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NETEC Webinar Series
Lab Samples and Suspect Cases:
How to Handle, Package, and Ship
Specimens from High-risk Patients
�Content Outline (TOC)
Welcome
Jill Morgan, RN, BSN
�Overview
Welcome:
Jill Morgan, RN, BSN
What is a Person Under Investigation (PUI)?
Jill Morgan, RN, BSN
Classification of PUI Specimens for Shipping
“Suspected” Category A versus Category A
Category A Packaging
Category A Couriers and Carriers
PUI Shipping Plan Considerations
Questions and Answers with NETEC
NETEC Resources: Jill Morgan, RN, BSN
Robert Nickla, RBP, CBSP(ABSA), QLS, M(ASCP)
Karen Stiles, SM(ASCP)CM
�NETEC Mission
NETEC sets and advances the gold standard for special
pathogen preparedness and response across health
care delivery systems with the goals of driving best
practices, closing knowledge gaps, and developing
innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
What is a
Person Under Investigation (PUI)?
Jill Morgan, RN, BSN
�What is a Person Under Investigation (PUI)?
Term that can vary between states, health departments,
healthcare systems and individual facilities
Typically defined as a person who is being monitored, investigated,
or suspected to be infected with a higher-consequence pathogen
• Examples: Ebola virus, measles, COVID-19/SARS-CoV-2, anthrax,
tuberculosis, monkeypox, etc.
üAny disease that has been determined / designated locally as
‘higher-risk’ or ‘higher-consequence’ and that is accompanied with
a response plan
�Arenaviridae
Filoviridae
Host = Bats?
Ebola, Marburg
Host = Rodents
Lassa
Junin, Machupo, Guanarito,
Sabia
VHFs
Zoonotic
Lipid enveloped RNA
r
Bunyaviridae
Host = Ticks, rodents, mosquitos
CCHF (Crimean-Congo Hemorrhagic Fever)
Junin, Machupo, Guanarito,
Sabia
Flaviviridae
Host = Ticks, mosquitos
Yellow Fever, Dengue
Kyanasur, Omsk
�Diagnosis
Symptoms
Disinfection
Treatment
Rapid testing available for some,
many require specimens to be
sent to the CDC
Prognosis
r
Fever
Headache
Nausea/vomiting
Diarrhea
Muscle/joint pain
Fatigue/malaise
Their lipid
envelope makes
these viruses
susceptible to
many cleaning
agents
Supportive care
May try some
antivirals
Some vaccines
but limited
Ranges from asymptomatic to
severe illness, organ failure, and
death
Transmission
Not all are known to be
transmissible person-to-person.
PPE differs
�Should we be screening all patients?
Identify
Symptoms may be vague and common, so early
identification of travel history or exposure risk is key.
While travel from Uganda is the current screening priority, building travel
screening into daily workflow can help identify many other infectious diseases
(norovirus, malaria, Yellow Fever) and can open up the opportunity to ask about
other potential exposures (pets, sick family members, high-risk contacts).
r
Isolate
Protect yourself and others by placing suspect patients into
private rooms when available and using the appropriate PPE for
the tasks at hand.
Not every Person Under Investigation (PUI) requires total body coverage
PPE. A risk assessment that includes what condition the patient is in and
what tasks HCW will perform can guide safe choices.
Inform
Know your internal stakeholders and public health partners; involve
them early for PPE, IPC, testing, treatment, and transfer options.
Transporting specimens and testing for Ebola and other special pathogens may
require consultation with public health, your public health lab, or the CDC.
Contact these partners early for assistance.
https://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.PDF
�https://www.mylifeelsewhere.com/country-size-comparison/uganda/united-states
r
https://www.cdc.gov/quarantine/interim-guidance-risk-assessment-ebola.html#box-1
�Initial Screening Questions
r
In the last 21 days, while in outbreak country:
1. Were you in the area where the outbreak is occurring (refer
to published map on CDC website)?
2. Did you have any contact with or were you around a person
sick with Ebola, or a person who was sick with or died of an
unknown sickness?
3. Did you have any exposure to blood or other body fluids?
4. Did you visit a health clinic or hospital?
5. Did you touch a dead body or attend a funeral?
https://www.cdc.gov/quarantine/interim-guidance-risk-assessment-ebola.html#box-1
Clinical testing: What can you offer?
What testing might help identify the patient/specimen?
POC, lab risk assessment?
�What is a Person Under Investigation (PUI)?
PUI Key Points
Must be prepared to promptly:
•
•
•
•
Identify
Isolate
Inform infection control, local public health agency
Initiate testing – may be asked to collect specimens
EMTALA - Ensure there is no delay in the care of these patients by being
prepared to test, manage, and treat alternative etiologies of febrile
illness (e.g., malaria in travelers) as clinically indicated.
�Content Outline (TOC)
Lab Samples and Suspect Cases:
How to Handle, Package, and Ship
Specimens from High-risk Patients
Presenter
Presenter
Robert Nickla, RBP, CBSP(ABSA), QLS, M(ASCP)
Karen Stiles, SM(ASCP)CM
�Classification of PUI Specimens for Shipping
PUI and Category A Specimens
“PUI” is an epidemiology and infection prevention term,
not a shipping classification term
Since PUIs typically refer to patients suspected to be infected with a
higher-consequence pathogen, their specimens therefore typically will
relate to pathogens and sample types that will be classified as
Category A for shipping purposes
• PUI specimens = usually classified as Category A
RN
�Classification of PUI Specimens for Shipping
PUI Specimens
PUI specimens will often need to be classified as a “Category A Infectious
Substance” or “Suspected Category A” for shipping purposes
• Can pose significant challenges for frontline facilities to maintain currently
trained staff and have Category A shipping materials on-hand
Classification will depend on several factors, such as:
• The specimen type (e.g., culture vs primary patient specimen)
• Test results from the specimen or patient
• Initial diagnostic testing, point of care level waived testing, confirmatory
testing
• Other knowledge about the patient (e.g., exposure history or recent travel)
and their related symptoms
RN
�Classification of PUI Specimens for Shipping
Division 6.2 Material
Division 6.2 infectious material is defined as hazardous material known, or
reasonably expected to contain a pathogen for shipping purposes.
A pathogen is a microorganism or other biological agent that can cause disease
in humans or animals when exposure to it occurs.
Pathogens are classified into organism risk groups, ranging from Risk Group 1
to Risk Group 4, based on hazard(s) posed.
• Helps shipper determine which pathogens should be classified as
Category A, Category B or exempt for shipping purposes.
RN
�Basis for the Classification of Biohazardous Agents by Risk Group (RG)
Risk Group 1
(RG1)
Agents that are not associated with disease in healthy adult humans
(e.g., Bacillus subtilis)
Risk Group 2
(RG2)
Agents that are associated with human disease which is rarely serious
and for which preventive or therapeutic interventions are often
available
(e.g., Salmonella, Norovirus, Pertussis, seasonal influenza)
“B à A”
Risk Group 3
(RG3)
Agents that are associated with serious or lethal human disease for
which preventive or therapeutic interventions may be available (high
individual risk but low community risk) (e.g., Tuberculosis, Brucella,
highly-pathogenic avian influenza)
Risk Group 4
(RG4)
Agents that are likely to cause serious or lethal human disease for
which preventive or therapeutic interventions are not usually
available (high individual risk and high community risk) (e.g., Ebola
virus)
RN
�Classification of PUI Specimens for Shipping
Division 6.2 Material
Division 6.2 hazardous material includes:
• Category B
• UN 3373 Biological Substance, Category B
• Category A
• UN2814 Category A, Infectious Substance Affecting Humans
• UN2900 Category A, Infectious Substance Affecting Animals Only
Category A organisms/substances (specimens)
pose a higher degree of risk than Category B
RN
�Classification of PUI Specimens for Shipping
Category A vs. Category B Classification
Determination of PUI Specimens
Will primarily depend on whether the suspected organism in the
specimen being sent for testing from the PUI with the corresponding
suspected disease is appearing on the Category A list or not
• DOT Category A List and Classification Resource:
• Transporting-Infectious-Substances-Safely.pdf (dot.gov)
• CDC Category A List and Classification Resource:
• https://www.cdc.gov/labtraining/docs/job_aids/packing_and_shipping
/Step_2_DOT_Job_Aid_508.pdf
RN
�Classification of PUI Specimens for Shipping
Category A Infectious Substances
UN2814 & UN2900
Category A Infectious Substances are capable of causing permanent
disability or life-threatening or fatal disease to otherwise healthy
humans or animals when exposure to it occurs.
An exposure occurs when an infectious substance is released
outside of its protective packaging, resulting in physical
contact with humans or animals.
“Category A“ wording does not appear on outer box
Only the wording “UN2814 Infectious Substance,
affecting humans” alerts the trained hazmat employee to the risk.
RN
�Classification of PUI Specimens for Shipping
Category A Specimens
Some pathogens listed on the Category A list without the word
“culture” or phrase “cultures only” after the pathogen name must
be classified as Category whether they are in a culture form or not
(e.g., primary patient specimen like blood or stool)
• For example, both a patient specimen and a culture of
suspected or confirmed Ebola virus would need to be classified
as Category A
RN
�Category A Specimens
When Category A specimen
is in culture form only
When Category A specimen
is in the form of a culture or
patient specimen
RN
�Examples of Category A UN2814 Infectious Substances Affecting Humans
• Bacillus anthracis cultures
• Francisella tularensis cultures
• Monkeypox virus
• Brucella abortus cultures
• Guanarito virus
• Mycobacterium tuberculosis cultures
• Brucella melitensis cultures
• Hantann virus
• Nipah virus
• Burkholderia mallei – Pseudomonas mallei –
Glanders cultures
• Hantaviruses causing hantavirus
pulmonary syndrome
• Omsk hemorrhagic fever virus
• Burkholderia pseudomelli – Pseudomonas
pseudomallei cultures
• Hendra virus
• Chlamydia psittaci – avian strain cultures
• Clostridium botulinum cultures
• Coccidioides immitis cultures
• Hepatitis B cultures
• Herpes B virus cultures
• Human immunodeficiency virus cultures
• Poliovirus cultures
• Rabies virus culture
• Rickettsia prowazekii cultures
• Rickettsia rickettsia cultures
• Rift Valley fever virus
• Coxiella burnetii cultures
• Highly pathogenic avian influenza virus
cultures
• Crimean-Congo hemorrhagic fever virus
• Japanese Encephalitis virus cultures
• Sabia virus
• Dengue virus cultures
• Junin virus
• Shigella dysenteriae type 1 cultures
• Eastern equine encephalitis virus cultures
• Kyasanur Forest disease virus
• Tick-borne encephalitis virus cultures
• Escherichia coli, verotoxigenic cultures
• Lassa virus
• Variola virus
• Ebola virus
• Machupo virus
• Venezuelan equine encephalitis virus
• Flexal virus
• Marburg virus
• West Nile virus cultures
• Russian spring-summer encephalitis virus
• Yellow Fever virus cultures
• Yersinia pestis cultures
RN
�HHS and USDA Select Agents
7 CFR Part 331, 9 CFR Part 121, and 42 CFR Part 73
www.selectagents.gov
RN
�“Suspected” Category A versus Category A
Select Agent Shipping
Confirmed Select Biological Agents & Toxins must be packaged
and shipped as Category A
Consult CDC/APHIS Select Agent list and required “Form 2”
www.selectagents.gov
à “Suspect Category A”
NOTE:
A PUI specimen would not be considered
a ‘confirmed’ select agent at the time it is being sent to a reference lab for diagnostic testing
RN
�“Suspected” Category A versus Category A
UN2814 Category A
Proper Shipping Names:
• UN2814 Infectious Substance, Affecting Humans
(technical name of organism)
• UN2814 Infectious Substance, Affecting Humans
(suspected technical name of organism)
• UN2814 Infectious Substance, Affecting Humans
(suspected Category A Infectious Substance)
Substances capable of causing disease in humans
or in both humans and animals
RN
�“Suspected” Category A versus Category A
Classifying as Category A
Regarding judgment: “Assignment to UN2814 or UN 2900 must be based on the
known medical history and symptoms of the source human or animal, endemic
local conditions, or professional judgment concerning individual circumstances of
the source human or animal.”
“...infectious substances...which do not appear in the table (Category A list) but
which meet the same criteria must be assigned to Category A.”
“...if there is doubt as to whether or not a substance meets the criteria [of Category
A] it must be included in Category A.”
Classification must be based on professional judgment concerning the
individual circumstances of the source
*CDC, WHO or DOT may provide timely guidance
for proper classification of emerging pathogens
RN
�“Suspected” Category A versus Category A
When an infectious substance to be shipped is unknown, but suspected of meeting
the criteria for inclusion in Category A and assignment to UN2814 or UN2900, the
words “Suspected Category A Infectious Substance” may be shown in parenthesis
as the technical name of the organism on the shipper’s declaration
UN2814, Infectious Substance, Affecting Humans
(Suspected Category A Infectious Substance)
All Category A requirements (e.g., packaging, labeling, marking, emergency
response, etc.) will apply regardless if the specimen and package are being
classified as ‘Category A’ or ‘Suspected Category A’
• Same UN certified triple package container, with the only difference being the
choice of the “proper shipping name” and using the term ‘suspected’
RN
�“Suspected” Category A versus Category A
PUI Specimen Classification Summary
Shippers must use professional judgement to classify all specimens
Classification will depend on specimen type
• Culture form vs. primary patient specimen (e.g., blood)
Will also depend on the level of information at the time of transport
• What is known about the patient and/or specimen and individual
circumstances of the source (e.g., travel history, exposure potential,
patient symptoms consistent with suspected disease)
• What level of rule-out testing, differential testing, point of care testing, or
diagnostic reference laboratory confirmatory testing has been performed
RN
�Category A Packaging
Packaging Infectious Materials
Potentially infectious materials must be packaged to withstand
content leakage, shocks, temperature changes, pressure changes
and other conditions that can occur during the rigors of transport.
Typically, only purchased from reputable manufactures.
All infectious materials must be tripled packaged.
Category A has stricter packing requirements then Category B.
KS
�Category A and Category B Packaging
KS
�Training Requirements of a Shipper
• General awareness/familiarization*
• Function-specific
(Classification, packaging, documentation)
• Safety
(e.g., bloodborne pathogen training; emergency response)
r
• Security awareness
(In-depth facility training, if required)
• In-depth security training
Certification from Employer (49 CFR 172 Subpart H)
• Employer certifies employee
• Employer required to maintain competency
program in Packaging & Shipping
KS
�Category A Packaging
Basic Triple Packaging System
• Must be used for all infectious substances
• Consists of three layers as follows:
• Primary container
Primary & Secondary packaging begins in the patient isolation room requires
• Secondary packaging
multiple disinfection steps. Only after handoff to clean side does final
• Outer/tertiary packaging packaging occur. Ideally, outer packaging completed immediately outside
room to minimize transport through hospital. Courier could pick up
immediately from this point. Other option to transport to lab for re-packaging.
Completed package is marked, labeled and accompanied with all appropriate
shipping documents
Category A must be in a UN certified package using
only manufacturer provided components
KS
�Triple Pack Example
üPrimary Container
üSecondary Container
üTertiary Container
KS
�Packing Instructions (PI) 620 Overview
Category A Infectious Substances
Shipments must be prepared so they arrive in good condition and pose no hazard to humans or
animals during transport
Packages must be UN certified and bear UN markings
Triple packaging consisting of leak proof primary receptacle, leak-proof secondary packaging
and an outer packaging of sufficient strength to meet the design test types (9-meter drop test,
puncture test)
Primary or secondary container capable of withstanding a 95Kpa internal pressure differential
when shipped by air
If multiple fragile primary receptacles are placed in a single secondary packaging, they must be
either individually wrapped or separated to prevent contact between them
Absorbent material sufficient to absorb the entire contents of hazmat, and cushioning material
as needed
Itemized list of contents must be included between the secondary and outer packaging
Name and number of the responsible person must appear on the outer package
Class 6 Infectious Substance label, and either UN2814 or UN2900 hazard identification label
present on outer package
Minimum dimension of labels 10cm x 10cm
KS
�The UN Marking System
4G/Class 6.2/06
USA/0000
Required for all
Category A shipments
•
•
•
•
•
•
•
UN encircled – United Nations symbol
4 – Box
G – Fiberboard
Class 6.2 – Infectious Substance Package
06 – Year of manufacture
USA – Manufacture country
0000- Test Facility’s / manufacturer’s code
KS
�Category A Packaging
Packing Tests
• Leakproof Test
• Stacking Test
• Vibration Test
• Wet Drop Test
• Cold Drop Test
• Impact Test
• Puncture-Resistant Test
• Temperature Test
• Absorbency Test
• Watertight Test
KS
�Category A (PI 620) Ambient Example
Additional specimen transport bag
(with biohazard symbol) not shown,
but highly recommended
KS
�Category A Packaging
• Must be triple packaged in accordance with PI 620 and DOT 49 CFR 173.196
• Must be UN certified package
• A UN certified package is the entire box/unit/system
(the outer package and the inner containers)
• The maximum allowable quantity on passenger aircraft is 50mL or 50g, and 4L or
4kg maximum quantity when shipped by air in one package in Cargo only. Must
include Cargo only handling label (may not need to mention??)
�Category A Packaging
Category A Labeling & Marking
Class 6 Infectious Substance Label
UN2814 or UN2900
Shipper & recipient’s full name, complete address
and phone number
Emergency Response Information
• Responsible person (name & number)
• 24-hour emergency contact
�Category A Packaging
Responsible Person
Can be either the shipper or the recipient
Name and phone number must be listed on the outside of Category A
and B packages
Must be listed on air waybills and Shipper’s Declaration forms when
required
NOT the same as a 24-hour emergency number, however, the person
responsible for the package must be knowledgeable about the
material being shipped
�Category A Packaging
24-Hour Emergency Contact
Must be listed on the Shipper’s Declaration form (for air transport) in
the designated space provided, or on the Shipping Papers (for ground
transport)
• 49 CFR Part 172.604
Must be the number of someone who is:
• Available the entire time the material is in transit
• Knowledgeable of the material being transported
• And has comprehensive emergency response mitigation
information for the material
• Live person, NOT an answering machine
• Third party company contracted to serve as Emergency Contact
KS
�Category A Couriers and Carriers
Air vs. Ground Transport
There are differences in packing requirements when shipping
infectious material by air vs. ground
Following the stricter IATA requirements for air transport will
generally help the shipper comply with all DOT Hazardous Material
requirements for ground transport
Need to know where your intended reference laboratory is for
where you would be sending PUI specimens!!
• Will help determine if you’ll be shipping by ground or air
KS
�Couriers and Carriers
Category B
• Several common
commercial carriers, such
as: USPS, UPS, FedEx,
Airborne Express, DHL
• Private Couriers
Category A
• Currently FedEx and UPS are the only
common commercial carriers that will
accept and ship Category A
• Private Couriers
• Dangerous Goods Shipper’s Declaration
required for air transport, or “Shipping
Papers” required for ground
Make sure you choose a trained, reputable and reliable
courier that is able to safely transport your shipment
�Category A Couriers and Carriers
If you are offering (providing) a hazardous material to a courier or carrier for
transport, they must be aware of the material
• Typically satisfied with the labelling and marking on the outer box and
with the accompanying paperwork
Transporter must be trained according to their intended functions
• Hazardous material recognition / hazard communication
• Incident response (e.g., responding to a leak or spill)
• Incident reporting for leaks or spills during transport
üCouriers = Typically smaller scale or quantity of shipments
üCarriers =Typically larger scale or quantity of shipments
KS
�Vetting Process for Specimen Couriers
Ensures that operating couriers demonstrate ability to comply with applicable
statutes and regulations.
Commercial intrastate hazardous materials carriers who haul types and quantities
requiring a safety permit must register for a USDOT Number.
MUST carry appropriate liability insurance for Hazmat Couriers ~ Category A
Degree to which existing or past violation exist
Hazardous material recognition / hazard communication – must recognize
difference between Category A vs Category B
Incident response (e.g., responding to a leak or spill)
Incident reporting for leaks or spills during transport
Be aware that some couriers and carriers may have their own specific requirements
E.g., FedEx not accepting risk group 4 pathogens
�Category A Couriers and Carriers
Category A Incidents
ALL incidents during transportation involving fire, breakage,
spillage, or suspected contamination involving a Category A
infectious substance must be reported by telephoning the
National Response Center at 1-800-424-8802 within 12 hours
KS
�Category A Couriers and Carriers
Shipping Exceptions to DOT Regulations
DURING PUBLIC HEALTH EMERGENCIES, LAW ENFORCEMENT AGENTS OR OTHER
DESIGNATED STATE OFFICIALS WITH IDENTIFICATION MAY DELIVER SPECIMENS
APPROVED BY THE DHHS AS FOUND IN THE 49CFR CODE 171.1 d(5-6):
Transportation of a hazardous material by a Federal, state, or local government
employee solely for noncommercial Federal, state, or local government
purposes.
Under these circumstances, hospitals may be exempt from using the “official”
shipping regulations, including training. Permission for exemption must be granted
by state officials.
Triple package required for safety reasons.
RN, KS
�PUI Shipping Plan Considerations
PUI Transport Plan Considerations
If your facility may encounter a PUI and need to ship a specimen…
• Obtain approval State/CDC EOC prior to collection
• Develop a plan for high-risk / high-consequence specimen shipping
• Ensure it is reviewed and tested appropriately with all interested parties
• Ensure an appropriate reference laboratory has been identified
• E.g., State Public Health Laboratory / Laboratory Response Network (LRN)
Reference Laboratory
• Commercial Reference Labs will NOT accept specimens from PUI for any
type of testing.
RN, KS
�PUI Shipping Plan Considerations
PUI Transport Plan Considerations
Have Category A shipping materials / supplies on-hand
Have an adequate number of staff currently trained and effectively exercised to
ship Category A specimens
Have an intended courier or carrier, and a backup if necessary
• Ensure their capabilities for Category A transport
Ensure proper communication
• Internally with key members of your facility
• With state and/or local health departments
• With couriers/carriers
• With recipient laboratory
• Have an intended ‘Responsible Person’ and 24-hour emergency contact
RN, KS
�Content Outline (TOC)
Resources
�NETEC Resources
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
https://repository.netecweb.org/files/original/9df43f2b1f9a06ff469f9df641468e57.pdf
1f65aae5f7bea44b032e2b9be29a3038
PDF Text
Text
NETEC Webinar Series
Lab Samples and Suspect Cases:
How to Handle, Package, and Ship
Specimens from High-risk Patients
�Content Outline (TOC)
Welcome
Jill Morgan, RN, BSN
�Overview
Welcome:
Jill Morgan, RN, BSN
What is a Person Under Investigation (PUI)?
Jill Morgan, RN, BSN
Classification of PUI Specimens for Shipping
“Suspected” Category A versus Category A
Category A Packaging
Category A Couriers and Carriers
PUI Shipping Plan Considerations
Questions and Answers with NETEC
NETEC Resources: Jill Morgan, RN, BSN
Robert Nickla, RBP, CBSP(ABSA), QLS, M(ASCP)
Karen Stiles, SM(ASCP)CM
�NETEC Mission
NETEC sets and advances the gold standard for special
pathogen preparedness and response across health
care delivery systems with the goals of driving best
practices, closing knowledge gaps, and developing
innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
What is a
Person Under Investigation (PUI)?
Jill Morgan, RN, BSN
�What is a Person Under Investigation (PUI)?
Term that can vary between states, health departments,
healthcare systems and individual facilities
Typically defined as a person who is being monitored, investigated,
or suspected to be infected with a higher-consequence pathogen
• Examples: Ebola virus, measles, COVID-19/SARS-CoV-2, anthrax,
tuberculosis, monkeypox, etc.
üAny disease that has been determined / designated locally as
‘higher-risk’ or ‘higher-consequence’ and that is accompanied with
a response plan
�Arenaviridae
Filoviridae
Host = Bats?
Ebola, Marburg
Host = Rodents
Lassa
Junin, Machupo, Guanarito,
Sabia
VHFs
Zoonotic
Lipid enveloped RNA
r
Bunyaviridae
Host = Ticks, rodents, mosquitos
CCHF (Crimean-Congo Hemorrhagic Fever)
Junin, Machupo, Guanarito,
Sabia
Flaviviridae
Host = Ticks, mosquitos
Yellow Fever, Dengue
Kyanasur, Omsk
�Diagnosis
Symptoms
Disinfection
Treatment
Rapid testing available for some,
many require specimens to be
sent to the CDC
Prognosis
r
Fever
Headache
Nausea/vomiting
Diarrhea
Muscle/joint pain
Fatigue/malaise
Their lipid
envelope makes
these viruses
susceptible to
many cleaning
agents
Supportive care
May try some
antivirals
Some vaccines
but limited
Ranges from asymptomatic to
severe illness, organ failure, and
death
Transmission
Not all are known to be
transmissible person-to-person.
PPE differs
�Should we be screening all patients?
Identify
Symptoms may be vague and common, so early
identification of travel history or exposure risk is key.
While travel from Uganda is the current screening priority, building travel
screening into daily workflow can help identify many other infectious diseases
(norovirus, malaria, Yellow Fever) and can open up the opportunity to ask about
other potential exposures (pets, sick family members, high-risk contacts).
r
Isolate
Protect yourself and others by placing suspect patients into
private rooms when available and using the appropriate PPE for
the tasks at hand.
Not every Person Under Investigation (PUI) requires total body coverage
PPE. A risk assessment that includes what condition the patient is in and
what tasks HCW will perform can guide safe choices.
Inform
Know your internal stakeholders and public health partners; involve
them early for PPE, IPC, testing, treatment, and transfer options.
Transporting specimens and testing for Ebola and other special pathogens may
require consultation with public health, your public health lab, or the CDC.
Contact these partners early for assistance.
https://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.PDF
�https://www.mylifeelsewhere.com/country-size-comparison/uganda/united-states
r
https://www.cdc.gov/quarantine/interim-guidance-risk-assessment-ebola.html#box-1
�Initial Screening Questions
r
In the last 21 days, while in outbreak country:
1. Were you in the area where the outbreak is occurring (refer
to published map on CDC website)?
2. Did you have any contact with or were you around a person
sick with Ebola, or a person who was sick with or died of an
unknown sickness?
3. Did you have any exposure to blood or other body fluids?
4. Did you visit a health clinic or hospital?
5. Did you touch a dead body or attend a funeral?
https://www.cdc.gov/quarantine/interim-guidance-risk-assessment-ebola.html#box-1
Clinical testing: What can you offer?
What testing might help identify the patient/specimen?
POC, lab risk assessment?
�What is a Person Under Investigation (PUI)?
PUI Key Points
Must be prepared to promptly:
•
•
•
•
Identify
Isolate
Inform infection control, local public health agency
Initiate testing – may be asked to collect specimens
EMTALA - Ensure there is no delay in the care of these patients by being
prepared to test, manage, and treat alternative etiologies of febrile
illness (e.g., malaria in travelers) as clinically indicated.
�Content Outline (TOC)
Lab Samples and Suspect Cases:
How to Handle, Package, and Ship
Specimens from High-risk Patients
Presenter
Presenter
Robert Nickla, RBP, CBSP(ABSA), QLS, M(ASCP)
Karen Stiles, SM(ASCP)CM
�Classification of PUI Specimens for Shipping
PUI and Category A Specimens
“PUI” is an epidemiology and infection prevention term,
not a shipping classification term
Since PUIs typically refer to patients suspected to be infected with a
higher-consequence pathogen, their specimens therefore typically will
relate to pathogens and sample types that will be classified as
Category A for shipping purposes
• PUI specimens = usually classified as Category A
RN
�Classification of PUI Specimens for Shipping
PUI Specimens
PUI specimens will often need to be classified as a “Category A Infectious
Substance” or “Suspected Category A” for shipping purposes
• Can pose significant challenges for frontline facilities to maintain currently
trained staff and have Category A shipping materials on-hand
Classification will depend on several factors, such as:
• The specimen type (e.g., culture vs primary patient specimen)
• Test results from the specimen or patient
• Initial diagnostic testing, point of care level waived testing, confirmatory
testing
• Other knowledge about the patient (e.g., exposure history or recent travel)
and their related symptoms
RN
�Classification of PUI Specimens for Shipping
Division 6.2 Material
Division 6.2 infectious material is defined as hazardous material known, or
reasonably expected to contain a pathogen for shipping purposes.
A pathogen is a microorganism or other biological agent that can cause disease
in humans or animals when exposure to it occurs.
Pathogens are classified into organism risk groups, ranging from Risk Group 1
to Risk Group 4, based on hazard(s) posed.
• Helps shipper determine which pathogens should be classified as
Category A, Category B or exempt for shipping purposes.
RN
�Basis for the Classification of Biohazardous Agents by Risk Group (RG)
Risk Group 1
(RG1)
Agents that are not associated with disease in healthy adult humans
(e.g., Bacillus subtilis)
Risk Group 2
(RG2)
Agents that are associated with human disease which is rarely serious
and for which preventive or therapeutic interventions are often
available
(e.g., Salmonella, Norovirus, Pertussis, seasonal influenza)
“B à A”
Risk Group 3
(RG3)
Agents that are associated with serious or lethal human disease for
which preventive or therapeutic interventions may be available (high
individual risk but low community risk) (e.g., Tuberculosis, Brucella,
highly-pathogenic avian influenza)
Risk Group 4
(RG4)
Agents that are likely to cause serious or lethal human disease for
which preventive or therapeutic interventions are not usually
available (high individual risk and high community risk) (e.g., Ebola
virus)
RN
�Classification of PUI Specimens for Shipping
Division 6.2 Material
Division 6.2 hazardous material includes:
• Category B
• UN 3373 Biological Substance, Category B
• Category A
• UN2814 Category A, Infectious Substance Affecting Humans
• UN2900 Category A, Infectious Substance Affecting Animals Only
Category A organisms/substances (specimens)
pose a higher degree of risk than Category B
RN
�Classification of PUI Specimens for Shipping
Category A vs. Category B Classification
Determination of PUI Specimens
Will primarily depend on whether the suspected organism in the
specimen being sent for testing from the PUI with the corresponding
suspected disease is appearing on the Category A list or not
• DOT Category A List and Classification Resource:
• Transporting-Infectious-Substances-Safely.pdf (dot.gov)
• CDC Category A List and Classification Resource:
• https://www.cdc.gov/labtraining/docs/job_aids/packing_and_shipping
/Step_2_DOT_Job_Aid_508.pdf
RN
�Classification of PUI Specimens for Shipping
Category A Infectious Substances
UN2814 & UN2900
Category A Infectious Substances are capable of causing permanent
disability or life-threatening or fatal disease to otherwise healthy
humans or animals when exposure to it occurs.
An exposure occurs when an infectious substance is released
outside of its protective packaging, resulting in physical
contact with humans or animals.
“Category A“ wording does not appear on outer box
Only the wording “UN2814 Infectious Substance,
affecting humans” alerts the trained hazmat employee to the risk.
RN
�Classification of PUI Specimens for Shipping
Category A Specimens
Some pathogens listed on the Category A list without the word
“culture” or phrase “cultures only” after the pathogen name must
be classified as Category whether they are in a culture form or not
(e.g., primary patient specimen like blood or stool)
• For example, both a patient specimen and a culture of
suspected or confirmed Ebola virus would need to be classified
as Category A
RN
�Category A Specimens
When Category A specimen
is in culture form only
When Category A specimen
is in the form of a culture or
patient specimen
RN
�Examples of Category A UN2814 Infectious Substances Affecting Humans
• Bacillus anthracis cultures
• Francisella tularensis cultures
• Monkeypox virus
• Brucella abortus cultures
• Guanarito virus
• Mycobacterium tuberculosis cultures
• Brucella melitensis cultures
• Hantann virus
• Nipah virus
• Burkholderia mallei – Pseudomonas mallei –
Glanders cultures
• Hantaviruses causing hantavirus
pulmonary syndrome
• Omsk hemorrhagic fever virus
• Burkholderia pseudomelli – Pseudomonas
pseudomallei cultures
• Hendra virus
• Chlamydia psittaci – avian strain cultures
• Clostridium botulinum cultures
• Coccidioides immitis cultures
• Hepatitis B cultures
• Herpes B virus cultures
• Human immunodeficiency virus cultures
• Poliovirus cultures
• Rabies virus culture
• Rickettsia prowazekii cultures
• Rickettsia rickettsia cultures
• Rift Valley fever virus
• Coxiella burnetii cultures
• Highly pathogenic avian influenza virus
cultures
• Crimean-Congo hemorrhagic fever virus
• Japanese Encephalitis virus cultures
• Sabia virus
• Dengue virus cultures
• Junin virus
• Shigella dysenteriae type 1 cultures
• Eastern equine encephalitis virus cultures
• Kyasanur Forest disease virus
• Tick-borne encephalitis virus cultures
• Escherichia coli, verotoxigenic cultures
• Lassa virus
• Variola virus
• Ebola virus
• Machupo virus
• Venezuelan equine encephalitis virus
• Flexal virus
• Marburg virus
• West Nile virus cultures
• Russian spring-summer encephalitis virus
• Yellow Fever virus cultures
• Yersinia pestis cultures
RN
�HHS and USDA Select Agents
7 CFR Part 331, 9 CFR Part 121, and 42 CFR Part 73
www.selectagents.gov
RN
�“Suspected” Category A versus Category A
Select Agent Shipping
Confirmed Select Biological Agents & Toxins must be packaged
and shipped as Category A
Consult CDC/APHIS Select Agent list and required “Form 2”
www.selectagents.gov
à “Suspect Category A”
NOTE:
A PUI specimen would not be considered
a ‘confirmed’ select agent at the time it is being sent to a reference lab for diagnostic testing
RN
�“Suspected” Category A versus Category A
UN2814 Category A
Proper Shipping Names:
• UN2814 Infectious Substance, Affecting Humans
(technical name of organism)
• UN2814 Infectious Substance, Affecting Humans
(suspected technical name of organism)
• UN2814 Infectious Substance, Affecting Humans
(suspected Category A Infectious Substance)
Substances capable of causing disease in humans
or in both humans and animals
RN
�“Suspected” Category A versus Category A
Classifying as Category A
Regarding judgment: “Assignment to UN2814 or UN 2900 must be based on the
known medical history and symptoms of the source human or animal, endemic
local conditions, or professional judgment concerning individual circumstances of
the source human or animal.”
“...infectious substances...which do not appear in the table (Category A list) but
which meet the same criteria must be assigned to Category A.”
“...if there is doubt as to whether or not a substance meets the criteria [of Category
A] it must be included in Category A.”
