Harbor:Ebola

Ebola Precautions

  • Medical info: Ebola_virus_disease
  • Specifics of Harbor Ebola Plan
  • Triage Screening - implemented 5-26-2026
    • If travel from Africa in the past month with viral symptoms (fever, fatigue, N/V/D, headache, abdominal pain, bleeding), place in immediate contact/droplet precautions until cleared by an attending.
      • Current confirmed cases in DRC & Uganda, high-risk countries include Angola, Burundi, Central African Republic, Republic of Congo, Ethiopia, Kenya, Rwanda, South Sudan, Tanzania, & Zambia
      • 5/29/26 - Air travelers from DRC, Uganda, or South Sudan within past 21 days will be directed through Dulles, Atlanta, Houston, of JFK for screening
      • 7/12/26 - 1,926 confirmed cases of Ebola with 702 deaths in DRC; 20 confirmed cases with 2 deaths in Uganda
    • Risk Factors: contact (with body fluids) with symptomatic person, PUI, or dead person in affected areas; lab or healthcare worker; contact with bats or wild animals; mine worker
  • Timeline
    • Infection
    • Incubation - 2 to 21 days; not contagious
    • Dry Phase - symptomatic (contagious) - fever, fatigue, headache, sore throat, muscle aches
    • Wet Phase - generally day 4 of disease (highly contagious) - conjunctivitis, vomiting, diarrhea, occasionally bleeding
    • Death - generally 7-10 days after symptom onset (most contagious - highest viral load)
  • Patient Isolation for PUI (Patient Under Investigation)
    • PUI is possible exposure to Ebola and subjective complaints consistent with Ebola infection (basically viral syndrome symptoms, abdominal pain, or bleeding). No fever or other visible findings are required to classify the patient as a PUI patient.
    • As soon as the patient is identified as a PUI - they should go straight into isolation
      • Immediate move to reassessment area behind Triage 1 for attending assessment
        • If indeed PUI, move to A21 when antechamber setup; all further evaluation is done there.
      • Mask patient (N95 preferred), contact/droplet precautions, ensure negative pressure working
      • PUI patients are not allowed to use the sink or toilet; use bedside commode with red bag - category A solid waste
      • Never enter a room with an Ebola PUI (Person Under Investigation) without full Ebola level PPE.
      • 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
      • Keep a log of anyone who enters PUI room
        • The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient.
      • Screen any family members/close contacts; no one allowed in isolation room
        • If asymptomatic, send home for 21-day quarantine
        • If symptomatic, place them in isolation as well
  • PPE
    • Call facilities x68501, x68381 to setup antechamber
    • Extreme care should be taken in any situation where a PUI patient may undergo a procedure that aerosolizes body fluids; use a CAPR (positive pressure fan)
    • 4 CAPRs in OCN office
    • Ebola PPE cart has a binder with step-by-step instructions for donning/doffing for both the treating provider and that provider's "buddy"
      • Gloves, masks, Tyvex suits, 2-way communication - iPad vs Cisco phone with charger, signage
      • Disposable equipment (thermometer, BP cuff, stethoscope, no room curtains, red bin, bleach wipes
    • This is a 1:1 nursing assignment
      • See specifics for donning and doffing below
      • After patient care, doff, remove hospital scrubs, shower, change into street clothes.
  • Testing
    • Avoid blood draws unless absolutely necessary; provide minimal care to stabilize patient
      • POC testing if needed
      • Confirmatory testing (if requested by LA County Acute Communicable Disease Control Program [ACDC]) in 2 blue, yellow, or purple tubes
        • ACDC Daytime 213-240-7941; after hours 213-974-1234
        • CDC Viral Special Pathogens Branch (SME 24/7): 770-488-7100
        • Malaria is #1 cause of of undifferentiated fever in travelers from Africa; P. falciparum progresses rapidly; taking malaria prophylaxis does NOT exclude malaria; can have concurrent malaria and ebola
          • Thick & Thin smears; air dry (no blower)
        • Neg PCR for Ebola with <72 hours of symptoms does NOT rule out the disease
  • Treatment Guidance for Physicians
    • If a patient is a legitimate PUI, the goal is rapid isolation, minimize treatments, and minimize exposed staff
    • Scenarios:
      • Patient appears well
        • Apply mask to patient and place in isolation room, use phone from outside the isolation room to communicate, patient may take off mask only for eating, "no testing or treatment"
      • Patient appears ill
        • Apply mask to patient and place in isolation room, apply all PPE prior to entering the room
        • If physical exam or emergent procedure is necessary, the physician may need to enter the room; you will be unable to exit until the antechamber is setup outside the room
        • If an IV is needed for IVF, antibiotics, or pressors, the nurse will need to enter the room; you will be unable to exit until the antechamber is setup outside the room
      • Cardiac Arrest
        • Potential harm to staff outweighs potential benefit of likely futile care
        • Do not attempt resuscitation
  • Treatment Steps
    • Avoid aerosol generating procedures (BiPAP, intubation, etc); use metered dose inhaler instead of nebulizer if needed
