Interim Guidance for Preparing Ebola Treatment Centers

Hospital has a private room with in-room dedicated bathroom or covered bedside commode, is equipped with dedicated patient-care equipment and has available separate areas immediately adjacent to patient room: one for putting on (donning) of personal protective equipment (PPE) and one for removing (doffing) of PPE. These areas must be large enough to allow a trained observer to safely and effectively supervise donning and doffing of PPE.

The state and local public health agency, emergency medical services provider(s), and the hospital have collaborated on the development of interfacility transportation plans that include identification of transport provider(s) with adequate training and PPE to safely transport a patient. Appropriate plans are in place for safe intrafacility patient transfer from ambulance entrance to treatment unit.

Laboratory procedures/protocols, dedicated space, if possible, possible point-of-care testing, equipment, staffing, reagents, training, and specimen transport are in place. See CDC’s Interim Guidance for Specimen Collection, Transport, Testing, and Submission for People Under Investigation (PUIs) for Ebola Virus Disease (EVD).

Readiness plans include input from a multidisciplinary team of all potentially affected facility departments, including clinical and nonclinical departments, and staff.

Staffing plans have been developed to manage several weeks of clinical care. Staffing includes dedicated critical care nurses, physicians, environmental services, infection control practitioners, laboratory staff, and respiratory services personnel designed to minimize the number of staff with direct patient contact.

The facility has a process for continuous staff input from those who may or may not be directly involved in care of patients with EVD, including from employee unions, and has addressed employee safety questions and concerns.

A limited number of staff should have direct contact with patients. All staff that will be involved in patient care or supporting patient care have been appropriately trained for their role.

Staff members who are involved in patient care have demonstrated proficiency in donning and doffing of PPE, proper waste management, infection control, and safe transport of lab specimens.

Ongoing training program is in place and breaches in infection control are addressed through retraining.

Teams have conducted a functional exercise of core processes.

For more information, see CDC’s Information for Healthcare Workers and Settings.

Given current PPE shortages, hospitals may not be able to procure in advance the amount of PPE needed for the time to care for a patient with EVD. Therefore, at a minimum, to be ready to accept and care for patients with EVD, hospitals will need sufficient PPE for Ebola for at least 7 days. If hospitalization is anticipated to exceed 7 days, state and local health authorities, in collaboration with CDC, may provide or facilitate the procurement of additional PPE supplies. Staff who are involved in patient care or supporting patient care have successfully drilled and demonstrated proficiency on donning/doffing.

The overall safe care of patients with EVD in a facility must be overseen by an onsite manager at all times.

Each step of every PPE donning/doffing procedure must be supervised by a trained observer to ensure proper completion of established PPE protocols.

Additional information regarding PPE supplies and how to increase access to PPE is available online.

Hospital should have secured the services of a waste management vendor capable of managing and transporting Category A infectious substances and have appropriate containers and procedures for the safe temporary storage of Category A infectious substances.

Staff are trained in the correct use of PPE and are trained in the proper handling and storage of Category A infectious substances at the facility.

If a vendor capable of transporting Category A infectious substances has not been arranged, hospitals may consider sequestering medical waste until the patient’s Ebola test result becomes known. At that time, if the patient is confirmed to have EVD, arrangements must be made with a vendor capable of managing for the waste as a Category A infectious substance; if the patient is ruled out for EVD, waste can be handled according to routine procedures in compliance with local waste management ordinances.

For more information, see: Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus.

Worker safety programs and policies are in place. The hospital is in compliance with all federal or state occupational safety and health standards applicable to reducing employee exposure to the Ebola virus. Hospital has a program for ensuring direct active monitoring of all healthcare workers involved in direct patient care to ensure monitoring for 21 days since last exposure. This monitoring should be done in coordination with local and state public health agencies.

Hospital has a program in place to clean and disinfect patient care areas and equipment, including use of an Environmental Protection Agency-registered hospital disinfectant with a label claim of potency at least equivalent to that for a nonenveloped virus, such as norovirus, rotavirus, adenovirus, and poliovirus.

Hospital has staff trained in correct cleaning and disinfection of the environment, safe practices, and correct use of PPE; and cleaning staff are directly supervised during all cleaning and disinfection.

For more information, see Information for Healthcare Workers and Settings.

The hospital has a practiced emergency management structure and a plan and methods for routinely communicating with relevant local and state public health agencies, emergency management authorities, its healthcare coalition (if appropriate), and the hospital’s employees, patients, and community to ensure coordination of the response and communication regarding any persons under investigation for EVD and patients being treated for EVD in the facility.

The hospital and the state public health department, as the hospital’s regulatory authority, have agreed that the facility is ready to serve as an Ebola treatment center.