Classification must be based on professional judgment concerning the
individual circumstances of the source
*CDC, WHO or DOT may provide timely guidance
for proper classification of emerging pathogens
RN
�“Suspected” Category A versus Category A
When an infectious substance to be shipped is unknown, but suspected of meeting
the criteria for inclusion in Category A and assignment to UN2814 or UN2900, the
words “Suspected Category A Infectious Substance” may be shown in parenthesis
as the technical name of the organism on the shipper’s declaration
UN2814, Infectious Substance, Affecting Humans
(Suspected Category A Infectious Substance)
All Category A requirements (e.g., packaging, labeling, marking, emergency
response, etc.) will apply regardless if the specimen and package are being
classified as ‘Category A’ or ‘Suspected Category A’
• Same UN certified triple package container, with the only difference being the
choice of the “proper shipping name” and using the term ‘suspected’
RN
�“Suspected” Category A versus Category A
PUI Specimen Classification Summary
Shippers must use professional judgement to classify all specimens
Classification will depend on specimen type
• Culture form vs. primary patient specimen (e.g., blood)
Will also depend on the level of information at the time of transport
• What is known about the patient and/or specimen and individual
circumstances of the source (e.g., travel history, exposure potential,
patient symptoms consistent with suspected disease)
• What level of rule-out testing, differential testing, point of care testing, or
diagnostic reference laboratory confirmatory testing has been performed
RN
�Category A Packaging
Packaging Infectious Materials
Potentially infectious materials must be packaged to withstand
content leakage, shocks, temperature changes, pressure changes
and other conditions that can occur during the rigors of transport.
Typically, only purchased from reputable manufactures.
All infectious materials must be tripled packaged.
Category A has stricter packing requirements then Category B.
KS
�Category A and Category B Packaging
KS
�Training Requirements of a Shipper
• General awareness/familiarization*
• Function-specific
(Classification, packaging, documentation)
• Safety
(e.g., bloodborne pathogen training; emergency response)
r
• Security awareness
(In-depth facility training, if required)
• In-depth security training
Certification from Employer (49 CFR 172 Subpart H)
• Employer certifies employee
• Employer required to maintain competency
program in Packaging & Shipping
KS
�Category A Packaging
Basic Triple Packaging System
• Must be used for all infectious substances
• Consists of three layers as follows:
• Primary container
Primary & Secondary packaging begins in the patient isolation room requires
• Secondary packaging
multiple disinfection steps. Only after handoff to clean side does final
• Outer/tertiary packaging packaging occur. Ideally, outer packaging completed immediately outside
room to minimize transport through hospital. Courier could pick up
immediately from this point. Other option to transport to lab for re-packaging.
Completed package is marked, labeled and accompanied with all appropriate
shipping documents
Category A must be in a UN certified package using
only manufacturer provided components
KS
�Triple Pack Example
üPrimary Container
üSecondary Container
üTertiary Container
KS
�Packing Instructions (PI) 620 Overview
Category A Infectious Substances
Shipments must be prepared so they arrive in good condition and pose no hazard to humans or
animals during transport
Packages must be UN certified and bear UN markings
Triple packaging consisting of leak proof primary receptacle, leak-proof secondary packaging
and an outer packaging of sufficient strength to meet the design test types (9-meter drop test,
puncture test)
Primary or secondary container capable of withstanding a 95Kpa internal pressure differential
when shipped by air
If multiple fragile primary receptacles are placed in a single secondary packaging, they must be
either individually wrapped or separated to prevent contact between them
Absorbent material sufficient to absorb the entire contents of hazmat, and cushioning material
as needed
Itemized list of contents must be included between the secondary and outer packaging
Name and number of the responsible person must appear on the outer package
Class 6 Infectious Substance label, and either UN2814 or UN2900 hazard identification label
present on outer package
Minimum dimension of labels 10cm x 10cm
KS
�The UN Marking System
4G/Class 6.2/06
USA/0000
Required for all
Category A shipments
•
•
•
•
•
•
•
UN encircled – United Nations symbol
4 – Box
G – Fiberboard
Class 6.2 – Infectious Substance Package
06 – Year of manufacture
USA – Manufacture country
0000- Test Facility’s / manufacturer’s code
KS
�Category A Packaging
Packing Tests
• Leakproof Test
• Stacking Test
• Vibration Test
• Wet Drop Test
• Cold Drop Test
• Impact Test
• Puncture-Resistant Test
• Temperature Test
• Absorbency Test
• Watertight Test
KS
�Category A (PI 620) Ambient Example
Additional specimen transport bag
(with biohazard symbol) not shown,
but highly recommended
KS
�Category A Packaging
• Must be triple packaged in accordance with PI 620 and DOT 49 CFR 173.196
• Must be UN certified package
• A UN certified package is the entire box/unit/system
(the outer package and the inner containers)
• The maximum allowable quantity on passenger aircraft is 50mL or 50g, and 4L or
4kg maximum quantity when shipped by air in one package in Cargo only. Must
include Cargo only handling label (may not need to mention??)
�Category A Packaging
Category A Labeling & Marking
Class 6 Infectious Substance Label
UN2814 or UN2900
Shipper & recipient’s full name, complete address
and phone number
Emergency Response Information
• Responsible person (name & number)
• 24-hour emergency contact
�Category A Packaging
Responsible Person
Can be either the shipper or the recipient
Name and phone number must be listed on the outside of Category A
and B packages
Must be listed on air waybills and Shipper’s Declaration forms when
required
NOT the same as a 24-hour emergency number, however, the person
responsible for the package must be knowledgeable about the
material being shipped
�Category A Packaging
24-Hour Emergency Contact
Must be listed on the Shipper’s Declaration form (for air transport) in
the designated space provided, or on the Shipping Papers (for ground
transport)
• 49 CFR Part 172.604
Must be the number of someone who is:
• Available the entire time the material is in transit
• Knowledgeable of the material being transported
• And has comprehensive emergency response mitigation
information for the material
• Live person, NOT an answering machine
• Third party company contracted to serve as Emergency Contact
KS
�Category A Couriers and Carriers
Air vs. Ground Transport
There are differences in packing requirements when shipping
infectious material by air vs. ground
Following the stricter IATA requirements for air transport will
generally help the shipper comply with all DOT Hazardous Material
requirements for ground transport
Need to know where your intended reference laboratory is for
where you would be sending PUI specimens!!
• Will help determine if you’ll be shipping by ground or air
KS
�Couriers and Carriers
Category B
• Several common
commercial carriers, such
as: USPS, UPS, FedEx,
Airborne Express, DHL
• Private Couriers
Category A
• Currently FedEx and UPS are the only
common commercial carriers that will
accept and ship Category A
• Private Couriers
• Dangerous Goods Shipper’s Declaration
required for air transport, or “Shipping
Papers” required for ground
Make sure you choose a trained, reputable and reliable
courier that is able to safely transport your shipment
�Category A Couriers and Carriers
If you are offering (providing) a hazardous material to a courier or carrier for
transport, they must be aware of the material
• Typically satisfied with the labelling and marking on the outer box and
with the accompanying paperwork
Transporter must be trained according to their intended functions
• Hazardous material recognition / hazard communication
• Incident response (e.g., responding to a leak or spill)
• Incident reporting for leaks or spills during transport
üCouriers = Typically smaller scale or quantity of shipments
üCarriers =Typically larger scale or quantity of shipments
KS
�Vetting Process for Specimen Couriers
Ensures that operating couriers demonstrate ability to comply with applicable
statutes and regulations.
Commercial intrastate hazardous materials carriers who haul types and quantities
requiring a safety permit must register for a USDOT Number.
MUST carry appropriate liability insurance for Hazmat Couriers ~ Category A
Degree to which existing or past violation exist
Hazardous material recognition / hazard communication – must recognize
difference between Category A vs Category B
Incident response (e.g., responding to a leak or spill)
Incident reporting for leaks or spills during transport
Be aware that some couriers and carriers may have their own specific requirements
E.g., FedEx not accepting risk group 4 pathogens
�Category A Couriers and Carriers
Category A Incidents
ALL incidents during transportation involving fire, breakage,
spillage, or suspected contamination involving a Category A
infectious substance must be reported by telephoning the
National Response Center at 1-800-424-8802 within 12 hours
KS
�Category A Couriers and Carriers
Shipping Exceptions to DOT Regulations
DURING PUBLIC HEALTH EMERGENCIES, LAW ENFORCEMENT AGENTS OR OTHER
DESIGNATED STATE OFFICIALS WITH IDENTIFICATION MAY DELIVER SPECIMENS
APPROVED BY THE DHHS AS FOUND IN THE 49CFR CODE 171.1 d(5-6):
Transportation of a hazardous material by a Federal, state, or local government
employee solely for noncommercial Federal, state, or local government
purposes.
Under these circumstances, hospitals may be exempt from using the “official”
shipping regulations, including training. Permission for exemption must be granted
by state officials.
Triple package required for safety reasons.
RN, KS
�PUI Shipping Plan Considerations
PUI Transport Plan Considerations
If your facility may encounter a PUI and need to ship a specimen…
• Obtain approval State/CDC EOC prior to collection
• Develop a plan for high-risk / high-consequence specimen shipping
• Ensure it is reviewed and tested appropriately with all interested parties
• Ensure an appropriate reference laboratory has been identified
• E.g., State Public Health Laboratory / Laboratory Response Network (LRN)
Reference Laboratory
• Commercial Reference Labs will NOT accept specimens from PUI for any
type of testing.
RN, KS
�PUI Shipping Plan Considerations
PUI Transport Plan Considerations
Have Category A shipping materials / supplies on-hand
Have an adequate number of staff currently trained and effectively exercised to
ship Category A specimens
Have an intended courier or carrier, and a backup if necessary
• Ensure their capabilities for Category A transport
Ensure proper communication
• Internally with key members of your facility
• With state and/or local health departments
• With couriers/carriers
• With recipient laboratory
• Have an intended ‘Responsible Person’ and 24-hour emergency contact
RN, KS
�Content Outline (TOC)
Resources
�NETEC Resources
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Nov 22, 2022 11:00 AM in Central Time (US and Canada)
Objectives
Define the term PUI (persons under investigation).<br />Describe how to classify PUI specimens for shipping purposes.<br />Describe key considerations of a frontline facility’s shipping plan and transport options for PUI specimens.<br /><br /><br />CONTINUING EDUCATION<br /><br />Continuing education credits will be provided for this activity. Participants will be asked to complete a post-webinar evaluation immediately following the webinar. We recommend accessing the webinar from a PC or Mac computer using the Chrome, Firefox, or Safari (Mac) web browser.
Event Type
Webinar, watch at link below.
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https://youtu.be/l2rgTw7929s
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<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/l2rgTw7929s" title="YouTube video player" frameborder="0"></iframe>
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Other URLs if necessary.
Go to CEU course: <a href="https://courses.netec.org/courses/lab-samples-and-suspect-cases" target="_blank" title="CEU course link" rel="noreferrer noopener">https://courses.netec.org/courses/lab-samples-and-suspect-cases</a>
Dublin Core
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NETEC Webinar Series (11/22/22)/Online Course: Lab Samples and Suspect Cases
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Lab Samples and Suspect Cases: How to handle, package, and ship specimens from high-risk patients<br /><br />This NETEC webinar will discuss frontline facility considerations for the packaging and shipping of specimens from high-risk patients. Topics include classifying specimens from persons under investigation and frontline facility shipping plans and transport options.<br /><br />PANELISTS<br /><br />Jill Morgan, RN, BSN<br />Site Manager, Serious Communicable Diseases Unit<br />Emory Healthcare<br /><br />Robert Nickla, CBSP, RBP(ABSA), QLS, M(ASCP)<br />Manager, Fellowship Program<br />Association of Public Health Laboratories<br /><br />Karen Stiles, SM(ASCP)^CM<br />State Training Coordinator<br />Nebraska Public Health Laboratory<br /><br />Webinar slides attached.<br /><br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/lab-samples-and-suspect-cases" target="_blank" title="CEU link" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
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NETEC
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-22
Type
The nature or genre of the resource
Webinar and Online Course
Frontline Facility
Laboratory
Online Course
Person Under Investigation (PUI)
R-Lab
Specimen Handling
Specimen Transport
Webinar
-
https://repository.netecweb.org/files/original/5465e51a135063fbc63f0a3c1a9f5290.png
6f083cca2e05b738a66e3cfdac4ce95a
https://repository.netecweb.org/files/original/eca789bac3c6f5807ec77562d70e9fc1.pdf
e7d805155946a10b842b5453a5e070a2
PDF Text
Text
NETEC Town Hall:
Preparing Frontline Health Care
Workers for Ebola
�Overview
Welcome:
Trish Tennill, RN, BSN
Current Sudan Ebolavirus Outbreak Overview:
Aneesh Mehta, MD
Infection Prevention & Control Considerations:
Trish Tennill, RN, BSN
Personal Protective Equipment Considerations:
Jill Morgan, RN, BSN
Laboratory Considerations for Frontline Hospitals:
EMS and Patient Transport Considerations:
Questions and Answers with NETEC
NETEC Resources:
Trish Tennill, RN, BSN
Vicki Herrera, MS
Alex Isakov, MD, MPH
�NETEC Mission
NETEC sets and advances the gold standard for special
pathogen preparedness and response across health
care delivery systems with the goals of driving best
practices, closing knowledge gaps, and developing
innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Current Sudan Ebolavirus
Outbreak Overview
Aneesh Mehta, MD
�Current Sudan Ebolavirus Outbreak Overview
Uganda Ebola Virus Disease Outbreak Update as of 10/14/2022
September 20, confirmed Ebola virus
disease outbreak caused by the
Sudan virus in the Mubende district,
western Region of Uganda.
October 14, outbreak has spread to
five districts.
64 confirmed cases
25 confirmed deaths
https://www.cdc.gov/vhf/ebola/outbreaks/uganda/2022-sep.html
�Current Sudan Ebolavirus Outbreak Overview
Travel and Spread
CDC has issued a level 2 travel alert for the area.
International spread is currently low
U.S. health care workers should remain vigilant and screen patients with
compatible symptoms, exposures, and recent travel history.
Health care facilities should implement identify, isolate, and inform process
for early and rapid patient identification.
Health care facilities should review their special pathogens
preparedness plans.
NETEC is here to help
�Content Outline (TOC)
Infection Prevention & Control
Considerations
Trish Tennill, RN, BSN
�Should we be screening all patients?
r
Identify
•
•
•
•
Know your points of entry.
Post signage for self-identification.
Screen all patients .
Ask about symptoms then travel history.
Isolate
•
•
•
•
If screened positive, ask individual to don a mask.
Place in private room, or a private area if a room is not available.
Limit contact with other patients, visitors, and healthcare workers.
Don appropriate PPE to care for the patient.
Inform
• Inform the patient of the process.
• Notify appropriate leadership in the unit and organization.
• Inform Public Health Officials through the appropriate channels.
https://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.PDF
�What makes waste from an Ebola PUI
different from regular medical waste?
How is Category A defined?
How is Category A waste handled?
Do you have a place to
sequester the waste?
r
Phone a friend
DOT resource
Resource: Managing Solid Waste Contaminated with a
Category A Infectious Substance
https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/202206/Cat%20A%20Waste%20Planning%20Guidance%20-%20Final%20-%202022-06.pdf
Do NOT overfill
waste containers
�Content Outline (TOC)
Personal Protective Equipment
Considerations
Jill Morgan, RN, BSN
�What PPE Should be Used for Ebola?
PPE for potential body fluid exposure
Surgical hood extending to shoulders.
Respirator or PAPR with full-face shield,
helmet, and shroud
Minimum PPE for a stable PUI, or those without
vomiting, bleeding, or diarrhea
Fluid-resistant gown or
fluid-resistant coveralls
Single-use full-face shield
r
Single-use impermeable
gown or coverall
Outer gloves with
extended cuffs
Two pairs of single-use
disposable gloves
Single-use fluid-resistant
apron covers torso to mid-calf
Single-use shoe or
boot covers
http://www.cdcmuseum.org/exhibits/show/ebola/item/828
Single-use full-face shield
Facemask
Two pairs of gloves should be worn.
At a minimum, outer gloves should
have extended cuffs
Fluid resistant sleeved aprons can provide added
protection to less-protective isolation gowns
Staff must be aware of PPE protective qualities and limitations.
�Isolation gown:
• Choose level of gown
based on risk.
Full body coverage:
• Coverall or Gown
• Shoe or boot covers
• Head cover, hood, or shroud
AAMI PB70 Level 1-3 have increasing levels
of resistance to fluids, Level 4 tested for
viral transfer
Blood and viral penetration resistance:
Gown = ANSI/AAMI PB70 Level 4
Coverall = ASTM F1671 or EN14126
Eye protection:
• Full face shield or goggles with
circumferential protection
Respiratory protection:
• N95 or higher filtering face
piece respirator (FFR) or
Powered Air Purifying
Respirator (PAPR)
Medical or surgical mask:
r
• For droplet or source protection
only. Does not provide
respiratory protection.
Gloves:
• Non-sterile medical exam
gloves. Double gloving and the
use of extended cuff gloves
may be advised.
�What is Different about VHF PPE and Why?
Because the infectious dose for Ebola and some other Viral Hemorrhagic Fevers is very small, and the
amount of virus present in many body fluids is very large, Full Body Coverage PPE is recommended.
• PPE selection should consider tasks to be performed. How
close or prolonged contact will be, potential exposures to
blood or any body fluids, and contaminated items and
surfaces.
• r
• Patient condition may change rapidly. The sudden presence of
body fluid risk should be anticipated.
• Patients may present at any point of illness. Screening for
symptoms and travel at all points of entry, including EMS, can
reduce HCW exposure.
• The use of a Trained Observer should be considered. Tasks
include verifying correct donning, observation of staff during
patient care, specimen collection, waste handling procedures,
and close observation and verification of safe doffing.
• Donning complex ensembles takes time
• Once appropriately donned, take care to
avoid contamination of PPE and the patient
care environment.
• Not all PPE is amenable to being cleaned
while in use.
• Contamination of PPE, skin, or clothing may
not be visible. Trained observers should
monitor for inadvertent contamination
during use and doffing of PPE.
• Regardless of task, consider PPE
contaminated and doff with care.
�Virus Family
Illness Caused
Common
Geography
Vector or
Source
Central, subSaharan Africa
Presumed bat
Ebola Virus Disease
Filoviridae
Marburg virus
Lassa fever
Arenaviridae
Junín
Machupo (Bolivian HF)
Guanarito (Venezuelan HF)
Sabia (Brazilian HF)
CCHF – Crimean Congo
Hemorrhagic Fever
Bunyaviridae
Hantaviruses
(HPS/HFRS*) (Sin
Precautions
YES
Contact,
Droplet/Airborne,
Eye
Full body coverage
for acute (wet)
phase
YES
Contact,
Droplet/Airborne,
Eye
Full body coverage
for acute (wet)
phase
Fruit bat
South America
Europe,
Mediterranean,
Middle East,
Africa, India, China
Rodents
Tick, infected
livestock
YES
Contact, Droplet*,
Eye
Worldwide
Rodent
Possible
All of sub-Saharan
Africa
Mosquito
No
Standard
Precautions
Yellow Fever
Tropics
Mosquito
Blood*
Dengue
Tropics
Mosquito
No
Rift Valley Fever
Kyanasur
Omsk
PPE
Comments
West Africa
Standard
Precautions unless
Andes virus
suspected
Nombre, Andes virus)
Flaviviridae
Person-toperson spread
Standard
Precautions
India
Siberia
Tick
No
*Add respiratory
protection (N95 or ↑) for
centrifugation
Contact,
Droplet/Airborne, Eye
for potential Andes
virus or contact/cleanup of rodent droppings
*Potential risk of Yellow
Fever transmission
in blood
transfusion, immediately
post vaccination
�Resources for PPE
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html
• r
Personal Protective Equipment Module
Estimates minimum personal protective equipment (PPE) needed by hospital personnel managing
patients suspected or known to be infected with a special pathogen. https://dashtool.org/
PPE Guidance for Viral Hemorrhagic Fevers: https://repository.netecweb.org/items/show/1693
Space Recommendations for PPE Donning/Doffing: https://repository.netecweb.org/items/show/1708
�Content Outline (TOC)
Laboratory Considerations for
Frontline Hospitals
Vicki Herrera, MS
�What diagnostic tests are available?
Sudan ebolavirus vs Zaire ebolavirus
• Limited testing available to detect Sudan ebolavirus
• CDC – Laboratory Response Network (LRN)
• Regional Emerging Special Pathogen Treatment Centers (RESPTCs)
• Other?
r
Contact your local Public Health Department
Specimen types may vary depending on the laboratory:
• EDTA Whole Blood
• Other?
�What are some specimen collection considerations?
Risk Mitigation:
Risk Assessment:
Do you have appropriate PPE?
• Staff should be familiar with PPE.
• Use of N95 requires fit testing.
Do you have a PPE donning plan?
• Designate a donning area.
• Familiarize staff with the protocol. Train!
• Gather supplies prior to entering the room.
Do you have all the supplies needed?
r
• For example, tubes, phlebotomy supplies, sharps container,
specimen bags.
• Note, always use plastic tubes, butterfly needles are not
recommended, do not take shipping boxes into the patient room.
Do you have trained personnel?
• Recommend an experienced person.
Do you need a partner (i.e., Trained Observer)?
• Assess the situation: acuity, pediatric patient,
agitated, etc.
Do you have a PPE doffing plan?
• Designate a doffing area
• Familiarize staff with the protocol. Train!
What do you do with laboratory waste?
• Follow facility plan for Category A waste.
�What are the shipping considerations?
• Category A
• Category A infectious substance affecting humans (UN 2814)
• Personnel must be trained & certified to ship Category A specimens
• Online trainings available
• Check with your facility or State Public Health Department
• Identify couriers
r
• Courier’s may have different requirements
• Ground courier vs air courier
• Do you have the correct shipping supplies?
• Category A box for required shipping condition & appropriate labels
• Appropriate packaging material
• What days can you ship?
• Is your courier available 7 days a week?
• Is your testing facility available 7 days a week?
�What are some considerations in routine testing?
Routine laboratory testing can and has been done successfully
and safely on patients with special pathogens.
Communication is key!
r
1st - Risk assessment
2nd - Risk mitigation
3rd - Implementation
4th - Ongoing assessments
�What routine testing can you do?
What testing can you do?
• What POC testing is available at your facility?
• What risks are involved with using this instrument?
• How many instruments do you have? Can one be dedicated to a
patient for a period of time?
• Where will you do the testing?r
• Do you have trained staff? Laboratory, Nursing, Other, etc.
• How will you clean and disinfect your instrument?
NETEC is here to help
Reach out to one of our NETEC laboratory experts if you have
additional questions or need help.
�Content Outline (TOC)
EMS and Patient Transport
Considerations
Alex Isakov, MD, MPH
�How should EMS implement Identify, Isolate, and Inform
for Ebola Virus Disease?
Identify:
• Travel history/exposure history
• Signs and symptoms of disease
• Emergency medical dispatch and field personnel
r
Isolate:
• Implement a hierarchy of controls
• Engineering controls
• Administrative policies and work practices
• Personal protective ensembles
Inform:
• Other responders, local and state public health, receiving facility
�How can EMS apply a hierarchy of control
for Ebola Virus Disease?
Engineering controls
• Separate driver compartment from
patient compartment
• Consider draping interior of ambulancer
to protect environmental surfaces for
confirmed or “wet” cases
• Adjust air handling to introduce fresh
air in both compartments
• Turn exhaust fan on high in-patient
compartment
�How can EMS apply a hierarchy of control
for Ebola Virus Disease?
Work practices – Patient prep
• Apply surgical mask to patient
• Consider
applying
impervious
suit
r
or impervious sheet
• Consider undergarment to
collect diarrhea
• Leak proof container for emesis
• Treat nausea to prevent emesis
�How can EMS apply a hierarchy of control
for Ebola Virus Disease?
Work practices – Personnel
• Avoid unprotected exposure
r
• Limit exposure to minimum number
of personnel
• Apply the 6-foot rule as appropriate
• Driver should not make patient contact
�How can EMS apply a hierarchy of control
for Ebola Virus Disease?
Work practices - Clinical care
• Limit use of sharps
• Limit aerosol generating
procedures if possible
r
• Be prepared to resuscitate the patient
• Review plans for patient deterioration
Photos/CDC
�How can EMS apply a hierarchy of control
for Ebola Virus Disease?
Personal Protective Ensembles
Standard + contact + droplet (+ airborne)
Stable PUI
Unstable PUI and confirmed EVD
• Fluid resistant gown or coverall
• Impermeable gown or coverall
• Full face shield
• Full face shield and N-95 respirator or PAPR
r
• Facemask
• Double gloves with extended cuffs
• Double gloves with extended cuffs
• Boot covers
• Apron
USE PROVEN CHECKLISTS and TRAINED OBSERVER
Consider comms, also thermal stress
Photo/Wade Miles
Photo/Alex Isakov
�What about cleaning, disinfection and waste management?
Cleaning and disinfection with an EPA-registered
hospital grade disinfectant
r
Category A waste is highly regulated
• Hazardous Materials Regulations
(HMR, 49 C.F.R., Parts 171-180)
• Best practice may be to leave waste
with receiving facility
Photo/Alex Isakov
�Anything special after patient transport?
Post-mission Medical Surveillance
Observe personnel for signs and symptoms of
disease for one incubation cycle or until the
r
disease of concern is ruled out
Coordinate with public health
Asymptomatic people are not contagious
�Resources for EMS
r
�Resources for EMS
Contents
r
�Resources for EMS
r
�Content Outline (TOC)
NETEC Resources
Trish Tennill, RN, BSN
�NETEC Resources
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Oct 20, 2022 11:00 AM in Central Time (US and Canada)
Objectives
PANELISTS<br /><br />Vicki Herrera, MS<br />Research Coordinator<br />University of Nebraska Medical Center/Nebraska Medicine<br /><br />Alexander P. Isakov, MD, MPH<br />Executive Director and Professor of Emergency Medicine<br />Emory School of Medicine<br /><br />Aneesh Mehta, MD, FIDSA, FAST<br />NETEC Co-Principal Investigator<br />Assistant Director of Transplant Infectious Diseases<br />Chief of Infectious Diseases Services<br />Emory University Hospital<br />Professor of Medicine and of Surgery<br />Emory University School of Medicine<br /><br />Jill Morgan, RN<br />Emory Healthcare, Atlanta, GA<br /><br />Patricia Ann Tennill RN, BSN<br />Associate Director of Nursing<br />NYC Health + Hospitals / Bellevue, New York, NY
Event Type
Webinar, watch at link below
URL
https://youtu.be/Okh_Sa9cVa4
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/Okh_Sa9cVa4" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
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Title
A name given to the resource
NETEC Webinar Series (10/20/22): NETEC Town Hall: Preparing Frontline Healthcare Workers for Ebola
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
This NETEC webinar series event will include a discussion about the current landscape of the Ebola outbreak, IPC and PPE considerations, lab safety precautions, transport, and training and preparedness needs for frontline workers.
Webinar slides attached.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-10-20
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-10-20
Type
The nature or genre of the resource
Webinar only
Ebola
Frontline Facility
Healthcare Worker Safety
Infection Prevention and Control
Internal Transport
Laboratory
Outbreaks
Personal Protective Equipment (PPE)
R-EM
Training
Viral Hemorrhagic Fever
Webinar
-
https://repository.netecweb.org/files/original/cff9ea03dd997f73dc4e7daaf05cde65.png
d3e4310606a86715d5bc08a3c4708a56
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2022/10/07/how-frontline-health-care-workers-can-prepare-for-an-ebola-outbreak/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
How Frontline Health Care Workers Can Prepare for an Ebola Outbreak
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This NETEC blog post discusses the Sudan ebolavirus outbreak in Uganda, differences and similarities among ebolavirus Species, the Identify, Isolate, and Inform process, and infection control and waste management.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-10-07
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-10-07
Contributor
An entity responsible for making contributions to the resource
Not yet reviewed new - IPC
Blog
Ebola
Frontline Facility
Identify
Inform
Isolate
Outbreaks
R-IPC
Waste Management
-
https://repository.netecweb.org/files/original/b9080714229d5a58675a78fc0c44d7f6.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/frontline-healthcare-facilities.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Interim Guidance for Preparing Frontline Healthcare Facilities for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD)
Subject
The topic of the resource
Physical Infrastructure
Description
An account of the resource
<div class="card mb-3">
<div class="card-header h4 bg-gray-l3">Page Summary</div>
<div class="card-body bg-gray-l3">
<p><strong>Who this is for</strong>: State and local health departments and frontline healthcare facilities (acute care hospitals, and other emergency care settings including urgent care clinics, and critical access hospitals). This guidance does not address Ebola preparedness for primary care offices and other non-emergent ambulatory care settings.</p>
<p><strong>What this is for</strong>: Guidance to assist frontline healthcare facilities and state and local health departments develop preparedness plans for patients under investigation (PUIs) for Ebola virus disease (EVD).</p>
<p><strong>How this relates to other guidance documents/purpose</strong>: This guidance provides specific recommendations for frontline healthcare facilities and state and local health departments as they develop Ebola preparedness plans. Context for this guidance document is provided in CDC’s <a href="https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html">Interim Guidance for U.S. Hospital Preparedness for Patients under Investigation and with Confirmed Ebola Virus Disease: A Framework for a Tiered Approach</a>. In addition, this document complements two other specific CDC guidance documents:<a href="https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/assessment-hospitals.html"> Interim Guidance for Preparing Ebola Assessment Hospitals</a> and <a href="https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/treatment-centers.html">Interim Guidance for Preparing Ebola Treatment Centers</a>.</p>
</div>
</div>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-08-28
Contributor
An entity responsible for making contributions to the resource
2022-11-14 by IPC general asset review, marked for archive "designations no longer in place, last updated in 2015"
2023-03-03 remarked active - in SPORSA
Relation
A related resource
Y - D0.1PI/D0.2PI Qualtrics # 122, original # 10
Y - D0.1PI/D0.2PI Qualtrics # 124, original # 12
Y - D0.1EM/D0.2EM Qualtrics # 503
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-03-03
Ebola
Frontline Facility
Infection Prevention and Control
Person Under Investigation (PUI)
Physical Infrastructure
R-PhIn
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/d66d4f70b33a2f895f30d6b673c9a4c7.docx
234ffdb6ac7aa41f8a54d1277ef855e8
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Frontline Facility Ebola Tabletop Exercise Template/Ejercicios de simulación para los establecimientos médicos de primera línea
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
Ejercicios de simulación para los establecimientos médicos de primera línea <br />This exercise template is also available in <a href="https://repository.netecweb.org/exhibits/show/exercise-templates/item/173">English</a>. Click <a href="https://repository.netecweb.org/exhibits/show/exercise-templates/item/173">HERE</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-01-03
Contributor
An entity responsible for making contributions to the resource
2024-03-27 IIT - haven't gotten back first review - bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
CONOPS
Emergency Management
EMS
Español
Exercises and Drills
Frontline Facility
Identify
Inform
Intake
Isolate
Patient Transport
Person Under Investigation (PUI)
Pre-hospital Transport
R-IIT
Spanish
Surge
Templates
-
https://repository.netecweb.org/files/original/54fa7d645eb1ca679a344d144caa376e.pdf
e266ae42ee9e81bee8be7f25d6e32581
PDF Text
Text
Healthcare Facility Preparedness Checklist for MERS-CoV
All U.S. healthcare facilities need to be prepared for new and emerging infectious disease threats such as
Middle East Respiratory Syndrome Coronavirus (MERS-CoV). All hospitals should be equipped and ready
to care for a limited number of infected patients as part of routine operations and also to potentially care
for a larger number of patients in the context of escalating transmission. Facilities should outline plans
for administrative, environmental, and communication measures and define the individual work
practices that will be required to detect the introduction of MERS-CoV or other emerging infectious
diseases, prevent spread, and manage the impact on patients, the facility, and staff.
The following checklist highlights some key areas for healthcare facilities to review in preparation for
MERS-CoV. The checklist format is not intended to set forth mandatory requirements or establish
national standards.
□ Ensure facility infection control policies are consistent with the Centers for Disease Control
and Prevention’s MERS-CoV guidance (http://www.cdc.gov/coronavirus/mers/infectionprevention-control.html)
□ Review procedures for rapidly implementing appropriate isolation and infection practices
for potential MERS-CoV patients
□ Review policies and procedures for screening and work restrictions for exposed or ill HCP
including ensuring that HCP have ready access, including via telephone, to medical
consultation
□ Review procedures for laboratory submission of specimens for MERS-CoV testing
□ Review plans for implementation of surge capacity procedures and crisis standards of care
□ Develop plans for visitor restriction if MERS-CoV is circulating in the community
□ Ensure that specific persons have been designated within the facility who are responsible
for communication with public health officials and dissemination of information to other
HCP at the facility
□ Confirm the local or state health department contact for reporting MERS-CoV cases and
confirm reporting requirements
□ Assure ability to implement triage activities based on public health guidance including at the
facility and using remote (i.e., phone, internet-based) methods where appropriate to
minimize demand on the health care system
□ Ensure that negative-pressure airborne infection isolation rooms are functioning correctly
and are appropriately monitored for airflow and exhaust handling
□ Ensure that HCP who will provide patient-care have been medically cleared, fit-tested, and
trained for respirator use
□ Provide education and refresher training in the next six weeks to HCP regarding MERS-CoV
diagnosis, how to obtain specimen testing, appropriate PPE use, triage procedures including
July 11, 2013
Centers for Disease Control and Prevention (CDC)
Page 1 of 2
�patient placement, HCP sick leave policies, and how and to whom MERS-CoV cases should
be reported, procedures to take following unprotected exposures (i.e., not wearing
recommended PPE) to suspected MERS-CoV patients at the facility
□ Assess availability of personal protective equipment (PPE) and other infection control
supplies (e.g., hand hygiene supplies) that would be used for both healthcare personnel
(HCP) protection and source control for infected patients (e.g., facemask on the patient)
□ Have contingency plans if the demand for PPE or other supplies exceeds supply
□ Assess effectiveness of environmental cleaning procedures; provide education/refresher
training for cleaning staff (http://www.cdc.gov/HAI/toolkits/Evaluating-EnvironmentalCleaning.html)
□ Monitor the situation at CDC’s MERS website:
http://www.cdc.gov/coronavirus/mers/index.html
For more information, visit http://www.cdc.gov/coronavirus/mers/preparedness/checklist-facilitypreparedness.html.
