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EBOLA HUMAN RESOURSE MANAGEMENT IN HOSPITALS
- The document outlines recommendations for managing human resources during an Ebola outbreak. It recommends a tiered approach for deploying healthcare workers based on facility risk level, from frontline facilities to Ebola assessment hospitals and treatment centers. - It provides guidance on infection control procedures across different areas of a healthcare setting, including emergency departments, labor and delivery units, and dialysis. It also covers recommendations for handling human remains, psychosocial support for healthcare workers and patients, and a suggested Ebola training program. - The overall goal is to provide a framework to help healthcare systems properly prepare, deploy and support staff while minimizing the risk of Ebola transmission both within facilities and communities.
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EBOLA HUMAN RESOURSE MANAGEMENT IN HOSPITALS
- 1. EBOLA : HUMAN RESOURCEMANAGEMENT Education Training Deployment and Sensitization Major (Dr) Shashi Kant Sharma Dept of Hospital Administration Armed Forces Medical College Pune Maharashtra
- 2. Scheme of Thought •References • Introduction • Risk Assessment • Tiered approach for deployment • Special areas in hospital • Recommendation for preventing transmission • Psychosocial Support • Model training programme • Conclusion
- 3. References • Ministry ofHealth and Family Welfare Guidelines • National Institute of Virology Guidelines • World Health Organization Guidelines • CDC Guidelines on control of Ebola
- 4. Introduction • Ebola VirusDisease (EVD) infections among healthcare workers : almost every outbreak • Devastating effects on healthcare systems and the communities they serve • Infection control is a key strategy in stopping the Ebola epidemic
- 5. RISK OF TRANSMISSION HEALTHCARE& COMMUNITY Two factors help determine the level of risk in community and healthcare settings: – Ebola transmission risk in community – Risk from suspected or confirmed Ebola patients under care in a given facility
- 6. COMMUNITY RISK • Linkedcommunity transmission • In unlinked community transmission • Low risk • High risk
- 7. Healthcare Facility Risk •Low risk • High risk
- 8. Facility risk Ebola RxUnits Communityrisk Liberia Sierra Leone, Guinea Countries with no or linked transmission Facility taking care of cases Countries with no or linked transmission
- 9. Tiered Approach • Prepare •Identify • Evaluate • Front Line Health Care Facilities • Ebola Assessment Hospitals • Ebola Treatment Centers • Emergency Department
- 10. Frontline Healthcare Facilities •Rapidly identify and triage patients • Isolate any patient • Immediately notify the hospital/ facility ICC/ state & local public health agencies • Transfer patient to an Ebola Assessment Hospital • Ensure no delay in the care
- 11. Resources Needed 1/2 •Number of staff with direct patient contact • Cross-training • Demonstrate proficiency : putting on (donning) & taking off (doffing) of PPE • Infection control practices and proper waste management • Ongoing training
- 12. Resources Needed 2/2 •Practice drill and correct any identified gaps • Continuous staff input • Prolonged care (>12–24 hours) : UNLIKELY • Plans for PPE supplies • Plans for Inter facility Transport
- 13. Ebola Assessment Hospitals •Receive and isolate a patient • Functioning as an Ebola assessment hospital • Transport patients with confirmed EVD to an Ebola Treatment Center • States: not planning Ebola Treatment Centers • 96 hours of evaluation and care
- 14. Ebola Treatment Centers •Comprehensive care • Functioning as an Ebola Treatment Center • Decisions to receive a confirmed Ebola patient • Training : functional exercise of core processes
- 15. Emergency Dept Evaluation &Management • Risk of transmission of Ebola virus • Majority febrile patients to ED do not have EVD • Administrative and environmental controls
- 16. Triage Recommendations 1/2 •Immediately upon entrance to the ED or in advance of entry: exposure history • Signs or symptoms • Isolate the patient • Log book : personnel who enter the patient’s room.
