Harbor Ebola Precautions
- Never enter a room with an Ebola PUI (Person Under Investigation) without full Ebola level PPE.
- The definition of a PUI is simple - possible exposure to Ebola and subjective complaints consistent with Ebola infection (basically viral syndrome symptoms or abdominal pain or bleeding). No fever or other visible findings are required to classify the patient as a PUI patient.
- Currently countries identified as travel locations we should be concerned about are coded into the "ID Risk Screen" the routers perform and you can find on Cerner under "Provider Notes"
- There are other ways to be exposed to Ebola virus: including sexual intercourse with a patient who has recovered from an Ebola infection.
- As soon as the patient is identified as a PUI - they should go straight into isolation (in AAED or PED, not RME); all further evaluation is done there.
- Residents should not be in a room with a PUI patient - only attendings and fellows acting as attendings should be involved in wearing PPE and entering a PUI room
- Notify the infectious disease service that you have a PUI patient in the emergency department - they will guide further screening to determine if the patient can be cleared or not.
- PUI patients are not allowed to use the sink or toilet. Mechanical should bring a porta-potty for patient use.
- The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient. Nursing has a list of nurses who have volunteered to care for PUI patients.
- Extreme care should be taken in any situation where a PUI patient may undergo a procedure that aerosolizes body fluids - the best PPE in this case is a PAPR unit - which is a helmet with a positive pressure fan. We will receive additional training on these in the future.
- There is a cart in the AAED that contains all of the PPE equipment to care for a PUI patient. It is currently across from the B side desk in the AAED, and looks like all the other yellow PPE carts. We are in the process of having it marked with a large "E" to distinguish it from the other PPE carts.
- In the top drawer of the Ebola PPE cart is a binder that has step by step instructions for getting into and out of PPE for both the treating provider and that provider's "buddy". We will plan more training to refresh everyone on this.
- The instruction book also contains a log to record who goes in and out of a PUI room.
- UCLA Medical Center in Westwood will be our referral center for patients who cannot be cleared in a reasonable timeframe' or become confirmed Ebola patients. The decision for the timing of transfer will be made in conjunction with the infectious disease consultant.
- EMS has a special unit to transport such patients - make sure they're aware that you have a PUI or confirmed case of Ebola.
M. Peterson 5/8/15
- See Monkeypox
- Consider in patients with travel history w/in 21d of symptom onset to West Africa, Europe (CDC link of non-endemic countries with cases)
- Rash typically preceded by fever, lymphadenopathy, malaise, HA, and muscle aches
- Vesicular or pustular rash, well-circumscribed, may be umbilicated or become confluent and progress over time to scabs
- Higher likelihood in MSM patients, presenting with lesions in the genital area
- Move directly to a negative-pressure room, cover rash; airborne (N-95) and contact precautions (gown)
- Call IPC x66532 and Micro x66289 and get a monkeypox collection kit from Microbiology
- Call LAC Acute Communicable Disease Control (weekdays 8:30A-5P 213-240-7941, after hours 213-974-1234 and ask for the physician on call) LA County Monkeypox