July 11, 2013
Centers for Disease Control and Prevention (CDC)
Page 2 of 2
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
URL
https://www.cdc.gov/coronavirus/mers/preparedness/checklist-facility-preparedness.html
Dublin Core
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Title
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Healthcare Facility Preparedness Checklist
Subject
The topic of the resource
Intake and Internal Transport
Description
An account of the resource
<p class="font-weight-bold">All U.S. healthcare facilities need to be prepared for new and emerging infectious disease threats such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV). All hospitals should be equipped and ready to</p>
<ul class="false">
<li class="font-weight-bold">care for a limited number of infected patients as part of routine operations</li>
<li class="font-weight-bold">potentially care for a larger number of patients in the context of escalating transmission</li>
<li class="font-weight-bold">outline plans for administrative, environmental, and communication measures</li>
<li class="font-weight-bold">define the individual work practices that will be required to detect the introduction of MERS-CoV or other emerging infectious diseases</li>
<li class="font-weight-bold">prevent spread of MERS-CoV</li>
<li class="font-weight-bold">manage the impact on patients, the facility, and staff</li>
</ul>
<p class="font-weight-bold">The following checklist highlights some key areas for healthcare facilities to review in preparation for MERS-CoV. The checklist format is not intended to set forth mandatory requirements or establish national standards.</p>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-08-02
Contributor
An entity responsible for making contributions to the resource
2024-03-27 IIT - haven't gotten back first review - bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Frontline Facility
Intake
MERS-CoV
Preparedness
R-IIT
R-Lead
-
https://repository.netecweb.org/files/original/502d76aaae559c53c9715f3fa560616f.pdf
a874f143f1771127c45487a959c7e507
PDF Text
Text
Healthcare Provider Preparedness Checklist for MERS-CoV
Front-line healthcare providers in the United States should be prepared to evaluate patients for
new and emerging infectious diseases such as Middle East Respiratory Syndrome Coronavirus
(MERS-CoV). The following checklist highlights key steps for healthcare providers to take in
preparation for transport and arrival of patients potentially infected with MERS-CoV.
□ Stay up to date on the latest information about signs and symptoms, diagnostic testing, and
case definitions for MERS-CoV disease (http://www.cdc.gov/coronavirus/mers/casedef.html)
□ Review your infection control policies and CDC infection control recommendations for
MERS-CoV http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html for:
□ Assessment and triage of acute respiratory infection patients
□ Patient placement
□ Visitor management and exclusion
□ Personal protective equipment (PPE) for healthcare personnel
□ Source control measures for patients (e.g., put facemask on suspect patients)
□ Requirements for performing aerosol generating procedures
□ Be alert for patients who meet the MERS-CoV case definition
(http://www.cdc.gov/coronavirus/mers/case-def.html)
□ Promptly implement source control for potential MERS-CoV patients before transport or
upon entry to the facility and triage according to facility plans (e.g., place in private room)
for evaluation
□ Know how to report a potential MERS-CoV case or exposure to facility infection control
leads and public health officials
□ Know who, when, and how to notify and when to seek evaluation by occupational health
following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or
confirmed MERS-CoV patient
□ Know how to contact and receive information from your state or local public health agency
□ Remain at home if you are ill
For more information, visit http://www.cdc.gov/coronavirus/mers/preparedness/checklist-providerpreparedness.html.
July 11, 2013
Centers for Disease Control and Prevention (CDC)
Page 1 of 1
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
URL
https://www.cdc.gov/coronavirus/mers/preparedness/checklist-provider-preparedness.html
Dublin Core
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Title
A name given to the resource
Healthcare Provider Preparedness Checklist for MERS-CoV
Subject
The topic of the resource
Intake and Internal Transport
Description
An account of the resource
Front-line healthcare providers in the United States should be prepared to evaluate patients for new and emerging infectious diseases such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV). The following checklist highlights key steps for healthcare providers to take in preparation for transport and arrival of patients potentially infected with MERS-CoV.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-08-02
Relation
A related resource
Y - D0.1IIT/D0.2IIT - Qualtrics # 714
Contributor
An entity responsible for making contributions to the resource
2024-03-27 IIT - haven't gotten back first review - bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Checklist
Frontline Facility
Intake
MERS-CoV
R-IIT
R-Lead
-
https://repository.netecweb.org/files/original/fa2f1e151449813d1ccb2330ca4ec58a.pdf
e2a1c8e3c0445fffd56b39b33af35408
PDF Text
Text
Biopreparedness: Identify, Isolate, Inform
Resources & References
Identify, Isolate, Inform
Identify
Outbreak Resources
•
•
•
•
•
•
•
•
•
NETEC Outbreak information: https://repository.netecweb.org/news#Map
Georgia Department of Public Health Travel Assistance:
https://dph.georgia.gov/TravelClinicalAssistant
CDC Travel Health Notices: https://wwwnc.cdc.gov/travel/notices
WHO Disease and Outbreak News: https://www.who.int/csr/don/en/
Identification of acutely sick people and facial cues of sickness (PDF):
https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2017.2430
CDC Chain of Infection:
https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section10.html
NNDSS Surveillance Case Definitions for Current and Historical Conditions:
https://wwwn.cdc.gov/nndss/conditions/
CDC Current Outbreak List: http://www.cdc.gov/outbreaks/
CDC Health Alert Network (HAN): http://emergency.cdc.gov/han/hantable.asp
Isolate
•
CDC and NIOSH guidance on AIIR and portable HEPA filters:
https://www.cdc.gov/niosh/topics/hcwcontrols/engcontrolsolutions/expedientpatient-isolation.html
Personal Protective Equipment (PPE)
•
•
•
•
•
CDC PPE Guidance for Ebola: https://www.cdc.gov/vhf/ebola/healthcareus/ppe/index.html
CDC PPE Guidance for MERS: https://www.cdc.gov/coronavirus/mers/infectionprevention-control.html
OSHA Standards for MERS:
https://www.osha.gov/SLTC/mers/control_prevention.html
CDC Donning and Doffing Videos for Ebola:
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html
CDC PPE calculator: https://www.cdc.gov/vhf/ebola/healthcareus/ppe/calculator.html
FUNDED BY ASPR & CDC
�General PPE Guidance:
•
•
•
•
This is the general guidance on personal protective equipment from NIOSH/NPPTL,
not specific to Ebola or special pathogens:
https://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html
This is the guidance on PPE for Ebola from the CDC used throughout our
presentations: https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html
Information on the AAMI Levels of garment protection:
https://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html
Information on the limits of protection due to differences in surface tension in water
versus body fluids:
https://wwwn.cdc.gov/PPEInfo/Standards/Info/ANSI/AAMIPB70Class4
Face Masks, Face Shields, N95’s and PAPRs:
•
•
•
“Facemasks may be labeled as surgical, laser, isolation, dental, or medical procedure
masks and are cleared by the FDA for marketing. They may come with or without a
face shield. Facemasks do not seal tightly to the wearer's face, do not provide the
wearer with a reliable level of protection from inhaling smaller airborne particles,
and are not considered respiratory protection.” https://www.fda.gov/medicaldevices/personal-protective-equipment-infection-control/masks-and-n95respirators
More on face masks, their levels and a guide to selection – an industry source (PDF):
https://www.crosstex.com/sites/default/files/public/educationalresources/products-literature/guide20to20face20mask20selection20and20use20202017.pdf
OSHA N95 Seal Check: https://www.osha.gov/lawsregs/regulations/standardnumber/1910/1910.134AppB1
Gloves:
•
•
Glove sanitizing: Pengfei Gao, Matthew Horvatin, George Niezgoda, Robyn Weible &
Ronald Shaffer(2016) Effect of multiple alcohol-based hand rub applications on the
tensile properties of thirteen brands of medical exam nitrile and latex
gloves, Journal of Occupational and Environmental Hygiene, 13:12, 905914, DOI: https://doi.org/10.1080/15459624.2016.1191640
How glove materials are tested and what the standards are:
http://www.psggear.com/index.php/quality-standards
Inform
•
Incident Command/HICS Structure:Online module (Internal Communications)
https://courses.netec.org/courses/18-ol-incom
FUNDED BY ASPR & CDC
�Treatment and Care
Patient Care
•
WHO EVD Manual:
https://apps.who.int/iris/bitstream/handle/10665/149781/WHO_EVD_Manual_ECU_15
.1_eng.pdf
Waste Management
•
•
•
•
•
•
•
CDC Guidance on Cleaning: https://www.cdc.gov/vhf/ebola/healthcareus/cleaning/hospitals.html
CDC Guidance for Ebola waste:
https://www.cdc.gov/vhf/ebola/clinicians/cleaning/waste-management.html
Survivability of Ebola in medical waste:
https://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/ebola-virussurvivability.html
Validation of Autoclave Protocols for Successful Decontamination of Category A
Medical Waste Generated from Care of Patients with Serious Communicable
Diseases: https://jcm.asm.org/content/55/2/545
Summary of new full guide, which supersedes the interim version published Jan
2017:
https://docs.google.com/viewerng/viewer?url=https://repository.netecweb.org/fi
les/original/01a0d83bed6d724e89456c3975050d7f.pdf
“Are you preparing suspected Ebola contaminated waste for transportation?” Poster
(PDF):https://www.phmsa.dot.gov/sites/phmsa.dot.gov/files/docs/Ebola_Contami
nated_Waste_for_Transportation_Poster.pdf
Disinfectants for Use against the Ebola Virus:
• EPA's registered antimicrobial products: https://www.epa.gov/pesticide-
registration/list-l-epas-registered-antimicrobial-products-meet-cdc-criteria-useagainst
Occupational Health
•
•
•
CDC notes on monitoring and moment of individuals exposed to Ebola (2014-2016
guidance): https://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movementof-persons-with-exposure.html
CDC Ebola risk classifications: https://www.cdc.gov/vhf/ebola/exposure/riskfactors-when-evaluating-person-for-exposure.html
CDC monitoring and movement guidance on for MERS:
https://www.cdc.gov/coronavirus/mers/hcp/monitoring-movementguidance.html
FUNDED BY ASPR & CDC
�Hospital Preparedness Performance Metrics
•
ASPR Implementation Guidance for Ebola Preparedness Measures (PDF):
https://www.phe.gov/Preparedness/planning/sharper/Documents/hpp-mmiguide-ebola-508.pdf
Exercise templates
•
NETEC Exercise Templates by facility type (Tabletop, full scale, and drills):
https://repository.netecweb.org/exhibits/show/exercise-templates/exercises
Transport and Testing
Interfacility transportation
•
•
•
CDC Guidance for Interfacility Transport for a person under investigation or patient
with confirmed Ebola: https://www.cdc.gov/vhf/ebola/healthcare-us/emergencyservices/interfacility-transport.html
CDC Guidance for patient handoff: https://www.cdc.gov/vhf/ebola/healthcareus/emergency-services/patient-handoff.html
CDC Guidance for air-to-ground handoff:
https://www.cdc.gov/vhf/ebola/healthcare-us/emergency-services/air-groundpatient-handoff.html
Ambulance decontamination
•
CDC guidance for ambulance decontamination:
https://www.cdc.gov/vhf/ebola/healthcare-us/emergency-services/ambulancedecontamination.html
All hazards EMS guidance
•
ASPR TRACIE EMS Playbook:
https://asprtracie.s3.amazonaws.com/documents/aspr-tracie-transport-playbook508.pdf
Laboratory Guidance
•
•
•
•
CDC Guidance for Collection, Transport and Submission of Specimens for Ebola
Virus Testing:https://www.cdc.gov/vhf/ebola/laboratorypersonnel/specimens.html
CDC Guidance for frontline labs: https://www.cdc.gov/vhf/ebola/healthcareus/preparing/frontline-healthcare-facilities.html
APHL Laboratory Risk Assessment Best Practices Templates (PDF):
https://www.aphl.org/programs/preparedness/Documents/APHL%20Risk%20As
sessment%20Best%20Practices%20and%20Examples.pdf
APHL Public Health Laboratory Risk Assessment Template for EBV (PDF):
https://www.aphl.org/programs/preparedness/documents/aphl-template.pdf
FUNDED BY ASPR & CDC
�•
•
•
•
APHL Biosafety Checklist (PDF):
https://www.aphl.org/AboutAPHL/publications/Documents/ID_BiosafetyChecklist
_42015.pdf
APHL Packaging and Shipping Seminars:
https://www.aphl.org/training/Pages/seminars.aspx
CDC Division of Laboratory Systems (DLS) Training Site:
https://www.cdc.gov/csels/dls/
Just-in-Time Training
•
•
NETEC online courses: https://courses.netec.org/
NETEC skills videos: https://repository.netecweb.org/exhibits/show/neteceducation/justintime
Additional Resources
•
•
•
•
•
CDC MERS Healthcare Provider readiness checklist:
https://www.cdc.gov/coronavirus/mers/preparedness/checklist-providerpreparedness.html
CDC MERS Healthcare Facility readiness checklist:
https://www.cdc.gov/coronavirus/mers/preparedness/checklist-facilitypreparedness.html
NYC NYCHH Frontline Hospital Planning Guide: Special Pathogens Playbook (PDF):
https://hhinternet.blob.core.windows.net/uploads/2019/07/NYCHH-FrontlineHospital-Planning-Guide.pdf
NETEC Leadership Toolbox:
https://repository.netecweb.org/exhibits/show/leadership
NETEC Regional Resources
FUNDED BY ASPR & CDC
�
https://repository.netecweb.org/files/original/2efd0cdb11b7b8a3cc1dabab4446d552.pdf
d29523c24141ed7a7a20e756cdfd2cb5
PDF Text
Text
CLICK
SUBSCRIBE!
SUBSCRIBE TO THE NETEC YOUTUBE CHANNEL!
http://bit.ly/thenetec-youtube
Below is our current library of videos
Identify, Isolate, Inform: Best practices for
the assessment, management, and
placement of patients under investigation
for exposure to Ebola or other special
pathogen.
National Ebola Training and Education Center | www.netec.org
�
https://repository.netecweb.org/files/original/21936c5abebdab86995339b63582041e.docx
8b0d045630b8b8e038b9033ca033d17c
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Biopreparedness: Identify, Isolate, Inform Resources & References
Subject
The topic of the resource
General
Description
An account of the resource
Frontline Facilities resource list
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-09-27
Contributor
An entity responsible for making contributions to the resource
2024-03-27 IIT - haven't gotten back first review - bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Ebola
Frontline Facilities Tools
Frontline Facility
Identify
Inform
Internal Transport
Isolate
R-IIT
R-Lead
Special Pathogens
Treatment and Care
-
https://repository.netecweb.org/files/original/464349b58ac0059a95dcb2d2e33c634a.pdf
db0302a7660d97b059107afbc5757adc
PDF Text
Text
Laboratory:
All states are strongly encouraged to consider identifying Ebola assessment hospitals;
however, in geographic areas where state and local public health authorities have
elected not to identify or designate Ebola assessment hospitals, all hospitals should
plan, in coordination with state and local authorities, for adequate staff training and PPE
supplies if a PUI has to be managed. In this instance, frontline healthcare facilities
should have plans in place to safely collect, package, and transport laboratory
specimens for PUIs, if needed. If frontline healthcare facilities cannot immediately
transfer the patient to another facility, they should also have plans in place to ensure
that routine laboratory tests needed to determine alternative diagnoses are performed
while the patient is evaluated for EVD.
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/frontline-healthcare-facilities.html
Before a Patient Presents:
Know your Resources and Capabilities for Lab Testing:
•
Get PH Lab (LRN Lab) phone numbers (weekday and weekend/holiday)
•
Know what screening tests are available at your PH LRN lab
•
Define an in-house testing menu
•
Identify certified Category A shipping person(s)
•
Define a specimen transport procedure
Specimen Collection and Packaging:
If your facility will draw lab samples to be sent for testing:
• Who will collect the samples? (special team, nursing, phlebotomy, etc)
o Does staff know the appropriate specimen to draw (serum, whole blood,
NP Swab, etc)? Contact your designated Public Health Lab for the
appropriate specimen based on the test.
o Is there a protocol in place for specimen collection from PUIs? (See
example protocol)
o Do you have the appropriate tubes/swabs on hand? If not, do you know
where to get some quickly? Will PH or other hospitals help provide
appropriate tubes or swabs if needed?
o Have staff practiced drawing labs in PPE?
o How can specimens be cleaned, labelled, packaged and removed safely
from the patient area?
o Do you know the turn-around time for these labs?
•
How will the specimens be transported to the public health or other reference
laboratory for testing?
FUNDED BY ASPR & CDC
�o How do those specimens need to be packaged (Cat A vs. Cat B) for
transport?
o Does your facility have a person that is certified in Cat A shipping?
o Does your facility have the appropriate packaging? If not, do you know
who to contact to obtain it?
o Who is responsible for the transport, and who will arrange transport for
those specimens? Is that person/company trained in Cat A transport?
o Are there any special considerations for specimen transport, such as
transporting on ice? Does your facility have access to ice packs or dry ice
if needed?
o Does your facility utilize a Chain of Custody (COC) document?
o How long is the anticipated turnaround time for results?
o Who will notify your facility of the test results?
o Who is responsible for notifying public health of the test results, according
to your state CONOPS?
Laboratory Testing (in-house):
• What laboratory testing can be done safely to provide appropriate clinical care
while screening testing is pending
o What tests do physicians need in order to care for the patient? (need vs.
want)
o Do you have Point of Care (POC) instruments? Who is trained to run
them?
o Where will testing take place? POC at bedside, main lab or alternate
space?
o Does the testing staff have PPE protocols in place for testing special
pathogens? Have staff practiced running tests in enhanced PPE?
o Do you have a way to track the location of every specimen as well as who
has handled or tested them?
•
Does the laboratory have a plan to manage laboratory waste if testing specimens
from a positive patient?
o Do you have an autoclave on-site?
o Do you have a plan to sequester all waste associated with these
specimens?
o Can laboratory waste go into the patient waste stream?
Patient Transport:
If your facility will engage EMS to transport the PUI:
• Which agency or agencies could perform the transport?
• Where would the handoff occur?
• What is required to secure that area and the transport route to it?
FUNDED BY ASPR & CDC
�•
•
•
•
•
Has this process been tested in an exercise or real-world event?
Which personnel would perform the transport and handoff to EMS?
o What PPE would these personnel wear? Have they received training on
how to safely don and doff this PPE?
o Would the EMS agency expect the patient to wear PPE? What type?
o Would a containment wrap or patient isolation transport device (e.g.
Isopod) be utilized (what, if anything, do the EMS agencies or state
CONOPS recommend?
If containment devices are used:
Who has access to them?
Are personnel trained on how to set them up and ensure they are
safe for patient use?
Does your facility have a plan to manage any body fluid spills that occur along
the transport route?
o Who will manage those spills?
o How will personnel package and process the waste generated during the
clean up of the spill?
Where will designated transport staff doff their PPE after handoff to EMS?
o What equipment will need to be decontaminated (or held pending testing)?
o Where will that occur? Who will do it?
What is your facility’s plan for holding or decontaminating the designated
isolation room pending results or after a confirmation?
o Will the EMS crew transport your facility’s waste with the PUI?
o If so, does our facility have a plan for transporting this waste to the
ambulance?
Decedent Management:
Does your facility have a plan to manage decedent remains of a PUI or patient
confirmed to have Ebola or other special pathogen?
• Do you have an established process for your facility to contact public health in
the event that a PUI or confirmed patient expires while at your facility?
• What is the process that Public Health would like you to use if a person under
investigation dies within your health system/hospital?
• If your facility is expected to package decedent remains, is there a strategy in
place to train staff in the process?
• Does your facility have access to recommended equipment or materials to
package the remains? Who are your resources to obtain them if you are
expected to package the remains?
• If diagnostic tests are pending when the patient expires, what does your public
health authority advise for your facility?
• Is there a designated mortuary or crematorium that will accept the remains?
FUNDED BY ASPR & CDC
�
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f40c660f985bd0028e22c779338b9a35
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Laboratory
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Laboratory
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All states are strongly encouraged to consider identifying Ebola assessment hospitals; however, in geographic areas where state and local public health authorities have elected not to identify or designate Ebola assessment hospitals, all hospitals should plan, in coordination with state and local authorities, for adequate staff training and PPE supplies if a PUI has to be managed. In this instance, frontline healthcare facilities should have plans in place to safely collect, package, and transport laboratory specimens for PUIs, if needed. If frontline healthcare facilities cannot immediately transfer the patient to another facility, they should also have plans in place to ensure that routine laboratory tests needed to determine alternative diagnoses are performed while the patient is evaluated for EVD.
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NETEC
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2019
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2023-12-18 by Lab (Vicki and Kim), 1 yr
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2024-12-18
Assessment Facility
Frontline Facilities Tools
Frontline Facility
Lab
Laboratory
Laboratory Testing
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
R-Lab
R-PPE
-
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Text
FRONTLINE HOSPITAL PLANNING GUIDE:
SPECIAL PATHOGENS
JUNE 2019
EMERGENCY
MANAGEMENT
�Background: NYC Health + Hospitals is the largest municipal healthcare delivery system in the United States, providing
essential inpatient, outpatient, and home-based services to more than one million New Yorkers every year in more than 70
locations across the city’s five boroughs. With our unique experiences in responding to emerging, re-emerging, and high
consequence infectious disease incidents, including safely and successfully treating NYC’s single, confirmed case of Ebola
virus disease and numerous persons under investigation, we understand first-hand the myriad impacts infectious disease
threats and special pathogens events have on healthcare delivery.
With the increasing demand for preparedness for and responses to the world’s emerging public health threats, this planning
guide breaks new ground and leads the way as a distinctive domestic resource for healthcare delivery systems to customize
their plans specific to their unique clinical, operational, and financial needs.
Purpose and Audience:
All hospitals must be prepared to identify and isolate a patient presenting with a suspected special pathogen infection
(i.e., one that is particularly virulent and requires care processes and personal protective equipment beyond daily infection
control practices) and inform internal and external stakeholders. This document provides high level planning guidance
for a frontline hospital multidisciplinary team (e.g., emergency management, infection prevention and control, emergency
department, inpatient care, safety, public relations, and infectious disease, depending on the resources and role of the facility
in the community) to support planning and training for the provision of initial care to such patients while determining whether
and when the patient will be transferred to another facility for further assessment and treatment. Though the target audience
is frontline hospitals, other facilities may find information that is applicable to their planning. The information in this planning
guide is neither presented as a complete and stand-alone resource for special pathogen management nor is it intended as a
universal document for all staff within an entire hospital. It aims to serve as a high level “jumping-off point” to be supplemented
by the most current pathogen-specific guidance and customized to meet facility needs.
Scope:
This document is NOT intended for facilities managing patients confirmed to have a viral hemorrhagic fever or special
respiratory pathogen. Rather, this planning guide is designed to assist frontline hospitals to develop systems and provide
training to screen for special pathogen infectious diseases and effectively identify, isolate, and inform when a case is
suspected, and safely manage patients until diagnosis, transfer, or release. In certain circumstances, patients may require
further intervention or invasive procedures based on clinical status or may be at frontline hospitals longer than 24 hours.
Hospitals should always consult with public health officials to ascertain risk and to obtain the most current information
available including their state and local health departments, the Centers for Disease Control and Prevention (CDC), and other
sources to assure their practices and knowledge are current.
The planning guide format provides an overview of the issues that should be addressed as well as planning considerations for
specific topics, particularly when such information is not easily accessible from other sources. Much more detailed guidance
on infection control for specific pathogens as well as personal protective equipment and other topics is available and is
referenced and linked throughout the document for use in planning by those personnel who need more specific information.
Frontline facilities are varied, from critical access hospitals to major metropolitan medical centers, and depending on the
regional resources and systems the frontline facility may have to simply recognize a suspect case and transfer them, or
provide patient care for days at a time awaiting confirmatory testing prior to patient movement. This planning guide attempts
to provide high level resources for the full spectrum of care and must be tailored to the specifics of the facility.
Notes and Caveats:
This document was created by subject matter experts using official or best practice information taken from multiple
organizations that was vetted and assembled by NYC Health + Hospitals. This document does not constitute official policies
or viewpoints of any government agency, including NYC Health + Hospitals.
The information contained in this planning guide is intended as a planning resource and should be incorporated in plans and
procedures developed by frontline hospitals.
The authors take no responsibility and bear no liability for any clinical care outcomes, provider injury/illness, or inaccuracies in
or resulting from this document. All content was current at the time of publication and vetted to the best of our ability.
Inclusion of specific references and resources is offered as an acknowledgement of their contribution of material and to
identify sources of additional information, but it does not constitute endorsement or vouch for the accuracy or applicability of
the referenced documents.
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
�Contents
1
12
19
29
36
42
44
64
P L A N N ING
S C R E E N ING
V I R A L HE MO RRHAG IC FEV ER (V HF)
S P E C I AL RESPIRATO RY
S P E C I AL CO NSIDE RATIO NS
E X E R C ISES AND MAINTAINING READINESS
R E F E R E NCE S AND RESO URCES
C H E C K LISTS
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Planning Assumptions and
Considerations
ASSUM P TIO N S
• The hospital has an infection prevention and
control program and respiratory protection
program including use of N95 respirators.
The hospital routinely applies standard and
transmission-based precautions for patients
presenting with infectious diseases (e.g.,
chicken pox, influenza).
• Once a special pathogen case is diagnosed,
the hospital applies transmission-based
precautions and follows current diseasespecific guidance.
• During known special pathogen outbreaks
when there is a greater risk of cases presenting
in the U.S., frontline facilities maintain
awareness of current disease-specific guidance
and prepare their staff to implement it.
Special pathogens are those that:
• are associated with high morbidity and/or
mortality;
• have a high likelihood of secondary cases
(person-to-person spread);
• lack an effective vaccine, prophylaxis, or
treatment and
• might prompt the use of a biocontainment unit
due to clinical or public health concerns.
Special pathogens pose a significant risk
to healthcare personnel and require specific
healthcare facility processes to ensure early
identification and isolation of infected patients
and the use of effective infection control practices
to prevent disease transmission while the patient
is further evaluated.
• Special pathogens to be planned for include
biosafety level 4 (BSL-4) agents with possible
person-to-person transmission and other highly
hazardous communicable pathogens.
This document concentrates on suspect viral hemorrhagic fever (VHF) and special respiratory pathogens
(e.g., severe acute respiratory syndrome [SARS], Middle East Respiratory Syndrome Coronavirus
[MERS-CoV], novel influenza); however, other pathogens such as poxviruses can also be managed
within the framework. The example screening personal protective equipment (PPE) ensemble, Special
Pathogen Basic PPE, described in Figure 1 can be suitable for screening and initial management of all
special pathogens aside from suspected VHF in a patient who is unstable or exhibits vomiting, diarrhea, or
bleeding.
• Travel-associated and emerging/re-emerging diseases (e.g., Ebola virus disease [EVD], Lassa fever, and
MERS) can present at any time to any facility at any stage of illness, though some facilities are at higher
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
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�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
risk than others due to population demographics and proximity to airports and other points of entry.
Sporadic cases may occur, but it is unlikely that triage personnel would recognize these based on
nonspecific symptoms. As part of a tiered, regional system1 established for the management of patients
with EVD and other special pathogens, frontline hospitals should be able to:
○○Implement the “identify, isolate, and inform” strategy including timely triage, initial evaluation, and initial
clinical management.
○○Initiate appropriate infection control protocols for the suspect case.
○○Rapidly inform internal (e.g., infection prevention staff) and external (e.g., state or local health officials)
stakeholders of a suspect case.
○○Provide enough PPE for healthcare workers (HCWs) for at least 24 hours of care.
○○Coordinate safe transfer of the suspect case to a designated assessment hospital or state or regional
Ebola and special pathogen treatment center, as needed according to the regional plan.
○○Have staff available who have been appropriately trained and have documented competency in safe
PPE practices.
○○Manage critically ill patients who may require intubation and other high-level care until diagnosis of a
special pathogen is either confirmed, ruled out, or the patient is transferred in accordance with the
Emergency Medical Treatment and Labor Act (EMTALA).
○○Have a plan to safely manage waste disposal, cleaning, and disinfection with the support of response
partners and vendors, as needed.
• Frontline facilities vary greatly from critical access hospitals to major tertiary care centers. All facilities must
have the ability to identify, isolate, and inform regarding a special pathogen case and have plans in place
to provide appropriate care while awaiting transfer. The information in this document reflects a wide
range of capabilities and should be adapted to the facility and community.
• Frontline hospitals have a clearly written procedure for how to contact consultation resources and referral
facilities and how to collect, process, and transport possible special pathogen specimens including
VHF and unusual respiratory pathogens. This plan is used to help guide PPE stocking, laboratory
responsibilities, supplies, and staffing and training required.
• Refer to Surge Incidents for multiple patient presentations.
The U.S. Department of Health and Human Services developed a nationwide, regional treatment network for Ebola and other special
pathogens. The network includes: 10 Regional Ebola and Other Special Pathogen Treatment Centers with enhanced capacity to care for
such patients; 63 state or jurisdiction Ebola Treatment Centers that can safely care for patients based on clinical judgment, resources,
and patient preference and if the capacity of the Regional Centers is exceeded; 217 assessment hospitals that can isolate and care for
patients until their diagnosis is confirmed/ruled out or they are discharged or transferred; and more than 4,800 frontline facilities that
can identify, isolate, and care for patients until they are transferred to a higher tier. Additional information about the tiered system may
be found in Regional Treatment Network for Ebola and Other Special Pathogens.
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
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�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
PP E A SSU M P T I O N S
Transmission-based precautions, the second tier of basic infection control, supplement standard
precautions for patients with suspected or confirmed infection or colonization of certain infectious agents
or epidemiologically important pathogens. PPE ideally is selected by transmission-based precautions that
match a specific pathogen to a level of protection. Table 1 shows types of precautions and associated PPE.
Table 1. PPE by Type of Precautions.
Type of Precautions
PPE
Standard
gloves, gown, simple mask1, goggles or face shield (exact
ensemble determined by the type of clinical interaction with
the patient and patient signs and symptoms)2,3
Contact
fluid-resistant gown, gloves2
Droplet
simple mask, eye protection (eye protection not required but
recommended by most sources)2
Airborne
fit-tested N95 or equivalent/higher respirator or powered
air-purifying respirator (PAPR)2,4
Other factors that influence PPE selection:
• Anticipated exposure (e.g., splashes, spray touch, large volumes of body fluids, and isolation precautions)
• Durability and appropriateness for the task
• Fit5
“Simple mask” is used throughout this document to refer to a flexible, half-face filtering facepiece, often referred to as a simple mask,
procedure mask, or surgical mask. It is distinct from the N95 respirator or PAPR that require specific National Institute for Occupational
Safety and Health (NIOSH) approvals and testing of filtration capability.
2
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)
3
Standard Precautions in Health Care
4
PAPR in this document refers to a PAPR that is equipped with appropriate N95 or higher filters.
5
Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-3
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Special pathogens require a combination of precautions. For example, MERS, SARS, and novel influenza
require a combination of airborne and contact precautions plus eye protection. Though there are distinctions
among the PPE ensembles needed for each pathogen, during the identification or screening phase, this
document assumes that simplicity is best for frontline providers dealing with a suspect special pathogen
case. Hospitals may elect to adopt other PPE postures at their discretion due to preference, training, supply
consistency, state occupational safety and health requirements, or other factors. Hospitals should consider
their role in the community, their resources, current PPE practices and materials, the anticipated time until
transfer of a suspect special pathogen case, and their emergency department provider types and patient
flow/movement (e.g., who encounters the patient first, when are the screening questions asked, etc.) when
considering levels, types, and training for PPE.
The multiple recommendations for PPE for different special respiratory pathogens and viral hemorrhagic
fevers (persons under investigation, clinically stable, and unstable or exhibiting vomiting, diarrhea, or
bleeding) do not lend themselves to simplicity for the initial encountering and assessing provider. The subject
matter expert authors of this document have elected to recommend PPE for the initial assessment and
evaluation of all suspected special pathogen patients that may be excessive for a specific condition
(e.g., two pairs of gloves for a respiratory pathogen, N95 respirator for stable potential EVD/VHF patient) but
cannot be safely omitted for another special pathogen. This does, however, create a single initial set of PPE
for simplicity and consistency. Hospitals may reasonably decide to adopt more specific screening-based
PPE ensembles than the ones presented here.
Following initial assessment, the clinical and infectious disease/infection prevention and control staff should
discuss any necessary changes to the Special Pathogen Basic PPE ensemble. If a VHF is suspected and
the patient is stable and there is no bodily fluid exposure risk at present, the facility may appropriately elect
to stay with the Special Pathogen Basic ensemble. However, many facilities assume that the patient could
develop vomiting, diarrhea, bleeding, or become unstable at any time and therefore elect to adopt VHF PPE
for these situations. We use this assumption in the planning guide understanding that this exceeds current
CDC recommended levels of protection. Providers and facilities should understand the increased heat
stress, mobility impairment, and other potential risks that can accompany higher levels of PPE and consider
these trade-offs in their decision-making.
Finally, note that the recommendation for the suspect case patient to wear a simple mask and for the
provider to wear an N95 respirator may in the end not be indicated, but creating an expectation for
consistent procedures dictates that one simple process be followed unless an epidemic/outbreak requires
just-in-time training and specific process deviations. Figure 1 describes the sample PPE ensembles that will
be referred to throughout this planning guide.
Early consultation with infection control and prevention and infectious disease experts can assist in tailoring
precautions to transmission-based as a diagnosis is established.
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-4
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
References
and
Resources
Exercises
Checklists
Figure 1. Sample PPE Use When a Patient with Suspected Special Pathogen is Identified.
TRIAGE
Patient
• Ask to wear a simple mask (i.e., flexible surgical mask/facemask)
and perform hand hygiene
Staff
• No physical contact with patient required: N95 respirator and gloves
• Contact required: Special Pathogen Basic PPE
Once a patient has been isolated, nursing and physician staff will confer and, depending on the suspected
disease based on the travel/exposure history and any additional epidemiological factors, will choose a PPE
ensemble. This PPE should ideally be packaged in kits or on a cart, well-labeled and ready for use.
Example Screening PPE
Special Pathogen Basic PPE
Precautions are to be initiated and PPE donned as soon as
a suspect case is recognized and sufficient for novel
influenza, MERS, SARS, and similar suspected diseases as
well as stable patients with suspect VHF.
Consists of1:
• Fit-tested N95 or equivalent/higher respirator2
• Fluid-resistant gown that extends to at least mid-calf
(may substitute impermeable, though heavier, hotter,
and costlier)
• Nitrile gloves with extended cuff - 2 pairs
• Face shield
• Consider booties and head cover (Note: not required by
CDC but recommended by Occupational Safety and
Health Administration (OSHA))
Note: The first four items should be available at triage and
routinely applied for any suspected special pathogen patient
requiring physical contact and during initial assessment.
Just-in-time training should reinforce the specific hazards
of VHF patients during outbreaks that may result in patients
presenting to the facility.
VHF PPE
Precautions are to be initiated and PPE donned when
suspicion for EVD or another VHF is high based on current
outbreak epidemiology and the patient is either unstable,
exhibits vomiting, diarrhea, or bleeding, or such conditions
are judged reasonably likely. The facility should select its
VHF PPE depending on what the providers are used to and
have available. For the purposes of this document, we
assume that gowns and N95 respirators are used since
these are more routinely available. The option for
coveralls with overboots/shoes is appropriate and may offer
additional protection from bodily fluid exposures and the use
of PAPRs offers an additional level of respiratory protection.
All skin should be covered.
