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Adult with Ebola

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The NIU Plan for an Adult with EVD
Deirdre Morley
Infectious Disease Specialist Registrar
Mater Hospital
Referral and transfer to National Isolation Unit
Airport or
Sea port
Another
healthcare
facility
Within the
Mater
ID
consultant
NIU
Case
Phone call from Emergency Department
40 year old nurse from Madrid
Presented to Emergency Department with 4 day history of fever,
chills, muscle aches
Involved with caring for patient with Ebola in Carlos III hospital
Madrid 2 weeks previously
EVD Algorithm
EVD Algorithm
Alert phase
Call from ED consultant
ID consultant on call
CEO
Switch board operator
Senior Nurse NIU
Second ID consultant
HPSC
Ambulance
Garda
Public health
Population health
Internal Communication
Activation of NIU
NIU activated by the on call ID consultant
Aim to facilitate safe and efficient transfer of patient
Readily available NIU Policy and “Action cards”
Clearly defined roles for all relevant staff members
National Isolation Unit
Two high specification negative pressure isolation rooms
HEPA filtration
Separate Air handling system
Separated from rest of ward
On street entrance
National Isolation Unit
Clean entrance room and anteroom for decontamination
Rooms equipped with Point of Care testing
Portable Ultrasonography
Can facilitate ICU equipment/ dialysis
National Isolation Unit preparation
Two rooms permanently vacated
Ready to receive patient within 1 hour
All twelve beds will be vacated if confirmed case (4 hours)
Ongoing maintenance
Negative pressure gauge
POCT equipment calibration
Fully stocked – checklist maintained by Nursing staff
Staff preparation
Nursing staff
ID Consultant/Registrar
ICU consultant
“Buddy” system PPE donning
Three staff members prepare for arrival of patient
Two nurses for isolation room per shift
Two nurses “Runners”
“Closed” Unit
Internal communication via ID consultant / CNM
External communication via CEO/ ID consultant 2
Restriction on non-essential staff
24 hour security
Log of all persons entering room and isolation facility
Transfer of patient
Ambulance transfer coordinated by HSE ambulance control
Designated ambulance and crew
Garda escort plus on street precautions
Ambulance Contact NIU with ETA
Transfer of patient
Transfer to entrance direct to NIU on Berkeley Road
Patient escorted by NIU staff to Isolation room
Initial patient assessment
Nursing staff/ ID doctor assessment
Early ICU consultant involvement
Early large bore IV access
Initial bloods
ABG/FBC/Clinical Chemistry/Coagulation profile
Transfer of specimens to NVRL
Staff trained in removal of specimen from room
24 hour on-call microbiologist NVRL
Courier transfer coordinated by medical staff
Training
Intensive targeted staff training
PPE “Buddy” system PPE donning and removal
Point of Care Testing training
Continual competency assessment
Deteriorating patient
Waste management
Training scenarios
24th October
ED activation – transfer and Admission to NIU
29th October
External transfer by ambulance and Garda – admission
POCT – Waste management – Staffing rotation
Debriefing following all drills – Internal and External
Root cause analysis
Maintaining competency
EVD committee meets every two weeks
CEO/Management
Medical/Nursing/ ICU
Laboratory staff
Infection Control staff
Waste management
Technical staff
Update Newsletter weekly
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