- 17. Triage Recommendations 2/2 •Clinically stable : face shield/ surgical face mask/ impermeable gown/ two pairs of gloves • Notify the Hospital Infection Control Program and other appropriate staff • PPE put on : Additional history & performing physical examination & routine diagnostics & interventions
- 18. Pregnant Women WithEVD • Prepared to screen patients for Ebola • Obstetric management • Healthcare workers who are pregnant • Pregnant women with known or suspected Ebola should be hospitalized
- 19. How EVD Affects: Pregnant Women Mupapa K, Mukundu W, Bwaka MA, et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis. 1999;179(suppl 1):S11-S12. • Limited evidence : increased risk of severe illness and death • Previous outbreaks in Africa : infants born to mothers with Ebola have not survived -------------------------------------------------------------------
- 20. Infection Control :Labor & Delivery Units • High likelihood of exposure to large amounts of blood & body fluids • Method of Delivery to Consider : No data exist to suggest • Breastfeeding Restrictions : women with Ebola should not breastfeed. --------------------------------------------------------------------------------------------------------- Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007;196 (suppl 2):S142- S147.
- 21. Hemodialysis in Patientswith EVD • Efforts to minimize direct blood exposure • CRRT preferred peritoneal dialysis • Performed in the patient’s isolation room.
- 22. Establishing Vascular Accessfor Dialysis • Patients may have DIC • Subclavian site: avoided • Hemodialysis/CRRT machine : dedicated for use
- 23. Safe Handling ofHuman Remains • Personnel who perform PM care in hospitals & mortuaries • Trained personnel • Handling of human remains kept to a minimum. • Autopsies: avoided
- 24. Preparation of theBody • Wrapped in a plastic shroud • Leave any intravenous lines or endotracheal tubes • Leak-proof plastic bag :150 μm thick & zippered closed • Another leak-proof plastic bag : 150 μm thick & zippered closed • Transported to the morgue.
- 25. Mortuary Care • Donot perform embalming • Do not open the body bags • Do not remove remains from the body bags • Mortuary care personnel should wear PPE • Bagged bodies :placed directly into hermetically sealed casket.
- 26. Recommendations for Prevention ofTransmission • Patient Placement – Single patient room – Log book – Posting personnel at the patient’s door • Personal Protective Equipment • Patient Care Equipment – Dedicated medical equipment
- 27. • Patient CareConsiderations – Limit the use of needles – Phlebotomy, procedures, laboratory testing should be limited – disposed in puncture-proof • Hand Hygiene • Environmental Infection Control • Safe Injection practices
- 28. Aerosol Generating Procedures Avoid AGPs Visitors should not be present Limiting the number of HCP Private room and ideally in an Isolation Room Room doors should be kept closed during the procedure HCP should wear appropriate PPE Environmental surface cleaning
- 29. Monitoring and Management sickleave policies for HCP that are non-punitive Stop working and immediately wash Immediately contact health/supervisor Monitoring twice daily for 21 days Potentially Exposed Personnel Visitors Avoid entry of visitors Scheduled & controlled Comply with precautions
- 30. Psychosocial Support Strictbio‐security measures Risk of being contaminated Common symptoms can be mistaken for ebola High mortality rate symptoms of ebola and rapid deterioration The tension between public health priorities and the wishes of the patients Stigmatization
- 31. Target Group • Patients •Affected communities • Staff • Volunteers
- 32. Model Training & On-siteOrientation The suggested training consist of 3 components 1. Combined training 2. Breakout sessions 3. Walk around
- 33. Combined Training forall Staff • Suggested Duration: 04 hrs • Learn the audience’s learning expectations of the training • Current situation overview • What all should know about Ebola • Essentials of PPE/Case management/ Environmental • Include demonstrations and trials of PPE • What’s the strategy to stop the outbreak
- 34.
- 35. Walk Around :02 Hrs • Look at patient flows/ Holding spaces/ Changing areas/ Waste flows/ PPE storage. • Lead by Medical & Nursing Director • Mock patient run through & establish processes going forward. • Demonstration of the monitoring and evaluation tool.
- 36.