Ebola and Frontline Healthcare Facilities

Introduction:

Frontline facilities vary widely from vital access hospitals to significant tertiary care facilities. However, all facilities must be able to recognize, contain, and communicate a unique pathogen case, including Ebola, and have preparations in place to deliver a suitable level of care while awaiting transfer.

What Is Ebola?

A viral infection brings it on with a member of the Ebola virus family. It is a rare, extremely contagious, and frequently lethal disease spread by contact with infected body fluids (either from a sick individual or bodily fluid-contaminated things). Ebola symptoms include fever, pain, diarrhea, and bleeding.

What Are Frontline Healthcare Facilities?

Frontline healthcare facilities include acute care hospitals, urgent care centers, critical access hospitals, and other emergency care facilities. Frontline healthcare facilities should be ready to investigate a patient who arrives with Ebola-like symptoms and has a known possible Ebola exposure, even if the possibility of this is extremely low. To ensure that patient care is completed on time, frontline healthcare providers should be equipped to quickly detect and segregate PUIs (patients under investigation) and notify state and municipal public health authorities.

What Function Do Frontline Medical Centers Serve?

Frontline hospitals should be able to perform the following as part of a tiered, regional system designed to manage patients with Ebola and other unique pathogens.

• Put the "detect, isolate, and inform" concept into practice by performing prompt triage, initial assessment, and beginning clinical care.

• For the suspected case, start the required infection control procedures.

• Quickly alert internal and external stakeholders of a suspect case, such as state or municipal health officials or infection prevention workers.

• Give healthcare workers (HCWs) enough personal protective equipment (PPE) to last at least 24 hours.

• Arrange a secure transfer of the suspected patient, as the regional plan requires, to an evaluation hospital, a state or regional Ebola and unique pathogen treatment facility, or both.

• Have workers on hand who have undergone the necessary training and have demonstrated competence in safe PPE procedures.

• Take charge of seriously ill patients who may need intubation and other high-level treatment until a diagnosis of a specific pathogen is confirmed, ruled out, or transferred in compliance with the Emergency Medical Treatment and Labor Act (EMTALA).

• Have a plan in place for safely managing waste disposal, cleansing, and disinfection with the assistance of vendors and response collaborators as necessary.

What Is the Role of Frontline Healthcare Facilities?

In collaboration with regional and state health departments, frontline healthcare facilities should be able to do the following.

Identify:

• Quickly recognize and prioritize patients with relevant exposure history and signs or symptoms associated with Ebola.

Isolate:

• Any patient with a relevant exposure history or symptoms consistent with Ebola should be isolated very away. In addition, it is necessary to protect the staff members taking care of the patient by using personal protective equipment as needed (PPE).

Inform:

• When a patient with relevant exposure and symptoms or signs suggestive of Ebola is discovered, it is imperative to immediately alert the hospital's infection control program, other suitable facility staff, and state and municipal public health authorities.

• When deciding whether or not Ebola testing is necessary, frontline healthcare facilities should speak with the state or local health agency. If testing is recommended, they should also decide where the patient should be looked for while the EVD testing is done.

• Frontline healthcare facilities should consider moving the patient to an Ebola evaluation hospital that can offer Ebola screening and support until the Ebola diagnosis is either confirmed or ruled out in conjunction with state and local health authorities and in accordance with the state's plan.

• In some instances, patients who need Ebola virus testing but are assessed to have a low risk of the disease based on clinical and epidemiologic indicators and who are just mildly unwell may stay at the frontline healthcare facility until testing is done.

• According to the state's plan, immediate referral to an Ebola treatment facility may be an option for individuals with a high chance of contracting the disease or who are more seriously ill. The closest Ebola evaluation hospitals and treatment centers should be known to all frontline healthcare facilities, and they should have a plan for patient transport in the unlikely event that it becomes essential. When it is decided to transport a patient, steps are taken to make sure that those who will provide the transport are aware of the patient's condition and have the necessary training and PPE to do so safely.

• Patients diagnosed with Ebola are moved to an Ebola treatment medical center.

What Are the Required Resources in Frontline Healthcare Facilities?

Cross-training should be considered where appropriate, and the number of employees who have direct contact with patients should be reduced. Staff members who assist or participate in patient care should have the necessary training for their positions and be able to do and take off PPE, follow infection control procedures, and handle waste correctly. Hospitals must offer continuous training and address infection control lapses through retraining. In addition, every hospital should carry out a PUI practice exercise, and any inadequacies found should be filled.

Up until the conclusion of the Ebola testing, preparations should be made for the safe, short-term storage of Category A infectious waste. A seriously unwell patient with a high risk of EVD is unlikely to need prolonged care (>12–24 hours) from frontline healthcare services. Therefore, PPE, recommended by the CDC for clinically stable PUIs, is used to treat most patients in these facilities. Plans for PPE supplies in frontline facilities should concentrate on ensuring an adequate supply of gloves, gowns, medical face masks, and face protection, as well as ensuring that all staff members receive regular training in its use.

Frontline healthcare facilities may want access to PPE sufficient for 12 to 24 hours of care in the unlikely event that PPE recommended for the maintenance of hospitalized patients with Ebola is required. They should also ensure that all healthcare workers who may need to use PPE for Ebola are trained for their roles in the care of patients with EVD and have demonstrated proficiency in using PPE, including wearing and doffing.

What Safety Precautions Must Healthcare Professionals in Healthcare Facilities Follow?

When there is a high probability of Ebola or another VHF (viral hemorrhagic fever), precautions are taken, and PPE is worn. When the patient either demonstrates instability, vomiting, diarrhea or bleeding, these conditions are deemed to be a reasonable likelihood. Depending on what the providers are accustomed to and have available, the facility should choose its VHF PPE (personal protective equipment).

It consists of the following:

• Two sets of extended-cuff nitrile gloves.

• A dress that is impermeable and at least calf-length.

• Knee-length, impermeable booties.

• Operating hood (complete head coverage falling onto shoulders).

• Face protection.

• Patients at high risk of exposure or significant bodily fluid loss should wear an impermeable apron.

Conclusion:

Ebola is a deadly disease caused by the Ebola virus. Therefore, it is crucial to identify, isolate and treat Ebola-infected patients with care. Frontline healthcare centers play an essential role in this.