Facility Support Teampre-Visit Considerations for U.S. Hospitals

FAST Previsit Preparedness ChecklistDRAFTRev.3

Facility Support TeamPre-visit Considerations for U.S. Hospitals

Introduction

The Centers for Disease Control and Prevention’s (CDC's)Rapid Ebola Preparedness Team (REP) is a preparedness team dedicated to assessing the needs of U.S. hospitals for managing a suspected or known Ebola Virus Disease (EVD)patient. The goal of the assessment is to help a healthcare facility move from the planning and exercising of plans to the functional capability and capacity to safely and efficiently care for a Person Under Investigation (PUI) for Ebola.The checklist below highlights key preparedness components U.S. hospitals should review and complete prior to a REP assessment.

1.Review key plans and protocols – Ensure your hospital has

An emergency operations plan (EOP) that includes(1) coordination mechanisms between thefacility, public health, healthcare coalitions, emergency medical services (EMS), and emergency management and (2)an appendix for Ebola and other category A agents.

Plans to provide safe clinical care for a patient with Ebola to include adequate respiratory support, safe administration of medication, sharps procedures, reinforcement of proper biohazard containment and disposal precautions, testing procedures, and palliative care.

Identified a Principal Investigator who is authorized to use investigational therapies and an Institutional Review Board designated to conduct an expedited review of these therapies.

Reviewed with the Ethics Committee the use of extraordinary care (i.e., intubation, dialysis, Extracorporeal Membrane Oxygenation) for a patient with Ebola.

2.Engage EMS in planning for transport to and inside hospital–Ensure your hospital has conducted training for

Pre-notification of hospital of patient under investigation for or confirmed Ebola.

Pre-determined route of entry into isolation room in Emergency Department or to assigned inpatient isolation room.

Designated area for doffing PPE from EMS personnel.

A designated area where EMS personnel can decontaminate their vehicle and dispose of contaminated PPE and medical waste.

1. Ensure triage procedures and protocols are in place to detect persons exposed to or ill with EVD –Ensure your hospital has

Procedures in place to rapidly identify a PUI for Ebola(includes triage screening and lab procedures).

4.Ensure isolation procedures and protocols are in place to reduce the risk of exposure to Ebola– Ensure your hospital has

Isolation rooms and protocols for placing any suspected or known EVD patient in a private room or isolated area for evaluation.

When available in your facility, Airborne Infection Isolation Rooms (AIIRs) that are functioning correctly and appropriately monitored for airflow.

Portable equipment availableto createnegative pressure in an isolation room in the event no negative pressure rooms exist.

Trained engineering department staff necessary to maintain the negative pressure records and portable equipment and comply with associated requirements.

5.Review infection control procedures and protocols to ensure they fully protect healthcare personnel and patients from exposure to Ebola– Ensure your hospital has

Designated individuals as site managers responsible for overseeing the implementation of precautions for healthcare workers and patient safety.

Enoughpersonal protective equipment (PPE) available to care for suspected or knownpatients with Ebola and an increase in resupply to support the increased demand.

Designated separate areas for donning (clean area) and doffing (dirty area) of PPE.

Personnel trained in donning and doffing procedures and proper disposal of PPE and other medical waste.

A buddy system protocolin place in which donning and doffing of PPE are directly observed by a trained observer.

Procedures for disinfecting reusable equipment based on manufacturer guidelines for proper disinfection prior to reusing it (e.g., powered air purifying respirators [PAPRs]).

A procedure for disinfecting isolation rooms and readying them for another patient.

A strategy to coordinate communication between (1) healthcare providers and the patient and (2) the patient and family members without the risk of exposure to Ebola.

A designated area and procedures for the disposal of Category A PPE and other medical waste.

6.Review security procedures and protocols to ensure access control to potentially contaminated areas – Ensure your hospital has

A protocol to ensure that only authorized persons have access to the room of a suspected or known EVD patientor any other potentially contaminated area.

7.Determine whether waste management procedures and protocols comply with applicable laws and regulations – Ensure your hospital has

Personnel who have coordinated with the local health department to identify applicable local regulations with regard toCategory A waste transportation.

Ensure both hospital and waste carrier have filed applicable waivers for the possible transportation of Ebola waste.

Trained staff on the proper procedures to package and dispose of Category A waste.

8.Review staffing procedures and protocols to ensure they reduce the risk of staff exposure to Ebola –Ensure your hospital has

A staffing schedule for case treatment that includes adjustedshifts (due to increased time for donning and doffing and use of PPE for prolonged periods), more staff than usual for an isolation patient, no ancillary services, and a care from a multidisciplinary team that may include nephrology, anesthesia, critical care, infectious disease, hospitalists, etc.

Policies and procedures in place for screening exposed or ill healthcare personnel and implementing predetermined work restriction of these exposed or ill workers.

A designated team to prepare risk communication messages for all internal staff.

A buddy systemprotocol and mechanism (window or monitor) to observe careof a suspected or known EVD patient and tracking of all personnel who enter patient roomthe patient zone/isolation unit.

9.Review laboratory testingprocedures and protocols to ensure they reduce the risk of exposure to Ebolaand to identify which testing can be done in house and which testing requires use of an external laboratory– Ensure your hospital has

Trained healthcare personnel to properlyhandle a specimen for Ebola testing.

Preparedfor bedside diagnostic testing, if the hospital will use this method.

Set aside an area in the lab for testing specimens from the patient with Ebola, if the hospital chooses this method.

10.Review exercising and testing records to determine that key elements of the hospital EOP appendix for highly infectious disease have beenexercised or tested with first-contact personnel, clinical providers, and ancillary staff– Key elements to be exercised or tested include

The plan or protocol for receiving from EMS and transporting a suspected or known EVD patient to isolation room.

Infectious disease procedures and protocols, including PPE donning and doffing.

Triage protocolsand Ebola screening questions.

Disease identification, testing, specimen collection, and specimen transport procedures.

Isolation and security procedures.

Communications and reporting procedures.

Cleaning and disinfection procedures.

The ability to share lessons learned between key stakeholders, coalition partners, public health, emergency management, and others without violating patient privacy rights.

October 27, 2014DRAFTPage 1 of 4