UCSF Infection Control Guidance for Managing Suspected Cases of Ebola Virus Disease For any suspected cases of Ebola Virus Disease, please contact: When Contact Business HEIC On-Call Mobile (Mon-Fri 8 AM-4PM): HEIC to follow Hours Only Notification Algorithm-see IC Policy 7.1, Appendix III AND Critical Care Medicine Pager Hospital Medicine Pager Infectious Diseases Pager Administrator On Call Pager NonHospital Nursing Supervisor Business Pediatric Nursing Supervisor Hours SUP to NOTIFY: Critical Care Medicine Hospital Medicine Infectious Diseases Patient Care Director On Call Administrator On Call Emergency Phone Tree Any hour Occupational Health Patient Placement-Prepare to vacate AIIR in 13ICU Lab (Blood Bank)-trigger Lab emergency phone tree UCPD-notify OEH&S Emergency Response Team (ERT) Security-set up badge scanner Facilities Management (FM)-establish isolation “ward” Materiel Services-deliver Ebola PPE cart Contact Information 806-0269 443-4443 Adults; 443-8368 Peds 443-4283 Adults; 443-8185 Peds 443-0670 Adults; 443-2384 Peds 443-9097 notify PCD On Call 3-1964 3-9195 443-4443 Adults; 443-8368 Peds 443-4283 Adults; 443-8185 Peds 443-0670 Adults; 443-2384 Peds See schedule 415-443-9097 (Sup’s reference) 5-7580 3-1937 3-1313 9-911 5-7890 3-1128 3-1837 1. Isolation: Place patient in a private Airborne Isolation Infection Room (AIIR) in Airborne*, Contact, and Droplet Precautions a. *Airborne: Although Ebola virus is not transmitted via the airborne route, patients will be placed in an airborne isolation room in the event that an aerosol-generating procedure is performed. b. Duration of precautions will be assessed on a case-by-case basis in conjunction with public health authorities 2. Hand hygiene must be performed before room entry and immediately after removal of PPE. 3. Monitoring (OEH&S Emergency Response Team [ERT]): a. ERT will monitor all HCW entering patient room for properly putting on and removing PPE, disinfection activities, hand hygiene. 4. Personal protective equipment (PPE): All persons entering the room will wear: a. Hospital-issued scrubs b. Gloves: 2 pr—1st pr next to skin prior to donning all other PPE, 2nd pr as per WHO donning guidelines c. Gown (AAMI level IV) – Cardinal Health or Kimberly Clark specialty surgical gowns; d. Face protection: i. N-95 respirator AND goggles or face shield—discard upon leaving room (1x use) OR ii. PAPR/CAPR (required if performing aerosol-generating procedures) e. Full Guard shoe covers with integral leggings f. Bouffant hair bonnet Last updated: 10/10/2014 g. Tychem QC coverall if anticipate significant exposure to bodily fluids *Refer to the links for guidance on putting on and removing PPE* 5. Patient care equipment a. Dedicated medical equipment for all patient care b. Use disposable equipment OR clean all non-disposable equipment according to hospital policies. 6. Staffing: a. Volunteer pool will be trained in care of Ebola pt b. Only trained staff will care for Ebola pts c. Adults: Ebola response provider team will be comprised of Critical Care Medicine (CCM) attending MDs and RNs, Hospital Medicine attending MDs and Infectious Diseases attending MDs. d. Peds: TBD e. Other dedicated personnel include: i. Respiratory Care Therapist ii. Hospitality iii. Clinical laboratory scientist iv. Pharmacist v. Security vi. Facilities Management vii. Clinical Engineering viii. Infection Control Practitioner f. Nursing will conduct phlebotomy (minimum necessary for safe pt care) g. At least 2 nurses per shift will be assigned h. CCM will conduct procedures i. Aerosol-generating procedures limited to those necessary for safe pt care 7. Laboratory Specimen Collection/ Labeling/ Transport a. Specimen collection: collect all samples wearing appropriate PPE b. Labeling/Packaging for transport: i. label all samples clearly as EBOLA ii. place in clear plastic biohazard zipper-locking bag iii. clean exterior with bleach iv. place in second clear plastic biohazard zipper-locking bag v. clean exterior with bleach vi. place in rigid, sealed pathology container vii. clean exterior with bleach c. Specimen transport: hand carry all samples to the lab (avoid pneumatic tube or dumbwaiters) 8. Environmental cleaning/ control a. Wear recommended PPE for all environmental cleaning and disinfection. b. Follow standard procedures, per hospital policy and manufacturers’ instructions for cleaning and/or disinfecting environmental surfaces and equipment 9. Occupational health considerations a. Maintain a log of all HCP entering the patient’s room b. Management of exposed HCP: i. Symptomatic – stay home from work/ immediately stop working, notify supervisor, notify OHS Last updated: 10/10/2014 ii. Asymptomatic – fever and symptom monitoring twice daily for 21 days after last known exposure; will assess need for work exclusion on a case-by-case basis in conjunction with public health authorities 10. Visitor monitoring a. Restrict all visitors into the patient’s room; may consider exceptions on a case-by-case basis. b. Maintain a log of all visitors entering the patient’s room. c. Visitors should be: i. Screened daily for symptoms before entering the hospital. ii. Educated and assessed for ability to comply with precautions iii. Restricted to the patient room and an immediately adjacent waiting area. 11. Waste handling (refer to full policies/procedures from Hospitality, Office of Environmental Health and Safety) a. All linen, textiles and waste generated (including excrement) will be discarded: i. Place in red biohazard bag, tie closed, clean exterior with bleach ii. Place in second red biohazard bag, tie closed, clean exterior with bleach iii. Place in biohazard toter, clean exterior with bleach iv. Roll over bleach-moistened bath blanket placed on floor outside anteroom v. Transport via otherwise empty service elevator to San-I-Pak at loading dock vi. Process in San-I-Pak as per instructions References: http://emergency.cdc.gov/han/han00364.asp http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html UCSF HEIC Communicable Disease Policy http://www.who.int/csr/resources/publications/ebola/filovirus_infection_control/en/ Last updated: 10/10/2014