Consists of:
• Fit-tested N95 or equivalent/higher respirator2
• Nitrile gloves with extended cuff - 2 pairs
• Impermeable gown that extends to at least mid-calf
• Knee high pull-on impermeable booties
• Surgical hood (full head coverage draping onto shoulders)
• Face shield
• Impermeable apron should be added for patients with
significant body fluid losses/exposure risk
Guidance on doffing/donning and use of PAPRs is
available from the CDC.
These materials should be immediately available at triage and staff should be able to don them rapidly. Inventory should be monitored
to ensure individual items are not removed from the ensemble for alternate uses. In the absence of a known outbreak, consider keeping
materials accessible but locked to prevent alternate use.
2
PAPR with proper filtration may be advisable if available for patients with respiratory symptoms or requiring airway intervention.
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
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�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
PL A NNI NG / P O L I C Y / R E S O URCE S
• All frontline hospitals should have a plan to manage patients potentially infected by a special pathogen.
Table 2 identifies key elements that should be considered in response plans.
• Hand hygiene (e.g., handwashing with non-antimicrobial soap and water, alcohol-based hand rub, or
antiseptic handwash) is one of the best ways to remove microorganisms, avoid getting sick, and prevent
the spread of infection to others.
• Each facility should consider its unique needs and assure compatibility with applicable regulatory
requirements and national standards when developing a response plan.1
• Facilities should consider developing algorithms to guide their procedures. A disease-specific algorithm
provides:
○○Case definition
○○Provider tasks
○○Hyperlinks to resources
○○Laboratory protocols
○○PPE instructions
○○Notification protocol
○○Pre-identified room to place patient
Table 2. Key Planning Elements for Frontline Facilities.
Overall Planning Considerations
• Risk/role
○○Role of hospital in community/region and available assessment/treatment/transfer resources
○○Patient demographics
○○At-risk populations
○○Proximity to transportation hubs (e.g., international airports)
• Resources – type and amount based on risk
○○Staff
○○Supplies (e.g., PPE and patient care)
○○Space (e.g., negative airflow rooms, doffing/donning space)
○○Systems (e.g., notification, electronic health record [EHR] integration, laboratory, policies, training systems)
○○Type and scope of infectious disease incidents (e.g., suspect special pathogen case, pandemic, severe influenza year)
• Response partners – who should be involved in the planning?
○○Facility partners (e.g., labor unions, emergency department, emergency management, infection control and prevention,
infectious disease, relevant inpatient units, public relations, chief medical officer [CMO]/chief nursing officer [CNO],
environmental services, plant operations/maintenance, clinical laboratory, admissions, hospital security)
○○Local agencies and healthcare coalition (e.g., local health department, emergency management, emergency
medical services [EMS], medical examiner)
○○State agencies (e.g., state health department - state agencies will involve federal partners as required)
Examples: 2017-2022 Health Care Preparedness and Response Capabilities, Implementation Guidance for Ebola Preparedness
Measures, and Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
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�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Emergency Management Considerations
• Hospital Incident Command System (HICS)
○○Authorities – legal (including isolation and quarantine regulations) and administrative
○○Organizational response structure for infectious disease incident
○○Triggers for activation of incident command
○○Activation/notification – process and persons notified and communication plan (consider contact list with
check-offs for who was notified and when)
○○Situation monitoring and communication process
○○Technical experts (e.g., infectious disease and infection control and prevention, legal)
○○Incident action planning process – consider facility-specific incident response guide
○○Public relations
• Internal communication
○○Facility personnel (e.g., clinical leadership, infection control and prevention, administration) – list and contact information
○○Staff
○○Patients, families, and visitors
• External communication
○○Communication and information sharing - what information is shared, with whom, and when - how is information
release coordinated with public health partners?
○○Communication with local, state, and federal partners – list and contact information
○○Communication with media/others – Health Insurance Portability and Accountability Act (HIPAA) and other issues
• Demobilization/disposal/after action review/recovery
Operational Considerations
• Points of entry into healthcare delivery system –screening for potential special pathogen cases at each entry
and process for transfer to emergency department (or direct via EMS to a different facility for assessment)
○○Nurse line/triage line phone call
○○Web-based encounter/telemedicine
○○Emergency department
○○Walk-in clinic/urgent care/free-standing emergency department
○○Ambulatory care center
○○Private physician/primary care provider office
○○Arrival via EMS
• Care team/staffing model
○○Skill mix and selection of personnel – special pathogens “team” or all personnel trained equally
○○Roles and responsibilities – lab, environmental services, use of trainees, etc.
○○Staffing model – hours, rotations, process – must be able to initiate care 24/7
○○Special populations (e.g., pediatric, labor and delivery, geriatric)
• Visitor/family management
• Language, religious, and cultural issues that may complicate patient care
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-7
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Infection Control Considerations
• Screening and identifying high-risk patients
○○Who (patient)
○○Where and when (travel history)
○○What is the concern/condition (according to CDC case definitions/epidemiology and how sick the patient is)
○○How (contact with a person confirmed to have a highly contagious disease)
• Isolating high risk patient
○○Suspected diagnosis and precautions to be taken
○○Administrative controls (e.g., policies, procedures, algorithms, checklists, training)
○○Engineering controls (e.g., negative pressure room, single occupancy room with restroom, cohort space,
evacuation route)
○○Physical controls (e.g., PPE)
○○Designated room
▪▪ Airborne infection isolation room (AIIR) – negative pressure isolation room or, if no AIIR room available, room
removed from immediate patient care areas with closeable door and no recirculation of air to facility unless
high-efficiency particulate air (HEPA) filtered
▪▪ Bathroom included, adjacent, or bedside commode (with a plan on how to dispose of the waste)
▪▪ Storage area for patient belongings
• Follow IPC practices and guidelines
• Waste process
○○Place to store waste – large volumes of PPE, linen, and other waste may be generated
○○Disposal plan (e.g., disinfect, use solidifiers)
• Area for donning/doffing – optimally in adjacent/anteroom but must secure sufficient protected space
• Dedicated equipment, hand hygiene, and restricted patient movement
• Extent of care at frontline facility (i.e., what are the goals at the facility and where and when will the patient
be transferred to a regional facility for further care?)
• Patient movement (i.e., transport and transfers)- who can provide, what are the resources
• Training needs and resources (e.g., National Ebola Training and Education Center [NETEC] courses, existing
in-house programs and systems, etc.)
Patient Care Considerations
• Patient condition
○○Ambulatory
○○Non-ambulatory
○○Critically ill
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-8
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
○○Special considerations
▪▪ At-risk and patients with functional needs
▪▪ Pregnant
▪▪ Pediatric
▪▪ Geriatric
▪▪ Delirious/confused (multiple issues including cooperation with caregivers)
▪▪ Clearly deceased/dead on arrival1
• Laboratory services
○○Specimen acquisition – who acquires and how are samples managed?
○○Diagnostic testing – what will be performed and where? – list of general and specific tests and the specimens
and tubes required2
○○Compliance with protocols and procedures for sending specimens for confirmatory testing, internal and external
specimen packaging, transport, storage prior to transport, tracking from collection to transport/destruction
• Disinfection and medical waste management - label, sequester, hold until test results completed
○○Category A waste management – VHF and other infectious substances capable of causing permanent disability or
life-threatening or fatal illness in exposed humans or animals3
○○Category B waste management – other infectious substances that do not meet the Category A criteria (note that
specimens for MERS-CoV are handled as Category B infectious substances but patient waste may be handled in
the usual manner)4
• High risk procedures (e.g., central line placement, intubation, surgery, dialysis, delivery/C-section for VHF)
• Linen service
• Food service
• Discharge
• Decedent management
• Decontamination of rooms/equipment
Healthcare Worker Safety Considerations
• Countermeasures (e.g., vaccination, prophylaxis)
• PPE
• Training (e.g., agent information, patient screening and care processes, drills, exercises, just-in-time
resources)
• Healthcare worker monitoring
Resuscitation should not be withheld because of infectious concerns. Few cases actually have the suspected disease and some
causes of cardiac arrest are correctable (e.g., altered electrolytes).
2
Basic laboratory tests include electrolytes, urinalysis (dip), urine pregnancy, hemoglobin, and malaria smear/rapid test.
3
Dangerous Goods Regulations.
4
Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome
Coronavirus (MERS-CoV).
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-9
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Financial Considerations
• Procurement/supply chain
• Documentation/legal statutes
• Accounting
SA F E SYST E M S O F WO R K
• To protect HCWs, healthcare facilities provide onsite management and oversight of adherence to safe
systems of work.
• Healthcare facilities should ensure their planning and policies are congruent with usual workplace safety
programs (e.g., Bloodborne Pathogens [29 CFR 1910.1030], PPE [29 CFR 1910.132], and Respiratory
Protection [20 CFR 1910.134] standards and other requirements under OSHA) as well as any state OSHA
or other regulatory requirements.
• Engineering controls and policy should specify:
○ Pre-identified negative pressure isolation rooms or other designated isolation room.
Designated cold, warm, and hot zones, where PPE donning/doffing occurs - contamination is
minimized in this area by following appropriate procedures:
▪ Green or cold zone (clean) is outside the area of patient care, PPE doffing, and waste storage/handling.
Yellow or warm zone is near the exit of the patient room or in the anteroom if one is available where
PPE doffing or contained waste handling occurs and contamination is a possibility.
Red or hot zone is the area within the patient room and is considered contaminated.
○ Safe flow and movement of patients.
• PPE is considered the least effective control by itself.
○○Each frontline facility should have enough PPE on hand to provide at least 12-24 hours of care as
commensurate with the tiered regional system. Generally, the items in the example Special Pathogen
Basic and VHF PPE ensembles should be available in all frontline hospitals, though specific models may
vary based on facility preferences, supply contracts, and other factors.
○○Selection and training on PPE should follow usual program requirements and include an understanding
of the risks of the PPE used. Some of the items in the example Special Pathogen Basic and VHF
PPE ensembles exceed what is recommended for specific special pathogens during screening. Each
frontline facility should balance the intent to use as protective an ensemble as may be necessary for an
unknown pathogen with the known risks of working in levels of PPE that are higher than usual.
○○Special Pathogen Basic PPE should be available at triage and in each patient treatment area. These
supplies should be considered in overall inventory management practices and rotated for clinical and
training uses to avoid waste and unnecessary stockpiling.
○○Frontline facilities should pay careful attention to ensure adequate space is available and checklists and
trained observers are used when donning and doffing higher than usual levels of PPE, particularly when
VHF is suspected.
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-10
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
○○Modify the initial level of isolation and PPE as additional symptoms and information are gathered. PPE
items may need to be added or removed as the likelihood of a specific pathogen increases. Once the
pathogen has been confirmed, frontline facilities should follow disease-specific guidelines for PPE and
infection control precautions.
• Consider the following when selecting the isolation room:
○○Patient movement routes from the emergency department (ED) triage area or the ambulance entrance
to the isolation room.
○○Ventilation characteristics.
○○Proximity to bathroom/integrated bathroom.
○○Ability to isolate individual patients or cohort patients by diagnosis, depending on the disease.
○○Availability of designated PPE donning and doffing area(s) or ability to control/cordon dedicated space.
○○Availability of initial waste storage space and pathway to secondary waste management space.
○○Ability to communicate with and monitor the patient from outside the room.
○○Sufficient space available to provide care in place while awaiting test results/transfer.
○○Proximity to staff relief areas.
• Refer to the Isolation Room Supply List for items that should be available in each patient isolation room.
A rigid outer receptacle (overpack) provided by an approved waste vendor and meeting U.S. Department
of Transportation (DOT) Hazardous Materials Regulations (HMR) requirements for Category A transport
should also be available at or to the facility to allow safe sample packaging.
Resources:
2017-2022 Health Care Preparedness and Response Capabilities
Bloodborne Pathogens (29 CFR 1910.1030)
Components Necessary for a “Ready” Frontline Hospital
Dangerous Goods Regulations
Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule
Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007)
Hierarchy of Controls
Implementation Guidance for Ebola Preparedness Measures
Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
MERS Control and Prevention
Multi-year Planning, Training, and Exercise Plan Template
Powered Air-Purifying Respirator (PAPR) and Gown Donning and Doffing Procedures
Preparing U.S. Hospitals for Ebola
PPE (29 CFR 1910.132)
Regional Treatment Network for Ebola and Other Special Pathogens
Respiratory Protection (20 CFR 1910.134)
Sample Needs Assessment Questionnaire
Standard Precautions in Health Care
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
1-11
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Screening and Electronic Health
Record Considerations
BAS ELINE SCR EE NING / N O CUR R E NT OUTB R E A K 1
• Sporadic cases of VHF and other unusual diseases occur. Trained staff in conjunction with algorithms/
prompts can be critical to identifying a new suspect case. These same screening mechanisms may help
identify measles, pox viruses, influenza, and other infectious diseases as well as potential travel-related
illness (e.g., NYC Health + Hospitals Initial Patient Screening Algorithm for Infectious Diseases for EDs).
• Patients do not usually present with a specific diagnosis. It is important to routinely apply standard
precautions and add appropriate transmission-based or special pathogens precautions whenever history
or exam findings warrant.
• Implementing screening during triage and before completing full patient evaluation can reduce transmission
and assist in identifying and isolating the patient.
• Triage/screening strategies should be tailored to facility needs and processes.
• Surveillance for general communicable diseases can include:
○○Visual communication such as posters/signage to report any recent international travel to the triage
staff and to “cover your cough” or encourage other infection control actions. Consider stations at
hospital entrances/triage with hand gel and masks with signs attached (e.g., Universal Screening Sign)
to encourage patients to self-identify and take actions to reduce transmission. Consider translation to
common local languages.
○○Travel and contact screening questions (e.g., international travel within the last 30 days) integrated into
the EHR. Sample questions are included in the Electronic Health Record Screening document.
○○Best practice advisories can flag fever and chief complaints in the EHR to prompt documentation of
travel history.
• Symptom/syndrome actions may include:
○○Febrile respiratory illness screening – provide a simple mask to those with cough and fever and rapidly
move them to a treatment room regardless of travel history.
○○Fever and rash – provide a simple mask and rapidly move to a treatment room unless clearly urticaria or
other benign rash.
○○Assessment by a provider for other risk factors if history of recent travel to a country where special
pathogens may be endemic.
• Additional screening questions should be guided by the background of the patient, the exposure history,
and disease epidemiology. Decision support tools (e.g., CDC disease-specific protocols) can assist once a
suspect case is identified.
Refer to Outbreak-Specific Changes to Screening section to tailor local screening questions to be adjusted for pathogen-specific and
associated precautions.
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-12
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
• Provider education and “just-in-time” training can help identify cases that are missed by usual symptom
and vital sign flags.
• If a communicable special pathogen disease is suspected, triage personnel may initiate isolation actions:
○○Patient performs hand hygiene and dons simple mask.
○○Provider dons gloves and N95 respirator (if physical contact with the patient cannot be avoided, rapidly
don Special Pathogen Basic PPE)
○○Escort patient to isolation room or designated room – clear hallway to isolation room for suspect VHF
cases.
○○Provider dons Special Pathogen Basic PPE to enter and assess patient further unless VHF is suspected
and the patient is unstable and/or there is high risk of exposure to bodily fluids, in which case VHF PPE
is donned.
○○Screen based on history and exam and continue or adjust PPE based on pathogen/disease suspected.
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-13
�Planning
Screening
Special
Respiratory
VHF
Special
Considerations
References
and
Resources
Exercises
Checklists
Figure 2. Sample Daily Screening and Triage Process - No Significant Risk of a Special Pathogens Patient Presenting.1
First Contact/Registration
NO
Triage
Has patient had
fever with cough or rash
in last week? 2
YES
Give patient simple
mask & ask to perform
hand hygiene.
NO
Is VHF suspected
AND is the patient unstable or
is there a high risk for bodily
fluid exposure?
Did patient
travel to a country with
an outbreak of concern or
endemic special
pathogen? 3
YES
Has patient
traveled outside the US
in the last 30 days?
Isolation Room
NO
Don Special
Pathogen Basic PPE
before entering room.
Don N95 respirator & gloves.
If physical contact required,
don Special Pathogen Basic
PPE.
NO
Don VHF PPE
before entering room.
Conduct patient assessment & determine
exposure risk using CDC case definition.4
Alert charge nurse & ask
for isolation room.
Escort patient to isolation
room keeping distance
from others.
Does patient
meet criteria for special
pathogen?
NO
YES
NOTES
YES
YES
Notify triage nurse
of positive
travel/symptoms
Post special pathogen
screening sign on door &
notify provider of
positive travel/symptoms.
Stop screening process.
Proceed with usual
patient process.
Stop screening process
& continue patient
assessment per
appropriate procedures,
including use of
transmission-based
precautions.
Which special pathogen?
SPECIAL
RESPIRATORY
VHF
Go to Special
Respiratory section.
Go to VHF section.
• Instruct patient how to put on mask.
• Special pathogens may still be considered in the absence of specific travel alerts.
• VHF or special respiratory-specific screening questions should be implemented during outbreaks with a reasonable risk of suspect case presentation to the facility
and appropriate PPE made available at triage for suspect cases if physical contact with a patient is unavoidable.
1
This is a general screening algorithm and should be modified during an epidemic and/or with current community cases.
Algorithms are helpful, but do not replace good clinical judgment.
Screening criteria may change to fever OR cough OR rash OR other hallmark signs/symptoms plus travel when a significant outbreak
increases the risk of patients presenting to the facility.
2
This should be based on information already available/known to the triage personnel. If unsure, isolate the patient while additional
information is gathered and other sources are used to determine epidemic and endemic disease.
3
4
Contact local health department to ascertain risk of special pathogen.
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-14
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
OU T B R E A K - S P E C I F I C C H ANG E S TO SCRE E NING
• Situational awareness of outbreaks is critical.
○○Monitor communicable disease outbreaks of international and public health concern through state and
local department of health alerts or advisories, CDC travel health notices, and other reliable sources
(e.g., Travel Clinical Assistant).
○○Ensure your facility website (e.g., NYC Health + Hospitals Special Pathogens Program) has an easy-tofind link to a reliable infectious disease information source.
• Outbreak/disease-specific changes to screening should be implemented in consultation with local and
state public health authorities.
○○Pre-designate who will be responsible for identifying the need and implementing outbreak-specific
changes to screening.
○○Refer to disease-specific guidance on Special Respiratory Disease and VHF.
○○Ask about disease-specific signs and symptoms of concern when there has been travel history to an
outbreak area within the incubation period (e.g., up to 21 days for most VHF, up to 14 days for MERS).
Post disease-specific algorithms at triage to assist.
○○If cases are present in the community, ask about exposure to ill individuals including those with known
disease or persons with recent relevant exposure or travel history.
○○Modify the EHR to include best practice advisories tailored to current outbreaks, including more focused
travel history and potentially broader inclusion symptoms for screening (e.g., cough, gastrointestinal [GI]
symptoms, or rash without fever).
• Posted information in the lobby/triage areas should reflect any specific symptoms or countries relevant to
current outbreaks (e.g., “Please let our triage nurse know right away if you have visited [country X] in the
last month”). Ensure that the signage is also translated into relevant languages.
• Provider education on symptoms/presentation of special pathogens can help detect atypical cases.
• Continue to Viral Hemorrhagic Fever or Special Respiratory Disease sections if patient meets criteria and is
at risk based on clinical judgement of the provider pending further history and evaluation.
• If the patient does not meet the suspect case definition and is unlikely to have the condition based on
potential exposure history or symptoms (see Figure 2), release from isolation.
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-15
�Planning
Screening
VHF
Special
Considerations
Special
Respiratory
References
and
Resources
Exercises
Checklists
Figure 3. Sample Screening and Triage Process for VHF.
1. IDENTIFY SIGNS AND SYMPTOMS
Customize to
specific suspected
VHF once sufficient
information is
obtained.
• Fever ≥100.4°F(≥38°C)
NO
AND/OR
• Compatible symptoms: headache, muscle pain, vomiting,
diarrhea, abdominal pain, or hemorrhage
Continue with
Usual Triage and
Assessment
YES
2. IDENTIFY EXPOSURE HISTORY
Within the last 21 days:
• Has patient lived in or traveled to a country with VHF outbreak?
NO
OR
• Has patient had contact with an individual with confirmed VHF?
YES
3. TAKE INITIAL TRIAGE ACTIONS
• Place simple mask on the patient and have perform hand hygiene
• If no physical contact required, don N95 respirator and gloves
• If contact is unavoidable, don Special Pathogen Basic PPE as rapidly as possible
• VHF PPE may be moved to triage if desired when an outbreak occurs and patient presentations to the facility are
likely (for triage personnel, impermeable coveralls may be faster to don than gown/booties)
4. ISOLATE PATIENT IMMEDIATELY
• Place patient in private room with private bathroom or covered bedside commode
• Follow VHF precautions
5. MODIFY PPE AS APPROPRIATE FOR UNSTABLE PATIENT/HIGH RISK OF BODILY FLUID EXPOSURE
• Fit-tested N95 or equivalent/higher respirator • Knee high pull-on impermeable booties
• Nitrile gloves with extended cuff - outer and inner • Surgical hood
• Impermeable gown that extends to at least mid-calf • Face shield
If patient has significant vomiting/diarrhea/bleeding, consider adding impermeable apron and using coveralls and/or PAPR in the ensemble
6. ASSESS PATIENT
• Limit and keep a log of personnel who enter and leave patient's room
• Consider alternate diagnoses and evaluate for risk of VHF
• Perform only necessary tests and procedures and avoid aerosol-generating procedures, if possible
• If VHF not suspected after evaluation, adopt transmission-based precautions for isolation and PPE
7. INFORM
• Complete internal & external notifications to initiate coordination
• Activate HICS according to facility plan and health department recommendations if patient is classified as a PUI
INTERNAL
• Infection control/prevention • Inpatient unit leader/charge nurse
• Infectious disease • Laboratory
• Administrator on duty/call • Environmental services
• Clinical leadership (e.g., CMO, CNO) • Security
• Emergency department • Public relations
Back to Contents
EXTERNAL
• Local or state health department
• Consultation with/notification of others per jurisdictional reporting/
coordination plan for special pathogens (e.g., assessment hospital,
designated state or regional Ebola and special pathogen treatment
center, EMS) as appropriate
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-16
�Planning
Screening
VHF
Special
Considerations
Special
Respiratory
References
and
Resources
Exercises
Checklists
Figure 4. Sample Screening and Triage Process for Special Respiratory.1
1. IDENTIFY SIGNS AND SYMPTOMS
Customize to specific
suspected special
respiratory disease
once sufficient
information is
obtained.
• Fever ≥100.4°F(≥38°C)
AND/OR
NO
• Compatible symptoms: coughing, shortness of breath, chills,
body aches, sore throat, headache, vomiting, diarrhea
Continue with
Usual Triage and
Assessment
YES
2. IDENTIFY EXPOSURE HISTORY
Within the last 14 days:
• Has patient lived in or traveled to a country with an outbreak of
special respiratory disease?
NO
OR
• Has patient had contact with an individual with confirmed
special respiratory disease?
YES
3. TAKE INITIAL TRIAGE ACTIONS
• Place simple mask on the patient and perform hand hygiene
• If no physical contact required, don N95 respirator and gloves
• If physical contact unavoidable, rapidly don Special Pathogen Basic PPE ensemble
4. ISOLATE PATIENT IMMEDIATELY
• Place patient in airborne infection isolation room, if available
• Follow special respiratory precautions
5. DON SPECIAL PATHOGEN BASIC PPE
• Fit-tested N95 or equivalent/higher respirator • Face shield
• Fluid-resistant gown that extends to at least mid-calf • Consider booties and head cover
• Nitrile gloves with extended cuff - outer and inner
6. ASSESS PATIENT
• Limit and keep a log of personnel who enter and leave patient's room
• Consider alternate diagnoses and evaluate properly
• Perform only necessary tests and procedures and avoid aerosol-generating procedures, if possible
• If special respiratory disease not suspected after evaluation, discontinue use of
Special Pathogen Basic PPE and adopt transmission-based precautions
7. INFORM
• Complete internal & external notifications to initiate coordination
• Activate HICS according to facility plan and health department recommendations if patient is suspect case
INTERNAL
• Infection control/prevention • Inpatient unit leader/charge nurse
• Infectious disease • Laboratory
• Administrator on duty/call • Environmental services
• Clinical leadership (e.g., CMO, CNO) • Security
• Emergency department • Public relations
EXTERNAL
• Local or state health department
• Consultation with/notification of others per jurisdictional reporting/
coordination plan for special pathogens (e.g., assessment hospital,
designated state or regional Ebola and special pathogen treatment
center, EMS) as appropriate
Though this is titled “Special Respiratory” it is also appropriate for poxviruses.
1
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-17
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Resources:
2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Appendix A
Check List for Arrival of Patient with a High Consequence Infectious Disease (HCID)
Cover Your Cough
Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments and Clinics with Potentially
Communicable Diseases of Public Health Concern
Door Isolation Signs: Level 1 and Level 2
Hand Hygiene Print Materials
High Consequence Infectious Disease (HCID) Screening Guidance
MERS Co-V ED Screening Protocol
MERS Health Advisory
NYC Health + Hospitals Special Pathogens Program
Pathogen Infectious Disease Isolation Guide
PPE Donning and Doffing: N95 and PAPR
Travel Clinical Assistant
Travel Health Notices
Yellow Book, Chapter 5: Post Travel Evaluation
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
2-18
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
V iral Hemorrhagic Fever
E X A MPLE D IS E AS ES
• Ebola virus disease (EVD), Marburg, Lassa, Lujo, South American hemorrhagic fevers.
• Transmission based PPE should be used once a specific VHF is suspected, defaulting to the VHF PPE
when a patient is unstable with vomiting, bleeding, or diarrhea and there is a high risk of exposure.
ID E NTIF Y
• Obtain exposure history:
○○International travel in past 21 days to an area with active transmission of a VHF or
○○Contact with an individual with a VHF disease within the previous month (longest incubation timeframe
for most VHFs is 21 days).
• Question patients who meet the exposure criteria about signs or symptoms compatible with VHF.
○○Signs and symptoms vary by disease and may be nonspecific, but in general, check for: abrupt onset of
fever, myalgias, and prostration.
○○GI symptoms (diarrhea, vomiting, abdominal pain) are common.1
○○Followed in severe forms by coagulopathy with a petechial rash or ecchymoses and sometimes overt
bleeding from mucous membranes, GI tract, or urinary tract.
• If the patient is unable to provide exposure history due to their clinical condition or other communication
barrier, elicit history from the next most reliable source (e.g., family, friend, EMS provider).
• Ideally, isolate patient and continue asking screening questions about:
○○Date of onset of symptoms.
○○Contact with body fluids (blood, saliva, sweat, nasal secretions, urine, tears, stool) or laboratory
specimens related to a person suspected of or diagnosed with a VHF.
○○Participation in any funeral preparations, burial services, or funeral rites for a deceased person.
○○Any contact with animals while travelling internationally.
○○Visitation at any healthcare facilities while traveling internationally.
○○Family members or other close contacts that are ill.
○○Whether the patient is taking malaria prophylaxis and, if so, what kind and for how long.
ISOL ATE
• If a relevant exposure history is reported and signs or symptoms consistent with a VHF are present,
immediately move the patient to the isolation room via a pre-designated route to limit exposures to other
staff, patients, and visitors.
○○Do not delay patient placement, but remove unnecessary equipment and supplies from the designated
isolation room as possible.
1
Yellow Book
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FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
3-19
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
○○The patient should perform hand hygiene and wear a simple mask.
○○Staff should don gloves and N95 respirator and avoid direct contact with the patient. If the patient needs
immediate assistance and contact is unavoidable, a provider should quickly don Special Pathogen Basic
PPE. Transmission based PPE should be used once a specific VHF is suspected, defaulting to the VHF
PPE when a patient is unstable with vomiting, bleeding, or diarrhea and there is a high risk of exposure.
○○Isolation should occur in a designated private room (with private bathroom or covered bedside
commode) separate from other patient care areas.1 While an airborne infection isolation room (AIIR) is
not required for VHF, some VHFs (e.g., Lassa fever) may be capable of spread via the respiratory route
and some facilities may elect to use an AIIR, if available.
• EMS transported patient: ED should have a system of advance notification from EMS about any suspect
case and receive the patient in a designated area (away from other patients). A plan for safely transporting
the patient on the stretcher to the isolation area with minimal contact with non-essential healthcare
workers or the public should be developed. EMS-specific procedures are outlined in the EMS Infectious
Disease Playbook.
• Limit the number of patient care providers and keep a log of those entering the room. Only trained HCWs
should enter the room; institutional policy should specify the level of training for providers including staff
requirements (e.g., only those trainees essential to accomplish critical procedures, no students) while
balancing available staffing with potential increased risks in involving less experienced HCWs.
• Determine visitor policies including how parents of children and family members accompanying a patient
will be handled. This may vary between facilities.
• Provide access to interpreter via phone as required for patient and ideally in person to address family and
visitor issues.
• Consider telemedicine if possible for consultations. If staff must enter the patient’s room, don appropriate
PPE based on the patient’s clinical status.
• Place appropriate infection control/infection prevention door and other relevant signage (e.g., “VHF Precautions”).
• Complete history and physical exam. Consider:
○○Utilizing diagnostic technology (e.g., bedside sonogram) and laboratory workup that can be performed
in the isolation environment.
○○Performing routine interventions (e.g., placement of peripheral IV, phlebotomy) per differential diagnosis
and patient’s clinical status in consultation with infection control/infectious disease and local or state
department of health.
○○Obtaining imaging in the isolation environment if possible. The need for plain film or CT imaging should
be carefully weighed and a process in place for safe transport and decontamination of the equipment if
the patient must be moved for imaging studies.
• Assess clinical stability and be prepared to intervene quickly if warranted.
• Evaluate for disabilities such as poor vision, developmental or physical limitations, and hearing issues and address.
• Provide means of communications to the patient (e.g., phone, tablet/slate computer, white board/dry
erase markers).
• Consider special population needs (e.g., pediatrics, obstetrics, geriatrics) in patient management.
Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus
Disease (EVD)
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• In the event of a medical emergency or acute deterioration in patient status, a crash/airway cart should be
readily available to obtain equipment and medications.
• Ensure safe medical devices, supplies, and patient care equipment are available (see Isolation Room
Supply List).
INFOR M
• Determine based on history, exam, and initial diagnostics whether the patient should be considered a
person under investigation (PUI) in consultation with public health authorities.
○○If no, release from VHF precautions and adopt standard or transmission-based precautions.
○○If yes, determine if the patient will be transferred for further workup or remain at the facility for evaluation.
• Upon the designation of a PUI, a facility should activate its HICS – an incident commander and a public
information officer should be designated at minimum. Depending on the situation and needs, the
command center may be opened.
• Unified command including Emergency Support Function 8 (ESF-8)/Health and Medical partners should
be established as required for complex situations.
• Follow notification protocols within the facility and externally with public health authorities and any
consulting or receiving facility. Consider developing a notification list.
• Internal notifications should occur as specified in Figure 3.
• External notifications should be made according to local protocols.
○○In most cases, the primary external notification is the local or state health department. In general,
the health department will be responsible for contact tracing, identification and health monitoring;
surveillance of persons at risk; providing outbreak response support; and implementing legal authorities.
○○If the patient is in a high risk category, the facility may assist with contact tracing/quarantine as
recommended by public health.
○○EMS should be notified about a PUI and, if EMS transported the patients, the providers should be notified.
PPE
• Refer to Figure 1 for the PPE ensemble.
• Refer to PPE Donning and Doffing Checklists.
• In the event of a PPE breach, consider:
○○Moving immediately away from source of contamination to an area where the breach can be evaluated
and doffing of PPE is possible.
○○Assessing the nature of the breach.
○○Assessing the risk of exposure to skin and mucous membranes.
○○Washing any exposed skin thoroughly with soap and water, after which an alcohol-based hand rub
(ABHR) can be used. Care should be taken not to abrade or damage the skin. Bleach solutions are not
recommended for cleansing of skin as they may damage the protective outer skin layer.
○○Flushing exposed mucous membranes thoroughly with water.
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○○Informing supervisory personnel, occupational health, and public health authorities immediately in the
case of exposure to bodily fluids.
○○Assessing need for post-exposure prophylaxis or vaccination depending on the exposure and
suspected agent.
INITI A L CLINICA L CA R E (FIRST 4 8 -72 HOURS) CO N S ID ER ATIO N S
This section is mainly applicable to frontline facilities that cannot transfer a PUI until the illness is confirmed by laboratory testing.
Airway issues
• PAPR with appropriate filtration and hood should be used if available during airway interventions such
as intubation and deep suctioning.
• Noninvasive ventilation is relatively contraindicated due to high incidence of aerosol generation and risk
of vomiting/aspiration.
• Dry powder inhalers should be used instead of nebulized liquid if bronchodilators are needed.
• Rapid sequence induction techniques are preferred for intubation to minimize coughing.
• Nasogastric tubes are relatively contraindicated except in intubated patients.
• Elective or semi-elective intubation is preferred, if possible, due to PPE donning requirements.
• Only the minimum number of staff needed to safely complete the intubation should remain in the room.
Intravenous access issues
• Consider oral rehydration if feasible to avoid IV placement.
• Central venous catheterization is NOT routinely required; generally reserve for central medication/
multiple medication drip indications. Experienced providers using ultrasound guidance are preferred.
• Adhesive dressings/steri-strips or staples should be used to immobilize catheters if possible instead of
suturing central lines in place.
• Intraosseous devices are an acceptable route of parenteral access.
Diagnostics
• Coordinate serologic testing for VHFs with the public health department (local or state per protocol).
• Diagnostic tests that will not immediately change the treatment of the patient should not be performed
if they require transporting the patient. More information on imaging caveats is available in the Isolate
section. Only obtain blood samples for required tests as disposal of blood if the patient is positive will
require special procedures.
• Testing should be performed inside the patient’s isolation room whenever possible (the Lab Issues
section contains related information).
• Consider dedicated equipment, such as a portable ultrasound, for use in the isolation room.
• If equipment is used in an isolation room and removed, ensure appropriate decontamination prior to
placing in service.
• Use disposable equipment and supplies whenever possible.
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Intensive therapies
• CDC guidelines should be followed regarding safely selecting and using equipment, handling and
disposing of waste, and disinfecting equipment.
• Blood product transfusion should be performed in accordance with conservative transfusion guidelines
and in conjunction with hematology consultation.
• HCWs must prevent and avoid direct contact or splashes with blood/bodily fluids, contaminated
equipment, and soiled environmental surfaces. Special attention is required to high pressure/flow in
central lines and other catheters with large residual blood volume.
• Dialysis/continuous renal replacement therapy (CRRT) should be via bedside unit in the isolation room.
Patients should NOT be transported to the hemodialysis unit. Hemodialysis/CRRT machines should
remain in the patient’s room after use until terminal cleaning is performed.
