This blog post was co-authored by: Anna Sivo Montejano MSN Ed, RN, CEN; Lynn Sayre Visser MSN, BS, RN, CEN, CPEN, CLNC; and Valerie Aarne Grossman MALS, BSN, RN.
The first patient diagnosed with the Ebola virus in the United States has died. Two nurses who provided direct care for that patient are infected: two healthcare providers, two of our very own. As nurses, we must keep our finger on the pulse of Ebola by asking pertinent travel and exposure history questions as well as knowing the signs and symptoms for immediate recognition. We must be prepared to initiate important steps to prevent the spread of this disease to other providers, our patients, and our community.
What is Ebola? Where did this virus come from? Knowing the real facts will enable us to stop this fatal virus from unexpectedly infecting another caregiver and the communities that surround each and every one of us.
As front line providers, we know this is a deadly and rare disease caused by one of the strains of the Ebola virus. Recently, several West African countries have been hit hard by the Ebola virus, with the most significant prevalence noted in Liberia, Sierra Leone, and Guinea. Healthcare workers must not skip a beat during the initial screening and isolation process. Failure to identify and act may put many others at risk including other healthcare providers.
Initial Screening Question, Assessment, and Isolation:
- Has the patient had a fever? The concern is that no one with a fever should have to wait for care. The patient should be isolated as the rest of the history is obtained. As stated by the President of the Emergency Nurses Association, Deena Breecher, in a recent alert (archived here): “We would rather over-screen and over-isolate than miss a potentially infected patient.”
- Recent travel history: Has the patient traveled to a country with a known Ebola outbreak within the last 21 days, or has the patient been exposed to anyone who either has or potentially has contracted the virus?
- Fever ≥ 100.4ºF or 38 °C (actual or subjective)
- Headache, diarrhea, vomiting, weakness, pain in the muscles and abdomen or hemorrhage
Nurse’s Immediate Action
- ISOLATE to a private room with a door and a private bathroom.
- Initially begin with standard contact and droplet precautions.
- Personal protective equipment (PPE) is mandatory. The Centers for Disease Control and Prevention announced more stringent guidelines for healthcare workers this week. As of October 22, 2014, the PPE recommended for U.S. healthcare workers includes:
- Double gloves
- Boot covers that are waterproof and go to at least mid-calf or leg covers
- Single use fluid resistant or impermeable gown that extended to at least mid-calf or coverall without integrated hood
- Respirators, including either N95 respirators or powered air purifying respirator (PAPR)
- Single-use full face shield that is disposable
- Surgical hoods to ensure complete coverage of the head and neck
- According to the CDC, "an apron that is waterproof and covers the torso to the level of the mid-calf (and that covers the top of the boots or boot covers) should be used if Ebola patients have vomiting or diarrhea"
- Please note, no skin or hair should be exposed when caring for a potential Ebola patient.
- A buddy system should be incorporated when donning and doffing PPE. Every step of the process should be observed by this designated person. Take your time. One slip-up can have significant ramifications.
- Disinfect gloved hands throughout the steps of removing PPE.
- Utilize diligent hand hygiene.
Due to ongoing guideline revisions,refer to www.cdc.gov for the most up-to-date recommendations for PPE.
- Ebola spreads by direct contact (through mucous membranes or broken skin) with body fluids or blood of an ill person infected with the Ebola virus.
Think Bodily Fluids
- Sweat, vomit, urine, feces, saliva, semen, breast milk
- Report to the hospital’s infection control program
- Notify the Health department as soon as possible
This deadly virus is looming around us; we have no idea when it will strike. We have the fears that many people are having, but our concern goes so much deeper. Will we be able to recognize a potential Ebola patient? Will we have immediate availability of an isolation room, needed personnel, and the recommended PPE? Will it all come together when we need it most?
The new guidelines increase safety for healthcare workers and include:
- Better training with systematic hands-on practice of donning and doffing PPE along with demonstrated proficiency.
- Direct supervision by a trained person during the PPE donning and doffing process.
- No skin exposure when wearing PPE.
More detailed algorithms and step-by-step guidelines are anticipated in the weeks ahead. Stay tuned.
Healthcare providers know stress first-hand. Decision-making is often not easy, but we must be smart and safe. When in doubt, err on the side of caution and isolate! Anything in the patient’s room stays in the patient’s room. Consider that any break in the system can result in the spread of this potentially deadly disease. Remember you have the ability to control the disease from infiltrating your department, hospital, or community. You are heroes of your communities. You are heroes of healthcare. We honor you for all that you do!
This information is accurate and evidence-based as of October 22, 2014 As ongoing research is underway, recommended practices may change.