alliance regional ebola update & ppe training october 2014 old dominion

ALLIANCE

Regional Ebola Update&

PPE Training

October 2014www.odemsa.vaems.org

OLD DOMINION

ODEMSA 2014 Regional Ebola Update &

PPE Training

Presented by:

ODEMSA Staff:

Adam Alford, ODEMSA Education Coordinator

Holly Sturdevant, ODEMSA Special Project Coordinator

Rachel Dillon, ODEMSA Program Coordinator

Damien Coy, ODEMSA Field Coordinator

Heidi Hooker, ODEMSA Executive Director

ODEMSA 2014 Regional Ebola Update &

PPE Training

To provide:

•Ebola facts•ODEMSA Ebola Virus Disease “EVD” Guidelines for EMS Providers•Donning/Doffing and disposal of Personal Protective Equipment (PPE)

Oct 2014 3

Purpose

ODEMSA 2014 Regional Ebola Update &

PPE Training

Oct 2014 4

Ebola Facts

ODEMSA 2014 Regional Ebola Update &

PPE Training

Facts Regarding Ebola…•Commonly referred to as “EVD,” or Ebola Virus Disease•On August 6, 2014 members of the World Health Organization (WHO) officially declared Ebola a public health emergency of international concern.•Currently, the US has seen 4 cases with one death

*This number may change daily*

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Signs and Symptoms:– Fever– Severe Headache– Muscle Pain– Weakness– Diarrhea/Vomiting/Abdominal Pain– Unexplained Hemorrhage (Bleeding or Bruising)

Symptoms may appear anywhere from 2-21 days after exposure to active EVD.

ODEMSA 2014 Regional Ebola Update &

PPE Training

• EVD Transmission

– Animal-to-person• It is believed that the first case of human

contracted EVD was transmitted from an infected animal to a susceptible host

– Person-to-person • Once EVD is contracted in a human, the host can

easily spread the virus through direct contact

ODEMSA 2014 Regional Ebola Update &

PPE Training

The human body produces many body fluids, secretions and excretions that may contain pathogens - avoid direct contact with:•Blood or body fluids

– Potentially infectious body fluids include: blood, vomit, feces, urine, sputum, saliva, and sweat, as well as amniotic, spinal, vaginal, pleural, pericardial, peritoneal, synovial fluids and semen

***To prevent exposure, ANY body fluid from any patient must be treated as potentially infectious!***

•Objects like needles & syringes that have been contaminated with EVD•Infected fruit bats or primates

ODEMSA 2014 Regional Ebola Update &

PPE Training

During outbreaks of Ebola, the disease can spread quickly within healthcare settings. Healthcare workers should use the following precautions when treating EVD patients:

• Standard Precautions (ALL patients)• Contact Precautions (“blood/body fluid”)

• Droplet Precautions (think “flu”)

ODEMSA 2014 Regional Ebola Update &

PPE Training

• All patients, all the time, any setting• Minimum PPE required:

– Disposable Gloves• Hand Hygiene• Additional PPE, as needed, to protect against blood,

body fluids, secretions & excretions:– Eye protection (goggles or face shield)– Respiratory protection (surgical face mask) – Impermeable or fluid-resistant gown

Oct 2014 10

Standard Precautions

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Protection against viruses (such as Ebola), Influenza, HIV, Hepatitis; plague, MRSA, VRE, Strep; patients with diarrhea, vomiting, or generalized rash

• Minimum PPE Required– Disposable Gloves (change if visibly soiled)– Gown

• Hand Hygiene• Disinfection of all equipment/surfaces

– Examples: monitor, glucometer, BP cuff, etc.

Oct 2014 11

Contact Precautions

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Large particles created by coughing, sneezing, suctioning or intubation

• Disease examples: Influenza, meningitis, pertussis, plague, Ebola, mumps, rubella, and most viruses (including Enterovirus D68)

• Any patient with fever, respiratory symptoms, rash, and/or flu-like signs/symptoms, such as weakness, vomiting, diarrhea, severe headache, abdominal pain, or muscle and body aches

Oct 2014 12

Droplet Precautions

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Hand Hygiene• Minimum PPE required:

– Gloves – Gown– Eye Protection– Bonnet– Leggings/Boot Covers (or Shoe Covers)– Respiratory Protection….

