Ebola Preparedness - Detect, Protect and Respond: Next Steps for Health Care Providers and In-House Counsel

As American health care gains some experience with Ebola patients, it is time to take the lessons learned from the facilities that first cared for patients with this disease to prepare your facility:

The first domestic transmission of Ebola has been confirmed. Donning and removing personal protective equipment (“PPE”) is a key risk for health care worker transmission and should be practiced by all who might come in contact with Ebola carriers. Note also the increased need for fluid-impervious gowns and boots and increase stock on hand.
Emory University Hospital found that even those waste contractors who were certified to handle Class A medical waste were hesitant to accept Ebola waste until it had been decontaminated, even when it had been prepared in accordance with CDC guidelines. Take the opportunity now to meet with your medical waste contractor to discuss the protocols for disposal of Ebola-contaminated waste in order to ensure that there is a clear understanding of the disposal process.
Similarly, the Water Authority threatened to turn off Emory University Hospital’s water supply unless Emory University Hospital pre-treated sanitary waste, even though CDC stated that pre-treatment was not necessary. Encourage dialogue now between public health officials and the Water Authority in your jurisdiction.
Emory University Hospital found that each patient required almost two nurses providing direct care at all times. High biosafety PPE are hot and cumbersome. Proper removal techniques for those using PPE should be practiced and monitored since self-contamination is most likely to occur when taking off PPE. Consider how staffing plans may need to be altered to accommodate these challenges.
Laboratory services for Ebola patients are a high-risk activity, and a spill will require extensive decontamination. Consider the feasibility of setting up a satellite laboratory location near the area where Ebola patients would be treated to avoid possible contamination of the primary lab. Consider whether dedication of other diagnostic machines, such as portable X-ray or ultrasound machines, would be advisable.
Ensure that laboratory staff have the necessary training to perform laboratory tests on blood and bodily fluids while wearing high biosafety PPE. Give staff time to practice those tasks wearing high biosafety PPE, as vision and dexterity are decreased, and fatigue sets in more quickly.
Contact your local EMS agency to ensure that they have medical dispatch procedures in place to screen for Ebola. EMS personnel should notify the receiving health care facility when transporting a suspected Ebola patient so that appropriate infection control precautions may be prepared prior to patient arrival.
Consider implementing drills to assess your staff’s ability to identify a potential Ebola patient and properly respond, including the use of PPE and isolation, as well as mobilizing other resources as necessary. Following the drill, assess staff’s performance and discuss ways to improve response.
If you haven’t done so already, consider developing a communication plan outlining the process for addressing patients, employees, media and the public should a crisis arise. Remember to consider the confidentiality requirements imposed by the Americans with Disabilities Act and HIPAA before publishing, internally or externally, any specific employee medical information.
On October 10, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a memorandum with information for hospitals and critical access hospitals (“CAHs”) concerning possible Ebola virus disease. In its memorandum, CMS strongly urges hospitals and CAHs to review and implement CDC guidance, particularly in their emergency and other outpatient departments, to allow for prompt identification and triage of patients who require further evaluation and to use CDC’s preparedness checklist to ensure their readiness to handle Ebola patients. Failure to provide an appropriate screening examination could violate EMTALA obligations, and it is likely that CMS will consider compliance with CDC guidelines in determining whether a screening examination was “appropriate.” The link to CMS’s memorandum can be found here.
The CDC website has many useful resources to assist health care providers in learning more about Ebola preparedness. This link includes CDC guidance for evaluating patients, protecting health care workers and collecting, transporting and testing specimens.
This is a great opportunity to work with your community on hand washing awareness. Consider a media campaign to encourage everyone to carefully wash their hands and to use paper towels to open doors in order to decrease the risk of transmission of many diseases, including Ebola.