October 7, 2014

Ebola not likely, but VUMC is prepared: officials

By Nancy Humphrey

Armed with a validated and orchestrated plan, Vanderbilt University Medical Center is prepared to safely and effectively treat patients with the bloodborne disease Ebola, should the need arise.

That’s what Tom Talbot, M.D., MPH, associate professor of Medicine and Health Policy and Chief Hospital Epidemiologist, wants Vanderbilt’s faculty, staff, patients and families to know following last week’s news that the country’s first Ebola patient was diagnosed and being treated in Dallas.

“There’s a lot of anxiety in the unknown, understandably, but we do have a plan,” Talbot said. “We’re prepared. We’ve drilled our plans. We’ve got some fine tuning to do, but if an Ebola patient arrived in our Emergency Department today, I feel very comfortable that we would be able to care for that patient safely and effectively.”

A recent hospital drill allowed Talbot and representatives from the Medical Center’s Infection Prevention and Emergency Preparedness teams to carefully examine the policies and processes in place to care for a patient with Ebola.

“It’s important to note that the likelihood that we will get a patient with Ebola is very rare, but we are more likely to than other places in the area given our size and expertise,” Talbot said. “In the case that we do, we are doing everything we can to be prepared and to make sure that everyone is protected.”

National and international health authorities are currently working to control a large, ongoing outbreak of Ebola in areas in West Africa. There are currently no reports that an Ebola infection has been acquired in the United States. There is no vaccine to prevent Ebola infection, the treatment is supportive, and the fatality rate is high.

Talbot said that it’s important to keep the facts in perspective. It’s difficult to contract Ebola. Since the virus is bloodborne and not airborne, you have to come in contact with an infected person’s bodily fluids — blood, vomit, feces, urine, sweat, saliva — to get it.

If Vanderbilt were to receive a patient with Ebola, the guiding principles behind the precautions that will be taken, although heightened, are similar to the basic infection control practices that would be used for any patient with a communicable disease: using screening questions to identify individuals as they come into the institution; putting the patient into isolation; and using the proper precautionary equipment with a focus upon ensuring that the equipment is both put on and taken off correctly.

“There’s nothing unique about the protective equipment we would use – double gloves, impermeable gowns, and eye and face protection,” Talbot said. “That’s how we’re approaching the care of a patient with suspected Ebola and that’s what is safely recommended by the Centers for Disease Control and Prevention.”

Talbot said it’s important to use the equipment that health care personnel are already familiar with. “A big rubber suit, like you’ve seen in the news media, doesn’t offer any more protection against Ebola than an impermeable gown like we wear in the operating room,” he said. However, the impacted faculty and staff would be re-trained on how to use the protective equipment.

Talbot said that health care personnel learned a valuable lesson from the SARS (Severe Acute Respiratory Syndrome) epidemic a decade ago --- that health care workers who became ill were wearing the correct protective gear, but they were just taking it off incorrectly and contaminating themselves.

“It’s important to count to five and slowly take off the protective gear, being careful not to rip anything or fling anything off. Your instinct is to take it off quickly, but you have to be careful,” Talbot said.

Identifying a suspected patient quickly is key. And it’s also important to note that quick identification isn’t just important for Ebola patients, but for any patient with a highly infectious disease like the bird flu and MERS (Middle East Respiratory Syndrome). Those diseases are actually more transmissible than Ebola because they spread in the air. “We want to make sure we catch any of these nasties when people come in, and that we use the appropriate precautions, including isolating that individual as quickly as possible,” Talbot said.

There will also be a buddy system in caring for the patient. Health care personnel will be teamed up to provide care with each person acting as a co-pilot to watch the other person don and remove the gear, to make sure there’s no contamination or breach in any protocol. A sentry will be situated at the patient’s door limiting access.

Talbot also said it’s imperative if a patient is suspected of having Ebola that Infection Prevention be called as quickly as possible.

The Medical Center also has other plans in place: blood specimens will not be placed in the hospital’s pneumatic tube system, but instead placed in non-breakable tubes, placed in a hard case, and hand delivered to lab personnel who will also be wearing protective equipment. It’s also important to dispose of waste such as fluid-saturated dressings and linens properly.

Gerald Hickson, M.D., VUMC’s senior vice president for Quality, Patient Safety and Risk Prevention, said that Vanderbilt’s Infection Prevention team has been actively engaged in reviewing the experiences of the teams at Emory University Hospital, who treated the first patients to be airlifted from West Africa and treated in the United States, and at Texas Health Presbyterian in Dallas, where the country’s first diagnosed patient is being treated.

“Vanderbilt team members are committed to those we serve, regardless of the conditions or circumstances that direct them to our door. We strive to deliver the safest and highest quality of care to every patient, every time,” said Hickson, assistant vice chancellor for Health Affairs, associate dean for Faculty Affairs and the Joseph C. Ross Professor of Medical Education and Administration.