Thursday June 29th 2017

Ebola revisited: ANA, CDC address ongoing efforts

Last summer, Ebola crept into the consciousness of at least some health care workers when the Centers for Disease Control and Prevention put out an advisory on its health alert network with guidelines for the evaluation of U.S. patients suspected of having the disease. That was Aug. 1, 2014, and at the time, there were no cases within the United States.

However, the advisory noted that the CDC was working with the World Health Organization, the ministries of health of Guinea, Liberia and Sierra Leone, and other international organizations in response to an outbreak of Ebola in West Africa, which was first reported in late March 2014.

As requested by the CDC, the American Nurses Association shared that information with its constituent/state nurses associations. Then on Sept. 30, 2014, the CDC reported the first laboratory-confirmed case of Ebola to be diagnosed in the United States. Soon afterward, two nurses who provided care to the patient at the Texas hospital were diagnosed with Ebola and subsequently treated.

From the onset of the U.S. cases, ANA carried on a multipronged campaign, pressing for increased safety measures for health care workers; offering targeted educational activities and resources for RNs, and in turn, the public; and participating in national and local media interviews to educate the public, as well as quell people’s fears.

In all, four patients were diagnosed with Ebola in the United States, 11 U.S. patients were treated in this country, and there was one fatality, according to the CDC.

What’s next, CDC guidance

ANA continues to call for greater preparedness and ongoing training to address emerging and other infectious diseases. At the association’s July Membership Assembly meeting, nurse representatives approved an action calling for ANA to identify and disseminate innovative strategies to engage nurses in broad infection protection and disaster preparedness activities, as well as work with stakeholders to provide education about infection control and prevention and disaster response.

The CDC has clarified its guidance regarding personal protective equipment for health care personnel caring for suspected and confirmed Ebola patients in U.S. health care facilities.

Specifically, it explains the use of fluid-resistant and impermeable gowns and coveralls. Specifications are provided in the guidance to assist facilities in selecting and ordering the recommended garments.

In addition to clarifying the specifications of gowns and coveralls recommended, the PPE guidance for confirmed Ebola patients is being updated with additional explanation, including:

• Expanding the rationale why respiratory protection is recommended when caring for an Ebola patient;

• Clarifying that the trained observer should not serve as an assistant for doffing PPE;

• Suggesting that a designated doffing assistant or “buddy” might be helpful, especially in doffing with the Powered Air Purifying Respirator (PAPR) option;

• Modifying the PAPR doffing procedure to make the steps more clear;

• Changing the order of boot cover removal. Boot covers are now removed after the gown or coverall;

• Emphasizing the importance of frequent cleaning of the floor in the doffing area.

Further, in the March 6, 2015, issue of Morbidity and Mortality Weekly Report, certain “next steps” were noted by the authors of an article, called “Systems for Rapidly Detecting and Treating Persons with Ebola Virus Disease — United States.” Specifically, they said the Office of the Assistant Secretary for Preparedness and Response “is developing a regional approach to caring for future patients with Ebola, in which up to 10 Ebola treatment centers will be designated to serve as regional Ebola and other special pathogens treatment centers (one in each of the 10 U.S. Health and Human Services regions).

These regional centers will have greater capabilities to care for Ebola patients, as well as those patients with other highly infectious diseases. Further, the authors noted: “They will be ready within a few hours to receive a patient with confirmed illness from their region or from across the United States, or a patient who has been medically evacuated from outside of the United States.”

The updated PPE guidance for confirmed Ebola patients can be found on CDC’s website: www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html.

CDC’s PPE guidance for clinically stable persons under investigation for Ebola can be found here: www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html.

The frequently asked questions page can be found here: www.cdc.gov/vhf/ebola/healthcare-us/ppe/faq.html.

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