• Line/dialysis effluent and body wastes should be disposed in toilet or drain that minimizes risk of
splashes and allows safe drainage into the sanitary sewer system.
• Detailed guidance for safely performing hemodialysis/CRRT in patients with EVD is available from CDC.
• Extracorporeal membrane oxygenation (ECMO) has not been evaluated in EVD/VHF patients but is
unlikely to be indicated.
Staffing
• Staffing at a nurse:patient ratio of 1:1 with continuous nursing presence in the room is advisable for
stable patients. For patients with vomiting, diarrhea, or bleeding/high risk of exposure or those requiring
intensive care, two providers are recommended though they may not be constantly required.
• Non-clinician HCWs can support clinical staff (e.g., oral rehydration administration) if required – however,
a minimum of staff should be used.
• Functioning in full PPE will require frequent staff changes and adequate rest. To reduce the stress on
staff, place a chair in the isolation room and consider turning the thermostat down if the patient is warm
enough to do so or can be insulated.
• Communication via windows, intercom, speakerphone, tablet computer with cleanable surface, white
board/dry erase markers, and/or video minimizes door opening and transit in and out of the PUI’s room.
• Staff within the isolation room will require support from staff outside the isolation zone (e.g., medications
prepared and sent in). Staff outside the room should monitor the activities in the isolation area. Staff
outside the room will also be needed to serve as observers for donning and doffing procedures.
Mental health/anxiety/dignity
• Patients and their loved ones may find the appearance of providers in PPE alarming.
• Patients in isolation may have higher depression and anxiety rates than those not isolated. Anger,
hostility, fear, and loneliness have also been reported by patients who have been isolated.
• Facilitating communication with family and friends of PUI and confirmed cases may improve
psychological well-being. Mobile phone, internet-based, and/or other two-way visual communication
between PUIs and loved ones may reduce distress without increasing the risk of disease transmission.
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• Counseling of PUI by mental health providers, even if by video, may be beneficial.
• Faith-based services, music therapy, and movies may also be beneficial to the mental health of patients
and their loved ones.
Mortuary affairs
• If a death occurs within the hospital setting, postmortem care should occur in collaboration with public
health officials in the state or local jurisdiction and the medical examiner including packaging and
transportation of the decedent.
• If the suspected VHF is a Category A infectious substance (e.g., EVD, Lassa Fever, Marburg) the body is
subject to local, state, and/or federal regulations for safe removal, transport, and disposal.
LA B I SSUES T O C O N S I D E R
• It may take up to 72 hours or longer after symptom onset to definitively confirm or rule out an EVD diagnosis,
with an additional 12 to 24 hours for specimen transport and testing. In some cases and geographic
areas, low risk patients will remain at the frontline hospital until confirmatory test results are obtained.
• Laboratory leadership should establish a test menu including minimum testing procedures for PUI sample
acquisition and processing including who obtains the labs and the process followed.
• The hospital core laboratory (e.g., central accessioning, pathology administration) should be notified prior
to specimen collection.
• Laboratory testing at frontline hospitals should be limited to the minimum necessary for diagnosis and
acute medical care. Testing should be performed inside the patient’s isolation room using bedside
instruments and methods whenever possible to avoid transport and equipment contamination issues.
Frontline hospitals that can immediately transfer PUIs should defer testing on stable patients to the
receiving facility.
• An example of a minimum menu of testing to ensure appropriate clinical care can include (tests are not
indicated in all patients):
○○A complete blood count (CBC), including differential, and platelet count.
○○Sodium, potassium, chloride, bicarbonate, blood urea nitrogen, creatinine, and glucose concentrations
(Chem 7).
○○Liver function tests (or consider bilirubin at minimum).
○○Coagulation testing, specifically prothrombin time (PT), expressed as international normalized ratio (INR).
○○Malaria testing (rapid testing).
○○Urinalysis (dipstick).
○○Urinary pregnancy test.
○○Influenza A and B and respiratory syncytial virus testing or respiratory viral panel (if available).
• Only trained employees should perform specimen collection. Specimen collection may be a one or two
person process.
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• During specimen collection:
○○Use only safety needles and catheters.
○○Use plastic blood collection tubes and ensure caps are tight.
○○Label each specimen with date and time.
○○Inspect each individual bag to ensure it is free of any tears, rips, or damage before placing the specimen
inside.
• Each collected specimen that must leave the room should be individually bagged and the exterior wiped
down with an Environmental Protection Agency (EPA)-registered disinfectant prior to handoff.
• If testing or packaging is conducted in the core laboratory:
○○PPE to be worn during transport within the facility should be determined by a site-specific risk
assessment and may vary among facilities.
○○The specimen must be hand-carried by a trained employee. Do NOT use a pneumatic tube system.
• If testing is conducted in core hospital laboratory on a suspected VHF case, the following are
recommended:
○○Procedures requiring centrifugation should be performed using biohazard sealed buckets or rotor.
○○If rapid malaria testing is not available, only thin smears should be prepared and should be performed
inside a BSL-2 cabinet and should not be removed from the cabinet until they have been fixed and
dried. Do NOT perform thick smears for malarial testing.
○○Cross-matching for blood transfusion should NOT be performed. The patient should be managed with
crystalloid, colloid, and, if necessary, O Negative blood transfusions (or O+ for post-menopausal or male
patients).
• Packaging specimens for shipping should be performed in the patient’s room, if possible.
• All persons packing and shipping infectious substances must be trained and certified in compliance with
the DOT or the International Air Transport Association (IATA) requirements every two years.
• Specimens should be shipped via courier or an assigned transporter to the public health laboratory for
testing. The local or state health department should be consulted if shipping samples directly to CDC.
• Samples from patients who are suspected or confirmed to have EVD or other regulated hemorrhagic
fevers should be packaged and shipped as Category A infectious substances in accordance with the
DOT’s Hazardous Materials Regulations (HMR) 49 CFR 171-180.
• Specimens for shipment should be packaged in a triple packaging system, which consists of: (1) a primary
container (a sealable specimen container) wrapped with absorbent material, (2) a secondary container
(watertight, leakproof), and (3) an outer shipping package. For questions about packaging regulations,
contact the DOT Hazardous Materials Information Center at 1-800-467-4922.
• Environmental surfaces must be cleaned with EPA-registered disinfectants.
• If patient is ruled in, thorough decontamination of bedside devices should be performed. If core laboratory
facility was used to process confirmed patient specimens, which should be a rare event, decontamination
should be conducted in consultation with subject matter experts.
• Information on managing laboratory-generated waste is provided in a subsequent section.
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PATIE NT MOV EME NT CO N S ID ER ATIO N S
• If the patient needs to be moved to another room within the facility:
○○Consider the risk/benefit of moving the patient. Can the services be brought to the patient?
○○Plan the route through areas with the lowest risk of traffic and control traffic during the move.
○○Security and facilities staff may need to be involved with planning/controlling route and elevators and to
provide decontamination as required after the moves/studies are completed.
○○Consider informing hospital staff prior to movement to minimize concerns.
○○Patient to wear simple mask and be wrapped in clean linen.1
○○If the patient is unstable or exhibits vomiting, diarrhea, or bleeding wrap them in an impermeable sheet
and consider diaper/chux and other mitigating strategies prior to movement.
○○During patient handoff from patient room to transport team, ensure staff performing the patient
transport wear appropriate and clean PPE to escort patient outside room.
○○Limit elevator occupancy to the patient and transporter.
WASTE A ND S PILL M A N AG EME NT CO N S ID ER ATIO N S
• Large amounts of waste are generated during care for PUIs due to PPE and other materials disposal.
Plans should account for multiple bins both in the room and the doffing area.
• Use of disposable supplies including food trays and patient care supplies is encouraged though it will
generate additional waste.
• Waste generated in the care of PUIs or patients with confirmed EVD including specimen collection is
subject to procedures set forth by local, state, and federal regulations due to the high hazard level. Basic
principles for spills of blood and other potentially infectious materials are outlined in the OSHA Bloodborne
Pathogens Standard.
• The facility hazardous infectious waste management plan should include procedures for:
○○Waste handling, including packaging area, storage area, and intra-facility transport protocol.
○○Inactivation of contaminated waste onsite (e.g., autoclave, incinerator - not considered hazardous waste
once sterilized) or protocol for transport offsite compliant with state and federal regulations.
○○Packaging and transport of waste in accordance with DOT regulations.
○○Decontamination of the room if the suspect case is transferred to a treatment center or prior to putting
the room back in service while awaiting confirmation.
• Frontline facilities should limit the number of personnel who handle waste. Facilities should consider preidentifying teams with specialized training in waste management procedures and proper use of PPE.
• Linens should remain in the patient’s room while laboratory testing occurs.
○○Linen should be contained in a soiled linen bag.
○○If patient tests positive for a VHF, linens should be handled as solid waste as described later including
pillow cases, sheets and permeable pillows, mattresses, and textile privacy curtains.
See NETEC training video Use of a Containment Wrap when Transferring a Patient with Ebola or Other Special Pathogen for
additional information.
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• To prepare for handling, packaging, and shipment of waste, frontline facilities should:
1. Prepare materials as listed in the Isolation Room Supply List Waste Kit. A rigid outer receptacle
(overpack) provided by an approved waste vendor and meeting DOT HMR requirements for Category
A transport should be located in the periphery of the PPE doffing area.
2. Follow CDC’s Procedures for Safe Handling and Management of Ebola-Associated Waste.
Body fluid spills
• To handle body fluid spills, frontline facilities should consider the following steps:
1. Preparation of materials, as listed in Isolation Room Supply List Spill Kit.
2. Consider safety measures, including the following:
▪▪ Assess the need for further assistance with the cleanup.
▪▪ Consider the need for a disposable impermeable apron over the standard PPE.
3. Take the following immediate actions:
▪▪ Layer the entire body fluid spill with enough absorbent pads to allow the fluid to become fully
absorbed into the material.
▪▪ If the absorbent pad becomes saturated and body fluid pools on the surface or it is suspected that
the pad is insufficient, place more pads on top.
4. For spill containment, once the fluid is absorbed, place an absorbent pad with a fluid resistant backing
on top of the layers (the fluid resistant backing should face up).
5. For disposal:
▪▪ Gather and bundle the pads by enclosing them in the outer absorbent pad.
▪▪ Gently place into an autoclave bag-lined trash can.
▪▪ If there is evidence that the body fluid is still present, place additional absorbent pads on the spill or
affected area and repeat the procedure.
6. Remove outer gloves and perform hand hygiene using EPA-registered hospital disinfectant wipes on
inner gloves before donning a clean pair of outer gloves.
7. Gently gather the neck of the autoclave bag and secure it with autoclave tape for bag disposal.
8. Follow waste processing policy above to remove the bagged items from the patient care area.
9. To disinfect the spill area:
▪▪ Consider using 1:10 bleach solution or EPA-registered hospital disinfectant, mop the area where the spill
occurred.
▪▪ If the body fluid spill is small, it is appropriate to use wipes instead of mopping.
▪▪ If the spill involves sharps, refrain from gathering or handling the materials without cut resistant gloves
and use tools rather than hands to package and move materials/waste.
▪▪ After the area has been mopped, remove the mop head from the mop and discard.
10. Document the spill/incident in the patient record and event log.
• Alternately, body fluid spills may be cleaned through the use of an absorber or solidifier, as follows:
○○Sprinkle the absorbent or solidifier over the liquid until the spill solidifies into a gel (about 2 minutes).
○○Scoop up the solidified gel on a dustpan using a disposable cardboard spatula (or similar).
○○The solidified gel can then be disposed of down any toilet or drain or gently placed into an autoclave
bag-lined trash can.
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Resources:
Bloodborne Pathogens Standard, 29 CFR 1910.1030
Cleaning and Decontamination of Ebola on Surfaces
Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body
Fluids
Dangerous Goods Regulations
Door Isolation Signs: Level 1 and Level 2
Ebola Control and Prevention
Ebola-Associated Waste Management
Ebola (Ebola Virus Disease): For Clinicians
EMS Infectious Disease Playbook
For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation
(PUIs) for Ebola Who Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
Guidance for Collection, Transport and Submission of Specimens for Ebola Virus Testing
Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and Mortuaries
Guidance for U.S. Laboratories for Managing and Testing Routine Clinical Specimens When There is a Concern about Ebola Virus
Disease
Guidance on Personal Protective Equipment (PPE) To Be Used by Healthcare Workers During Management of Patients with
Confirmed Ebola or Persons Under Investigation (PUIs) for Ebola Who Are Clinically Unstable of Have Bleeding, Vomiting, or
Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE
Hazardous Materials Regulations, 49 CFR 171-180
Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus
Disease (EVD)
Information on the Survivability of Ebola Virus in Medical Waste
Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
Interim Guidance for Preparing Frontline Healthcare Facilities for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD)
Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease
(EVD): A Framework for a Tiered Approach
Interim – Planning Guidance for the Handling of Solid Waste Contaminated with a Category A Infectious Substance
List L: Disinfectants for Use Against the Ebola Virus
Packaging and Shipping Clinical Specimens Diagram
PPE Selection Matrix for Occupational Exposure to Ebola Virus
Preparing Category A Lab Specimens for Transport
Procedures for Safe Handling and Management of Ebola-Associated Waste
Recommendations for Safely Performing Acute Hemodialysis in Patients with Ebola Virus Disease (EVD) in U.S. Hospitals
Safe Handling, Treatment, Transport, and Disposal of Ebola-Contaminated Waste
Selecting, Evaluating, and Using Sharps Disposal Containers
Yellow Book, Chapter 3, Infectious Diseases Related to Travel, Viral Hemorrhagic Fevers
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Special Re spirator y
E X A MPLE D IS E AS ES
• MERS, SARS, novel influenza strains (e.g., H3N1, H5N1, H7N9)
• Transmission based PPE should be used once a specific special respiratory disease is suspected.
ID E NTIF Y
• Obtain relevant exposure history:
○○International travel in past 14 days to an area with active transmission of a special respiratory disease
and/or
○○Contact with an individual with a special respiratory disease within the previous 14 days (incubation
period may be as long as 14 days).
• Question patients who meet the exposure criteria signs or symptoms compatible with a special respiratory
disease. Signs and symptoms vary by disease and may be nonspecific, but may include fever, chills,
cough, sore throat, shortness of breath, muscle aches, vomiting, diarrhea, headache, skin rash, and
potentially severe respiratory failure.
• If the patient is unable to provide exposure history due to their clinical condition or other communication
barrier, elicit history from the next most reliable source (e.g., family, friend, EMS provider).
• In addition to countries visited, timeframe, and contact with ill persons, ideally, isolate patient and continue
asking screening questions about:
○○Date of onset of symptoms.
○○Close contact with anyone known to have a respiratory disease and, if so, who.
○○Close contact with an ill traveler from the Arabian Peninsula (MERS).
○○Visitation or work at a healthcare facility on the Arabian Peninsula (MERS).
○○Recent close contact with camels (MERS) or other species linked to novel influenza transmission.
○○Employment as a HCW.
○○Underlying medical conditions.
ISOL ATE
• If a relevant exposure history is reported and signs or symptoms consistent with a special respiratory
disease are present, immediately move the patient to an AIIR1 or, if no AIIR is available, to a separate
private room via a pre-designated route to limit exposures to other staff, patients, and visitors.
1
An AIIR is a single patient room at negative pressure relative to the surrounding areas and with a minimum of six air changes per hour
(12 air changes per hour recommended for new construction or renovation). Air from the room should be exhausted directly outside
or filtered through a high-efficiency particulate air filter before recirculation. Room doors should be kept closed except when entering
or exiting the room, which should be minimized. Facilities should monitor and document the proper negative-pressure function of the
room. Taken from Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory
Syndrome Coronavirus (MERS-CoV).
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○○The patient should perform hand hygiene and wear a simple mask.
○○Staff should don an N95 respirator and gloves and avoid direct contact with the patient until Special
Pathogen Basic PPE is donned. Transmission based PPE should be used once a specific special
respiratory disease is suspected.
○○Once the patient is in an AIIR, the patient’s mask may be removed if desired. Consider continued mask
use if patient is actively coughing.
○○If the facility does not have any isolation or in-room HEPA capability, a private room away from other
patients should be used. The patient should continue to wear a simple mask if possible. Rapid transfer
to a facility with an isolation room should be arranged. If this is not possible or the facility is at risk for
patient presentations due to disease in the community, a temporary negative pressure room may be
created.
○○Ensure all persons with symptoms of a respiratory infection adhere to respiratory hygiene and cough
etiquette, hand hygiene, and triage procedures.
• EMS transported patient: Ensure the patient is wearing a simple mask, then move directly to the
designated isolation room for assessment, avoiding contact with additional staff or patients.
• Limit the number of patient care providers and visitors and keep a log of people who enter the room.
Institutional policy should specify the level of trainee and minimum standard of training required for those
who enter the room (e.g., only those trainees essential to accomplish critical procedures, no student
involvement).
• Consider telemedicine if needed for consultations.
• Place appropriate infection control/infection prevention door and other relevant signage (e.g., “Special
Respiratory Precautions”).
• Adhere to procedures and precautions designed to prevent transmission by direct or indirect contact (e.g.,
dedicated equipment and supplies, hand hygiene, and restricted patient movement).
• Complete history and physical exam. Consider:
○○Using diagnostic technology (e.g., bedside sonogram) in the isolation environment if possible.
○○Performing routine interventions (e.g., placement of peripheral IV, phlebotomy) per differential diagnosis
and patient’s clinical status in consultation with infection control/infectious disease and local or state
health department.
○○If imaging is required, it should be performed in the isolation room if possible. If this is not possible,
provide the patient with a simple mask and clear the route to the radiology room. Ensure technologists
wear Special Pathogen Basic PPE during patient contact and at least an N95 respirator and gloves
while in the room with the patient.
• Assess clinical stability and be prepared to intervene quickly if warranted.
• Evaluate for disabilities such as poor vision, developmental or physical limitations, and hearing issues and
address.
• Consider special population needs (e.g., pediatrics, obstetrics, geriatrics) in patient management.
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• In the event of a medical emergency or acute deterioration in patient status, a crash/airway cart should be
readily available to obtain equipment and medications.
• Ensure safe medical devices, supplies, and patient care equipment are available.
INFOR M
• Upon the designation of a suspect case, a facility should consider at least partial activation of their HICS
including, at minimum, designation of an incident commander and a public information officer. Depending
on the situation and needs, the command center may be opened.
• Unified command including ESF-8/Health and Medical partners should be established as required for
complex situations.
• Follow notification protocols within the facility and externally with public health authorities and any
consulting or receiving facility.
○○Internal notifications should occur as specified in Figure 4.
▪▪ Consider what information, if any, to provide to hospital patients and visitors.
○○External notifications should be made according to local protocols.
▪▪ In most cases, the primary external notification is the local or state health department. In general,
the health department will be responsible for contact tracing, identification, and health monitoring;
surveillance of persons at risk; providing outbreak response support; and implementing legal
authorities.
▪▪ The facility may assist with contact tracing/quarantine as recommended by public health.
▪▪ EMS should be notified about the suspect case and if the patient arrived by ambulance the crew
should be notified and coordinate with public health any monitoring or quarantine required.
• Test for special respiratory diseases in consultation with the health department.
PPE
• Refer to Figure 1 for the Special Pathogen Basic PPE ensemble. If VHF is not suspected may discontinue
double-gloving.
• Frontline hospitals may also use a PAPR with appropriate filtration levels instead of an N95 respirator if
PAPRs are customarily used in the facility and to protect staff who cannot wear a fit-tested N95. Use of a
PAPR may be advisable when caring for patients with airway issues or respiratory distress. If using PAPRs,
confirm training and policies for cleaning/decontamination of PAPR after use are in place. PAPR filters
enclosed in hard cases should be able to be wiped down and reused unless the filter media has become
wet or clogged. Soft filters will need to be discarded after each use.
• Refer to Special Pathogen Basic PPE Donning and Doffing Checklist.
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INITI A L CLINICA L CA R E (FIRST 4 8 -72 HOURS) CO N S ID ER ATIO N S
This section is most applicable when the facility will be providing patient care during confirmatory testing.
Airway issues 1
• PAPR with appropriate filtration and hood should be used if available during airway interventions such
as intubation and deep suctioning.
• Noninvasive ventilation is relatively contraindicated due to high incidence of aerosol generation and risk
of vomiting/aspiration.
• Avoid procedures likely to generate higher concentrations of infectious respiratory aerosols including
cough-generating procedures, bronchoscopy, sputum induction, intubation and extubation, and open
suctioning of airways.
• Dry powder inhalers should be used instead of nebulized liquid if bronchodilators are needed.
• Rapid sequence induction techniques are preferred for intubation to minimize coughing.
• Nasogastric tubes are relatively contraindicated except in intubated patients.
• Elective or semi-elective intubation is preferred, if possible, due to PPE donning requirements.
• Only the minimum number of staff needed to safely complete the intubation should remain in the room.
Diagnostics
• Only diagnostic tests that will significantly change the course of treatment should be performed,
particularly when this may involve transporting the patient outside the isolation room.
• If equipment is used in an isolation room and removed, keep a log of equipment and assure appropriate
decontamination (usually wiping with an EPA-registered hospital disinfectant) prior to next patient use.
Intensive therapies
• Dialysis/CRRT should be via bedside unit in the isolation room. Patients should NOT be transported to
the hemodialysis unit. Hemodialysis/CRRT machines should remain in the patient’s room after use until
terminal cleaning is performed.
• Venovenous ECMO may have a role in respiratory failure for special respiratory pathogens with acute
respiratory distress syndrome (ARDS) and refractory hypoxia.
L A B IS SUES TO CO N S ID ER
• Respiratory specimens should be collected as soon as possible.
• If available, a respiratory virus panel can help rule in or out other diagnoses.
• Consult local or state health department on types and quantities of specimens to collect as multiple
specimens from different sites may be needed.
1
See example MERS CoV Guidelines for Respiratory Care Services developed by Nebraska Medicine.
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• It may take +/- 72 hours to definitively confirm or rule out a special respiratory diagnosis, with an
additional 12 to 24 hours for specimen transport and testing.
▪▪ It may take 48 hours or longer to definitively confirm or rule out a MERS or SARS diagnosis.
• Lower respiratory specimens (e.g., bronchoscopic lavage or induced sputum) should only be collected
when the workup requires them due to aerosol generation risk. Providers performing bronchoscopy
should strongly consider use of PAPRs.
• Upper respiratory specimens (e.g., oro- and naso- pharyngeal swabs) must be carefully collected
(e.g., sample instructional video and lab protocol). The specimen must be hand-carried by a trained
employee. Do NOT use a pneumatic tube system.
• Specimens for shipment should be packaged in accordance with Category B infectious substance
regulations, which consists of: (1) a primary container, (2) a secondary packaging, and (3) a rigid
outer packaging. For questions about packaging regulations, contact the DOT Hazardous Materials
Information Center at 1-800-467-4922.
PATIE NT MOV EME NT CO N S ID ER ATIO N S
• Consider admitting patients of older age and/or with pre-existing comorbid conditions with suspected
or confirmed special respiratory disease to an intensive care unit given the risk of progression to critical
illness to minimize room changes.
• If the patient needs to be moved to another room within the facility, consider:
▪▪ The risk/benefit of moving the patient.
▪▪ Limiting transport and movement of the patient outside of the AIIR to medically-essential purposes.
▪▪ When outside of the AIIR, patients should wear a simple mask.
▪▪ Planning the route through areas with the lowest risk of traffic and control traffic.
▪▪ Informing hospital staff prior to movement to minimize concerns.
▪▪ Ensuring that staff performing the patient transport wear appropriate PPE.
▪▪ Limiting elevator occupancy to the patient and transporter.
• Consider use of isopod, if applicable.
DECONTAMINATION AND WASTE MANAGEMENT CONSIDER ATIONS
• Medical waste has not been implicated in the transmission of special respiratory diseases such as
MERS and SARS. Therefore, at this time, no special handling procedures are recommended for
contaminated medical waste.
▪▪ Consult latest CDC guidance for updates/changes to medical waste.
• Medical and patient waste may be disposed of in the usual manner.
• Standard cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces
prior to applying an EPA-registered disinfectant to frequently touched surfaces or objects for
appropriate contact times as indicated on the product’s label) are appropriate.
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• Management of laundry, food service utensils, and medical waste should also be performed in
accordance with routine procedures.
• Detailed information on environmental infection control in healthcare settings can be found in CDC’s
Guidelines for Environmental Infection Control in Health-Care Facilities and Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (section IV.F. Care of
the environment).
SURGE INCIDENT CONSIDER ATIONS 1
• Consider how multiple patients will be handled at once for screening or inpatient treatment – 2, 5, 10
patients. Refer to The Joint Commission Standard IC:01:06:01 for guidance.
• Consider the following when identifying surge spaces:
▪▪ Within the building footprint (e.g., closed yet functional patient unit, designated inpatient unit
cohorting).
▫▫ Advantages: Existing heating, cooling, sinks and bathrooms; IT connections are generally easier;
environmental services protocols are familiar/known; patient transport is easier.
▪▪ Potential “pop up” space (e.g., medical tents).
▫▫ Advantages: Isolation from hospital (e.g., in parking lot), scalable with added tents, minimizes
hospital disruption.
▫▫ Disadvantages: Climate, environment of care issues, unable to offer full range of services, may
require a CMS waiver and prior inspection by the state’s licensing authority and fire department.
May be appropriate for screening but generally not ongoing care.
▪▪ Managing triage/waiting area - segregation of potentially infectious patients from others
▪▪ Patient care operations within surge space
▫▫ Replicating familiar supply carts and diagnostics
▫▫ Adding/updating EHR accessibility
▫▫ Bedside lab testing
1
See Considerations for the Use of Temporary Surge Sites for Managing Seasonal Patient Surge for additional information.
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Resources:
2018 Infectious Diseases Laboratory Test Directory
Airborne Infectious Disease Management: Methods for Temporary Negative Pressure Isolation
Alternate Care Sites (Including Shelter Medical Care) Topic Collection
Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition
Collection of Nasopharyngeal Specimens with the Swab Technique
Considerations for the Use of Temporary Surge Sites for Managing Seasonal Patient Surge
Dangerous Goods Regulations
Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
Guidelines for Environmental Infection Control in Health-Care Facilities
In the Absence of SARS-CoV Transmission Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and
Reporting
Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Middle East Respiratory
Syndrome Coronavirus (MERS-CoV) – Version 2
MERS Control and Prevention
MERS CoV Guidelines for Respiratory Care Services
MERS Health Advisory
Middle East Respiratory Syndrome Coronavirus (MERS Co-V) Lab Protocol for Person Under Investigation (PUI)
NYC DOHMH Guidance Document for Development of Protocols for Management of Patients Presenting to Hospital Emergency
Departments and Clinics with Potentially Communicable Diseases of Public Health Concern
New York State Department of Health SARS Guidance Document, Chapter 4: Laboratory Diagnosis of SARS
Postmortem Handling of Human Remains (SARS)
Supplement I: Infection Control in Healthcare, Home, and Community Settings
UN 3373 Category B Schematic for Packaging
Yellow Book, Chapter 3, Infectious Diseases Related to Travel, Middle East Respiratory Syndrome (MERS)
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Special Considerations
HE A LTHCA R E WOR K ER CO N S ID ER ATIO N S
• Consider excluding from the care team staff who are pregnant, immunocompromised, cannot wear PPE
for extended periods, or are the sole caregiver for dependents that would preclude routine quarantine
actions. Facilities may have more stringent requirements for medical clearance depending on their policies.
Volunteer team members for special pathogen care are ideal, but adequate staffing and training must be
sufficient to provide initial isolation and care at all times.
• Exposed employees should be monitored for symptoms. The hospital should coordinate with public health
to determine the means, need, and duration of monitoring.
• Possible criteria for monitoring includes employees who:
○○Provided direct care to a confirmed special pathogen patient.
○○Provided care to a patient with special pathogen and did not use appropriate precautions.
○○Processed laboratory specimens without taking appropriate precautions.
○○Were exposed to the patient’s body fluids (including a mucous membrane exposure and/or a
needlestick) despite using appropriate precautions.
○○Other criteria, as applicable.
• Each facility should have a post-exposure plan to include relevant employee and source labs and
a consultation plan to determine appropriate interventions as well as a monitoring/quarantine plan
appropriate for the agent involved. See above for a VHF PPE breach process. For respiratory illnesses,
follow usual institutional exposure protocols adding a monitoring component appropriate for the suspected
disease.
• Any HCW under monitoring who develops signs of illness should not report to work or should immediately
stop working and notify their supervisor. Prompt medical evaluation should be arranged.
• HCWs should be assessed regarding possibility of post-exposure prophylaxis or treatment depending on
the agent and exposure. Post-exposure prophylaxis is seldom indicated but may be considered based on
the agent/type of exposure. Prophylaxis with antivirals may be considered in unprotected exposures to
novel influenza. In selected situations vaccination may be indicated after a viral exposure (e.g., smallpox,
EVD).
• HCWs can experience distress, anxiety, and fear for personal and family safety during the infectious
disease event and these feelings may linger after the event has concluded. Providing an orientation for
family members of HCWs about the special pathogen, describing how the HCW will work in this setting,
and answering questions about potential infection of family members can help address these concerns.
Behavioral health support should be provided to mitigate adverse reactions.
• Claustrophobia, anxiety, shortness of breath, and other symptoms are commonly associated with wearing
respiratory protection and in particular with use of PAPR hoods. Employees should be educated and
have sufficient practice in PPE to recognize and mitigate these symptoms. Employees who experience
challenges while wearing PPE should discuss modifications to PPE or work duties with their supervisor.
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PE DI AT R I C C O N S I D E R AT I O NS
• Pre-hospital
○○Children should wear a simple mask during evaluation and transportation if possible.
○○EMS agencies specializing in pediatric transport are preferred for the inter-facility transport of a pediatric
suspected or confirmed special pathogens patient.
○○Use the child’s own car seat for transport, if available. Otherwise, use the EMS agency’s car seat or
child restraint system.
○○If possible, let a caregiver accompany the child during transport, as applicable. The caregiver must use
PPE consistent with the suspected or confirmed infectious disease.
○○Comfort items such as stuffed animals may not be able to be decontaminated.
• Consider the risks/benefits of separating pediatric patients from their parents or guardians.
○○Screening and isolation of children is similar to the process for adults except that parents/guardians
may accompany the child.
○○Parents/guardians may be able to help with care, especially for preschool age children, as well as
provide comfort.
○○Parents/guardians should wear appropriate PPE in the isolation area.
○○Only one parent/guardian should be in the patient’s room.
○○Infection control should determine limitations to parental movement within the hospital given their
heightened risk of infection.
○○The advantages of family-centered care should be balanced against the need for infection control.
○○Facilities should understand their state laws on protective custody and other regulations governing the
emergency care of minors and infectious disease emergencies.
• Allocate resources appropriate to the clinical and behavioral health needs of pediatric patients.
○○Treatment area should have adequate pediatric equipment including pediatric masks and intravenous
access/phlebotomy devices.
○○Consider having dedicated toys, media (age-appropriate movies, child-friendly television channel),
games including tablet-based games, and comfort items available.
○○If a suspect VHF patient is pregnant be prepared to support delivery and infant care if necessary.
• Consider the child’s developmental stage when explaining/involving in decision-making, such as mask
wearing, separation from parents/guardians, and explanations provided regarding their illness evaluation
and treatment.
○○Caregivers can facilitate age-appropriate communication regarding illness, testing, and comfort.
• Manage the anxiety of patients and families during evaluation. Providers in PPE can be frightening for the
patient and stressful for the parents.
• Work with state or local public health department public information officer to develop community
messaging and ensure that any needed school-based notification occurs. Health departments have
additional resources, authority, and credibility in message delivery.
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VISI T OR / FA M I LY C O N S I D E RATIO NS
• Visitors and family members who were in contact with a suspect case patient before hospitalization should
be screened (fever and other symptoms) and appropriate quarantine precautions discussed with them per
public health agency direction.
○○Visitor/family movement within the facility should be restricted to the patient care area and immediate
surrounding area (ideally a designated family room or waiting area).
○○Visitors and family may have difficulty understanding the need for or complying with PPE use and
infection prevention precautions. It may require substantial effort, possibly through interpreters, to help
them understand the process and expectations.
○○Avoid routine entry of visitors into patient rooms.
▪▪ Exceptions to visitation restrictions may be considered on a case-by-case basis for those essential to
patient well–being.
▪▪ Provide instructions before entry into patient care area to:
▫▫ Perform hand hygiene.
▫▫ Limit touching of surfaces.
▫▫ Use PPE according to potential diagnosis.
▪▪ Evaluate the risks of visitation to the health of visitors/family and the community and their ability to
comply with precautions.
▪▪ Offer alternatives to visitation such as video-chats, phone, etc.
PUB LIC R EL ATIO N S / INFOR M ATIO N CO N S ID ER ATIO N S
• If there is public knowledge about the suspect case, there may be tremendous interest from the media,
advocacy groups, embassies, and other groups. The hospital should work with local and state public
health, EMS, and emergency management through the Joint Information Center to craft messages about
the situation and the impact/risk to the public.
• The hospital and public health department should monitor traditional and social media for inaccurate
information and correct it as soon as possible as well as issue proactive messages to counter likely
misinformation (e.g., about contagion risk).
• Hospital legal counsel should work with public relations and public health to assure that HIPAA
requirements are followed.
• Public information officer/public relations staff should discuss with the patient and family any potential
interview/information requests and confirm that there will be opportunity for the hospital to provide
comment on any interviews granted.
• Public information officer/public relations staff should also work with incident command, administration,
and infection prevention and control to craft messages for employees (and patients if needed) regarding
the situation.
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SE CUR I T Y C O N S I D E R AT I O N S
• Security personnel have many potential roles during a special pathogen response:
○ Securing the area around the isolation room.
○ Addressing family member and visitor concerns regarding their limited access to other areas of the
hospital.
○ Preventing media from accessing the facility.
○ Securing elevators and cordoning off hallways, ambulance driveway, and other interior and exterior
areas to enable safe patient movement.
• Security personnel must understand and be trained for any anticipated roles during a special pathogen
response including safe use of PPE and providing services in PPE if required.
• The role of security in providing patient restraint should be agreed upon prior to any incident and specific
training with the care teams is critical to the safety of the staff and patient.
• Frontline hospitals may require additional security personnel due to the multiple roles above. Supplemental
or contract staff may not be trained in use of PPE and patient care techniques but can provide access
controls and other services.
D E TER IOR ATING PATIE NTS
• Frontline hospitals should plan to handle a wide range of severity of illness including patient deterioration
during care.
• Delirium is a potential condition that can arise and requires special consideration and planning to avoid
exposure. Delirium can cause the patient to become agitated and combative, possibly compromising
provider PPE. Chemical and physical restraint policies should be in place and adequate staff should
always be available in PPE to be able to immediately control behavior.
