1. Governor’s Secure Commonwealth Initiative, Health and Human Resources Sub-Panel Meeting Janis Ober MSN RN CIC Director, Infection Prevention

2. Ebola Timeline Initiate Plan and PPE Protocol Person Under Investigation

3. Personal Protective Equipment CDC recommendations –N95 mask –Gown, booties or knee high protection –Gloves, double –Face mask or goggles VCUMC –PAPR –Tyvek suit –Double gloves –Knee high fluid resistant

5. Patient placement Initial plan –MRICU Two rooms separated by “Hopper room” –PICU Add anteroom and use bathroom –L/D Add anteroom Negative pressure room

6. Emergency Department Access Immediate entrance through decontamination Identified two rooms in low traffic area Negative pressure rooms Linen Cart and Ebola cart for barrier Restrict entrance to unit Shower identified

7. Initial Checklist Don PPE in designated area Assemble PPE and assistant Wash hands or use alcohol hand rub Don long gloves, assistant should tape gloves to suit Put on Tychem suit, zippering to waist Tape gloves to suit sleeves Put on knee high shoe covers Put on PAPR hood with assistance Tuck inner hood layer into suit Zipper suit Smooth PAPR hood apron over shoulders and arms Fasten PAPR belt and adjust strap Assistant should turn on PAPR Don second pair of gloves Doff PPE Wash gloved hands in pt room Step to decontam area Wipe off sleeves, PAPR hood apron, and upper legs with disinfectant wipe Remove shoe covers and discard Step into decontam area as you remove the shoe cover Remove first pair of gloves Unzip suit to waist Roll PAPR hood apron in front and back, assistant may aid in removal Remove PAPR hood over back and allow to fall to floor Pull back of suit to bring down to shoulders Remove one glove Reach across touching only the inside of the suit, roll suit back on first side then do the same on the opposite side. Roll suit down touching only the inside of the suit. Step out of the suit into clean area, discard suit into trash. Remove second pair of gloves and discard Perform hand hygiene. Monitoring A RN monitor will be available 24/7 outside the patient’s room to assist in donning and doffing of PPE The monitor will document all entering patient room

8. Latest Checklist

10. Patient Placement Revisited MRICU Challenge –Closed 6 beds –Limited access to section of unit –Security visible in public hallway –Affected entire unit –Limited monitoring capability

11. Current Patient Plan Developed Unique Pathogen Unit Patient care areas separated from unit Create negative pressure pt rooms Two patient care rooms Lab Staff support areas Storage Showers Capability of monitoring activity Area easily secured

12. Unique Pathogen Unit Capability expanded –Pediatric patient –NICU patient –Mom and newborn –Laboring patient

13. Emergency Department Update Door placed between two patient rooms Doors placed in hall defining restricted space Third room added to mix of required space Secure pathway from ED to the UPU to be cleared by security

14. Ongoing development Communication Team development Permanent negative pressure capability Waste management improvement –Autoclave –Revise waste stream Second shower Refine staff space/break area Employee monitoring

15. Thank you for the invitation! Jober @mcvh-vcu.edu 804-828-2121