Photograph of UC Davis clinical resource nurse and infection preventionist Amie Ragasa-Sta. Maria wearing the personal protective equipment.
Although there have been only four confirmed cases of Ebola diagnosed in the U.S. — and no suspected or confirmed cases in California — hospitals nationwide have been revising infection prevention protocols and procedures to protect members of their health-care and environmental services team, who are most susceptible to infection because of their close contact with patients during or after treatment.
At UC Davis, Chief Medical Officer Doug Kirk and Chief Nursing Officer Carol Robinson lead a special Ebola preparedness task force that has been meeting almost daily for several weeks to develop the health system’s coordinated strategy against the deadly virus. The task force includes more than 20 physician, nurse and clinical resource specialists with expertise in an array of disciplines, from infection prevention and emergency medicine, to critical care, pathology and equipment procurement.
“We have been closely monitoring information about the Ebola outbreak in Africa and developments in the U.S. and the Sacramento region since late summer,” said Kirk. “We also are in communication with the county and state public health officials to develop a regional response to a potential case, even though it is very unlikely that an Ebola patient would arrive in Sacramento. Our goal is to ensure that our providers and support staff are well equipped and trained to safely handle any potential case.”
UC Davis, a priority hospital
Recognizing the rapid response to the Ebola challenge as well as abilities to ensure protection for their health-care teams and the safe disposal of hazardous medical waste, the University of California Office of the President last month identified UC Davis among the five UC hospitals that would care for confirmed Ebola cases in California.
“Our care teams are well-trained and skilled in infectious disease protocols and procedures,” Robinson said, “but the Ebola virus presents unique challenges that require a heightened level of preparedness, communication and coordination.”
“To respond to a potential case, we’ve assembled a team of care champions and developed extensive protocols,” she said. “These teams are receiving intensive training to ensure that our infection control protocols and procedures are fully understood and followed.”
Ebola-care champions include representatives from units throughout the hospital who would care for a patient. They include nurses, hospitalists, environmental services workers, respiratory therapists, intensivists, clinical laboratory technologists and pathologists.
Treating an Ebola patient would require 24/7 care and observation, possibly for several weeks, Kirk said. UC Davis has identified an isolation room within the hospital where the patient would be treated. The task force also is exploring the feasibility of using a clinical space separate from the hospital that could potentially be used an alternative treatment location.
Ongoing intensive training
Overall Ebola readiness at the Medical Center, especially efforts to protect the safety of health-care workers, meets or exceeds current guidelines established by the Centers for Disease Control and Prevention (CDC).
“We have been steps ahead of CDC guidelines in acquiring the appropriate personal protective equipment needed for nurses and front-line staff,” she said. “Since early September, we’ve been scouring the nation’s medical supply inventories to find and select the best gear for our staff. We even tossed aside some protective equipment because our nurses found unforeseen problems in using it, such as the potential for their skin to be exposed during typical clinical-care activities.”
UC Davis also has been providing PPE training sessions every 90 minutes during the day, five days a week for the dedicated, Ebola response-team members. Putting on and taking off the equipment – known as donning and doffing – is a detailed, step-by-step process that requires a three-person team to ensure protocols are followed perfectly.
Doffing the gear, for example, is the most challenging and complex part of the process. Taking off the headgear, impervious gloves, coveralls, gowns, and leg and shoe covers requires more than 25 very specific steps.
In addition to a special, four-hour Ebola seminar in mid-October, UC Davis has logged nearly 900 hours of PPE training, classes, demos and train-the-trainer sessions. Earlier this week, the emergency department also conducted its annual training, incorporating a potential Ebola patient in its mass casualty incident scenario.
The health system is also conducting spot trainings throughout its hospital and clinics to provide educational updates and boost staff awareness, reinforce skills and ensure adherence to critical safety procedures.
“UC Davis Medical Center has established a reputation for stepping up to meet health care challenges, Kirk said. “Responding to public-health threats is nothing new for us. We are always working with public-health leaders at the federal, state and local levels to monitor and refine our response strategies to infectious disease outbreaks. We are definitely well prepared for whatever comes our way.”