• Have a plan in place to safely manage the patient while in a potentially highly infectious environment and
maintain safety in PPE. Key principles include:
○○Prevent cross contamination.
○○Increase distance from the patient.
○○Always face patient and never turn your back on a combative or agitated patient.
○○Maintain effective communication with staff outside room if assistance is needed to manage a
combative patient.
○○Exercise extreme caution when administering medications to an uncooperative patient, particularly via
the intramuscular route.
○○Anticipate potential interventions and have supplies in the room and ready to minimize potential delays
and mitigate hazards.
○○Keep emergency medication readily accessible, if needed.
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INTER FACILIT Y TR A N S FER CO N S ID ER ATIO N S
• Detailed information for EMS is available in the EMS Infectious Disease Playbook.
• If a decision is made to transfer the patient to a treatment center, frontline facilities should consider the
following steps:
○○Consult with and notify internal and external stakeholders of the decision.
▪▪ Activate HICS if not already activated.
▪▪ Notify facility leadership.
▪▪ Coordinate with state or local health department to obtain transfer approval, if required.
▪▪ Coordinate with receiving facility to confirm patient information and estimated time of arrival as well
as an accepting physician. Confirm that nursing and physician reports are called to the receiving
hospital.
▪▪ Coordinate with designated EMS agency to confirm locations, transfer point, timeline, staffing,
and equipment required. Ensure EMS understands the potential diagnosis and that they have the
appropriate resources.
▪▪ Identify the patient movement team if an internal move is needed during the transfer process.
▪▪ Designate EMS liaison if not already done.
○○Immediate actions include:
▪▪ Assemble the patient movement team/plan patient movement.
▪▪ Determine potential needs along the patient egress route (e.g., security, spill cleanup).
▪▪ Gather supplies and equipment (e.g., blankets, spill kit).
▪▪ Secure staff donning and doffing locations if required.
▪▪ Designate a facility stretcher or wheelchair for patient use for suspect VHF if EMS is not supplying.
▪▪ Ensure the patient movement team has donned appropriate PPE.
○○EMS liaison actions.
▪▪ Coordinate with EMS on patient movement.
▪▪ Verify any special EMS precautions/equipment are being addressed (e.g., isolation devices/
ambulance protection for VHF).
▪▪ Provide EMS updated patient status information and medical records.
▪▪ Verify EMS has donned appropriate PPE.
○○Prepare the patient for movement.
▪▪ Refer to NETEC’s Use of a Containment Wrap when Transferring a Patient with Ebola or Other
Special Pathogen training video.
▪▪ Patient movement team decides on staff roles and positions.
▪▪ Place patient on portable devices (e.g., oxygen, cardiac monitor, etc.).
▪▪ Patient movement leader directs movement (e.g., bed to stretcher, bed to wheelchair, wheelchair to
stair chair).
▪▪ Clear and secure the egress route and patient transfer point at time of patient movement.
▪▪ Patient movement team awaits confirmation that egress route is clear.
○○Move patient.
▪▪ Secure and control corridors/elevator, if needed, until egress is complete.
▪▪ EMS moves patient to ambulance. Facility staff may assist at the request of EMS.
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▪▪ EMS loads and departs.
▪▪ Facility leadership notifies receiving facility of departure.
▪▪ The condition/mobility of the patient should be considered when planning patient movement.
▫▫ For ambulatory patients:
›› Clear the egress path before escorting the patient from the isolation room to the transfer point.
›› Move slowly.
›› Be ready to guide the patient to the floor if the patient becomes weak.
▫▫ For wheelchair-bound patients:
›› Lock wheelchair wheels before loading the patient.
›› Assist the patient in moving from the bed or chair to the wheelchair.
›› Plan for potential of equipment/PPE contamination.
▫▫ For EMS stretcher-bound patients:
›› Make a patient movement plan with EMS before starting move.
›› Be ready to assist with patient movement if requested by EMS.
›› Always follow directions before moving or operating the EMS stretcher.
○○Recover.
▪▪ Isolation room and patient care devices are secured until disinfected.
▪▪ Staff doffs PPE and rehabilitates per protocol.
▪▪ Environmental services personnel are notified.
○○Complete documentation.
▪▪ Document the transfer events in the patient record as well as unusual occurrence/exposure log as
needed.
• Attention to body mechanics during patient movement is an important component of worker safety and
prevents:
○○Musculoskeletal strain.
○○Injury to the patient.
○○Overheating and fatigue while wearing PPE.
○○Inadvertent contamination/tears in PPE.
Resources:
Adopting a Global Safety Standard for the Prevention of Ebola Needle-Stick Exposures
Blood/Body Fluid Exposure Option
Bloodborne Pathogens and Needlestick Prevention
Care of a Neonate Born to a Mother who is Confirmed to have Ebola, is Person under Investigation, or has been Exposed to Ebola
Crisis and Emergency Risk Communication (CERC)
EMS Infectious Disease Playbook
Example: Standard Operating Procedure (SOP) for Patient Handoff between a Healthcare Facility and a Transporting Ambulance
Guidance for Developing a Plan for Interfacility Transport of Persons Under Investigation or Confirmed Patients with Ebola Virus
Disease in the United States
Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals
Management of Accidental Exposure to Ebola Virus in the Biosafety Level 4 Laboratory, Hamburg, Germany
Use of a Containment Wrap when Transferring a Patient with Ebola or Other Special Pathogen
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Exercises and Maintaining Readiness
• Maintaining readiness is a challenge. Given competing priorities, it is difficult to allocate resources to
infrequent incidents. However, “ready or not, patients will present.” Lack of readiness creates significant
safety problems.
• Plan elements (e.g., PPE donning/doffing, patient management standard operating procedures [SOPs]
and protocols) should be frequently tested by training staff and exercised with plausible, varied scenarios.
The exercise templates listed under Resources below contain specific examples.
• Providers must have ready access to the correct sizes and types of PPE and understand when to apply
which ensemble. Policies, algorithms, and templates must be easily available and understandable.
• Assess if the communicable disease response plan is following an “all hazards approach” in structure
and activation and is scalable enough to apply to various communicable disease emergencies. Integrate
infectious disease issues into emergency management processes/projects.
• Be aware of special pathogen disease outbreaks occurring around the world and latest CDC guidance.
• Training and education may be in the form of didactic (e.g., team meetings, discussing current events),
experiential, or competency-based trainings (e.g., using equipment, performing procedures, and practicing
communication while in PPE).
• Drills and exercises should include scenarios of varying type and scale and should involve internal and
external partners (e.g., health department, EMS, obstetrics, laboratory, pediatrics, clinic). Exercises
should use checklists including job action sheets, an activation checklist, and an equipment list whenever
possible.
• Consider testing surveillance and initial actions on each shift by having a “mystery patient” present for
evaluation. After the “identify” goal is met, it is recommended the evaluator/“mystery patient” reveals that it
is an exercise and then asks the provider to take them through the subsequent actions required (similar to
a “tracer” inspection event).
• Consider outside expert observers to assist with evaluation of exercises and competency testing of staff.
• A hotwash should be done within hours after conclusion of an exercise or an episode of care. It should
capture initial observations on what went well and what can be improved, recognize the staff efforts,
and acknowledge emotional stress and impact. As part of formal after-action process, emergency
management should review the response and care provided and create a corrective action plan to address
identified gaps.
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• Restocking is critical to maintaining readiness for future incidents. Activities include:
○○Reviewing the activation equipment/supply checklist to identify items for replacement, as well as new
items or those that require modification.
○○Inventorying and restocking equipment and supplies after an incident or exercise.
○○Taking inventory of items used or currently in stock.
○○Purchasing additional equipment and supplies used to replenish stock and any reserves.
Resources:
Ebola Drill, Functional and Full-Scale Exercise Template - NETEC
Ebola Tabletop Exercise Template - NETEC
Exercise Templates for Frontline Facilities - MN Dept. of Health
Frontline Facility Special Pathogen (Airborne) Tabletop Exercise Template - NETEC
New York City Health + Hospitals Mystery Patient Exercise Plan: Exercise Plan, Appendix I, and Appendix J
Special Pathogen Mystery Drill Toolkit Drill, Functional, and Full-Scale Template - NETEC
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Reference s and Resources
ASPR TRACIE. (2017). EMS Infectious Disease Playbook.
This playbook synthesizes multiple sources of information in a single planning document addressing the
full spectrum of infectious agents to create a concise reference resource for emergency medical services
(EMS) agencies developing their service policies. The information can be incorporated into agency
standard operating procedures and reviewed by the EMS medical director.
Boggild, A., Esposito, D., Kozarsky, P., et al. (2015). Differential Diagnosis of Illness in Travelers Arriving
from Sierra Leone, Liberia, or Guinea: A Cross-Sectional Study from the GeoSentinel Surveillance Network.
Annals of Internal Medicine. 162(11):757-764.
The authors examined reported illnesses among travelers returning from Sierra Leone, Liberia, or Guinea
during the West Africa Ebola outbreak. They emphasize the importance of considering differential
diagnoses during such outbreaks and avoiding delays in diagnosis and management of patients.
Centers for Disease Control and Prevention. (2007). 2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings.
This document provides infection control guidelines for healthcare settings across the continuum of care.
Centers for Disease Control and Prevention. (2007). 2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings, Appendix A.
Though somewhat dated, this table provides a good association of selected infections and conditions
with the type and duration of precautions.
Centers for Disease Control and Prevention. (2009). Biosafety in Microbiological and Biomedical
Laboratories (BMBL) 5th Edition.
This document provides best practices for biosafety in biomedical and clinical laboratories.
Centers for Disease Control and Prevention. (2013). Blood/Body Fluid Exposure Option.
This document assists healthcare facilities in recording HCW bloodborne pathogen exposures and their
management.
Centers for Disease Control and Prevention. (2018). Care of a Neonate Born to a Mother who is
Confirmed to have Ebola, is a Person under Investigation, or has been Exposed to Ebola.
These guidelines pertain to U.S. hospitals and how to care for a neonate born to a mother who is
confirmed to have Ebola, is a Person under Investigation (PUI), or has been exposed to the Ebola virus.
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Centers for Disease Control and Prevention. (2018). Crisis and Emergency Risk Communication (CERC).
This website hosts the Centers for Disease Control and Prevention’s crisis and emergency risk
communication training modules, resources, shared learning materials (e.g., case studies), and social
media links.
Centers for Disease Control and Prevention. (2015). Ebola-Associated Waste Management.
The information on this webpage helps healthcare providers and facility staff safely handle, transport, and
dispose of waste associated with the care of patients with suspected or confirmed EVD.
Centers for Disease Control and Prevention. (2016). Example: Standard Operating Procedure (SOP) for
Patient Handoff between a Healthcare Facility and a Transporting Ambulance.
This sample SOP is intended to enable planning between an EMS agency and a healthcare facility on the
handoff of patients with serious communicable diseases.
Centers for Disease Control and Prevention. (2015). For U.S. Healthcare Settings: Donning and Doffing
Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who Are
Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea.
This document provides guidance to healthcare workers on donning and doffing personal protective
equipment while evaluating a clinically stable person under investigation who does not have bleeding,
vomiting, or diarrhea.
Centers for Disease Control and Prevention. (2016). Frequently Asked Questions on Screening for Ebola
Virus Disease for Providers, Healthcare Facilities and Health Departments.
This webpage includes frequently asked questions related to screening for Ebola virus disease.
Centers for Disease Control and Prevention. (2018). Guidance for Collection, Transport and Submission
of Specimens for Ebola Virus Testing.
This document provides guidance to laboratories on the collection, transport, and submission of
specimens for Ebola testing. It contains information on when and how to collect specimens, transport
of samples within and outside a facility, and information on how to ship specimens to CDC, including a
packaging diagram.
Centers for Disease Control and Prevention. (2016). Guidance for Developing a Plan for Interfacility
Transport of Persons Under Investigation or Confirmed Patients with Ebola Virus Disease in the United
States.
This guidance was developed for personnel engaged in planning for the ground/air transport of persons
under investigation or patients with confirmed Ebola virus disease. Additional guidance is provided on
developing standard operating procedures for patient handoff between facilities and air-to-ground patient
handoff.
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Centers for Disease Control and Prevention. (2015). Guidance for Safe Handling of Human Remains of
Ebola Patients in U.S. Hospitals and Mortuaries.
The document provides step-by-step guidance on safe handling of human remains that may contain
Ebola virus to those providing postmortem care in hospitals and mortuaries.
Centers for Disease Control and Prevention. (2018). Guidance for Screening and Caring for Pregnant
Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals.
This webpage provides guidance for healthcare workers on screening and treating suspected or
confirmed cases of Ebola in pregnant women.
Centers for Disease Control and Prevention. (2018). Guidance for U.S. Laboratories for Managing and
Testing Routine Clinical Specimens When There is a Concern about Ebola Virus Disease.
This webpage provides guidance to laboratorians and others who may handle or test routine clinical
specimens when there is concern about Ebola virus disease. It provides an overview of management and
testing considerations and links to additional specific guidance.
Centers for Disease Control and Prevention. (2015). Guidance on Personal Protective Equipment (PPE)
To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under
Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S.
Hospitals, Including Procedures for Donning and Doffing PPE.
This webpage includes guidance on the types of personal protective equipment (PPE) that should be
used by those caring for patients with Ebola. It also includes steps for donning and doffing PPE as well as
what trained observers should do to ensure these steps are followed.
Centers for Disease Control and Prevention. (n.d.). Guideline for Disinfection and Sterilization in
Healthcare Facilities (2008). (Accessed 5/6/2019).
This guidance provides an overview of performance characteristics of various disinfectants to assist in
selection.
Centers for Disease Control and Prevention. (2016). Identify, Isolate, Inform: Emergency Department
Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD).
This guidance provides information to emergency department personnel on how to implement the
identify, isolate, and inform strategy when screening patients for Ebola virus disease.
Centers for Disease Control and Prevention. (2017). In the Absence of SARS-CoV Transmission
Worldwide: Guidance for Surveillance, Clinical and Laboratory Evaluation, and Reporting.
This webpage provides guidance on surveillance, clinical and laboratory evaluation, and reporting related
to SARS.
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Centers for Disease Control and Prevention. (2019). Infectious Diseases Laboratory Test Directory,
Version 9.2.
This directory provides test ordering information for all CDC laboratory testing.
Centers for Disease Control and Prevention. (2015). Information on the Survivability of the Ebola Virus in
Medical Waste.
This webpage includes information on physical and chemical agents that can be used to dispose of
waste generated during the care of a patient with Ebola virus disease.
Centers for Disease Control and Prevention. (2018). Interim Guidance for Environmental Infection Control
in Hospitals for Ebola Virus.
This webpage provides information on infection control precautions for healthcare facilities caring for
patients under investigation or confirmed Ebola virus disease and particularly the cleaning and disinfection
of the facility environment.
Centers for Disease Control and Prevention. (2015). Interim Guidance for Preparing Frontline Healthcare
Facilities for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD).
This guidance outlines the identify, isolate, and inform strategy for the management of patients
under investigation for Ebola virus disease and actions frontline facilities should take to improve their
preparedness.
Centers for Disease Control and Prevention. (2015). Interim Guidance for U.S. Hospital Preparedness for
Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered
Approach.
This guidance describes the tiered approach to the management of patients under investigation or
confirmed to have Ebola virus disease. It outlines the responsibilities at each tier: frontline facilities,
assessment hospitals, and treatment centers.
Centers for Disease Control and Prevention. (2015). Interim Infection Prevention and Control
Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERSCoV).
This webpage provides recommendations for preventing transmission of MERS-CoV in healthcare
settings.
Centers for Disease Control and Prevention. (2014). Packaging and Shipping Clinical Specimens
Diagram.
This diagram shows the triple packaging system for the shipment of Category A infectious substances.
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Centers for Disease Control and Prevention. (2014). Powered Air-Purifying Respirator (PAPR) and Gown
Donning and Doffing Procedures.
This video shows how to don and doff personal protective equipment when using a PAPR.
Centers for Disease Control and Prevention. (2018). Preparing U.S. Hospitals for Ebola.
This infographic highlights the differences between a frontline healthcare facility, an Ebola assessment
hospital, and an Ebola treatment center.
Centers for Disease Control and Prevention. (2015). Procedures for Safe Handling and Management of
Ebola-Associated Waste.
The webpage provides information for hospital infection control, occupational health systems, and facility
medical waste personnel on the safe handling and management of waste generated in the care of
patients infected with Ebola virus disease.
Centers for Disease Control and Prevention. (2005). Public Health Guidance for Community-Level
Preparedness and Response to Severe Acute Respiratory Syndrome (SARS) Supplement I: Infection Control
in Healthcare, Home, and Community Settings.
This web page contains links to guidance on SARS infection control in various settings.
Centers for Disease Control and Prevention. (2015). Recommendations for Safely Performing Acute
Hemodialysis in Patients with Ebola Virus Disease (EVD) in U.S. Hospitals.
The Centers for Disease Control and Prevention provide this guidance for individuals performing renal
replacement therapy in patients with Ebola.
Centers for Disease Control and Prevention. (2018). Travel Health Notices.
This web page, searchable by disease or country name, lists all current CDC travel notices. Notices are
classified as Watch Level 1: Practice Usual Precautions, Alert Level 2: Practice Enhanced Precautions,
and Warning Level 3: Avoid Nonessential Travel.
Centers for Disease Control and Prevention. (2014). UN 3373 Category B Schematic for Packaging.
This diagram shows the packaging requirements to ship Category B infectious substances.
Centers for Disease Control and Prevention. (2017). Yellow Book.
Chapter 3 focuses on infectious diseases related to travel and includes information on transmission,
epidemiology, clinical presentation, diagnosis, and treatment. Chapter 5 includes information on
assessing illnesses in returned travelers, including elements of a complete medical history, illnesses
associated with fever in the first two weeks following travel, common syndromes, and management.
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Centers for Medicare and Medicaid Services. (2016). Emergency Preparedness Requirements for
Medicare and Medicaid Participating Providers and Suppliers Final Rule.
This rule establishes consistent emergency preparedness requirements for health care providers
participating in Medicare and Medicaid, increases patient safety during emergencies, and establishes a
more coordinated response to natural and man-made disasters.
DeCarli, G., Fusco, F., Puro, V., et al. (2015). Adopting a Global Safety Standard for the Prevention of
Ebola Needle-Stick Exposures. Infection Control and Hospital Epidemiology. 36(6):745-746.
This editorial emphasizes the importance of using safety devices to prevent needlestick injuries among
healthcare personnel managing patients with highly infectious diseases.
Domestic Resilience Group. (2017). Interim – Planning Guidance for the Handling of Solid Waste
Contaminated with a Category A Infectious Substance.
This federal inter-agency guidance approved by the Domestic Resilience Group of the National Security
Council is for the safe handling of Category A contaminated solid waste.
Environmental Protection Agency. (n.d.). List L: Disinfectants for Use Against the Ebola Virus. (Accessed
5/6/2019).
The EPA lists products that meet the CDC’s criteria for use against the Ebola virus on hard, non-porous
surfaces. Products are listed by name and indicate whether they are approved for use in hospital/
healthcare facilities, institutions such as schools and offices, and residences.
Georgia Department of Public Health. (n.d.). Travel Clinical Assistant. (Accessed 5/6/2019).
This webpage provides post-travel clinical information for travel-related diseases, searchable by entering a
country name or clicking its location on a map.
Government Publishing Office. (n.d.). Code of Federal Regulations Title 49 Subtitle B Chapter I
Subchapter C – Hazardous Materials Regulations. (Accessed 5/6/2019).
These regulations govern the safe and secure transportation of hazardous materials in commerce.
Gunther, S., Feldmann, H., Geisbert, T., et al. (2011). Management of Accidental Exposure to Ebola
Virus in the Biosafety Level 4 Laboratory, Hamburg, Germany. The Journal of Infectious Diseases.
204(suppl_3):S785-S790.
The authors describe a needlestick injury involving Zaire ebolavirus and the use of an experimental
vaccine for post exposure prophylaxis.
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International Air Transport Association. (2017). Dangerous Goods Regulations.
These regulations outline transport requirements for dangerous goods including infectious substances,
radioactive material, and corrosives.
Minnesota Department of Health, Association for Professionals in Infection Control and
Epidemiology-Minnesota, and Health Care Coalitions of Minnesota. (2018). High Consequence
Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.
This toolbox includes a variety of resources to assist frontline facilities in their readiness activities related
to patients with high consequence infectious diseases. Included are planning and training tools, exercise
templates, and the components (e.g., screening guide, checklists, posters) to create a readiness binder.
National Ebola Training and Education Center. (n.d.). Online Courses. (Accessed 5/6/2019).
This webpage includes links to free, online training courses developed by NETEC.
National Ebola Training and Education Center. (n.d.). Resource Repository. (Accessed 5/6/2019).
This webpage includes links to training and other helpful resources specific to special pathogens (e.g.,
Ebola and MERS).
National Institute for Occupational Safety and Health. (2018). Considerations for Selecting Protective
Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids.
This webpage of the National Personal Protective Technology Laboratory provides background
information on understanding different types of worker exposures, discusses the selection of protective
clothing, identifies current healthcare protective clothing standards and specifications, and includes links
to additional information.
National Institute for Occupational Safety and Health. (2018). Hierarchy of Controls.
This webpage provides a graphical illustration and describes the hierarchy of controls to protect workers
from occupational hazards.
National Institute for Occupational Safety and Health. (1998). Selecting, Evaluating, and Using Sharps
Disposal Containers.
This document outlines the performance criteria and existing standards related to sharps disposal
containers and provides criteria for the selection of containers to be used as part of a healthcare facility’s
needlestick injury prevention plan.
Nebraska Medicine. (2019). MERS Co-V ED Screening Protocol.
This algorithm shows the Nebraska Medical Center emergency department screening protocol for MERS
Co-V.
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Nebraska Medicine. (n.d.). MERS Co-V Guidelines for Respiratory Care Services. (Accessed 12/12/2018).
These guidelines identify respiratory therapy modalities to be used based on indications and patient
treatment needs.
Nebraska Medicine. (2017). Middle East Respiratory Syndrome Coronavirus (MERS Co-V) Lab Protocol for
Person Under Investigation (PUI) Main Campus.
This document describes the laboratory protocol used by Nebraska Medicine for MERS Co-V.
New England Journal of Medicine. (2009). NEJM Procedure: Collection of Nasopharyngeal Specimens
with the Swab Technique.
This video demonstrates how to collect nasopharyngeal specimens.
New York City Department of Health and Mental Hygiene. (2014). NYC DOHMH Guidance Document
for Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments
and Clinics with Potentially Communicable Diseases of Public Health Concern.
This document provides guidance to healthcare facilities on developing or updating protocols for
screening and isolation of patients potentially infected with a communicable disease.
New York City Health + Hospitals. (2017). Mystery Patient Exercise Plan.
The plan serves as a template to support health care delivery sites for highly infectious disease
preparedness and response through exercises. It provides exercise participants with the necessary tools
to conduct Mystery Patient Drills and the flexibility to adapt the exercise to the individualized needs of
each facility and the varied composition of each local community.
New York State Department of Health. (2003). New York State Department of Health SARS Guidance
Document, Chapter 4: Laboratory Diagnosis of SARS.
This chapter of a larger guidance document provides information on laboratory testing related to SARS,
including which tests will be performed, safety precautions when handling specimens, and how to collect,
test, and ship specimens.
North Shore-LIJ Health System. (2014). Ebola Virus Disease (EVD) Preparedness Manual.
This manual offers best practices on preparedness of healthcare facilities for Ebola virus disease.
Occupational Safety and Health Administration. (2012). Bloodborne Pathogens (29 CFR 1910.1030).
This page contains the regulatory language for the bloodborne pathogens standard.
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Occupational Safety and Health Administration. (n.d.). Bloodborne Pathogens and Needlestick
Prevention. (Accessed 7/13/2018).
This webpage provides an overview of bloodborne pathogens and links to information on guidance,
enforcement, hazard recognition, standards, and evaluating and controlling exposures.
Occupational Safety and Health Administration. (2016). Cleaning and Decontamination of Ebola on
Surfaces: Guidance for Workers and Employers in Non-Healthcare/Non-Laboratory Settings.
This factsheet provides guidance on Ebola cleaning and decontamination procedures for those who work
in non-healthcare and non-laboratory settings. Links to information on disinfectants, waste disposal, and
personal protective equipment are provided throughout the document.
Occupational Safety and Health Administration. (n.d.). MERS Control and Prevention. (Accessed
5/6/2019).
This webpage includes background information, guidance, and links to resources for specific types of
workers who may be exposed to MERS-contaminated environments.
Occupational Safety and Health Administration. (n.d.). Ebola Control and Prevention. (Accessed
5/6/2019).
This webpage includes background information, guidance, and links to resources for specific types of
workers who may be exposed to Ebola-contaminated environments.
Occupational Safety and Health Administration. (2016). PPE (29 CFR 1910.132).
This standard provides information on the selection and use of PPE based on an assessment of potential
hazards.
Occupational Safety and Health Administration. (2014). PPE Selection Matrix for Occupational Exposure
to Ebola Virus.
The U.S. Department of Labor shares information on the type of PPE to be worn in various situations
(e.g., normal work activities, casual interaction, providing medical and supportive care, cleaning and
disinfecting environments, and dealing with waste).
Occupational Safety and Health Administration. (2011). Respiratory Protection (20 CFR 1910.134).
This standard details requirements and criteria for respiratory protection. This webpage provides the
major requirements for this standard, to include: respiratory protection program, selection of respirators,
medical evaluation, fit testing, use of respirators, maintenance and care, training and information, and
program evaluation.
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Occupational Safety and Health Administration, National Institute of Occupational Safety and
Health, and Environmental Protection Agency. (2016). Safe Handling, Treatment, Transport and Disposal
of Ebola-Contaminated Waste.
This fact sheet provides a step-by-step summary of actions workers should take from the point Ebolacontaminated waste is generated through final disposal.
Office of the Assistant Secretary for Preparedness and Response (2016). 2017-2022 Health Care
Preparedness and Response Capabilities. U.S. Department of Health and Human Services.
This 70-page document describes the four capabilities that healthcare coalitions and individual healthcare
facilities need to prepare for, respond to, and recover from emergencies. The capabilities are: foundation
for healthcare and medical readiness; healthcare and medical response coordination; continuity of
healthcare service delivery; and medical surge.
Office of the Assistant Secretary for Preparedness and Response. (2017). Hospital Preparedness
Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures.
This manual provides implementation guidance on performance measures for awardees receiving federal
funds for Ebola preparedness and response through the Hospital Preparedness Program.
Office of the Assistant Secretary for Preparedness and Response. (2017). Regional Treatment Network
for Ebola and Other Special Pathogens.
This report provides information on the regional treatment network established for the management
of patients with Ebola and other special pathogens, its oversight and financing, the current state of
preparedness, and planning and future considerations.
Sehulster, L. and Chinn, R. (2003). Guidelines for Environmental Infection Control in Health-Care Facilities:
Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).
MMWR Recommendations and Reports. 52(RR10):1-42
These recommendations review previous infection prevention guidelines and provide evidence-based
recommendations for environmental infection control in healthcare facilities.
World Health Organization. (2007). Standard Precautions in Health Care.
This fact sheet provides background information and advice, a checklist, and key elements for standard
precautions in healthcare facilities.
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IND E X OF A B B R E V I ATIO N S
ABHR
alcohol-based hand rub
AIIR
airborne infection isolation room
ARDS
acute respiratory distress syndrome
ASPR
Assistant Secretary for Preparedness and Response
BSL
biosafety level
CBC
complete blood count
CDC
Centers for Disease Control and Prevention
CFR
Code of Federal Regulations
CMO
chief medical officer
CNO
chief nursing officer
CRRT
continuous renal replacement therapy
DOT
U.S. Department of Transportation
ECMO
extracorporeal membrane oxygenation
ED
emergency department
EHR
electronic health record
EMS
emergency medical services
EMTALA
Emergency Medical Treatment and Labor Act
EPA
U.S. Environmental Protection Agency
ESF
emergency support function
EVD
Ebola virus disease
GI
gastrointestinal
HCID
high consequence infectious disease
HCW
health care worker
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HEPA
high-efficiency particulate air
HHS
U.S. Department of Health and Human Services
HICS
hospital incident command system
HIPAA
Health Insurance Portability and Accountability Act
HMR
Hazardous Materials Regulations
IATA
International Air Transport Association
INR
international normalized ratio
MERS
Middle East Respiratory Syndrome
NETEC
National Ebola Training and Education Center
NIOSH
National Institute for Occupational Safety and Health
OSHA
Occupational Safety and Health Administration
PAPR
powered air-purifying respirator
PPE
personal protective equipment
PT
prothrombin time
PUI
person under investigation
SARS
severe acute respiratory syndrome
SOP
standard operating procedure
TRACIE
Technical Resources, Assistance Center, and Information Exchange
VHF
viral hemorrhagic fever
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EL E CTR O N I C H E A LT H R E C O RD SCREE NING
SA M P L E Q U E S T I O N S
Symptom Screening
Has the patient had any of the following symptoms in the last week?
(select fever, cough or
respiratory symptoms, rash)
Travel Screening
Has the patient traveled outside of the U.S. in the last month?
(select yes/no)
If yes, which regions were visited?
(select from list from multipick)
African countries
(select from list)
South Asian countries
(select from list)
Central American countries
(select from list)
North American countries
(select from list)
South American countries
(select from list)
European countries
(select from list)
Middle Eastern countries
(select from list)
Australian and Oceanic countries
(select from list)
Caribbean countries
(select from list)
Asian countries
(select from list)
Exposure Screening
Has the patient been in close contact with someone with a known
communicable disease in the last month?
(select yes/no)
If yes, which disease?
(select from list)
When was the exposure date?
(select from list)
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ISOLATION ROOM SUPPLY LIST EX AMPLE
Disposable Medical Supplies Cart
Stethoscope
Thermometer
Blood pressure cuff (range of sizes)
Emesis bags (preferred to basin)
Absorbent pads/Chux
Gauze sponges
Basins
Bedside commode
Respiratory supplies – oxygen masks, cannula, tubing, suction
Infusion supplies – IV drip tubing, IV fluids
Phlebotomy supplies – including blood draw and IV start
Specimen transport boxes from lab (i.e., triple packing system)
Spill Kit
Absorbent pad with fluid-resistant backing/Chux
Absorbent pads
Bleach 1:10 solution or other EPA-registered hospital disinfectant
Bleach wipes or other EPA-registered hospital disinfectant
Mop bucket
Mop pole
Clean mop head
Broom with removable handle
Long handled dust pan with removable handle
Cut resistant gloves
This list assumes the isolation room has standard headers with electrical, oxygen, and suction available. These supplies may be
housed in the room, in boxes, or on dedicated carts, but they should be assembled and easily accessible.
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Autoclave bag-lined trash can x2
Solidifier (if using)
Disposable cardboard spatula (if using)
Spill protocol
Waste Kit
Leak-proof biohazard bags with a minimum thickness of 1.5 mils and a capacity of 175 liters or less
Approved sharps container
Waste bin (larger and multiple compared to usual patient rooms)
Transport cart
Absorbent disposable towels and disposable cleaning cloths
EPA-registered hospital disinfectant solutions and cloths
ABHR
Dedicated Patient Equipment
IV poles
Vital signs/cardiac monitor/oxygen saturation monitor
Glucometer
Patient phone
Translator phone (if necessary)
Tablet computer/slate for patient, television, white board/dry erase markers
Facial tissue
Urinal to patient care supplies
Dedicated Linen
Disposable sheets
Blankets
Patient gowns
Towels and washcloths
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UNI VE R SA L S C R E E N I N G S I GN E XAMPLE
ATTENTION ALL PATIENTS
Cough? Fever? Rash?
Back to Contents
1
PLEASE TAKE A MASK!
2
REPORT YOUR SYMPTOMS
AND TRAVEL HISTORY
3
CLEAN YOUR HANDS OFTEN
If no masks are available, please
use a tissue to cover your nose and
mouth when coughing or sneezing.
Alert staff if you, or someone you
have had close contact with has
been ill and recently traveled
internationally.
Use an alcohol-based hand
cleaner or wash with soap and
water. Clean hands save lives!
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DOO R SI GN E X A M P L E
SPECIAL PATHOGEN BASIC PPE
• Fit-tested N95 or equivalent/higher respirator
• Fluid-resistant gown that extends to at least mid-calf
• Nitrile gloves with extended cuff - 2 pairs
• Face shield
• Consider booties and head cover
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DOO R SI GN E X A M P L E
VHF PPE
• Fit-tested N95 or equivalent/higher respirator
• Nitrile gloves with extended cuff - 2 pairs
• Impermeable gown that extends to at least mid-calf
• Knee high pull-on impermeable booties
• Surgical hood
• Face shield
• Impermeable apron should be added for patients
with significant body fluid losses/exposure risk
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�Planning
Screening
Special
Respiratory
VHF
Special
Considerations
Exercises
References
and
Resources
Checklists
Initial Patient Screening Algorithm for
Infectious Diseases for EDs
LOCATION
ROLE
Registration
Desk
Greeter/
Triage RN
ACTIVITY
NOTES
1. Ask patient: in the past week have you had fever, have you had a cough, have
you had a rash?
Instruct patient how to put on
mask
YES
Give patient surgical mask and
ask to use alcohol-based hand
sanitizer
2. Ask patient: have you traveled outside the country within the past 30 days OR had
If patient has yes to fever +
cough or fever + rash, escort
patient to private room if
available and continue patient
assessment
contact with someone that has traveled and is sick within the past 30 days?
YES
NO
Stop screening process,
and proceed with patient
registration
3. Notify Triage RN to report travel/symptoms
Triage/Clinic
RN/
Provider
4. Conduct initial assessment and travel history: ask what country(s) patient has
traveled to OR had contact with someone that has traveled and is sick in the past
30 days?
YES
NO
Special Pathogen Intranet page:
http://hhcinsider.nychhc.org/
corpoffices/Special-Pathogens/
Pages/Index.aspx
5. Go to Infectious Disease Dashboard
(found on special pathogen intranet page).
Type disease or country(s) traveled.
If positive for travel areas with active highly
infectious disease transmission
YES
Note: highly infectious diseases
may be considered even in
the absence of specific travel
alerts and consider domestic
infectious disease outbreaks.
NO
If available, contact your
facility infectious disease/
infection control department(s)
for guidance.
6. Escort patient with surgical mask on to
isolation room keeping a distance of 3 feet
away of patient.
7. Post “Screening in Progress” sign on door,
place Special Pathogen Cart outside room
and, notify provider of travel/symptom(s)
Patient Room
Provider
Stop screening process and
continue patient assessment
per appropriate procedures
8. Provider to put on appropriate PPE ensemble if entering patient’s room or
perform evaluation remotely
9. Conduct patient assessment and determine exposure risk. Is there a concern for a
highly infectious disease?
