Thursday, April 23, 2015

Hospital Preparedness: Ebola Assessment Hospitals

Ebola assessment hospitals are facilities prepared to receive and isolate PUIs and care for the patient until a diagnosis of EVD can be confirmed or ruled out and until discharge or transfer is completed. All states, particularly those not planning to designate Ebola treatment centers, should strongly consider identifying Ebola assessment hospitals to ensure that people with symptoms and exposure history consistent with EVD can be cared for until the diagnosis of EVD is confirmed or ruled out. States should consider selecting enough hospitals to provide adequate geographic coverage across the state and avoid extended transport times of more than 1 to 2 hours from areas in which there are large populations of returning travelers, if possible.

Coordinated public health systems are in place to monitor people potentially exposed to EVD (i.e., active and direct active monitoring). Public health authorities may identify people under monitoring who need testing for EVD if they develop compatible signs or symptoms, and may refer them to Ebola assessment hospitals. These people are likely to have been previously identified as at some level of risk for EVD through airport screening[PDF - 2 pages] and will be actively monitored by public health authorities during the 21 days following travel to an affected country or other potential EVD exposure. Therefore, patients at high risk for EVD should be referred primarily to Ebola assessment hospitals (or treatment centers) rather than frontline healthcare facilities. State and local public health authorities will coordinate closely with facilities when directing patients to a designated Ebola assessment hospital or Ebola treatment center.
  • PUIs are likely to present for evaluation with mild symptoms such as isolated fever. Therefore, initial isolation and evaluation of these minimally symptomatic patients can be performed using PPE according to CDC’s Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD).
  • In addition, Ebola assessment hospitals should be equipped with PPE needed for clinical care of patients with EVD with more severe symptoms and have staff trained in correct PPE use for PUIs who have vomiting, copious diarrhea, or obvious bleeding,
  • Because it may take 72 hours or longer after symptom onset to definitively confirm or rule out an EVD diagnosis (with an additional 12 to 24 hours for specimen transport, testing, and identification of another facility for transfer if needed), Ebola assessment hospitals should be prepared to provide care for PUIs for up to 96 hours. Therefore, Ebola assessment hospitals should have PPE for Ebola sufficient for at least 4 to 5 days of patient care and ensure that staff members involved in or supporting patient care are appropriately trained for their roles. This includes demonstrated proficiency in donning and doffing (putting on and taking off) PPE, proper waste management, infection control practices, and specimen packaging and transport.
  • In collaboration with public health officials, Ebola assessment hospitals also should be prepared to coordinate Ebola testing, which may involve transferring specimens to an LRN laboratory capable of EVD testing. Decisions about when to transport to an Ebola treament center a PUI for EVD or patient with confirmed EVD should be informed by discussions among public health authorities and the referring and receiving physicians on a case-by-case basis. When the decision has been made to transport a patient, preparations should ensure that transport providers are aware of the patient’s status and have appropriate training and PPE to safely transport a patient to a treatment center.
  • Ensure there is no delay in the care of these patients by being prepared to test, manage, and treat alternative etiologies of febrile illness (e.g., malaria in travelers) as clinically indicated.

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