Ebola fears remain high, despite new guidelines
CDC stresses best practices
If you are an accredited hospital, you already know what to do if Ebola comes to your door. At least that’s the theory. But what we think we know how to do, and what actually happens may not always coincide.
The fears about Ebola continue to run high, although influenza is easier to transmit and likely to kill thousands in the next few months. Because of that heightened anxiety, the best thing to do is to be ready to reassure your community that you are ready to deal with any Ebola patient and contain the threat.
The Centers for Disease Control and Prevention (CDC) released new guidelines for healthcare workers in October (http://www.cdc.gov/vhf/ebola/hcp/ed-management-patients-possible-ebola.html) to help reduce the risk to them of any transmission from a patient.
There is much less risk from patients presenting with just a fever in the ED compared to patients with severe illness who are hospitalized. The more severe the disease, the higher the level of virus production, and the bigger the danger to those who come in contact. For those very ill patients, best practices would include ensuring the proper donning and doffing of protective clothing — something that has its own section on the CDC’s Ebola website (http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html).
Best practices, according to the CDC, include taking a relevant exposure history and looking for symptoms of the disease. Because the symptoms are common to other illnesses, the combination of exposure and symptoms is important. If both history and symptoms suggest potential Ebola, the CDC says the patient should be immediately isolated in an area with a private bathroom or covered bedside commode, with all usual precautions used to prevent transmission by direct or indirect contact.
The CDC recommends the following:
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For patients coming in by ambulance that meet the criteria, hospitals need a designated space away from other patients where the patient in question can be seen.
Minimize the number of people who provide patient care, and keep a log of everyone who enters the patient’s room. Everyone who does so should wear appropriate safety gear based on how ill the patient is.
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Contact the local health department, which will help determine whether or not to test for Ebola.
The Joint Commission hasn’t issued any new guidelines, but it did put together a list of the standards that relate to effective management of the disease. The Joint Commission’s vice president and chief medical officer, Ana Pujols McKee, MD, says the organization is working closely with the CDC to release Ebola-related briefs and updated guidelines as needed, noting that "following the relevant CDC guidelines is a requirement for Joint Commission accreditation."
She says that The Joint Commission is stressing the importance of preventing transmission of Ebola, and the "evolving information around how to best care for [Ebola] patients means that health care organizations need to be on alert and ready to respond to changing requirements."
In addition to the CDC guidelines, the processes outlined in The Joint Commission’s "Infection Prevention and Control" chapter of its accreditation manuals and related sections of the "Environment of Care" chapter are applicable to all infections or potential sources of infection that health care staff, practitioners and administrators might encounter, including Ebola. For that virus, McKee says it is important for organizations to focus on emergency management standards, too, which are "designed to assist health care organizations, both large and small, in developing and maintaining an effective program that covers a wide range of situations."