YES
NO
Stop screening process and
continue patient assessment
per appropriate procedures
10. Notify infection control to discuss case
11. Document evaluation in EMR
12. Call NYCDOHMH Provider Access Line: 866-692-3641 to
discuss case.
After consultation with NYCDOHMH if patient is suspected to have a special
pathogen and is classified as a person under investigation (PUI) immediately
notify Facility’s Medical Director & Central Office Special Pathogens Program:
646-864-5442
Back to Contents
Recommended triage PPE:
mask & gloves
Recommended escort PPE:
mask & gloves
Special Pathogen Level 1 PPE:
N95, 2 pairs of gloves,
impermeable gown, face shield
Special Pathogen Level 2 Viral
Hemorrhagic Fever (VHF) :
N95, face shield, coverall,
2 pairs of gloves, hood, shoe
cover, apron (level 2 for all VHF
suspected cases)
Refer to special pathogen
intranet page for additional
guidance
Call to NYCDOHMH
Be prepared to provide patient
demographic information,
travel and symptom information
(e.g., dates and locations of
travel, date of symptom onset),
comorbidities, and any additional
epidemiological linkages
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
7-62
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
The Infectious Disease
Dashboard, electronically linked
within NYC Health + Hospitals
electronic medical records
system (screenshot to the right)
serves as a decision-support
tool for screening and patient
management.
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
7-63
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Special Pathogen Basic Personal Protective Equipment
Donning Checklist Example
Step #
Task
Criteria
Gather PPE in
proper sizes
•
•
•
•
•
•
2§
Prepare to don
PPE
• Trained observer present with checklist
• OUTSIDE of the patient’s room in designated donning area
• Remove watches, jewelry, and dangling items that could interfere
with integrity of PPE
• Secure eyeglasses with a tie
• Hydrate and attend to personal hygiene
• Consider medical screening if entering for shift per facility policy
Yes
No
3§
Inspect PPE
• Inspect PPE for serviceability (e.g., not torn or ripped) and proper size
Yes
No
4§
Perform hand
hygiene
• Perform hand hygiene with alcohol-based hand sanitizer
Yes
No
5§
Don nitrile
gloves
• Don inner gloves and extend cuffs up arms
Yes
No
6§
Don booties,
if wearing
• Sit down and pull on booties
Yes
No
7§
Don fluid
resistant gown
• Fully cover torso from neck to knees and arms to end of wrists;
leave no skin exposed
• Fasten at the back of neck; tie at waist
• Do not tie inside ties
• Ensure no trip hazard exists
Yes
No
8§
Don N95
respirator
• Don N95 respirator and check for seal
Yes
No
9§
Don head
cover, if
wearing
• Contain hair and cover ears
Yes
No
1§
Fluid resistant gown
N95 respirator
Nitrile gloves, extended cuff (2 pairs – inner and outer)
Face shield
Booties (optional)
Head cover (optional)
Completed
Yes
No
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who
Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-64
�Planning
Screening
Step #
Task
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Criteria
Checklists
Completed
10§
Don face
shield
• Position shield above eyebrows and mid-forehead to cover eyes
Yes
No
11
Don nitrile
gloves
• Don outer gloves
• Extend to cover the sleeves or cuffs of the gown
• Tuck excess material at sleeve into cuff
Yes
No
12§
Inspection
• Extend arms and verify integrity of PPE with observer:
• Bend at waist
• Squat and return to standing position
• Slowly turn in circle for final inspection
• Observer marks suit with wearer’s name and time donned
Yes
No
13§
Reminder
• Keep hands away from all mucous membranes
• Review hand signals for “OK,” “not OK,” and “coming out”
Yes
No
§
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who
Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-65
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
Special Pathogen Basic Personal Protective Equipment
Doffing Checklist Example
Step #
Criteria
Completed
Trained
Observer1
• Engage the trained observer outside patient room with the checklist
• Determine contact time requirement for disinfectant wipe per product
label
Yes
No
2†
Inspect PPE
In patient room:†
• Inspect PPE for soiling or breaches
• If PPE is visibly contaminated, disinfect by using an EPA-registered
disinfectant wipe (allow contact time per product label)
Yes
No
3†
Perform hand
hygiene
• Perform hand hygiene by using an EPA-registered disinfectant wipe
(allow contact time per product label) or with alcohol-based hand sanitizer
Yes
No
Doff outer
gloves
• Using gloved hand, grasp the palm area of the other gloved hand and
peel off first glove
• Hold the removed glove in the opposite gloved hand
• Slide fingers of the ungloved hand under the remaining glove at the wrist
and peel off the remaining outer glove over the first glove
• Discard both outer gloves in the infectious waste container
Yes
No
Disinfect inner
gloves
• Inspect outer surface of gloves for visible contamination, cuts, or tears
• If no visible contamination is identified on the inner gloves
• Disinfect the inner-gloved hands with either an EPA-registered
disinfectant wipe (allow contact time per product label) or
alcohol-based hand sanitizer
• If an inner glove is visibly soiled
• Disinfect the glove with an EPA-registered disinfectant wipe
(allow contact time per product label)
• Remove the inner gloves
• Using the gloved hand, grasp the palm area of the other gloved
hand and peel off the first glove
• Hold the removed glove in the opposite gloved hand
• Slide fingers of the ungloved hand under the remaining glove at
the wrist and peel off the remaining outer glove over the first glove
• Discard both inner gloves in the infectious waste container
• Perform hand hygiene with alcohol-based hand sanitizer on bare hands
• Don a new pair of inner gloves
• If a cut or tear is detected on an inner glove, immediately initiate
occupational exposure protocol
Yes
No
1
‡
4†
5†
1
Task
Trained observers are most important if VHF is suspected, their use is optional for special respiratory pathogens
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who
Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-66
�Planning
Step #
Screening
VHF
Task
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Criteria
Checklists
Completed
6†
Doff face
shield
• Face shield is considered contaminated
• Remove by tilting the head slightly forward, grasping the rear strap and
pulling it gently over the head and allowing the face shield to fall forward
• Discard in the infectious waste container
Yes
No
7†
Perform hand
hygiene
• Perform hand hygiene and disinfect inner-gloved hands with
alcohol-based hand sanitizer
Yes
No
8†
Doff head
cover, if
wearing
• Remove and discard in infectious waste container
Yes
No
9†
Perform hand
hygiene
• Disinfect inner-gloved hands with alcohol-based hand sanitizer
Yes
No
10†
Doff fluid
resistant gown
• Front and sleeves are potentially contaminated
• Pull the gown away from the body until the ties break
• Remove gown by pulling the gown away from the neck and shoulders,
touching the inside only
• As the gown is rolled away from the body it is turned inside out, folded,
or rolled into a bundle and discarded into an infectious waste container
Yes
No
11†
Perform hand
hygiene
• Disinfect inner-gloved hands with alcohol-based hand sanitizer
Yes
No
12†
Doff booties,
if wearing
• Sitting on a clean and stable surface at the border of the patient’s room
and the designated decontamination area, remove booties one at a time
• Discard in infectious waste container
Yes
No
13†
Perform hand
hygiene
• Disinfect inner-gloved hands with alcohol-based hand sanitizer
Yes
No
14†
Doff inner
gloves
• Using gloved hand, grasp the palm area of the other gloved hand and peel
off first glove
• Hold the removed glove in the opposite gloved hand
• Slide fingers of the ungloved hand under the remaining glove at the wrist
and peel off the remaining inner glove over the first glove
• Discard both inner gloves in the infectious waste container
Yes
No
15†
Don new pair
of gloves
• Clean bare hands with alcohol-based hand sanitizer
• Don a new pair of nitrile gloves
Yes
No
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who
Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-67
�Planning
Step #
Screening
VHF
Task
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Criteria
Checklists
Completed
16‡
Relocate
• Move to designated doffing area‡
Yes
No
17‡
Remove N95
respirator
• Remove N95 respirator from the back to front and discard in the
infectious waste container
Yes
No
18‡
Doff gloves
• Using gloved hand, grasp the palm area of the other gloved hand and
peel off
• Slide fingers of the ungloved hand under the remaining glove at the wrist
and peel off the remaining glove
• Discard in the infectious waste container
Yes
No
19‡
Perform hand
hygiene
• Wash or clean hands with an alcohol-based hand sanitizer; hands
completely dry before exiting the area
Yes
No
20‡
Inspect
• Perform a final inspection of the surgical scrubs or disposable garments.
• If contamination is identified, carefully remove the garments and shower
immediately
Yes
No
21§
Follow up
• Perform staff rehab, medical monitoring, documentation, and behavioral
wellness check as indicated
Yes
No
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who
Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-68
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
VHF Personal Protective Equipment
Donning Checklist Example
Step #
1§
Task
Criteria
Gather PPE in
proper sizes
•
•
•
•
•
•
•
•
N95 respirator mask
Face shield
Impermeable gown
Nitrile gloves, extended cuff, non-sterile (inner)
Nitrile gloves, extended cuff, non-sterile (outer)
Surgical hood
Impermeable knee high shoe cover
Impermeable apron (for patient with significant body fluid
losses/exposure risk)
Completed
Yes
No
2§
Prepare to
don PPE
• Trained observer present with checklist
• OUTSIDE§ of the patient’s room
• Remove watches, jewelry and dangling items that could interfere with
integrity of PPE
• Secure eyeglasses with a tie
• Hydrate and attend to personal hygiene
• Consider medical screening if entering for shift per facility policy
3§
Inspect PPE
• Inspect PPE for serviceability (e.g., not torn or ripped) and proper size
Yes
No
4§
Perform hand
hygiene
• Perform hand hygiene with alcohol-based hand sanitizer
Yes
No
5§
Don gloves
• Don inner gloves
Yes
No
6
Don
impermeable
gown
•
•
•
•
Yes
No
7§
Don
impermeable
knee high shoe
covers
• Sit down and pull on impermeable knee high shoe covers
§
Fully cover torso from neck to knees; arms to end of wrists
Fasten at the back of neck; tie at waist
Do not tie inside ties
Ensure no trip hazard exists
Yes
No
Yes
No
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons
under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-69
�Planning
Screening
Step #
VHF
Task
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Criteria
Checklists
Completed
8§
Don N95
respirator
• Don N95 respirator and check for seal
Yes
No
9§
Don surgical
hood
•
•
•
•
Yes
No
10§
Don outer
nitrile gloves
• Extend to cover the sleeves or cuffs of the gown
• Tuck excess material at sleeve into cuff
Yes
No
11
Don
impermeable
apron,
if needed
• Don impermeable apron over hood
• Secure apron ties as necessary
Yes
No
12§
Don face
shield
• Position shield above eyebrows and mid-forehead to cover eyes
Yes
No
13§
Inspection
• Extend arms and verify integrity of PPE with observer – no exposed skin
• Bend at waist
• Squat and return to standing position
• Slowly turn in circle for final inspection
• Observer marks suit with wearer’s name and time donned
Yes
No
14§
Reminder
• Keep hands away from all mucous membranes
• Review hand signals – “OK,” “not OK,” and “coming out”
Yes
No
§
Ensure that the hood covers all the hair and ears
Place hood over the mask and secure appropriately
Recheck that eyeglasses are secured
Recheck N95 respirator for seal
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons
under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-70
�Planning
Screening
VHF
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Checklists
VHF Personal Protective Equipment
Doffing Checklist Example
Step #
Task
Criteria
Completed
Trained
Observer
• Engage the trained observer outside patient room with the checklist
• Determine contact time requirement for disinfectant wipe per product
label
Yes
No
2†
Inspect PPE
In patient room;†
• Inspect PPE for soiling or breaches
• If PPE is visibly contaminated, disinfect by using an EPA-registered
disinfectant wipe (allow contact time per product label)
Yes
No
3†
Perform hand
hygiene
• Perform hand hygiene by using an EPA-registered disinfectant wipe
(allow contact time per product label) or with alcohol-based hand sanitizer
Yes
No
Doff apron
(if wearing)
• Use care not to spread contamination if apron is soiled
• Remove (e.g., by breaking or untying neck strap and releasing waist ties)
• Touch inside of apron only to remove by folding and rolling into a bundle
and discard into an infectious waste container
• Re-inspect PPE that was under apron and disinfect with wipes as needed
Yes
No
Doff outer
gloves
• Disinfect outer-gloved hands with either an EPA-registered disinfectant
wipe (allow contact time per product label) or alcohol-based hand sanitizer
• Using gloved hand, grasp the palm area of the other gloved hand and
peel off first glove
• Hold the removed glove in the opposite, gloved hand
• Slide fingers of the ungloved hand under the remaining glove at the wrist
and peel off the remaining outer glove over the first glove
• Discard both outer gloves in the infectious waste container
Yes
No
Disinfect
inner gloves
• Inspect the inner gloves’ outer surfaces for visible contamination, cuts,
or tears
• If no visible contamination is identified on the inner gloves
• Disinfect the inner-gloved hands with either an EPA-registered
disinfectant wipe (allow contact time per product label) or
alcohol-based hand sanitizer
• If an inner glove is visibly soiled
• Disinfect the glove with an EPA-registered disinfectant wipe (allow
contact time per product label)
• Remove the inner gloves
• Using gloved hand, grasp the palm area of the other gloved hand
and peel off first glove
1
‡
4†
5†
6†
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons
under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-71
�Planning
Screening
Step #
VHF
Task
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Criteria
Checklists
Completed
• Hold the removed glove in the opposite, gloved hand
• Slide fingers of the ungloved hand under the remaining glove at
the wrist and peel off the remaining outer glove over the first glove
• Discard both inner gloves in the infectious waste container
• Perform hand hygiene with alcohol-based hand sanitizer on bare hands
• Don a new pair of inner gloves
• If a cut or tear is detected on an inner glove, immediately initiate
occupational exposure protocol
Yes
No
7
Doff face
shield
• Face shield is considered contaminated
• Remove by tilting the head slightly forward, grasping the rear strap and
pulling it gently over the head and allowing the face shield to fall forward
• Discard in the infectious waste container
Yes
No
8†
Perform hand
hygiene
• Perform hand hygiene and disinfect inner-gloved hands with
alcohol-based hand sanitizer
Yes
No
9†
Doff surgical
hood
• Lean forward to avoid allowing the front of the hood from brushing over
exposed mucous membranes (e.g., eyes)
• Remove hood by gently pulling the hood from the rear of the head in a
motion that is down and away from the neck and shoulders
• Discard in the infectious waste container
Yes
No
10†
Perform hand
hygiene
• Disinfect inner-gloved hands with alcohol-based hand sanitizer
Yes
No
11†
Doff gown
• Front and sleeves are considered contaminated
• Pull the gown away from the body until the ties break
• Remove gown by pulling it away from the neck and shoulders, touching
the inside only
• As the gown is rolled away from the body it is turned inside out, folded
or rolled into a bundle and discarded in the infectious waste container
Yes
No
12†
Perform hand
hygiene
• Disinfect inner-gloved hands with alcohol-based hand sanitizer
Yes
No
13
Doff shoe
covers
• Sitting on a clean and stable surface at the border of the patient’s room
and the designated decontamination area, remove shoe covers one at a
time
Yes
No
6†
(cont.)
†
†
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons
under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-72
�Planning
Step #
Screening
VHF
Task
Special
Respiratory
Special
Considerations
Exercises
References
and
Resources
Criteria
Checklists
Completed
Perform hand
hygiene
• Disinfect inner-gloved hands with alcohol-based hand sanitizer
Yes
No
15‡
Doff inner
gloves
• Using gloved hand, grasp the palm area of the other gloved hand and
peel off first glove
• Hold the removed glove in the opposite, gloved hand
• Slide fingers of the ungloved hand under the remaining glove at the wrist
and peel off the remaining outer glove over the first glove
• Discard both inner gloves in the infectious waste container
Yes
No
16‡
Perform hand
hygiene
• Perform hand hygiene and disinfect inner-gloved hands with
alcohol-based hand sanitizer
Yes
No
17‡
Don new pair
of gloves
• Clean bare hands with alcohol-based hand sanitizer
• Cover cleaned hands with clean gloves
Yes
No
18‡
Remove N95
respirator
• Remove N95 respirator from the back to front and discard in the
infectious waste container
Yes
No
19‡
Perform hand
hygiene and
doff final
gloves
• Disinfect gloved hands with alcohol-based hand sanitizer
• Remove gloves using same procedure as first two pairs
Yes
No
20‡
Perform hand
hygiene
• Clean bare hands with alcohol-based hand sanitizer
• Ensure hands are completely dry before exiting the area
Yes
No
21‡
Inspect
• Perform a final inspection for contamination of the surgical scrubs or
disposable garments
• If contamination is identified, carefully remove the garments and shower
immediately
Yes
No
22§
Follow up
• Perform staff rehab, medical monitoring, documentation, and behavioral
wellness check as indicated
Yes
No
14‡
Colored steps indicate location: Red (†) =In patient room Yellow (‡) =In designated decontamination area Green (§) =In cold/clean zone outside decontamination area
Reference: Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons
under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals
Back to Contents
FRONTLINE HOSPITAL PLANNING GUIDE: SPECIAL PATHOGENS
8-73
�Acknowledgments
This planning guide is a product of NYC Health + Hospitals with initial draft materials developed
by Syra Madad, DHSc, MSc, MCP, Senior Director, System-wide Special Pathogens Program,
NYC Health + Hospitals and Sean Studer, MD, MSc, Chief of Medicine, NYC Health + Hospitals
/ Kings County; additional contributions and editing by Nicholas V. Cagliuso, Sr., PhD, MPH,
Senior Assistant Vice President for Emergency Management, NYC Health + Hospitals. NYC
Health + Hospitals gratefully acknowledges the contribution of materials from the CDC, Minnesota
Department of Health, NETEC, NIOSH, and OSHA.
Additionally, NYC Health + Hospitals thanks the following subject matter experts for their review of
this document:
Amesh Adalja, MD, FIDSA, FACP, FACEP, Senior Scholar, Johns Hopkins Center for Health
Security; Eric Alberts, CEM, FPEM, FPEM-HC, CHPP, CHEP, SEM, Corporate Manager,
Emergency Preparedness, Orlando Health, Inc. (Hospital System); Gerrit Bakker, Senior
Director, Public Health Preparedness, Association of State and Territorial Health Officials; Mary
Ellen Bennett, MPH, RN, CIC, Nurse Specialist, Infection Control Assessment and Response,
Minnesota Department of Health; Eileen Blake, MPH, Associate Director, Yale New Haven Health
System Center for Healthcare Solutions/Center for Emergency Preparedness and Response; Ami
Boonjaluksa, RN, Disaster Program Manager, Los Angeles County EMS Agency; Julie Bulson,
DNP, MPA, RN, NE-BC, Director, Emergency Preparedness, Spectrum Health; Keri Cain,
Hospital Preparedness Program State Coordinator, Texas Department of State Health Services;
Willie Carley, Veteran Integrated Service Network 3, Network Emergency Management Program
Coordinator, Department of Veterans Affairs; Craig DeAtley, PA-C, Director, Institute for Public
Health Emergency Readiness, MedStar Washington Hospital Center; Lorraine Fearon, APRN,
Nurse Practitioner, Loyola Employee and Student Health; Emily Gould, Rural Preparedness
Coordinator, Nevada Public Health Preparedness Program; Tammy Hale, MSN, RN, CIC, Nurse
Specialist, Infection Control Assessment and Response, Minnesota Department of Health; Mark
Jarrett, MD, MBA, MS, SVP & Chief Quality Officer/Associate Chief Medical Officer, Northwell
Health and Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell; Christopher
Lake, PhD, Executive Director, Community Resilience, Nevada Hospital Association; Brad Learn,
CHEP, Emergency Preparedness Coordinator, Kentucky Hospital Association; Deborah Levy,
PhD, MPH, Professor and Chair, Department of Epidemiology, College of Public Health, University
of Nebraska Medical Center; Nicolette Louissaint, PhD, Executive Director, Healthcare Ready;
Joseph Masci, MD, Chairman, Global Health Institute, Elmhurst Hospital Center and Professor
of Medicine and Preventive Medicine, Icahn School of Medicine at Mount Sinai; Lyle Moore,
Jr., MPH, Director, Hospital Emergency Preparedness, Colorado Hospital Association; Kenneth
Onye, MPH, Special Pathogen Consultant, Bureau of EMS, Trauma, and Preparedness,
Michigan Department of Health and Human Services; James Paturas, CEM, CBCP, EMTP,
FACCP, Director, Yale New Haven Health System Center for Emergency Preparedness and
Disaster Response; Amber Pitts, Hospital Preparedness Program Section Manager, Division of
Emergency Preparedness and Response, Michigan Department of Health and Human Services;
Terri Postma, MD, Medical Officer, Performance-Based Payment Policy, Centers for Medicare
and Medicaid Services; Amy Priddy, DNP, RN, CIC, Senior Manager, Infection Prevention
and Control Service, Park Nicollet Health Services; Mary Russell, EdD MSN, RN Emergency
Services, Boca Raton Regional Hospital; Shelly Schwedhelm, MSN, RN, NEA-BC, Executive
Director, Emergency Management and Biopreparedness, Nebraska Medicine; Barbara A. Smith,
RN, BSN, MPA, CIC, FAPIC, Infection Preventionist, Mount Sinai St. Luke’s/Mount Sinai West;
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN, Program Director for
Serious Communicable Diseases, Emory University Hospital: Mark Van Dyke, MEd, Manager,
Emergency Preparedness, Spectrum Health; Boyd Wilson, MS, CIC, FAPIC, Director of Infection
Prevention and Control, Regions Hospital; and Representatives from the NETEC, Emergency
Nurses Association and the Johns Hopkins Biocontainment Unit.
�EMERGENCY
MANAGEMENT
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
<strong>Purpose and Audience:</strong><br />All hospitals must be prepared to identify and isolate a patient presenting with a suspected special pathogen infection (i.e., one that is particularly virulent and requires care processes and personal protective equipment beyond daily infection control practices) and inform internal and external stakeholders. This document provides high level planning guidance for a frontline hospital multidisciplinary team (e.g., emergency management, infection prevention and control, emergency department, inpatient care, safety, public relations, and infectious disease, depending on the resources and role of the facility in the community) to support planning and training for the provision of initial care to such patients while determining whether and when the patient will be transferred to another facility for further assessment and treatment. Though the target audience is frontline hospitals, other facilities may fnd information that is applicable to their planning. The information in this planning guide is neither presented as a complete and stand-alone resource for special pathogen management nor is it intended as a universal document for all staff within an entire hospital. It aims to serve as a high level “jumping-off point” to be supplemented by the most current pathogen-specific guidance and customized to meet facility needs. <br /><br /><strong>Scope:</strong> <br />This document is NOT intended for facilities managing patients confirmed to have a viral hemorrhagic fever or special respiratory pathogen. Rather, this planning guide is designed to assist frontline hospitals to develop systems and provide training to screen for special pathogen infectious diseases and effectively identify, isolate, and inform when a case is suspected, and safely manage patients until diagnosis, transfer, or release. In certain circumstances, patients may require further intervention or invasive procedures based on clinical status or may be at frontline hospitals longer than 24 hours. Hospitals should always consult with public health officials to ascertain risk and to obtain the most current information available including their state and local health departments, the Centers for Disease Control and Prevention (CDC), and other sources to assure their practices and knowledge are current.<br /><br />The planning guide format provides an overview of the issues that should be addressed as well as planning considerations for specific topics, particularly when such information is not easily accessible from other sources. Much more detailed guidance on infection control for specific pathogens as well as personal protective equipment and other topics is available and is referenced and linked throughout the document for use in planning by those personnel who need more specific information. Frontline facilities are varied, from critical access hospitals to major metropolitan medical centers, and depending on the regional resources and systems the frontline facility may have to simply recognize a suspect case and transfer them, or provide patient care for days at a time awaiting confirmatory testing prior to patient movement. This planning guide attempts to provide high level resources for the full spectrum of care and must be tailored to the specifics of the facility.<br /><br /><strong>Notes and Caveats:</strong> <br />This document was created by subject matter experts using official or best practice information taken from multiple organizations that was vetted and assembled by NYC Health + Hospitals. This document does not constitute official policies or viewpoints of any government agency, including NYC Health + Hospitals.<br /><br />The information contained in this planning guide is intended as a planning resource and should be incorporated in plans and procedures developed by frontline hospitals.<br /><br />The authors take no responsibility and bear no liability for any clinical care outcomes, provider injury/illness, or inaccuracies in or resulting from this document. All content was current at the time of publication and vetted to the best of our ability.<br /><br />Inclusion of specific references and resources is offered as an acknowledgement of their contribution of material and to identify sources of additional information, but it does not constitute endorsement or vouch for the accuracy or applicability of the referenced documents.
URL
https://www.nychealthandhospitals.org/center-for-global-healthcare-preparedness-for-special-pathogens/tools-and-resources/#infocus
Dublin Core
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Title
A name given to the resource
Frontline Hospital Planning Guide: Special Pathogens
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
With the increasing demand for preparedness for and responses to the world’s emerging public health threats, this planning guide breaks new ground and leads the way as a distinctive domestic resource for healthcare delivery systems to customize their plans specific to their unique clinical, operational, and financial needs. (2)
Creator
An entity primarily responsible for making the resource
NYC Health + Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-06-30
Relation
A related resource
Y - D0.1EM/D0.2EM Qualtrics # 511
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
Checklist
Emergency Management
Exercises and Drills
Frontline Facility
R-EM
Respiratory Pathogen
Special Pathogens
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
<h2>Purpose of toolbox</h2>
<ul>
<li>Provides ready-to-use tools for frontline facilities to prepare and respond to patients who may have a high consequence infectious disease (HCID).</li>
<li>Helps facilities meet CMS emergency preparedness regulatory requirements for training and testing programs.</li>
<li>Helps facilities develop a multi-year plan for HCID education and exercises.</li>
<li>Incorporates standard infection prevention concepts into training and exercises.</li>
</ul>
URL
https://www.health.state.mn.us/diseases/hcid/
Dublin Core
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Title
A name given to the resource
High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<h2>This toolbox contains</h2>
<ul>
<li>Planning Tools</li>
<li>Training Tools</li>
<li>Exercise Templates</li>
<li>Readiness binder</li>
<li>References</li>
</ul>
<h2>How to use the toolbox</h2>
<ul>
<li>Use sample multi-year planning, training and exercise plan templates to lay out preparedness activities over multiple years.</li>
<li>Incorporate readymade slides and personal protective equipment (PPE) videos into facility infection prevention and emergency preparedness training.</li>
<li>Use or modify sample exercises (seminar, workshop, table top, mini-exercise, game) and templates (Planning Tool, After Action Report).</li>
<li>Use components to make a binder for staff to use at point of care.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Minnesota Department of Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-06-11
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Example
Frontline Facility
High Consequence Infectious Disease (HCID)
Infection Prevention and Control
R-PPE
Special Pathogens
-
https://repository.netecweb.org/files/original/173ada81a253b9456583326761cc82cf.pdf
94dad44b81d050f3652715beaafb75bd
PDF Text
Text
State and Regional
Concepts of Operations (CONOPs)
NETEC Faculty
NETEC Spring 2017
https://netec.org
�Objectives
• Review the requirements and roles of frontline
facilities, assessment hospitals, State-designated Ebola
Treatment Centers, Regional Ebola and Special
Pathogen Treatment Centers (RESPTC) and health care
coalitions in State and regional concepts of operations
(CONOPs) for a patient with a suspected or confirmed
highly infectious disease
• Discuss strategies for engaging key stakeholders in
State and regional CONOPs planning
NETEC Spring 2017
https://netec.org
2
�CDC’s Tiered System
NETEC Spring 2017
https://netec.org
3
�NYC Health + Hospitals’
Tiered System
Frontline Healthcare
Facility
Quickly identifies and
isolates patients with
possible Ebola
Notifies facility infection
control and state and city
public health officials
Has enough PPE equipment
for 12-24 hours of care
Transfers patient to Region
2 Ebola Treatment Center
Ambulatory/
Outpatient Facility
Region 2 Ebola
Treatment Center
Safely receives and
isolates patients with
confirmed or suspected
Ebola
Cares for patients with
Ebola for duration of
illness
Quickly identifies and
isolates patients with
possible Ebola
Notifies facility infection
control and state and city
public health officials
Has enough PPE equipment
for <8 hours of care
Transfers patient to Region
2 Ebola Treatment Center
Has enough Ebola PPE
for at least 7 days of
care (will restock as
needed)
Has sustainable staffing
plan to manage several
weeks of care
NETEC Spring 2017
https://netec.org
4
�What are Concepts of
Operations?
• Outline plans for transport of highly
infectious patients in states or regions.
– State plans should detail patient
transportation logistics and communications.
– Regional plans should focus on collaboration
and communication amongst states in a
particular region.
– CONOPs leads should communicate,
coordinate and collaborate with key
stakeholders throughout the CONOPs process.
NETEC Spring 2017
https://netec.org
5
�NYC Health + Hospitals’
CONOPs
NETEC Spring 2017
https://netec.org
6
�CONOPs vs. IRG
Incident Response Guide (IRG)
Concept of Operations (CONOPS)
VS.
NETEC Spring 2017
https://netec.org
7
�NYC Health + Hospitals’ CONOPs
Essential Elements of Information
Agency/Organization
Type of Information
All of NYC Health + Hospitals integrated healthcare
facilities
Notification of suspected or confirmed EVD
case
New York City Fire Department (FDNY)
Transportation of PUI(s) from external
healthcare facility to one of NYC Health +
Hospitals facilities OR intra-system
transportation
New York City Department of Health and Mental Hygiene Clinical laboratory specimen to rule out or
confirm EVD
(NYC DOHMH) – Laboratory
Department of Health and Mental Hygiene (DOHMH)
Sent to Agency Received by
by NYC Health NYC Health +
+ Hospitals
Hospitals
Within NYC
Health +
Hospitals
X
X
X
X
Situational Update
X
Centers for Disease Control and Prevention (CDC)
Situational Update
X
Federal Emergency Management Agency Region (FEMA)
Situational Update
X
New York City Emergency Management (NYCEM)
Situational Update
X
New York State Department of Health (NYSDOH)
Situational Update
X
NETEC Spring 2017
https://netec.org
8
�NYC Health + Hospitals’ CONOPs
Internal & External Communication
NETEC Spring 2017
https://netec.org
9
�① Patient transfer determined by NYCDOHMH:
•
FDNYEMS notified
•
CMO at Bellevue Hospital Center notified
•
NYC Health + Hospital Leadership notified
Transfer Hospital Facility
FDNY EMS
② Transfer Hospital Facility will
follow facility-specific Bio
Isolation Transfer Card (BIT):
② After receiving notification
from NYCDOHMH for transport
from transfer facility to
treatment facility, FDNY EMS
dispatch initiates:
•
Briefing with Hospital Liaison
prior to Patient Transfer
•
Confirm Transfer Point
•
Decontamination Corridor
Prepared
•
Deployment of Haz-Tac Units
and Resources to Transfer
Hospital Facility
•
•
•
•
•
•
•
Transfer Team Dons PPE
Control of Transfer Area via
Hospital Police/Security
Hospital Liaison reports to the
Command Post
Identify Transfer Location
(based on BIT)
Await HazTac Personnel to
hand-off Patient
HazTac Personnel Accepts
Patient
HazTac Transport Patient to
Treatment Facility (Bellevue)
•
•
•
•
•
•
Intra-System
Transportation Protocol
Note: See Appendix H: NYC Health +
Hospitals Facility-Specific Bio
Isolation Transfer Cards
② Activation of the Special
Pathogens Unit via DOHMH/
FDNY Transfer to Bellevue:
•
•
•
•
•
Assemble SPP Receiving
Team
Prepare 55 Gallon Bio-Waste
Drums
SPP Liaison Report to the
Command Post
SPP Team Don PPE to
Receive Patient from FDNY
Standby at the Transfer Point
③ FDNYEMS arrival at Transfer
Hospital Facility:
•
③ Transfer Facility
Decontamination as per NYC
Health + Hospital protocol
Receiving Hospital Facility
(Bellevue)
HazTac Officer meets
Hospital Liaison
Transfer Point Confirmed with
Liaison
HazTac Personnel Don PPE
Note: See “Ebola Treatment
Facility (Bellevue)
Transportation Protocol” for
continuation of receiving facility
transport procedures.
HazTac Officer supervises
transfer
Ensure response of Clean
Ambulance
Both Ambulances driven by
clean personnel ONLY
HazTac Doffing and Decon
per FDNY EMS protocols
Note 1: Any patient assessment
and treatment shall be initiated
according to FDNY EMS policies,
procedures and protocols.
Note 2: DOHMH shall notify the
OLMC Physician of patient results
determined by treatment hospital
facility.
④ Haz-Tac Team Doff and
Decon per FDNY EMS protocols
and procedures.
NETEC Spring 2017
https://netec.org
Note; All disposable materials will
be bagged in prepared 55 Gallon
Bio-Waste Drums and disposed
according to NYC Health +
Hospital Regulated Waste
Protocol.
10
�Region IV CONOPS
• Built upon established relationships.
• Shared more mature plans to jumpstart
planning in less advanced states and
facilities.
• Led partners to resources, but did not
force them to follow.
• Understood that planning is an ongoing
process.
NETEC Spring 2017
https://netec.org
11
�Region IV Lessons
Learned
• Need for sound and exercised
communication pathways.
• Essential to have “Plan B” for
transport.
• Just because something worked does
not mean it is finished.
NETEC Spring 2017
https://netec.org
12
�Region IV “A-ha” Moments
and Promising Practices
• Don’t forget about your Field Project
Officer.
• Important to account for differing
levels of experience.
• Active support from leadership makes
the process easier.
NETEC Spring 2017
https://netec.org
13
�Region VII CONOPS
Content Example
• Promulgation Statement and
Signatures
• Waste Management
• Mortuary Affairs
• Purpose, Scope, Situation, and
• Administration and Finance
Assumptions
• Organization and Assignment
of Responsibilities
• Direction, Control, and
Coordination
• Air Transportation Plan to
Regional Treatment Center
• Ground Transportation Plan to
Regional Treatment Center
NETEC Spring 2017
https://netec.org
• Training and Exercise
• Plan Development and
Maintenance
• Authorities and References
Easy place to find 24 hour
contact information
14
�Region VII CONOPS
Development
• Embarked on process with a number of conference calls with
ASPR FPO, ASPR REC, and state officials representing entire
region.
• An in-person meeting was held to share about state plans and
begin a section-by-section revision of a Regional CONOPS Plan
that all participants could agree upon. This took several
follow up phone conference meetings to complete.
• Details that were state-specific were often removed to be
described in detail in the state CONOPS plans.
• Goal: A new state official could utilize the document in the
event of a Ebola or other dangerous, highly infectious disease
event.
