Friday, April 10, 2015

Hospital Preparedness: Frontline Healthcare Facilities

Most U.S. acute care facilities that are equipped for emergency care (such as hospital-based emergency departments and other emergency care settings including urgent care clinics and critical access hospitals) are in this tier. Frontline healthcare facilities do not include primary care offices and other nonemergent ambulatory care settings. Preparedness guidance for these settings can be found at: Identify, Isolate, Inform: Emergency Department Evaluation and Management of Patients Under Investigation for Ebola Virus Disease[PDF - 1 page].

CDC’s Interim U.S. Guidance for Monitoring and Movement of People with Potential Ebola Virus Disease (EVD) recommends active monitoring by state and local public health agencies for all people who have a recognized potential exposure to EVD within the previous 21 days. These people will be directed to designated facilities for evaluation if they become ill. However, it is also possible that patients with unrecognized EVD will present to a frontline healthcare facility without warning or, rarely, patients may be temporarily referred to frontline healthcare facilities when it is not feasible to refer them to an Ebola assessment or Ebola treatment center, based on distance, bed availability, or other considerations. Therefore, frontline healthcare facilities should be prepared to promptly identify and isolate patients who may have EVD and promptly inform the hospital/facility infection control program and state and local public health agency according to the CDC guidance for emergency departments. In some situations, frontline healthcare facilities may also arrange for Ebola testing at the nearest Laboratory Response Network (LRN) laboratory capable of performing testing for EVD, in accordance with the state’s plan. Frontline healthcare facilities are not expected to provide prolonged care (>12–24 hours) for a severely ill patient.
Specifically, frontline healthcare facilities should, in coordination with local and state health authorities, be able to:
  • Rapidly identify and triage patients with relevant exposure history AND signs or symptoms compatible with EVD as outlined in CDC’s Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease(EVD).
  • Immediately isolate any patient with relevant exposure history and signs or symptoms compatible with EVD and take appropriate steps to adequately protect staff caring for the patient, including appropriate use of personal protective equipment (PPE) as outlined in CDC’s Emergency Department Evaluation and Management of Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD).
  • Immediately notify the hospital/facility infection control program, other appropriate facility staff, and the state and local public health agencies that a patient has been identified with relevant exposure AND signs or symptoms compatible with EVD; discuss level of risk, clinical and epidemiologic factors, alternative diagnoses, and plan for EVD testing and further care. Patients who are deemed to have low likelihood of EVD on the basis of clinical and epidemiologic factors and have mild illness, but who nonetheless require EVD testing, may, in some circumstances, remain at the frontline healthcare facility while testing is conducted.
  • Frontline healthcare facilities, in accordance with the state’s plan, should consider immediately transferring patients who have a higher probability of EVD or are more severely ill to either an Ebola assessment hospital or to an Ebola treatment center that can provide Ebola testing and care for the higher risk patients until an EVD diagnosis is either confirmed or ruled out. The state plan may include plans to transfer the patient out of state based on the patient’s risk and severity of illness and the geographic location of Ebola assessment hospitals and Ebola treatment centers. Such plans 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.

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