Oct 2014 13

Droplet Precautions

ODEMSA 2014 Regional Ebola Update &

PPE Training

• What level of respiratory protection?• Healthcare Providers (with eye protection):

– At least standard surgical face mask

– N95 mask for “Aerosol-Generating Procedures” or other high-risk procedures (e.g. CPR)

• See UTSW/BioTel TB 14-007 PPE

• Patient (especially if coughing or sneezing):

– Standard surgical face mask or N95, if tolerated

– Add Nasal Cannula O2, if supplemental oxygen needed

Oct 2014 14

Droplet Precautions

ODEMSA 2014 Regional Ebola Update &

PPE Training

Oct 2014 15

ODEMSA Ebola Virus Disease “EVD” Guidelines for EMS

Providers

ODEMSA 2014 Regional Ebola Update &

PPE Training

Compiled by a Regional Team of Experts:

•EMS Professionals•Fire Service Professionals•Hospital Administrators•Epidemiologist•Hazardous Materials Specialists•Educators

ODEMSA 2014 Regional Ebola Update &

PPE Training

Agencies MUST work with their local health department and Operational Medical Director to develop patient care plans.

This is a fluid situation – be flexible as there may be frequent changes

Changes made to this document will be posted to our website

ODEMSA 2014 Regional Ebola Update &

PPE Training

Dispatch Centers – PSAP’s should screen calls for potential Ebola patients- PRIOR to YOUR Arrival

“EVD ALERT” has been designated as the regional alert to be used by pre-hospital

ODEMSA 2014 Regional Ebola Update &

PPE Training

Each agency should inventory available supplies and ensure an adequate supply

ODEMSA is conducting a regional needs assessment.

You WILL be contacted by ODEMSA staff

ODEMSA 2014 Regional Ebola Update &

PPE Training

Ensure an adequate supply, for EMS personnel, of:

•Fluid resistant or impermeable gowns Double layer of gloves •Shoe covers, boots, and booties•All of the following:

• N95 respirators or greater (i.e. APR, PAPR, SCBA)

• Eye protection• Fluid/splash shield (in addition to

eye protection and N95 mask)•Other infection control supplies (e.g. hand hygiene supplies) We will always use the current CDC recommendations

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Don full PPE

• Limit exposed personnel• Only allow the patient and

protected providers in patient compartment

• Cab of ambulance MUST remain clean

• Seal cab compartment• Driver should not

participate in patient care

ODEMSA 2014 Regional Ebola Update &

PPE Training

Information to Convey to Hospital

•Notify hospital as soon as you identify a potential case

•Use “EVD ALERT” trigger

•Describe Patient• Low Acuity – Delay transport• High Acuity – Transport

• Hospital personnel may provide care until they are ready to receive the patient

• EMS might be asked to assist hospital personnel

ODEMSA 2014 Regional Ebola Update &

PPE Training

When arriving at the hospital:

•You may be directed to park in an area away from other traffic

•Remain in the ambulance and await direction from the hospital staff.

ODEMSA 2014 Regional Ebola Update &

PPE Training

Patient Refusal or Pronouncement:

•Report to your local Health Department by calling 866-531-3068

• Ask for the Epidemiology Investigator on call

• They will give instruction• Connect you with local

team

ODEMSA 2014 Regional Ebola Update &

PPE Training

If a Patient Reports to Your Facility:

•Do NOT allow them inside

•Resources should be dispatched like any other medical emergency

•Wear appropriate PPE before patient contact

ODEMSA 2014 Regional Ebola Update &

PPE Training

Doffing – PPE Removal:

•MOST Exposures Occur during PPE Removal

•Use a “Buddy System”

•EMS Providers – Await Decontamination Assistance from Hospital Personnel.

•Hospital Will Provide a Change of Clothing

ODEMSA 2014 Regional Ebola Update &

PPE Training

Equipment/Ambulance Decontamination and Disinfection:

•Plans should be made in advance• Suggest

• Local HazMat response• 3rd Party Decontamination

Company

ODEMSA 2014 Regional Ebola Update &

PPE Training

Post-Exposure:

•Follow Instructions from your OMD and VA Department of Health

•Self-Monitor for Fever

•If your patient is Ebola positive, monitor for EVD symptoms for 21 days in conjunction with VDH and CDC

ODEMSA 2014 Regional Ebola Update &

PPE Training

Oct 2014 29

Donning/Doffing PPE

ODEMSA 2014 Regional Ebola Update &

PPE Training

ODEMSA 2014 Regional Ebola Update &

PPE Training

Oct 2014

31

PPE = Gloves and….