    • Notify the infectious disease (ID) service p7804 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. ID will then notify infection control prevent (IPC).
    • No FDA approved treatment; MBP134 - experimental antibody cocktail
    • No FDA approved vaccine (ERVEBO does not cross-protect against Bundibugyo)
    • Key is IVF and electrolyte repletion
  • Transfer
    • Utilize MAC Emerging Infectious Disease Transport Guidelines
    • Cedar's Sinai 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.
  • PPE Step-by-Step
    • Donning
      • Trained observer will direct and ensure compliance of each step with checklist.
      • Observer will take the vital signs of the primary RN to ensure they meet parameters to don PPE and provide patient care.
        • Decon Medical Monitoring form to be completed before donning process.
      • Primary RN will take care of personal needs before donning PPE.
      • RN will remove personal clothes, change into surgical scrubs and rubber shoes.
      • Perform hand hygiene with hand sanitizer.
      • Inspect and fit check PPE- (Decon hood, battery belt, Tychem suit)
        • Battery belt- with the hose pointing up, secure the belt to waist and adjust to fit.
          • Check the peak flow- Attach the three filters. Turn on the battery. Attach the peak flow meter and ensure black indicator rises to the top. Remove the peak flow meter when test is completed. Remove the belt and set aside.
        • Inspect integrity of Decon hood- Adjust hood strap to size. Cotton strap should wrap in front of forehead (like a sweatband). After fit test is complete, remove hood and set aside.
      • Hand hygiene
      • Don boot covers. Pull them up as far as possible. Tie the covers at the ankles.
      • Don sterile gloves. Pull them up as far as possible.
      • Don Tychem suit over boot covers. Zip suit up. Secure adhesive liner.
      • Don battery belt around waist and secure.
      • Don blue isolation apron, utilizing thumb holes. Observer can assist with tying apron.
      • If desired, N95 can be applied at this time.
      • Don outer gloves over coveralls. Chemo gloves or surgical gloves are appropriate. If surgical gloves are used, it is recommended to go up a size.
      • Don decon hood.
        • Adjust the headband to ensure fit.
        • Observer will attach the hose to the battery pack.
        • Observer will turn on battery pack.
        • Observer will start a timer (Observer will perform a wellness check at 20 minutes to ensure RN is able to tolerate suit)
        • RN will tighten cord on Decon hood.
        • Observer will assist in tucking inner shroud into Tychem suit
        • Outer shroud will lay on top on Tychem suit.
      • Ensure all areas of body, including hair, are covered.
      • Observer does another check and make sure RN’s ROM is not restricted, all areas of skin are covered, and PPE is intact.
    • Doffing
      • There will be the RN who is wearing the PPE, an observer who is utilizing the checklist and observing the doffing process, and an assistant to physically assist the RN doff PEE.
      • Observer will utilize Doffing checklist to guide RN through each step. Observer and assistant will have on PPE.
        • Surgical scrubs
        • Blue plastic isolation gown
        • Surgical gloves
        • Chemo gloves
        • Bouffant cap- optional
        • N95
        • Face shield
        • Boot covers
      • RN and observer will check for any rips/ tears/ contaminants on PPE.
      • Disinfect outer gloves with hand sanitizer. Remove any excess contaminant with bleach wipes, if applicable.
      • Remove blue isolation apron and outer gloves
        • Assistant will untie blue apron. RN will roll apron inside to outside. Carefully and slowly remove outer gloves with apron, dispose of gown and gloves into trash.
      • Inspect inner gloves for visible tears or contamination.
      • Disinfect inner gloves with hand sanitizer.
      • Assistant detaches the hose from hood and holds the battery pack.
      • RN unbuckles and removes belt.
      • Assistant places battery pack in black bucket for appropriate disposal.
      • Assistant rolls the outer shroud of hood up to RNs shoulders by rolling inward to create a cuff.
      • RN removes the Decon hood by leaning forward and pulling hood off and directly into trash.
      • Disinfect inner gloves
      • Break adhesive seal on Tychem suit
      • Disinfect inner gloves
      • Unzip Tychem suit completely with one hand. Avoid touching skin.
        • Assistant will roll suit down off the shoulders and down to waist of RN, rolling outward.
        • RN may need to sit on designated clean chair when removing coverall.
      • Dispose of coverall in trash
      • Disinfect inner gloves
      • Untie boot tie. Remove boot covers. Utilize designated clean chair, if needed.
      • Disinfect inner gloves
      • Disinfect shoes with bleach wipes. Avoid contact with skin
      • Disinfect the inner gloves
      • Remove and discard inner gloves. Do not touch any exposed skin or any surface in the room.
      • Hand hygiene with hand sanitizer.
      • If N95 was applied:
        • Apply new gloves
        • Remove N95
        • Remove gloves
        • Hand hygiene
      • Observer will inspect body for contamination, compromise to clothes.
      • Exit the anteroom.
      • Shower after providing patient care, if desired.

See Also

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