Tucson’s only academic medical center took a second look at its Ebola plan this week after one and then two cases were confirmed in Dallas health-care workers.
Dr. Sean P. Elliott, the director of infection prevention at the University of Arizona Medical Center, convened a “hotwash” on Monday — a multidisciplinary meeting that used cases of Ebola in health-care workers in both Spain and the U.S. to fine-tune and practice their own protocol.
The hospital has an order out for extra protective gear with built-in hoods and booties. It is also giving all of its health-care workers a refresher course in protocol.
The Star talked with Elliott on Thursday about how Tucson’s only academic medical center has prepared for possible cases of Ebola. Here are excerpts of the interview.
Have all staff members at the University of Arizona Medical Center been trained in Ebola protocol?
There isn’t a specific Ebola protocol. It’s contact precautions with nonpermeable personal protective equipment. Based on experiences with Dallas Presbyterian, we’re realizing that it wasn’t so much putting on the equipment but taking off the equipment in a proper order. It’s no problem to get gowned up in a spacesuit and take care of patients all day long, the major risk comes when you are doffing or degowning, that’s when the splashes occur.
That is likely what happened with at least that first nurse in Dallas. You are supposed to take your mask off last. So any splashes from the gloves, from the gown, don’t enter into your mouth accidentally. So that is something. We are making no assumptions. As we speak, we are going to do an in-network training to remind every health-care worker how to properly take off their personal protective equipment.
It’s obviously a huge thing to coordinate. Logistically it is kind of a challenge. The expectation is we will have accomplished that in the next one to two weeks.
What is the UA Medical Center doing to protect health-care workers?
The major intervention is not so much the equipment, it’s making sure that people use it properly. One thing that has changed, and I think this is across the country, is that anybody who is doffing or taking of their personal protective equipment, does so with a buddy system. Somebody watches them every step of the way. That is something that as we go through our repeat refresher training, we’ll introduce the concept of buddy system.
So the UA Medical Center has an Ebola plan?
Yes. We created both a task force and a response plan, a good five or six weeks ago. That was us sort of anticipating the likelihood that a patient like the Dallas patient would occur. So just as soon as the situation in West Africa became so dire, it was clear to me that we would have travelers coming into the U.S. just like what happened in Dallas and we needed to be ready.
Was the news about the infected health-care workers in Dallas a game changer for you?
In part. I think the biggest challenge is looking at the discrepancy between Emory, the center in Atlanta, which knew patients were coming in, has a quarantine unit versus a center like Dallas Presbyterian, which was surprised, I think is the best word.
We, I think, practice on the assumption that something infectious could come in at any time, day or night. We are prepared for that. We did not have to create new policies or procedures to deal with Ebola, it’s just that we put a name on what might come in. But with the anticipation that it’s a highly contagious organism, we just want to take extra steps and maximize our use of personal protective equipment based on others’ experience.
Is the protocol for Ebola difficult?
The isolation and prevention measures for Ebola truly are simple. They don’t need to be advanced. It’s just that one has to be careful in taking them off. That is the major problem.
That there is a specific order in doffing the equipment and that order has to be followed very carefully, very specifically each time. ... The nurse who became infected in Spain specifically has recounted feeling a splash inside her mouth when she took off her gloves. Her mask was off first. And then she took her gloves off.
Are you equipped to handle an outbreak?
It depends what you call an outbreak. We are certainly equipped to handle individual cases. We’re (UA Medical Center) prepared to handle no more than three or four. And you have to look at staff support. But an outbreak such as more than 15 or 20 or 30 — no. Nobody is prepared for that.
But keep in mind the CDC is creating its rapid response force. And their intent is to be on site within 24 hours of a patient, and they would handle logistics. And if we had an outbreak like they have in Western Africa, we’d be talking tents, other structures.
If your protocol was followed 100 percent, are you confident it would prevent the spread of disease?
Absolutely. That is my expectation, but we are not taking that for granted. We are in the process of arranging simulation testing for our patient-care staff, and it’s really kind of neat.
Our health-care workers would suit up as they are supposed to and we would dust them with an ultraviolet dust, which is designed to simulate the Ebola virus. They would do simulated procedures, intubation, blood draws, dialysis etc. After they doff or degown their equipment, we scan them to see was there any break in their technique. So I’m confident we’re 100 percent effective at protecting our patient safety, and our health-care worker safety, but we are going to test that in real time in this simulation lab.
What precautions can the general public take?
If they have fever-like illness and travel to one of those West African countries, I strongly encourage them not to go straight to the emergency room but to call their health-care provider and we can arrange a direct admission to protect the rest of the community.
As bad as the Ebola virus is and the concerns in this country are, the bigger threat to health is influenza, which is right around the corner.