As the international community continues to grapple with the numerous challenges associated with the evolving Ebola outbreak in West Africa, the isolated instances in which patients with Ebola have been treated in the U.S. have heightened the need for all hospitals and health systems to be prepared to treat a patient thought to have a significant risk of infection with, or exposure to, Ebola virus.
Duke University Health System (DUHS) began to plan and prepare for the unlikely, though possible, need to treat an Ebola patient in August – following reports that two U.S. healthcare workers in Liberia had contracted Ebola.
“Duke Medicine is fortunate to have extensive expertise in infection prevention and control, and many infectious-disease specialists across our system; so we were able to draw upon these resources to create a comprehensive preparedness and response plan,” said Thomas Owens, M.D., DUHS chief medical officer.
Duke’s infection prevention and control plan was developed with input from representatives across the organization and utilizes the lessons learned from the national and international experience with Ebola to date.
“Dealing with a virus like Ebola is a two-step process – identifying patients with potential presence of or exposure to the virus, and then appropriately managing their care, with an emphasis on utilizing all recommended safety measures to protect all patients, visitors and staff,” said Cameron Wolfe, M.D., of the Division of Infectious Diseases.
Duke’s infectious disease team is in regular contact with the federal Centers for Disease Control and Prevention (CDC) and the N.C. Department of Health and Human Services. “This is a continually evolving situation that requires close collaboration and communication, so we are in ongoing close contact with our local, state, regional and national partners to share any new information and share the latest best practices,” Wolfe said.
Among the first steps in Duke’s plan was the implementation of a health system-wide protocol to identify patients at potential risk of exposure across all intake points to the health system, including call centers, emergency departments, the transfer center and clinics.
Any patients identified as potentially at-risk through the initial screening process would then be assessed by designated infectious-disease experts to determine any next steps. Specific plans are in place to ensure the utmost safety and care for patients and healthcare providers in all emergency departments and clinics, including designated areas to quickly isolate patients and use recommended personal protective equipment (PPE).
A team of Duke physicians, nurses and other healthcare providers have volunteered for training in the proper care of patients that require inpatient containment, further testing and treatment. The staff is receiving extensive training, and will participate in ongoing drills to ensure their proficiency with safety protocols and equipment, including the appropriate way to put on and take off PPE, in accordance with best practices. Staff treating the patient will also be constantly monitored by trained experts to ensure all steps are taken to control infection and prevent exposure.
Should it be needed, a separate space has been identified within Duke University Hospital to provide care for a suspected or confirmed Ebola patient. The space is a former ICU and is separate from other units within the hospital. The unit is being equipped with all appropriate isolation and sterilization equipment, as well as the necessary equipment and supplies to conduct any necessary lab work.
Even as DUHS takes these very prudent safety precautions, Wolfe emphasized that Ebola is only spread by coming into contact with the bodily fluids of a person who is sick with the virus.
“While we understand and recognize the concern associated with potential exposure to Ebola, it is important to remember and also remind anyone who is concerned that there are no known cases in the U.S. of patients or visitors contracting the virus in hospitals that were caring for Ebola patients,” Wolfe said.
“While the risk of exposure to the virus is extremely low and highly unlikely, we continue to take very seriously our comprehensive preparations for any instance in which a potential Ebola patient arrives at any of our care facilities,” said William J. Fulkerson Jr., M.D., DUHS executive vice president. “We are committed to keeping everyone informed about our ongoing preparation efforts and appreciate the thoughtful planning and coordination under way with countless individuals across the health system.”
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