SPECIAL EDITOR’S NOTE: Special thanks to Barbara Citarella, MS, RN, RBC, Limited Healthcare & Management, www.rbclimited.com, for writing today’s story on “Home Care and Hospice Preparation for Ebola.” If you are attending the National Association of Home Care and Hospice (NAHC) Annual Meeting & Exposition in Phoenix, AZ on October 19 – 22, 2014, Barbara will present two education sessions at the Annual Meeting. The first session will take place on Sunday, Oct. 19, entitled “How to Prevent Infection Control Breaches,” and the second session will be held on Tuesday, Oct. 21, entitled “How to Identify Home Care and Hospice’s Triggers and Indicators: Crisis Standards of Care.”
As the Ebola outbreak continues to make headlines around the world, much of the focus, guidance and protocol development have been on acute care facilities. But we in home care and hospice need to be prepared also. At this moment in time, chances are slim we will see an acutely ill patient with Ebola, but we cannot rule it out as the situation changes daily. (As of this moment, a second strain of Ebola has been identified in the Congo, which has a 71% mortality rate.) Here are some suggestions that providers can begin implementing now for the current situation. We will update as it changes.
- Agencies should begin a comprehensive infection prevention education program for all staff but especially for field staff. Intensive training in the use of personal protective equipment (ppe) is paramount. Staff need to know how to don and doff ppe without contaminating themselves. This includes gloves, masks (either surgical or N95 respirator masks), gowns, and face shields. Hand washing is included. Agencies should bring staff in for demonstrations and re-demonstrations. An increase in field supervision should follow as a “buddy system” to monitor infection prevention technique.
- Reinforce the proper use of bag technique. According to the World Health Organization, Ebola can be spread by contact with previously contaminated surfaces (October 6, 2014). Home care and hospice providers do not control their environment.
- Reassure staff by giving them the facts on Ebola. Share your mission to keep them safe while they provide patient care. Have a communication plan for your staff and patients.
- Review and update policies such as your pandemic plan, influenza protocols, and monitoring staff that may have been exposed. Don’t forget to include the intake process of new patients. All new patients, and the referral source, should be asked questions following the CDC algorithm. Is the patient symptomatic, if so, what are the symptoms? Then obtain a travel history of the patient, family, and friends. If the answers meet the CRITERIA for possible Ebola, contact the health department. (9-1-1 dispatchers are being trained to handle these possible transports.)
- Check your supplies of ppe. If they are outdated- DO NOT USE. The integrity may be compromised. Order additional supplies including some booties and head coverings. Don’t wait. Remember how quickly health care providers ran out of ppe during the H1N1 pandemic.
- If a possible Ebola patient (meeting the criteria) is identified during a home visit. The staff should immediately don personal protective equipment and place patient in a room by him or herself. It should preferably be one with a door but this is home care and we may not always have that option. Staff should then call the health department and 9-1-1 explaining the situation and wait for guidance. No one should leave the home until clear guidance has been given. That includes staff.
- Research your state health department’s website. They all have the most recent information and may have some specifics for your state. Keep your staff informed daily but be sure the information you share is accurate. People are anxious and inaccurate information can spread easily.
As home care and hospice providers, our role is to prevent and control the spread of the Ebola virus while protecting our staff and patients.
- Algorithm – Evaluating Returned Travelers for Ebola, US[PDF – 1 page]
- Checklist for Patients Being Evaluated for Ebola in the U.S.[PDF – 1 page]
Protecting Healthcare Workers: