07:28pm Monday 11 December 2017

UW Ebola preparedness plans reflect changing situation

An artist’s conception of the Ebola virus.Krisha Kumar.Thinkstock

EbolaThe UW is working closely with Public Health-Seattle & King County and the Washington State Department of Health on preparedness planning.

As long as the Ebola epidemic remains uncontained in West Africa, untold lives will be lost in that region. Other parts of the world will remain on alert for new cases cropping up in their countries. The Centers for Disease Control and Prevention, an arm of the U.S. Department of Health and Human Services, leads U.S efforts, in conjunction with many organizations ranging from port authorities to state and county public health services.

“Universities and colleges across the country also are among those being called upon to be part of Ebola preparedness,” said Lynn Sorensen, nurse manager for Hall Health Center, the UW campus health service. “This is largely due to the global programs and multinational population of faculty, staff and students at many universities.”

Additionally, some major universities, as is true of the University of Washington, also run teaching hospitals and other medical services to care for patients in conjunction with education and research missions. Like health institutions everywhere, UW Medicine has to prepare for the possibility of an Ebola diagnosis in a patient coming to them for treatment.

The UW campus as a whole, and UW Medicine as a health-care system, have done extensive work on readiness plans that align with national guidance from the Centers for Disease Control and Prevention and with localized advisories from city, county and state health departments.

“Plans are constantly updated to stay abreast of the latest information and guidelines on Ebola, and to incorporate lessons learned from institutions and individuals who have managed cases,” said hospital infection control expert Dr. John Lynch, who is working with Dr. Timothy Dellit on overseeing UW Medicine Ebola preparedness. Both physicians are associate professors in the Division of Allergy and Infectious Diseases, UW Department of Medicine.

If the need arises, the integrated response system that scores of people have been refining and testing for the past several months will be activated at short notice.

The precautions include, but are not limited to, helping those with exposure risks check for symptoms during a 21-day watch period, screening for and managing potential cases of Ebola Virus Disease, safeguarding health workers and others who care for any possible Ebola patients, and preventing the spread of infection to others.

The UW is also reviewing its policies to advise employees or students who might be affected by other public health measures to avert or control outbreaks, such as contact monitoring or household quarantines.

“Practicing good infection control practices at a university is always important even outside of the present concerns about Ebola,” Sorensen said. Ebola adds another dimension of prudence, according to Sorensen, but should not be a cause for alarm.

While the chance of Ebola exposure within the United States is extremely low, people who have very recently lived in or traveled to West Africa, however, could have been exposed, depending on their activities while there. The disease is spread when virus-infected body fluids of the sick or dead enter through a break in the skin or through a mucus membrane, such as those lining the eyes, mouth, nose and anal/genital area. Body fluids refer to blood, saliva, semen, urine, vomit, sweat, nasal discharge, diarrhea, breast milk and the like.

One of series of international pictographs to teach people the symptoms of Ebola, in this case, fever.ThinkStock

 

One of series of pictographs to teach people the symptoms of Ebola, in this case, fever. People with symptoms can pass the infection to others. Reactions to the virus vary: some resist it completely, some suffer and recover, but some succumb to the disease. Early symptoms resemble many other sicknesses going around: fever, muscle aches, diarrhea, vomiting and cough. If the disease progresses, bleeding, organ failure and shock can occur.

UW travelers to Africa should realize that butchering or eating bush meat can transmit the disease. In Africa fruit bats and some monkeys and apes may carry the virus, according to the UW School of Public Health’s Peter Rabinowitz, who studies zoonotic diseases – illnesses that are transmissible between animals and humans.

On Sept. 17 the UW community received an e-mail notice that the UW was restricting any non-essential travel to Sierra Leone, Liberia, Nigeria and Guinea. Mali is now under review, UW Global Emergency manager Pascal Schuback noted. For details on UW travel restrictions, contact Schuback at 206-616-7927.

UW travelers abroad to any part of the world are encouraged to register with the UW Travel Registry. Members of the UW community who have been in one of the affected African countries within the past 21 days being asked to notify Hall Health (206-221-2517) or the Employee Health Clinic (206-685-1026), said a representative from UW Environmental Health and Safety.

Anyone at the UW with a risk of exposure who does become ill with symptoms resembling Ebola should phone for medical assistance before going to Hall Health or a hospital, Sorensen advised.

She explained that, “Voluntary quarantine of anyone who has symptoms of Ebola and a recent travel history to an affected region will help protect others. It is very important for a person with these risk factors to call the clinic for advice to allow time for a plan to be set in place by the clinic or hospital response team.”

Hall Health, like other of the nation’s walk-in clinics, is preparing for unexpected cases. Designated response teams are being formed. Staff members are checking patients travel history, other risk factors, and symptoms, Sorensen said. Suspected Ebola cases will be taken to an isolated, closed-off area for evaluation and first line of care. Other treatment and infection control guidelines, including the use of personal protective gear, health department notification, and decontamination procedures, will be followed.

“Ambulatory clinics have guidelines for Ebola detection and initial management tailored to being a walk-in source of medical care,” Sorensen said. Clinics are expected to arrange with their local health department concerning the transport of suspected cases to hospitals ready to receive them.

“Communication among the various agencies that are part of the Ebola response is essential,” Sorensen said. “There are so many pieces, and we’re just one of the pieces.”

“At UW Medicine’s hospitals and clinics, physicians and staff from a wide range of units are receiving training and are actively involved in Ebola preparedness,” said Johnese Spisso, chief health system officer, UW Medicine, and UW vice president for medical affairs. Daily huddles by leadership team members are being completed. Information is cascaded to staff daily through information lines and intranet sites.

Town-hall meetings have also been occurring to present general information, while educational sessions are held to teach UW Medicine staff about specific Ebola response measures. Importantly, the information is put into practice in training sessions and drills. A staged drill might begin with the unannounced presence of an actor in the role of a patient with a fever and raging gut. If the intake reveals a travel history and other risk factors for Ebola, the plan is set in motion.

While all the details are too numerous to mention here, they would include: reassuring the patient, donning the proper protective care, isolating the patient in a specialized room, assigning a care team, reporting to public health agencies, providing supportive treatment and nursing care, ordering an Ebola test, handling lab specimens safely, removing gear in a manner that eliminates exposure, having observers confirm that nothing is amiss, performing decontamination procedures, and following many other guidelines recently established.

In addition, similar dress-rehearsals in infection control have been held for health sciences students, along with education on Ebola and its treatment. Lectures are also being offered by experts in various aspects of the epidemic, not the least of which is how to teach about it as the situation quickly changes.

This past Saturday, for example, veterinarians and physicians in the region learned about Ebola preparedness in relation to household pets at a breaking news session of a local medical conference. In a country where many consider dogs and cats family, Rabinowitz said, public health officials are concerned about the need for evidence on how best to manage an exposed pet.

“Developing effective guidelines for how exposed domestic animals will be handled during the epidemic is part of public health preparedness,” Rabinowitz.

The Ebola readiness underway strengthens the overall ability of UW health services to recognize and manage new disease agents.

“We may never have a case of Ebola, but other types of emerging infectious diseases could find their way here,” said Sorensen. “We need to be just plain prepared. This takes away the fear factor. Groups like Doctors Without Borders have been dealing with Ebola in austere conditions in countries that have sparse resources. They use simple measures – tents, cots, buckets, protective gear and bleach spray – with very few instances of provider infections. We can learn from their skill and their courage.”

“We should be able to do this.”

Read the UW Medicine Q & A on Ebola.

UW Health Sciences/UW Medicine


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