in room 1, as it can be accessed directly from the lobby or from an ambulance bay
without having the patient move through the ED and potentially expose others. In addition, it is a large room with
plenty of space to contain the necessary supplies and for staff to carefully put on and take off his or her personal
protective equipment (PPE).
Q: How does the Ebola infection spread?
A: The virus is found in the blood and body fuids (including saliva, tears, and sweat) of infected patients. The CDC
does not believe Ebola is spread through the air. Patients are not contagious until they are sick (unlike the fu, which
people can spread before they know they are sick.)
Q: If employees need to care for a patient suspected of having Ebola what kind of PPE will they use?
A: While the CDC recommends a gown, mask, gloves, and goggles or a face shield, we want to provide an extra level of
protection for our staff. Staff caring for these patients will wear a jumpsuit with a hood and shoe covers, a N95 respi-
rator, a full face shield, and two pairs of gloves.
Q: According to CDC reports, it is very easy to contaminate yourself when removing protective garb
after caring for someone with Ebola. How can we be sure our staff are safe?
A: Very few of our employees are familiar with the level of protective equipment that is required to take care of a
patient who is suspected of having Ebola. Therefore, the Haz Mat Team leader from the Northampton Fire Dept.
offered a train the trainer class with our ED staff and frst responders. These people then worked with the other staff
to practice putting on and taking off the protective equipment.
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If a suspected patient comes to our ED, we will limit the number of staff who care for the patient. Registration will be
done by phone. One nurse and one doctor will be assigned to the patient. No labs are being done at CDH and a
portable X-ray will only be done if absolutely necessary.
In addition, there will be a designated room monitor who will record the names of everyone who enters the room.
The main job of the room monitor will be to watch and be sure that PPE is put on and taken off correctly. The room
monitor will put on a gown, gloves, and N95 mask and will remove the PPE from the care providers to be sure that
there is minimal risk for contamination.
We are planning drills to test our processes and to give staff continued practice putting on and taking off PPE. We also
have a box of practice suits that can be used when the drills are held.
Q: Where will the patient go from the ED?
A: Because we cant test blood in the lab due to the risk of contaminating very expensive machines, we are unable to
treat suspected patients with Ebola at CDH. Therefore, a person suspected of having Ebola will be transferred to Mass
General to receive care.
Q: What about all the germs in the room and on equipment?
A: Any linens and disposable items in the room will be discarded in hazardous red bag waste. The Ebola virus is killed
using our hospital grade cleaner/disinfectants. In addition, we have the added protection of the Xenex ultraviolet
light, which readily kills the virus as well as germs more diffcult to kill, such as C. diff and MRSA.
Q: Patients also visit other registration areas and offsite locations within the Cooley Dickinson
system. Are we screening patients there as well?
A: We are revising screening tools like those the ED is using to customize them for offsites. We will be working with
managers to develop site-specifc processes. Personal protective equipment is not needed for people who have a travel
history but no symptoms.
Q: Who else needs to know about possible Ebola patients?
A: The Massachusetts Dept. of Public Health will be immediately notifed if we have patients who meet the travel and
exposure history criteria. DPH staff are available 24/7 and will give us specifc instructions for managing the patient.
The local boards of health are responsible for investigating community contacts and they would also be working
directly with DPH.
If you have questions, contact linda_riley@cooley-dickinson.org, Infection Prevention
Manager, or joanne_levin@cooley-dickinson.org, Infection Prevention Medical Director.
10/2014