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Disposable Gloves• Disposable Gown (Impermeable or Fluid Resistant)• Eye Protection

– Wraparound Goggles, Safety Glasses or Face Shield• Respiratory Protection (must be worn with eye protection)

– Lowest: Standard surgical face mask – Higher: N95 filter mask (respirator)– Highest: Air-Purifying Respirator (“APR”) – powered or not;

half-face, full-face or hood• Other components for high volume fluid environments:

– Disposable Boot Covers (or Shoe Covers)– Disposable Bonnets

Oct 2014 32

PPE Components

ODEMSA 2014 Regional Ebola Update &

PPE Training

• A trained observer shall monitor donning/doffing procedures

• “Buddy” (in PPE) watches to prevent compromises or other procedural breaches

• Any compromise/breach must be reported to your EMS Field Supervisor immediately

Oct 2014 33

“Buddy System”

ODEMSA 2014 Regional Ebola Update &

PPE Training

Donning

ODEMSA 2014 Regional Ebola Update &

PPE Training

Using Buddy System:

1.Remove all personal items (jewelry, watches, phones, pens, etc.)

2. Hand Hygiene, put on inner gloves• Inner Pair MUST be under cuff of the sleeve of gown/coverall

3.Leggings/Boot Covers (or Shoe Covers), if used

4.Gown or coverall suit (tie at waist and neck)

5.Eye Protection

6.Mask or Respirator (ensure proper fit)

7.Bonnet, if indicated. Must tape all visible gaps in suit

8.Outer Gloves • Outer pair must be over cuff of the sleeve of gown/coverall leaving NO SKIN exposed

Remember: Do NOT touch your eyes, nose or mouth

Oct 201435

Donning Sequence

ODEMSA 2014 Regional Ebola Update &

PPE Training

Decontamination

ODEMSA 2014 Regional Ebola Update &

PPE Training

Doffing

ODEMSA 2014 Regional Ebola Update &

PPE Training

Most Provider exposures occur during PPE Removal (doffing)!

Oct 2014 38

Doffing (Removal) = Critical Process

ODEMSA 2014 Regional Ebola Update &

PPE Training

• PPE must be removed in the proper sequence & with extreme care/caution, to prevent inadvertent exposure

• Basic Principle:– Touch ONLY “clean to clean” and “dirty to dirty”

• Perform hand hygiene & replace gloves if hands become contaminated during removal AND immediately after PPE removal

• PPE must be removed immediately after patient care is transferred to hospital staff

Oct 2014 39

Doffing (Removal) = Critical Process

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Needed BEFORE beginning:– Fresh disposable gloves– BioHazard bags/receptacles (“Triple bagged”)– Hand Hygiene supplies

• Sequence - “Touch ONLY clean to clean AND dirty to dirty”:

1. Outer Gloves: Touching ONLY inside, remove Biohazard disposal

2. Gown: Touching ONLY inside, Roll away from wearer, down to wrists, remove Biohazard disposal

3. Leggings/Boot Covers (or Shoe Covers): Touching ONLY inside, roll down and away from wearer, remove Biohazard disposal

4. Inner Gloves: Touching ONLY inside, remove Biohazard disposal– Continued….

Oct 2014 40

Doffing Sequence

ODEMSA 2014 Regional Ebola Update &

PPE Training

5. Hand Hygiene (dry hands as much as possible)

6. Don a fresh pair of gloves

7. Bonnet (grasp as far to the rear as possible) Biohazard disposal

8. Goggles (grasp as far to the rear as possible) Biohazard disposal

9. Respirator/Mask (grasp from as far to the rear as possible) Biohazard disposal

10. Last Pair of Gloves: Touching ONLY inside, remove Biohazard disposal

11. HAND HYGIENE, including wrists and fingernails

Oct 2014 41

Doffing Sequence

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Once the contaminated PPE is placed in the Biohazard bag and bag is triple-sealed, follow directions of facility staff for proper disposal and decontamination.

**Remember, the ODEMSA hospitals have committed to decontaminate EMS personnel (not vehicles) after

contact with a potentially infectious EVD patient. Follow the direction of the hospital staff.**

Oct 2014 42

Disposal of Contaminated PPE

ODEMSA 2014 Regional Ebola Update &

PPE Training

• Hand hygiene is the single most important way to prevent infection spread

• Proper selection of appropriate PPE is vital

• Standard: ALL Patients

• Contact + Droplet: Sick Patients at risk for infectious diseases

• Doffing (removal) = greatest risk to Providers

• A “Buddy System” – especially during doffing – will reduce the risk of compromise/breach

• PPE must be disposed of properly after removal

Oct 2014 43

Summary

ODEMSA 2014 Regional Ebola Update &

PPE Training

Oct 2014 44

If you have questions…

Virginia Department of Health – Ebola Hotline 1-877-ASK VDH3 (1-877-275-8343)

ODEMSA Office Number: (804) 560-3300 Website: www.odemsa.vaems.org