The Greenville Health System (GHS) has developed detailed plans to help manage Ebola patients both at GHS hospitals and throughout the Upstate as part of a statewide Ebola regional referral system.
More details about the regional system are expected to be released later this week.
"While the likelihood of an Ebola patient coming to GHS is very small, hospitals must be prepared for everything — including Ebola," said Angelo Sinopoli, M.D., Greenville Health System's vice president of clinical integration and its chief medical officer. "As an academic health center, GHS brings unique expertise in everything from infectious-disease management to advanced-care nursing and laboratory diagnostics. And being a community leader means meeting the community’s needs. We stand ready to do that."
Far-reaching protocols, preparation and training also mean that safeguards are in place to ensure that GHS is able to provide sequestered state-of-the-art care to those patients while continuing to care for patients in its emergency departments, physician offices and all hospitals, he said.
Extensive protocols in place
GHS already had extensive protocols in place to safely treat patients with communicable infectious diseases such as Ebola, but those protocols were significantly strengthened in the wake of additional guidance from the Centers for Disease Control and Prevention and peer hospitals. GHS staff who volunteered to provide intensive care to Ebola patients are already receiving additional safety training on the use of special personal protective equipment (PPE) that is beyond CDC-recommended levels.
Staff throughout GHS who may be first point-of-contacts with less-ill patients are also receiving additional information on utilizing appropriate personal protective equipment. Meanwhile, all GHS employees are now required to complete computer-based training that provides an overview of the illness or, for clinical volunteers, includes specific instruction about the donning and removing of personal protective equipment and supplemental information such as minimizing the use of sharps. Information forums for employees are also being held.
All points of entry, such as physician offices, emergency departments and urgent-care centers, are receiving special instruction on how to isolate any potential Ebola patient and transport to Greenville Memorial Hospital. Additional triage measures have been in place since August at GHS emergency departments and physician offices to screen for potential Ebola patients. That protocol, which includes warning signs on doors, includes checking for flags such as fever, recent travel in an area where Ebola transmission is active or patient contact with someone believed to have Ebola.
Employees who screen suspected Ebola patients will be required to wear a CDC-approved PPE. Employees who deal with advanced-illness Ebola patients will wear an enhanced-level PPE: a Tyvek suit; three sets of gloves with the bottom two layers taped to the suit to ensure no exposed skin; a procedure mask or N 95 respirator and a powered air-purifying respirator with neck skirt and a full face piece, breathing tube, battery-operated blower and HEPA particulate filter. The gear would include leg/shoe covers and a cover gown to protect the zipper in the front of the Tyvek suit to reduce possible contamination during the removal process.
GHS will also use a buddy system to ensure that a trained observer is closely monitoring the putting on or removing of PPE to ensure that safety is maintained.
Staff involved in treatment of a potential Ebola patient would be notified of the Ebola diagnosis so that all proper precautions would be taken immediately. Waste management will also be a critical element in keeping the community safe. All patient waste materials will be triple bagged in viricide-treated biological hazard bags before being stored in special drums in the isolation unit until removed by a U.S. Department of Transportation-certified waste-management company.
Upholstered furniture and decorative curtains would be removed from the isolation room prior to use, with used linens, pillows and mattresses discarded as hazardous medical waste. All non-disposable equipment, such as portable X-ray or EKG equipment, would undergo CDC-recommended levels of cleaning and disinfecting. Any material not immediately removed by certified handlers after being taken out of the room would be stored in special locked containers inside secured areas that would include 24-7 security.
Facts about contagion risks
"It's important for everyone to remember that Ebola patients are only contagious when they're symptomatic," said Scott Sasser, MD., chair of GHS' emergency medicine department and a national leader in disaster preparedness and planning. "You can’t get Ebola from standing next to someone in the grocery store line or even if you used the grocery store cart after that person if they don’t have symptoms. Ebola is only transmitted by contact with body fluids, such as vomit, blood or diarrhea of people who have the disease. Those symptoms occur later in the disease progression, which is why it's so important to provide additional layers of protection for healthcare workers caring for advanced Ebola patients," he said. "The risk of contagion increases as people get sicker and have a higher viral load in their bodily fluids." Public health agencies' aggressive contact tracing of suspected cases and U.S. healthcare availability and expertise make a West Africa-like Ebola scenario in the U.S. extraordinarily unlikely, said Rhett Shirley, M.D., a GHS infectious disease physician with tropical medical training who worked in Kenya for several years.
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