In Wake of U.S. Ebola Infections, Local Hospital Addresses Precautions

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Questions for Beaufort Memorial Hospital President & CEO Rick Toomey:

Question: Given the remote possibility of an Ebola infection here in the Lowcountry, and that the CDC lacks the authority to mandate requirements for handling the disease, is the hospital required under any state law to follow precautions for such an outbreak?

Answer: The hospital is not mandated to follow CDC guidelines but we have written policies and procedures that specify we would follow the CDC’s recommendations as the leading U.S. authority on infection control and prevention, as well as other resources, including the local expertise from our military community in training staff and managing bio-hazardous conditions.

 

Question: A patient with a fever and no other symptoms is sitting on a hospital gurney in the ER and describing to a nurse his recent trip to West Africa when all of the sudden, he starts to seize and goes into respiratory arrest. He’s not breathing and his heart could stop at any second. What is the first thing the hospital would do? What kind of protocols, if any, are in place in this remote scenario?

Answer: We have recently put protocols into place to screen patients upon presentation to the ER and any outpatient registration area – physicians’ offices included – whereby our registrars ask patients if they have 1) Traveled to West Africa or other areas known to have Ebola outbreaks in the past three weeks; 2) Been in contact with someone who has traveled to West Africa or other areas known to have Ebola outbreaks in the past three weeks; and 3) Are exhibiting any of the symptoms associated with Ebola, which are listed for them. If the patient answers “yes” to questions one and two they are given information and the Nursing Supervisor is contacted and calls Infection Control and DHEC for further instruction. If the patient answers “yes” to all three questions the patient is immediately isolated while the nursing supervisor and the Department of Health and Environmental Control (DHEC) are notified and further instructions are given. Given these protocols, the above scenario likely would not have the opportunity to occur in our facilities.

Question: If the man tests positive for Ebola, when do you call the CDC? Who else is on the “need-to-know” list, the governor?

Answer: The first point of contact from a health control perspective is DHEC, which in turn notifies the CDC.

Question: Is the hospital equipped with protective equipment and gear and an isolation unit?

Answer: The hospital is equipped with the personal protective equipment (PPE) needed for our employees, and training sessions for the proper “donning and doffing” of PPE has been ongoing in our ER and on our nursing floors. Our ER has two negative pressure rooms and a decontamination room with negative pressure. We also have a protocol in place to treat a potentially infected patient in the decontamination room, which is adjacent to the ER, until the proper transfer arrangements are made.

Question: How many healthcare workers would deal with the crisis in the ER? Would the hospital isolate the workers afterwards? How?

Answer: As few as possible. The goal in dealing with Ebola patients is to limit exposure to the least number of people needed to provide the best and most appropriate care. A log of individuals participating in the care would be recorded. That said, because of recent events in Texas and the need to treat any equipment, materials or surface related to an Ebola patient’s care with the utmost safety, we would rely on bio-hazardous materials experts to safely help healthcare workers remove PPE and bio-hazardous waste from the patient’s rooms in accordance with the latest recommendations from the CDC and our own infection prevention team. We are fortunate to have a team from Parris Island Fire and Rescue who are certified in and have volunteered to be on call to assist us with both the “donning and doffing” process and other needs.

Question: Has the news from Dallas prompted the hospital to rethink any safeguards in place for infectious disease, such as staff retraining, new cleaning products, or evaluation of protective equipment?

Answer: Certainly. We have long been trained to safely treat patients with infectious diseases which is fortunate from a staff and patient perspective because much of the equipment and cleaning products needed for protection against this virus is already in our possession. Our biggest area of focus now is providing a pre-emptive screening process and stepping up training on the safe “donning and doffing” of PPE. Education is of paramount importance, and our education team is rounding on both nursing units and offsite locations to ensure that all of our frontline staff are aware of and can follow the new screening protocols we’ve put into place.

Question: The director of the CDC, Dr. Thomas Frieden said on September 30, “I have no doubt that we will stop [Ebola] in its tracks in the U.S.” But he began his press briefing on October 13 by saying that “stopping Ebola is hard.” He also said that the CDC is “doubling down” the amount of support the agency is providing to U.S. hospitals. Is the CDC or other state and federal health officials working with the hospital?

Answer: We have a multi-disciplinary team of physicians and specialists whose members meet with and/or speak with experts from DHEC several times a week, and who participate in nationwide calls coordinated by the CDC when new information needs to be shared or new protocols developed. President Obama recently directed CDC officials to ensure they have a team on the ground of a hospital with an infected patient within 24 hours of notification, as well, so we believe that everyone involved in healthcare is taking every precaution possible given the information available, while being flexible enough to adapt quickly to changing recommendations to maintain the safety of our patients, staff and community.

Question: Are there other measures you have put into place to ensure the safety of your staff, patients and community?

Answer: Again, the three-question screening checklist we developed will be read to or completed by every patient who approaches any Beaufort Memorial registration area or who calls a physician’s office to schedule an appointment related to flu-like symptoms, which will serve to divert patients to a place where they can be safely evaluated and isolated, if necessary. Also, the Medical University of South Carolina, Greenville Hospital System and Palmetto Health have agreed to be the state’s receiving hospitals for any patient who has been positively identified as infectious, which is a great service to the nearly 60 other hospitals located throughout the state, including ours.