1. EBOLA VIRUS DISEASE PREPAREDNESS Screening, Detection & Planning

2. Assumptions P/SL will only have 1 potential Ebola patient at a time – With more than 1 patient the plan would be altered Ebola is transmitted through contact with infectious droplets and contact with body fluids Donning and doffing of PPE presents the highest risk of exposure to healthcare workers Limit staff and physicians in the room to essential personnel only

3. 3 EBOLA BACKGROUND Predominantly in West Africa HIGH RISK Countries = Liberia, Sierra Leone, Guinea Medium Risk Countries = Democratic Republic of Congo (DRC), Republic of Congo (ROC), Uganda, Senegal, Gabon, Ivory Coast, South Sudan, Nigeria Low Risk= Other African countries Understanding the Geography Patients are screened for recent travel outside of the US. It’s important to know which areas of the world currently present the highest risk

4. Ebola Symptoms Symptoms may appear from 2 to 21 days after exposure, average is 8 to 10 days. Initial Signs – Fever (at least 100.4°F) – Weakness & exhaustion – Pain Severe headache Muscles & joints Abdominal pain – Sore throat – Nausea – Dizziness

5. Ebola Transmission

6. Should I be concerned? HCA/HealthONE & PSL Leadership and Physicians are implementing best practices across the system. Our priority is the health and safety of our patients, employees, physicians, and the community. Anticipate additional communication, education and training as we continue to prepare The initial step of SCREENING & DETECTION is essential and your role is very important

7. First Point of Contact Infectious Disease Screening Patient registration staff all have infectious disease and Ebola risk screening questions on Meditech. Will immediately notify Infection Prevention and appropriate staff if patient screens positive for Ebola risk. Screening questions also in Meditech for nursing staff during assessment.

8. First Point of Contact Infectious Disease Screening Emergency Department Screening 100% of patients and visitors – Security completes screening form If positive, Security contacts ED staff – Patient is masked – Asked to wait in wheelchair for ED staff If negative, form is given to patient or visitor

10. Levels of Isolation Level 1 ( Possible Ebola): – Airborne and Contact Isolation – Gown, gloves, N95 Level 2* (Probable Ebola): – Impermeable gown – 3 layers of gloves – N95 or PAPR hood – Face shield – Surgical hood – Boot covers *For patients with advanced disease including uncontrollable vomiting and diarrhea that cannot be contained use Tyvek suits with impervious apron and option of PAPR hood

11. If, at any time, a patient is deemed high risk for Ebola Virus, initiate Level II Isolation immediately.

12. Location of Care All patients will be cared for in ICU setting – Ideal location equipped with: Negative pressure room Sink outside door to patient room Anterooms no longer required or needed for negative air pressure rooms due to more efficient design. – Location isolated from other patients if possible – Locations may vary within hospitals. All PSL patients will be in room 15 in the ICU with dedicated equipment stored in room 14

13. Established Protocols for: Personal Protective Equipment ( PPE) donning and doffing Environmental cleaning Waste management Laboratory Specimen Transport Patient transport