COMPLETE COVERAGE ONLINE
Ebola virus questions and answers, plus the latest local Ebola coverage, photos and videos. Only at www.journal-news.com/s/news/world/ebola
In a collaborative effort, health officials across Butler County — from hospitals, health departments and school nurses — are reviewing protocols, adding extra precautions and disseminating education to the public as the nation’s attention is focused on the possible spread of the dangerous and deadly Ebola virus.
“We feel we’re very prepared to handle a patient coming into the emergency department,” said Dr. Marcus Romanello, chief medical officer at Fort Hamilton Hospital and medical director of the emergency department.
The hospital last week started taking extra precautions by erecting a sign near the entrance to the emergency room that asks a patient to self identify any flu-like symptoms, and further move into an isolated area if they’ve traveled anywhere outside the country.
This measure is to reduce the risk to other patients and the triage nurse inside the ED, Romanello said.
“We recognize intercontinental travel and crossing paths with infected patients,” Romanello said. “(In isolation) we can then interview and de-escalate the precautions.”
Romanello said emergency medical services workers across Butler County are also being educated on flu-like symptoms associated with Ebola and key questions to ask patients picked up by ambulance, including travel history.
The EMS workers will then notify the hospital before arriving if the patient matches the early indicators of a possible Ebola case, Romanello said.
That early notification, he said, allows the hospital to prepare for receiving the patient into an isolated exam room. The hospital follows Centers for Disease Control and Prevention recommendations for containment, isolation and personal protective equipment for staff.
At the Hamilton hospital, medical staff will wear a full gown, gloves, booties up to the knee and a full head piece. The hospital staff held drills last week to practice putting on and taking off the protective equipment.
The full respiratory head piece is “to provide the most comfortable level of protection for the head and neck,” Romanello said, but it’s not currently a mandate from the CDC. He said the hospital is taking that measure because traditional goggles can fog up easily.
That protocol of asking for a patient’s travel history and identifying symptoms matching Ebola is practiced by all hospitals that follow CDC guidelines, including but not limited to Atrium Medical Center, Mercy Health — Fairfield Hospital and UC Health’s West Chester Hospital.
Linda Jamison, infection preventionist at West Chester Hospital, said the UC Health network works with the Greater Cincinnati Health Council to have a unified approach to the disease.
“It’s a high-risk but low-likelihood event,” Jamison said.
The symptoms hospitals look for in possible Ebola cases include fever, muscle pain, stomach pain, diarrhea, weakness and bleeding.
Jamison said at West Chester Hospital, the staff will be holding “donning and doffing” drills in the next two weeks for staff to review the proper practice of taking off their protective gear following contact with a suspected or confirmed Ebola patient. That gear includes a full body suit.
“It feels good to be prepared,” Jamison said. “The challenge is going to be, people get the symptoms seasonally. That’s the challenge, keeping it in perspective.”
Romanello said another recommendation from the CDC is to have anterooms, which are smaller rooms attached to patient rooms, for staff to use for putting on and taking off protective equipment in a specialized way.
Fort Hamilton is working on preparing a specialized room — separate from all other care units — with its own anteroom and glass side to communicate and monitor the patient through.
Other precautions the hospital is developing include separate protocol for disposing of waste, such as linens, gowns and patient body waste; a separate area for analyzing blood; a dedicated staff member to log all staff coming in and out of the patient’s room; and updating the electronic medical records system to include pop-ups with the patient’s travel history and best practice advisories.
“Hospitals nationwide are taking steps for readiness, supplies, protocol, personnel education and practicing to be prepared,” Romanello said.
Romanello said in the case the hospital does have a suspected Ebola case, it would alert the Ohio Department of Health and CDC, rather than first contacting the city health department.
“It’s a state-reportable disease; we have to escalate quickly,” Romanello said.
After the CDC advises a patient’s blood needs tested, the hospital draws the blood and specially packages it for transportation. The package is sent by courier — not mailed — to the state lab for testing.
Jamison said at West Chester Hospital, the staff would first notify the Butler County Health Department which would coordinate communication to the state and CDC.
Romanello said in the meantime as the patient’s blood is tested, supportive measures are given such as medications for sodium and potassium, due to dropped levels from diarrhea, and nutritional drinks with high levels of protein and electrolytes. Results of the blood sample are determined between six and 24 hours.
Patricia Burg, director of the Butler County Health Department, said public health has two major responsibilities related to communicable diseases: contact ODH and begin contact tracing of those who had contact with the Ebola patient to reduce spread of the illness.
“There’s a small window; we use the time aggressively to identify (close contacts),” Burg said, and educate them on symptoms to look out for. “As long as there’s Ebola in Africa or anywhere, it can happen anywhere because we’re such a mobile society.”
School response
The Butler County Health Department last week met with officials from at least six Butler County school districts including Lakota, Middletown, Fairfield and Butler Tech.
Burg said district superintendents and nursing staff were invited to run through various scenarios and what role the health department would play in assisting. Burg said her office is willing to make presentations to other community organizations and groups with concerns about Ebola.
Randy Oppenheimer, spokesman for Lakota schools, said as well as the meeting with Butler County officials, the district met with West Chester Hospital and is planning a similar meeting with Cincinnati Children’s Hospital Medical Center in Liberty Twp.
“Schools for a long time have had plans and procedures in place for dealing with communicable diseases,” Oppenheimer said. “We’re reviewing what we already do and if there are any changes due to this outbreak.”
Oppenheimer said the exact response would be based on the specific scenario, such as a visitor to the school or a student in the building. The general response would be to stay aware of the symptoms of the individual and work with the hospitals and EMS crews.
“If it’s a confirmed case, closing a school is something that could come into play,” Oppenheimer said.
Officials from Middletown and Fairfield schools said similarly they work cooperatively with their respective health departments to keep students, parents and staff updated on current information.
The Fairfield and Hamilton districts were among those who had nursing staff attend a webinar Thursday hosted by the state health department with updates on Ebola for nurses working in schools.
“We are in the process of adding to our district emergency management plan, procedures outlining how staff members should deal with an Ebola case should our district be faced with such an incident,” said David Foster, support services director for Fairfield schools. “Our goal is to continue to inform and educate our community (parents, students, staff) which will ease the fears many have.”
Tracy Heinecke, head nurse at Hamilton schools, said while there are no specific requirements for schools, the ODH webinar outlined CDC information on knowing the signs and symptoms of Ebola, asking the student or staff member about their travel history and isolating the person if Ebola is suspected.
“We’re familiar with what to look for and how to educate parents who call in,” Heinecke said.
About the Author