CDC Taking Active Steps Related to Hospital Preparedness for Ebola Treatment

CDC Support in Dallas
In addition to an initial team of 10 public health professionals sent on September 30 to support contact tracing and response after an index patient was hospitalized with Ebola in Dallas, CDC has sent new resources to Dallas to support the highest standard of infection control. CDC has deployed a second team of 16 to Dallas to train and assist the hospital in infection control and the monitoring of health care workers who had contact with the index patient. These join the 2 CDC officials who were assisting the hospital previously. The additional CDC team includes experts in:

• Infection control
• Ebola virus control and infectious diseases
• Laboratory science
• Personal protective equipment
• Hospital epidemiology
• Workplace safety

The team includes experts who successfully controlled outbreaks of Ebola in Africa in the past two decades, including in health-care settings. Team members have worked with Doctors Without Borders on infection control protocols and trained others in Africa to follow those protocols. This expertise is being directly shared with the hospital. In addition, two infection control nurses from Emory University hospital who have experience treating Ebola patients without infecting health-care workers are joining the response at the Dallas hospital to provide peer-to-peer training and support. This combination of training will help hospital staff across a range of care and management experiences.

Focus of the Dallas Hospital Investigation
The CDC team is assisting the hospital in rapidly reducing the risk of further spread of Ebola and investigating how the healthcare worker may have become infected with Ebola. The team is looking into:

• What personal protective equipment (PPE) is being used and how it is being put on and taken off
• What medical procedures were done on the index patient that may have exposed the healthcare worker
• The decontamination processes for workers leaving the isolation unit

• Ensuring oversight and monitoring of all infection control practices, particularly putting on and taking off PPE, at each shift in each location where this occurs should be implemented

• What enhanced training and/or changes in protocol may be needed

Immediate Actions in Response to the Investigation
While we do not yet know the source of the exposure of the infected health care worker and the investigation is ongoing, CDC’s immediate improvements in processes and procedures reduce risk to health care personnel. Care for a patient with Ebola requires meticulous attention to detail, and refining these steps makes it safer and easier.

The protocol offers a range of choices for implementation. In Dallas, CDC is making specific improvements in the following process and procedures:

Personal protective equipment

• PPE suits will be standardized, to include a specific type of suit to ensure consistency in both training and use, possibly using only full-body suits. This is consistent with current CDC recommendations.
• Use of a model of hood that protects health care worker’s neck so the neck will not be exposed.
• Removing PPE now includes an enhanced and detailed step-by-step disinfection of hands process with specific sequencing for removal of each piece of equipment and the hand washing.

Oversight and monitoring

• The single most important aspect of safe care of Ebola is to have a site manager at all times who oversees the putting on and taking off of PPE and the care given in the isolation unit. A site manager is now in place and will be at the hospital 24/7 as long as Ebola patients are receiving care.

Enhanced training

• CDC is providing additional onsite intensive infection control training and education with heath care workers in Dallas. In addition, two infection control nurses from Emory who have experience treating Ebola patients are in Dallas to provide peer-to-peer training and support. Strict infection control is critical to stopping chains of transmission. Standard infection control practices in U.S. healthcare facilities apply to the safe management of patients with Ebola, but must be adhered to rigorously and meticulously. Hospitals should have staff practice the procedures and practice using the protective garb in advance.

Establishing a Dedicated CDC Response Team

• CDC is setting up a dedicated CDC Response Team that could be on the ground within a few hours at any hospital that receives a confirmed patient with Ebola. The CDC Response Team would provide in-person, expert support and training on infection control, healthcare safety, medical treatment, contact tracing, waste and decontamination, public education and other issues. The CDC Response Team would help ensure that clinicians, and state and local public health practitioners, consistently follow strict standards of protocol to ensure safety of the patient and healthcare workers.

Ensuring Healthcare Workers and Facilities are Prepared
CDC is providing more opportunities for U.S. healthcare providers to receive additional training and to get their questions answered from CDC experts. Clinicians can get updates on these events at www.cdc.gov/Ebola. Training and educational session will include:

• On October 14, CDC hosted a partner conference call with clinicians to focus on healthcare systems preparedness, and how Emory University Hospital and Nebraska Medical Center prepared for patients with Ebola and the lessons learned
• On October 15, CDC will host a call with the American Nurses Association to discuss how to better prepare frontline nurses for Ebola
• On October 16, CDC will host a call with the American Hospital Association on Ebola preparedness
• On October 20, CDC and HHS will host joint conference calls for U.S. healthcare workers to discuss healthcare preparedness and answer questions or concerns. These calls will be scheduled regularly
• On October 21, CDC will host a live event in New York City with the Partnership for Quality Care and the Greater New York Hospital Association/1199SEIU Healthcare Education Project to educate frontline healthcare workers on Ebola; the event will be streamed live to hospitals across the country
• CDC will host a series of ongoing webinars tailored to specific healthcare specialties on preparedness
• CDC will host conference calls with professional organizations to discuss member questions or concerns and to increase dissemination of critical information to healthcare providers

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES