1. Ebola Viral Disease October 21, 2014

2. Overview  Historical perspective  Current epidemic update  OSUWMC preparedness  Signage and marketing  Screening  Isolation activation  Inpatient management  Staff education and training; simulations  Challenges

3. Challenges  Balancing preparedness and informative education with alarmism  Forced isolation/treatment  Global presence of our university community  Dynamic nature of the epidemic  Changing protocols  Other problems to not forget….  Enterovirus D68, Influenza

4. Ebola Epidemiology  Acute infection starts as a non-specific febrile illness  Fever (>100.4), severe headache, muscle pain, malaise; progression to include GI symptoms (diarrhea and vomiting)  Symptoms may appear 2-21 days after exposure  8-10 day window the most common  Significant dehydration and electrolyte disturbances  Small vessel involvement  Increased permeability due to cellular damage  Multi-organ system failure  Hemorrhage may develop in the second week  Poor prognosis associated with shock, encephalopathy, extensive hemorrhage Jay Varkey, MD; Emory University Hospital

5. Ebola Historical Perspective  Family Filoviridae  Two genera: marburgvirus and ebolavirus  Enveloped RNA virus  Five subtypes of Ebola virus  Zaire (EBOV)  Sudan (SUDV)  Tai Forest (TAFV)  Bundibugyo (BDBV)  Reston (RESTV)  No vaccines/treatments approved for humans  Case-fatality rates of up to 90% in African settings Jay Varkey, MD; Emory University Hospital

6. Ebola Historical Perspective  1976: Simultaneous outbreaks in Zaire (now DRC) & Sudan  Zaire: 318 cases and 280 deaths (88% mortality)  Sudan: 284 cases and 151 deaths (53% mortality)  1976 & 1979: Small-to-midsize outbreaks Central Africa  1995: Large outbreak in Kikwit (DRC)  315 cases (81% mortality)  Since 2000: Near-yearly outbreaks in Gabon, DRC or Republic of Congo  2000-2001: Largest outbreak on record (Sudan)  425 cases (53% mortality) Jay Varkey, MD; Emory University Hospital

7. Current EVD Epidemic  West African outbreak limited to:  Guinea: 1519 cases / 862 deaths  Liberia: 4249 cases / 2484 deaths  Sierra Leone: 3410 cases / 1200 deaths  Total: 9178 cases / 4546 deaths  Senegal (8/29/14) and Nigeria (9/5/14) no longer considered at risk  Early August 2014 – first health care workers brought from West Africa to Emory University Hospital  Other individuals brought from West Africa since then  September 30, 2014 – first case diagnosed in the US (Dallas) of a Liberian man traveling to the US  Patient passed away October 8, 2014 www.cdc.gov and Fox News

8. Current EVD Epidemic  Two nurses at Dallas hospital have tested positive for Ebola (October 10 th and October 14 th )  Second nurse traveled through NE Ohio from 10/10- 10/13  Over 100 people in NE Ohio on quarantine/isolation or monitoring of temperatures  Risk points of when a health care worker can most commonly become infected:  From exposure to body fluids during patient care  From error during doffing of PPE  From time when patient is intubated or during certain procedures due to increased aerosolization of secretions www.cdc.gov and Fox News

11. EVD Preparedness at OSUWMC  Both UH and UHE ED’s need to be prepared for walk-ins and EMS traffic  Volunteer team designated for inpatient care  Medical Team  Nursing  RT/team  Six hours of training in three two-hour phases  “Buddy System” for PPE  Point of Care testing equipment for in-room use for routine labs  EVS, solid and liquid waste plans developed

12. EVD Preparedness at OSUWMC  All patients planned to be admitted to 5 Ross – this may change after mid-December when old James available  Will have a donning/doffing room adjacent to each room  Entry restricted to assigned care team with log  2 nurses per patient – one inside/one outside  If critically ill, consider two inside/one outside  Team huddle including Critical Event Officer and senior clinical leaders two times per day  No transport outside room unless approved by the Critical Event Officer  All deviations to SOP’s need to be approved by Critical Event Officer prior to implementation

13. EVD Preparedness at OSUWMC  Collaboration between the CMO’s of Franklin County Hospitals, Columbus Public Health and COTS  Outreach to regional hospital leadership and MedCare ambulance service  “Secret shopper” simulations  Three+ have been completed  Screening questions in outpatient IHIS workflows with BPA that fires if screen positive to alert rest of care team  Working closely with University officials on how this will affect the rest of campus

14. Challenges  Balancing preparedness and informative education with alarmism  Forced isolation/treatment  Global presence of our university community  Dynamic nature of the epidemic  Changing protocols  Other problems to not forget….  Enterovirus D68, Influenza

15.  Special thanks to Drs. Naeem Ali, Julie Mangino, and Christina Liscynesky for resources and data