Only three days after Mount Sinai Medical Center in Manhattan confirmed it had the capability to isolate a patient if someone presented with symptoms of the deadly Ebola virus, the hospital got its first test.
Staff received the call Aug. 4 that a 27-year-old man who had Ebola-like symptoms including high fever, diarrhea and severe headache, and recently returned from Sierra Leone, one of the West African countries where the virus was spreading was on his way to the ED.
The Centers for Disease Control and Prevention said symptoms may appear anywhere from two to 21 days after exposure. The virus had killed more than 2,900 people as of Oct. 1, according to the World Health Organization.
Mount Sinai staff nurse Margaret Kraus, MPH, RN, CDE, was a little nervous to say the least when she was told she would be the only nurse and the only staff member other than a physician who would care for the patient that shift. The patient came so quickly after the CDC issued directives on procedures that nurses hadnt had time to train.
Kraus had to get used to the astronaut-like Tyvek protective suit, which she had to put on and remove with great care. Coverage layers also trap body heat.
I drank four 16-ounce glasses of water down when I came out; I was so parched, Kraus said, noting heat makes it difficult to see because the protective goggles can fog up.
Nurses caring for a patient in isolation have to organize their thoughts and equipment, she said.
If you forget something, you just cant run out, get it and come back in again, Kraus said.
Even pen and paper are items that should be part of supplies already in the room, she said.
Cart, phone numbers should be readyNathaniel Bravo, RN
The patient was found not to have Ebola, but the case helped guide procedures, said Nathaniel Bravo, BSN, MSA, RN, CIC, assistant director for infection control at Mount Sinai.
Nurses, physicians and staff met after the event about improving procedures. Changes have included having a cart ready in the isolation area with supplies such as fluid-resistant gowns, shoe coverings, gloves with longer cuffs and bleach wipes.
Bravo said they also compiled a single sheet of phone numbers for key employees from all departments who needed to be notified, including clinicians, housekeeping and laboratory staff.
By mid-September, the hospital had only one other patient presenting with Ebola-like symptoms, but the virus was ruled out in that case, too. Bravo said the hospital gets updates and support from the city and state departments of health. Were not doing this in a vacuum, he said.
Janet Haas, PhD, RN, CIC, director of infection prevention and control at Westchester Medical Center, Valhalla, N.Y., said coordination efforts, including telephone conferences and webinars between the Greater New York Hospital Association, the CDC and New York State have been helping nurses stay on top of the latest information on the spread of the disease.
As hospitals form their plans, its important to consider extra staff needed to cover the care of the other patients in such an event and how to answer questions by both patients and staff who may be concerned about their own health, Haas said.
Westchester has a bioalert system initiated by a clinician who suspects a patient has Ebola. The system triggers an automated communication alert to leaders in specified departments.
ED registration clerks are trained to first ask whether a person has traveled to West Africa in the last three weeks. If so, the person is given a mask and goes right to triage rather than sitting in a waiting room, Haas said.
Lets be overcautiousDonna Armellino, RN
Donna Armellino, DNP, RN, CIC, vice president of infection prevention at North Shore-LIJ Health System in New Hyde Park, N.Y., said the health system gets calls each week reporting fever and travel history to West Africa.
But only two patients had been isolated as of last month, and neither had the virus.
I probably get a call once every other day where a patient enters the [ED] and they have travel history and fever, she said. If ED patients have traveled to specified countries and have symptoms, they get a mask and nurses immediately move them to isolation, she said.
Once a patient gets there, we would do further investigation with infectious disease as well as infection control to see if theres risk, Armellino said.
Nurse training has included educational meetings with nursing, physician staff, ancillary staff and lab personnel. Nurses have made sure that when they label specimens, they are hand-delivered to the lab and it is clear it is a rule-out Ebola specimen so lab staff can examine the specimens under a bio-safety hood.
Nurses practiced taking protective garments on and off to eliminate contaminating themselves.
Armellino is working with the informatics team to see whether the electronic health record system can build an alert system when patient symptoms and travel history meet Ebola criteria.
The training builds on nurses previous knowledge and work for handling Middle East Respiratory Syndrome and H1N1, Armellino said. But because of the rapid spread and mortality rate, anxiety is heightened for Ebola.
Armellino said her guiding principle is: Lets be overcautious and immediately isolate, and then well get the details.
Marcia Frellick is a freelance writer.