NETEC Spring 2017
https://netec.org
15
�Resources
• NETEC
– www.netec.org
• Regional ETC
– 10 Regional Centers
• CDC
• Local Public Health
• Local Medical Response System
– i.e: OMMRS
NETEC Spring 2017
https://netec.org
16
�Poll Question 1
What is the current status of your State
CONOPs?
a) No plan
b) In progress
c) Complete
d) Unsure
NETEC Spring 2017
https://netec.org
17
�Poll Question 2
What is the current status of your
Regional CONOPs?
a) No plan
b) In progress
c) Complete
d) Unsure
NETEC Spring 2017
https://netec.org
18
�CONOPS Workshop
• Divide participants into groups based on their
respective regions.
– CONOPs Planning Template will serve as catalyst
• Groups to discuss:
– What’s one key success of the CONOPS
planning/development process?
– What’s one key challenge of the CONOPs
planning/development process?
– For those without a Regional or State CONOPs:
• Why? What’s your next step?
• Reconvene all participants for hot wash.
NETEC Spring 2017
https://netec.org
19
�CONOPS Workshop
Hot Wash
• Each group to share:
– One success
– One challenge
– How can NETEC assist?
NETEC Spring 2017
https://netec.org
20
�Development Strategies
• In-person meetings, with a facilitator or
policy development team if possible.
• Periodic web-conferencing with revisions
to the document segment by segment.
• CONOPs meetings might be planned to
coordinate with existing training or
planning dates to reduce travel expenses.
• Set ground rules. Bring up issues as they
arise, don't let them fester.
NETEC Spring 2017
https://netec.org
21
�Hospital Strategies
• Think about what details are important in
the different documents. The State
CONOPs may be much more detailed than
the regional CONOPs.
• CONOPs planning is an exercise in
planning, documentation, and relationship
building with peer institutions and
community partners.
NETEC Spring 2017
https://netec.org
22
�Engagement
• Celebrate the completion of the plan.
• Plan to meet at least annually to share
your key learnings from the past year and
to update any necessary items in the
CONOPS accordingly.
• Know your partners at the regional, state,
and local level.
• Share the contents of your CONOPS
documents and constantly seek feedback
and suggestions.
NETEC Spring 2017
https://netec.org
23
�NETEC Spring 2017
https://netec.org
24
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC State and Regional CONOPs
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
In Person Course
Document relating to an in person course.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC State and Regional CONOPs
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Past In Person Course Presentation.<br /><br />
<ul>
<li>Review the requirements and roles of frontline facilities, assessment hospitals, State-designated Ebola Treatment Centers, Regional Ebola and Special Pathogen Treatment Centers (RESPTC)and health care coalitions in State and regional concepts of operations(CONOPs) for a patient with a suspected or confirmed highly infectious disease.</li>
<li>Discuss strategies for engaging key stakeholders in State and regional CONOPs planning.</li>
</ul>
Date
A point or period of time associated with an event in the lifecycle of the resource
2017
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T & E group, mark archived
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Archived
Archived
Assessment Facility
Communications
CONOPS
Frontline Facility
R-T&E
Treatment Facility
-
https://repository.netecweb.org/files/original/c452ea1767874811b5f3075767c747c9.docx
56f3b544fa5d878f913a40e9ea4de52b
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Frontline Facility Preparedness Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Frontline Facility Preparedness Checklist
Subject
The topic of the resource
General
Description
An account of the resource
NETEC Checklist
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-17
Contributor
An entity responsible for making contributions to the resource
2024-03-27 R-Lead – never reviewed – make due in 6 months
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Assessment Facility
CONOPS
Ebola
Federal
Frontline Facility
Healthcare Coalition
Public Health
R-Lead
Regional Treatment Center
Special Pathogens
-
https://repository.netecweb.org/files/original/b0efe4a5233d511813db1ddf916bc4bd.docx
55f37fb0ab3eea365ad4f6c56ee45d26
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Frontline Facility Ebola Tabletop Exercise Template
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Frontline Facilities- Exercise Materials for Ebola<br />This exercise template is also available in <a href="https://repository.netecweb.org/items/show/655">Spanish</a>. Click <a href="https://repository.netecweb.org/items/show/655">HERE</a>.<br /><span class="tlid-translation translation"><span>Este ejercicio de simulación también está disponible en <a href="https://repository.netecweb.org/items/show/655">español</a>.</span> <span>Haga clic <a href="https://repository.netecweb.org/items/show/655">aquí</a>.</span></span>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-24
Contributor
An entity responsible for making contributions to the resource
2023-10-30 by Darrell Ruby/EM WorkGroup - Update or Archive - submitted Asset Update form
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-10-30
CONOPS
Emergency Management
EMS
Exercises and Drills
Frontline Facility
Identify
Inform
Intake
Isolate
Patient Transport
Person Under Investigation (PUI)
Pre-hospital Transport
R-T&E
Surge
Templates
-
https://repository.netecweb.org/files/original/2b202f19680711f2e0903669f528c639.png
fc2de66555f6b0b731a05aa819471b43
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
URL
https://repository.netecweb.org/pdfs/ebolaexercisetemplates.zip
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Frontline Facility Ebola Drill, Functional & Full-Scale Exercise Template
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Frontline Facilities - Exercise Materials for Ebola
Download the zip file from the URL below.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-24
Contributor
An entity responsible for making contributions to the resource
2023-10-30 by Darrell Ruby/EM WorkGroup - Update or Archive - submitted Asset Update form
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-10-30
CONOPS
Emergency Management
EMS
Exercises and Drills
Frontline Facility
Identify
Inform
Intake
Isolate
Patient Transport
Person Under Investigation (PUI)
Pre-hospital Transport
R-T&E
Templates
-
https://repository.netecweb.org/files/original/90af27cf44307bb1187f3f6d96119ac2.docx
9058fd1c25e84f96bd830af04f097883
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Exercise
Exercise templates for training and education.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Frontline Facility Special Pathogen [Airborne] Tabletop Exercise Template
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Frontline Facilities- Exercise Materials for Special Pathogens
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-30
Contributor
An entity responsible for making contributions to the resource
2023-10-30 by Darrell Ruby/EM WorkGroup - Update or Archive - submitted Asset Update form
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-10-30
Airborne Transmission
CONOPS
Emergency Management
EMS
Exercises and Drills
Frontline Facility
Identify
Inform
Intake
Isolate
Patient Transport
Person Under Investigation (PUI)
Pre-hospital Transport
R-T&E
Templates
-
https://repository.netecweb.org/files/original/b9d3c47b44b51d8226a5939175c746e1.pdf
4d0f3a7a17ebae045756b4b0c5735086
PDF Text
Text
Ebola Assessment Hospital Preparedness Checklist*
Updated December 21, 2017
Develop a Concept of Operations
Number
Performance Measure
Goal
Data Source
1
Time, in minutes, it takes from an assessment hospital’s
notification to the health department of the need for an
inter-facility transfer of a patient confirmed with Ebola
or other special pathogen to the arrival of a staffed and
equipped EMS/inter-facility transport unit, as evidenced
by a no-notice exercise.
Within 240 minutes or 4
hours
Coalition or awardee
exercise or real event
Comments/Strategies
Note: This measure does not apply to awardees/facilities addressing
other special pathogens
Assure Readiness of Assessment Hospitals
Number
Performance Measure
Goal
Data Source
<60 seconds
8
Time, in seconds, from active monitoring/direct active
monitoring (AM/DAM) patient’s arrival to placement in
isolation at assessment hospital.
AH exercise or
coalition exercise, or
real-world event
Within 5 minutes
AH exercise or
coalition exercise, or
real-world event
Comments/Strategies
Note: This measure does not apply to assessment hospitals
addressing other special pathogens
9
Time, in minutes, it takes an assessment hospital to
identify and isolate a patient suspected with Ebola or
other special pathogen following emergency department
triage, as evidenced by a real-world case or no-notice
Page | 1
�exercise.
10
(EVD)
Proportion of health care facility and emergency medical
services (EMS) workers in PPE, of those that makes
contact with an AM/DAM suspected Ebola patient
under investigation (PUI) after health department
notification to the assessment hospital.
100%
AH exercise or
coalition exercise, or
real-world event
10 (OSP)
Proportion of health care facility and emergency medical
services (EMS) workers in PPE that a patient suspected
of another special pathogen makes contact with after
health department notification to the assessment hospital
or EMS agency.
100%
AH exercise or
coalition exercise, or
real-world event
11
Number of health care facility and EMS workers in PPE
that an AM/DAM suspected Ebola patient makes
contact with after health department notification until
isolation.
=<3
AH exercise or
coalition exercise, or
real-world event
Note: This measure does not apply for assessment hospitals
addressing other special pathogens
12
Proportion of emergency department staff trained at least
annually in infection control and safety.
100%
AH exercise
13
Proportion of intensive care unit staff trained at least
annually in infection control and safety.
100%
AH exercise
14
Proportion of assessment hospitals that can access their
PPE supply (i.e., know location and have sufficient
quantity of unexpired supply) within 10 minutes of
transfer notification or arrival (if no notification) of a
patient with suspected Ebola or other special pathogen.
100%
AH exercise
Note: This measure does not apply to facilities addressing other
special pathogens
Page 2
�*Based on ASPR Hospital Preparedness Program (HPP) Preparedness Measures, version 8.0; additional information and definitions can be found at
https://www.phe.gov/Preparedness/planning/sharper/Documents/hpp-mmi-guide-ebola-508.pdf
Please note, per the HHP Preparedness Measures, in order for an awardee or facility to be eligible to start planning and exercising a scenario other than Ebola, they must first successfully test and
meet all Ebola performance measures. Further, the awardee or facility must utilize the NETEC exercise template to meet their annual performance measure reporting requirements for the HPP
Ebola Preparedness and Response Activities.
Page 3
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Assessment Hospital Preparedness Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Assessment Hospital Preparedness Checklist
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
General
Description
An account of the resource
NETEC Checklist
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-12-21
Contributor
An entity responsible for making contributions to the resource
2024-03-27 R-Lead – never reviewed – make due in 6 months
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Assessment Facility
CONOPS
Ebola
Federal
Frontline Facility
Healthcare Coalition
Public Health
R-Lead
Regional Treatment Center
Special Pathogens
-
https://repository.netecweb.org/files/original/fc8b80eedff5b1c2ad221164fdf9759b.pdf
6667dfc698a456254688726b1831a69a
PDF Text
Text
Regional Ebola and other Special Pathogens Treatment Center Preparedness Checklist*
Updated December 21, 2017
Develop a Concept of Operations
Number
Performance Measure
Goal
Data Source
1
Time, in minutes, it takes from an assessment hospital’s
notification to the health department of the need for an
inter-facility transfer of a patient confirmed with Ebola or
other special pathogen to the arrival of a staffed and
equipped EMS/inter-facility transport unit, as evidenced
by a no-notice exercise.
Within 240 minutes or 4
hours
Coalition or awardee
exercise or real event
(Rationale—RESPTCs should be able to meet ETC Performance Measures)
Number Performance Measure
Goal
Data Source
2
Proportion of rostered /covered staff that are trained in
safely donning and doffing personal protective equipment
(PPE).
100%
ETC measure
3
Time it takes for all rostered /covered staff to receive justin-time (JIT) training, upon notification of a patient with
Ebola or other special pathogen at the regional Ebola and
other special pathogen treatment center.
Within 72 hours
ETC exercise or real
event
Comments/Strategies
Note: This measure does not apply to awardees/facilities addressing
other special pathogens
Assure Readiness of Ebola Treatment Centers
Comments/Strategies
Page | 1
�4
Time until an ETC is ready to admit a patient with Ebola
or other special pathogen as evidenced by an exercise or
actual patient transfer.
Within 72 hours of
confirmation of an Ebola
or other special pathogen
patient at a regional center
ETC exercise or real
event
5
Proportion of rostered /covered staff contacted by
hospital within 4 hours of a patient confirmed with Ebola
or other special pathogen admission to a regional Ebola
and other special pathogen treatment center.
100%
ETC exercise or real
event
6
Proportion of rostered /covered staff contacted that
indicated they are able to report to fulfill Ebola or other
special pathogen-related staffing needs within 72 hours.
100%
ETC exercise or real
event
7
Proportion of ETCs that can access their PPE supply (i.e.,
know location and have sufficient quantity of unexpired
supply) within 10 minutes of transfer notification or upon
the patient’s arrival (if no notification) of patient with
suspected Ebola or other special pathogen.
100%
ETC exercise or real
event
Note: This measure does not apply to facilities addressing other
special pathogens
Assure Readiness of Assessment Hospitals
(Rationale—RESPTCs should be able to meet Assessment Hospital Performance Measures)
Number Performance Measure
Goal
8
Time, in seconds, from active monitoring/direct active
monitoring (AM/DAM) patient’s arrival to placement in
isolation at assessment hospital .
Data Source
<60 seconds
AH exercise or
coalition exercise, or
real-world event
Within 5 minutes
AH exercise or
coalition exercise, or
real-world event
Comments/Strategies
Note: This measure does not apply to assessment hospitals
addressing other special pathogens
9
Time, in minutes, it takes an assessment hospital to
identify and isolate a patient suspected with Ebola or
other special pathogen following emergency department
triage, as evidenced by a real-world case or no-notice
Page 2
�exercise.
10
(EVD)
Proportion of health care facility and emergency medical
services (EMS) workers in PPE, of those that makes
contact with an AM/DAM suspected Ebola patient under
investigation (PUI) after health department notification to
the assessment hospital.
100%
AH exercise or
coalition exercise, or
real-world event
10 (OSP)
Proportion of health care facility and emergency medical
services (EMS) workers in PPE that a patient suspected of
another special pathogen makes contact with after health
department notification to the assessment hospital or
EMS agency.
100%
AH exercise or
coalition exercise, or
real-world event
11
Number of health care facility and EMS workers in PPE
that an AM/DAM suspected Ebola patient makes contact
with after health department notification until isolation.
=<3
AH exercise or
coalition exercise, or
real-world event
Note: This measure does not apply for assessment hospitals
addressing other special pathogens
12
Proportion of emergency department staff trained at least
annually in infection control and safety.
100%
AH exercise
13
Proportion of intensive care unit staff trained at least
annually in infection control and safety.
100%
AH exercise
14
Proportion of assessment hospitals that can access their
PPE supply (i.e., know location and have sufficient
quantity of unexpired supply) within 10 minutes of
transfer notification or arrival (if no notification) of a
patient with suspected Ebola or other special pathogen.
100%
AH exercise
Note: This measure does not apply to facilities addressing other
special pathogens
Support Regional Planning for the Development of a Regional Network for Ebola Patient Care
Page 3
�(Rationale—RESPTCs should have an awareness of performance measures impacting regional CONOPS)
Number
Performance Measure
Goal
Data Source
19
Time from confirmation of patient with Ebola or other
special pathogen at assessment hospital or ETC to
notification by the health department and/or transferring
hospital (assessment hospital or ETC) to the health
department in the state/jurisdiction where the regional
Ebola and other special pathogen treatment center is
located about the need for patient transfer.
Within 30 minutes
AH or ETC exercise
20
Proportion of member states/jurisdictions in the region
that have participated in the development of the regional
CONOPS.
100%
Part B awardee
measure
21
Proportion of states/jurisdictions in the HHS region for
which a current written and signed agreement is in place
to transfer patients from assessment hospitals or ETCs to
the regional Ebola and other special pathogen treatment
center.
100%
Part B awardee
measure
22
Proportion of states/jurisdictions in the HHS region that
have demonstrated the ability to move a patient across
jurisdictions by ground or air to a regional Ebola and
other special pathogen treatment center, as evidenced by a
real-world event or participation in a multi-jurisdiction
exercise.
100%
Part B awardee
measure
Comments/Strategies
Developing, Supporting and Maintaining Regional Ebola and other special pathogen Treatment Centers
Number
Performance Measure
Goal
Data Source
23
Proportion of rostered/covered staff at the regional Ebola
and other special pathogen treatment center that received
quarterly training in infection control and safety, and
patient care for a patient with Ebola or other special
100%
Regional ETC or
other special pathogen
treatment center
measure
Comments/Strategies
Page 4
�pathogen.
24
Time it takes for the on-call team to report to the unit
upon notification of an incoming patient with Ebola or
other special pathogen, as evidenced by a real-world event
or no-notice exercise.
4 hours
Part B exercise or real
event
25
Proportion of rostered/covered staff contacted by the
regional Ebola and other special pathogen treatment
center within 4 hours upon notification of an incoming
patient with Ebola or other special pathogen, as evidenced
by a real-world event or no-notice exercise.
100%
Part B exercise or real
event
26
Time until a regional Ebola and other special pathogen
treatment center is ready to admit a patient with
confirmed Ebola or other special pathogen (adult or
pediatric patient), as evidenced by an exercise or actual
patient transfer.
Within 8 hours of
notification
Part B exercise or
actual patient transfer
*Based on ASPR Hospital Preparedness Program (HPP) Preparedness Measures, version 8.0; additional information and definitions can be found at
https://www.phe.gov/Preparedness/planning/sharper/Documents/hpp-mmi-guide-ebola-508.pdf
Please note, per the HHP Preparedness Measures, in order for an awardee or facility to be eligible to start planning and exercising a scenario other than Ebola, they must first successfully test and
meet all Ebola performance measures. Further, the awardee or facility must utilize the NETEC exercise template to meet their annual performance measure reporting requirements for the HPP
Ebola Preparedness and Response Activities.
Page 5
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Regional Ebola and other Special Pathogens Treatment Center Preparedness Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Regional Ebola and other Special Pathogens Treatment Center Preparedness Checklist
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
General
Description
An account of the resource
NETEC Checklist
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-12-21
Contributor
An entity responsible for making contributions to the resource
2024-03-27 R-Lead – never reviewed – make due in 6 months
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Assessment Facility
CONOPS
Ebola
Federal
Frontline Facility
Healthcare Coalition
Public Health
R-Lead
Regional Treatment Center
Special Pathogens
-
https://repository.netecweb.org/files/original/a98665a7eb4d1af900a91f2400991785.pdf
7549350d9a0167f1a6e4e4f3e0bc757b
PDF Text
Text
Ebola Treatment Center Preparedness Checklist*
Updated December 21, 2017
Develop a Concept of Operations
Number
Performance Measure
Goal
Data Source
1
Time, in minutes, it takes from an assessment hospital’s
notification to the health department of the need for an
inter-facility transfer of a patient confirmed with Ebola or
other special pathogen to the arrival of a staffed and
equipped EMS/inter-facility transport unit, as evidenced
by a no-notice exercise.
Within 240 minutes or 4
hours
Coalition or awardee
exercise or real event
Comments/Strategies
Note: This measure does not apply to awardees/facilities addressing
other special pathogens
Assure Readiness of Ebola Treatment Centers
Number
Performance Measure
Goal
Data Source
2
Proportion of rostered /covered staff that are trained in
safely donning and doffing personal protective equipment
(PPE).
100%
ETC measure
3
Time it takes for all rostered /covered staff to receive justin-time (JIT) training, upon notification of a patient with
Ebola or other special pathogen at the regional Ebola and
other special pathogen treatment center.
Within 72 hours
ETC exercise or real
event
Comments/Strategies
Page | 1
�4
Time until an ETC is ready to admit a patient with Ebola
or other special pathogen as evidenced by an exercise or
actual patient transfer.
Within 72 hours of
confirmation of an Ebola
or other special pathogen
patient at a regional center
ETC exercise or real
event
5
Proportion of rostered /covered staff contacted by
hospital within 4 hours of a patient confirmed with E bola
or other special pathogen admission to a regional Ebola
and other special pathogen treatment center.
100%
ETC exercise or real
event
6
Proportion of rostered /covered staff contacted that
indicated they are able to report to fulfill Ebola or other
special pathogen-related staffing needs within 72 hours.
100%
ETC exercise or real
event
7
Proportion of ETCs that can access their PPE supply (i.e.,
know location and have sufficient quantity of unexpired
supply) within 10 minutes of transfer notification or upon
the patient’s arrival (if no notification) of patient with
suspected Ebola or other special pathogen.
100%
ETC exercise or real
event
Note: This measure does not apply to facilities addressing other
special pathogens
Assure Readiness of Assessment Hospitals
(Rationale—ETCs should be able to meet Assessment Hospital Performance Measures)
Number Performance Measure
Goal
8
Time, in seconds, from active monitoring/direct active
monitoring (AM/DAM) patient’s arrival to placement in
isolation at assessment hospital.
Data Source
<60 seconds
AH exercise or
coalition exercise, or
real-world event
Within 5 minutes
AH exercise or
coalition exercise, or
real-world event
Comments/Strategies
Note: This measure does not apply to assessment hospitals
addressing other special pathogens
9
Time, in minutes, it takes an assessment hospital to
identify and isolate a patient suspected with Ebola or
other special pathogen following emergency department
triage, as evidenced by a real-world case or no-notice
Page 2
�exercise.
10
(EVD)
Proportion of health care facility and emergency medical
services (EMS) workers in PPE, of those that makes
contact with an AM/DAM suspected Ebola patient under
investigation (PUI) after health department notification to
the assessment hospital.
100%
AH exercise or
coalition exercise, or
real-world event
10 (OSP)
Proportion of health care facility and emergency medical
services (EMS) workers in PPE that a patient suspected of
another special pathogen makes contact with after health
department notification to the assessment hospital or
EMS agency.
100%
AH exercise or
coalition exercise, or
real-world event
11
Number of health care facility and EMS workers in PPE
that an AM/DAM suspected Ebola patient makes contact
with after health department notification until isolation.
=<3
AH exercise or
coalition exercise, or
real-world event
Note: This measure does not apply for assessment hospitals
addressing other special pathogens
12
Proportion of emergency department staff trained at least
annually in infection control and safety.
100%
AH exercise
13
Proportion of intensive care unit staff trained at least
annually in infection control and safety.
100%
AH exercise
14
Proportion of assessment hospitals that can access their
PPE supply (i.e., know location and have sufficient
quantity of unexpired supply) within 10 minutes of
transfer notification or arrival (if no notification) of a
patient with suspected Ebola or other special pathogen.
100%
AH exercise
Note: This measure does not apply to facilities addressing other
special pathogens
*Based on ASPR Hospital Preparedness Program (HPP) Preparedness Measures, version 8.0; additional information and definitions can be found at
https://www.phe.gov/Preparedness/planning/sharper/Documents/hpp-mmi-guide-ebola-508.pdf
Page 3
�Please note, per the HHP Preparedness Measures, in order for an awardee or facility to be eligible to start planning and exercising a scenario other than Ebola, they must first successfully test and
meet all Ebola performance measures. Further, the awardee or facility must utilize the NETEC exercise template to meet their annual performance measure reporting requirements for the HPP
Ebola Preparedness and Response Activities.
Page 4
�
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NETEC Treatment Center Preparedness Checklist
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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NETEC Treatment Center Preparedness Checklist
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NETEC
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NETEC Checklist
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2017-12-21
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2024-03-27 R-Lead – never reviewed – make due in 6 months
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2024-11-27
Assessment Facility
CONOPS
Ebola
Federal
Frontline Facility
Healthcare Coalition
Public Health
R-Lead
Regional Treatment Center
Special Pathogens
State Treatment Center
-
https://repository.netecweb.org/files/original/045dfe2c605cd7927ad713b5d52c8948.pdf
3b9db751d4892055f90fe1fe899b905b
PDF Text
Text
Hospital Preparedness Program (HPP)
Measure Manual:
Implementation Guidance for Ebola
Preparedness Measures
May 2017
U.S. Department of Health and Human Services
Office of the Assistant Secretary for Preparedness and Response
�Hospital Preparedness Program (HPP)
Ebola Preparedness and Response Activities
CFDA # 93.817
VERSION 8.0
1|Page
�— This Page Intentionally Left Blank —
2|Page
�U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSISTANT SECRETARY FOR PREPAREDNESS AND RESPONSE
Hospital Preparedness Program (HPP) Measure Manual:
Implementation Guidance for Ebola Preparedness
Measures
May 2017
3|Page
�The Hospital Preparedness Program (HPP) Measure Manual, Implementation Guidance for the HPP
Ebola Preparedness Measures (hereafter referred to as Ebola Measures Manual) is a highly iterative
document. Subsequent versions will be subject to ongoing updates and changes as reflected in HPP
policies and direction.
4|Page
�Introduction
Beginning in March of 2014, West Africa experienced the largest Ebola virus disease (Ebola)
outbreak on record. Unlike many smaller preceding outbreaks of Ebola, this particular
outbreak spread to multiple African countries and caused (as of April 2017) more than 28,000
suspected human cases and resulted in over 11,000 deaths. In August 2014, the first
American citizen with Ebola was flown to the United States (U.S.) for treatment. Additional
patients have subsequently been medically-evacuated to the U.S. and two returned travelers
were diagnosed and treated in Dallas, Texas and New York City, New York. In addition to
these experiences, the secondary infections of two health care workers in a Dallas hospital
identified opportunities to improve preparedness for and treatment of suspected and
confirmed patients with Ebola. In response, Congress appropriated emergency funding, in
part to ensure that the health care system is adequately prepared to respond to future
patients infected with Ebola. In doing so, Congress directed the Department of Health and
Human Services (HHS) to develop a regional approach to caring for future patients with Ebola.
The funding provided through the Hospital Preparedness Program (HPP) Ebola Preparedness
and Response Activities is intended to ensure the nation’s health care system is ready to
safely and successfully identify, isolate, assess, transport, and treat patients with Ebola or
patients under investigation for Ebola, and that it is well prepared for a future Ebola
outbreak. While the focus will be on preparedness for Ebola, it is likely that preparedness for
other novel, highly pathogenic diseases will also be enhanced through these activities. In line
with ensuring that healthcare systems are ready to treat patients with Ebola and other special
pathogens, HPP has adapted the performance measures to better reflect the inclusion of
preparedness for other special pathogens in addition to Ebola. Assuring that patients with
Ebola and other special pathogens are safely and well cared for in the U.S. health care system
and that frontline providers are protected and trained to recognize and isolate a person with
suspected Ebola and other pathogens are the primary goals of the HPP Ebola Preparedness
and Response Activities funding opportunity announcement (FOA).
Experience with patients with Ebola in the U.S. has highlighted both strengths and areas for
improvement in the care of patients affected by Ebola. The clinical care of such individuals
and prevention of its transmission is complex, requiring highly skilled health care providers
and technologically-advanced care. This has led Congress, experts, and stakeholder groups to
suggest that, to the extent possible, care of patients with Ebola should be concentrated in a
small number of facilities. At the same time, however, the nation’s hospitals must be
prepared to handle one or more simultaneous clusters of Ebola or other special pathogens.
Further, all hospitals must be able to identify, diagnose, and treat a patient with suspected
Ebola or other special pathogen until they can be transferred to a facility that can provide
definitive care. Ultimately, the HPP funding aims to ensure the health care system is well
prepared in the event of future Ebola or other special pathogen outbreaks.
5|Page
�Preface: How to Use This Manual
The Hospital Preparedness Program (HPP) created this manual as a resource for HPP awardees
to clarify the meaning of the performance measures for Ebola and other special pathogens
and assess outcomes. HPP expects that awardees will use the manual as a reference tool.
The performance measures were designed to demonstrate achievement or progress towards
accomplishing the relevant goals described in the HPP Ebola Preparedness and Response
Activities Funding Opportunity Announcement (FOA). Although most of the Ebola capabilities
are intended to be addressed in the first year of funding, these capabilities and those for
other special pathogens will continue to be built and maintained over the remaining four
years. In line with this goal, the performance measures have been adapted to include
references to Ebola and other special pathogens, and the measures and goals may be refined
in future years.
All awardees receiving funds for the HPP Ebola Preparedness and Response Activities should
understand that the federal government requires program measures. The Ebola measures aim
to describe and illustrate an awardee’s progress toward meeting Part A and Part B (applicable
only for Part B awardees) goals described in the HPP Ebola Preparedness and Response
Activities FOA. It is the responsibility of the awardees to provide performance information
through the Ebola measures. Ebola performance information will be collected in an Excel
template, annually beginning in May (Part A) and June (Part B), for the next five years to
monitor progress. This information will allow the HPP to assess both the awardee and its
effectiveness in implementing the Program’s goals. Where a measure is a
proportion/percentage, the numerator and denominator (defined on pages 12-28) will be
collected. This manual provides:
• Performance Measures: Each measure includes a performance measure number and
the performance measure language
• Part: Refers to awardee type as described in the HPP Ebola Preparedness and Response
Activities FOA (i.e. Part A or Part B)
• Activity: The section within the HPP Ebola Preparedness and Response Activities FOA
for which the performance measure applies
• Reporting Element: The suggested source from which the performance measure data is
derived
• Data Source: The organization(s) and/or its activity from which the data is derived
• Metrics: Defines the components that make up the operational intent of the measure
(e.g. numerator, denominator, start time, and stop time)
• Goals: This section will outline the ideal or recommended result
• Definitions: Detailed information that clarifies and provides guidance on how to
interpret key terms and phrases within the context of the performance measure.
The Ebola Measures
There are 26 core Ebola measures outlined in this document that address both Part A (18
measures) and Part B (8 measures). The data to support these measures will be collected by
the awardee, coalitions, Ebola treatment centers (ETC), and assessment hospitals (AH) for
Part A, and the awardee and the regional Ebola and other special pathogen treatment center
for Part B. While the measures primarily aim to address health care workforce training and
patient care, much of the data will be collected during training, exercises, and real-world
events.
6|Page
�There are also eight additional measures developed to better illustrate impact. These impact
measures are both quantitative and qualitative. Four impact measures will ask awardees to
rate their levels of preparedness for an Ebola or special pathogen event both pre- and postfunding on a 5-point Likert scale (from ‘1= Not Prepared’ through ‘5= Very Prepared’). The
remaining four open-ended qualitative questions will highlight the most prominent perceived
impacts and gaps.
Other Special Pathogen (OSP) Measures
Many awardees and facilities reported having met the Ebola performance measures and the
goals in year one. To improve overall preparedness for Ebola and other special pathogens,
many jurisdictions have voiced a desire to plan and exercise for other special pathogens in
addition to Ebola. Further, NETEC has released exercise templates for airborne transmissible
special pathogens. As such, the performance measures have been updated to address those
who are exercising other pathogens in year two.
In order for an awardee or facility to be eligible to start planning and exercising a scenario
other than Ebola, they must first successfully test and meet all Ebola performance measures.
Further, the awardee or facility must utilize the NETEC exercise template to meet their
annual performance measure reporting requirements for the HPP Ebola Preparedness and
Response Activities. All performance measures still apply except where noted below:
Measure Status
Modified Language
1
Does not apply
n/a
7
Does not apply
n/a
8
Does not apply
n/a
10
Modified
Proportion of health care facility and emergency medical
services (EMS) workers in PPE that a patient suspected of an
other special pathogen makes contact with after health
department notification to the assessment hospital or EMS
agency.
11
Does not apply
n/a
14
Does not apply
n/a
15
Modified
Proportion of frontline facilities that receive information from
their coalition on the quantity and location of personal
protective equipment (PPE) supply within 8 hours of a
suspected patient arrival at a coalition member facility.
6|Page
�Reporting Requirements
Per the FOA, the awardee, coalitions, ETCs, and assessment hospitals must conduct annual
exercises, and regional Ebola and other special pathogen treatment centers must conduct
quarterly exercises. To ensure these exercises allow each entity to collect sufficient data to
collect the measures, the National Ebola Training and Education Center (NETEC) developed a
suite of exercise templates for use by awardees, coalitions, and individual health care
facilities to facilitate and conduct exercises to capture the required metrics.
Awardees will be expected to provide an end-of-year report on their activities and level of
performance ninety days after the conclusion of each budget period and at the conclusion of
the project period. End-of-year reports should reflect the period of performance that spans
from May 18 through May 17 for each Part A budget year and June 15 through June 14 for
each Part B budget year. Each facility must meet the performance measures for the role(s) in
which they were designated by the jurisdiction. For example, if a jurisdiction designates a
facility as an ETC with the expectation that the facility would have the capability of an
assessment hospital or frontline facility or designates a facility as both then that facility
would need to meet the ETC measures and AH measures; however, if a jurisdiction delineates
roles between ETCs and AHs, then the facility is required to meet the performance measures
for the facility type that applies.
Sufficient Documentation
Awardees and sub-recipients should maintain appropriate documentation for all data reported
on the HPP Ebola Measures. Documentation should contain sufficient information to
substantiate HPP Ebola measure data submitted to ASPR. ASPR may request documentation
to clarify or verify information submitted by awardees.
7|Page
�HPP Ebola Preparedness Measures
8|Page
�Summary of Ebola Performance Measures
In order for an awardee or facility to be eligible to start planning and exercising a scenario
other than Ebola, they must first successfully test and meet all Ebola performance measures.
Further, the awardee or facility must utilize the NETEC exercise template to meet their
annual performance measure reporting requirements for the HPP Ebola Preparedness and
Response Activities.
Develop a Concept of Operation
Number
1
Part
A
Activity
Performance Measure
A
Time, in minutes, it takes from an assessment hospital’s
notification to the health department of the need for an
inter-facility transfer of a patient confirmed with Ebola or
other special pathogen to the arrival of a staffed and
equipped EMS/inter-facility transport unit, as evidenced by
a no-notice exercise (Goal: Within 240 minutes or 4 hours).
*Note: This measure does not apply to awardees/facilities
addressing other special pathogens
Data Source
Coalition or
awardee exercise or
real event
Assure Readiness of Ebola Treatment Centers
Number
Part
Activity
2
A
B
3
4
5
6
7
A
A
A
A
A
B
B
B
B
B
Performance Measure
Data Source
Proportion of rostered/covered staff that are trained in
safely donning and doffing personal protective equipment
(PPE) (Goal: 100%).
Time it takes for all rostered/covered staff to receive justin-time (JIT) training, upon notification of a patient with
Ebola or other special pathogen at the regional Ebola and
other special pathogen treatment center (Goal: Within 72
hours).
Time until an ETC is ready to admit a patient with Ebola or
other special pathogen as evidenced by an exercise or
actual patient transfer (Goal: Within 72 hours of
confirmation of an Ebola or other special pathogen patient
at a regional center).
Proportion of rostered/covered staff contacted by hospital
within 4 hours of a patient confirmed with Ebola or other
special pathogen admission to a regional Ebola and other
special pathogen treatment center (Goal: 100%).
Proportion of rostered/covered staff contacted that
indicated they are able to report to fulfill Ebola or other
special pathogen-related staffing needs within 72 hours
(Goal: 100%).
Proportion of ETCs that can access their PPE supply (i.e.,
know location and have sufficient quantity of unexpired
supply) within 10 minutes of transfer notification or upon
the patient’s arrival (if no notification) of patient with
suspected Ebola or other special pathogen (Goal: 100%).
*Note: This measure does not apply to facilities addressing
other special pathogens
ETC measure
ETC exercise or real
event
ETC exercise or real
event
ETC exercise or real
event
ETC exercise or real
event
ETC exercise or real
event
9|Page
�Assure Readiness of Assessment Hospitals
Number
8
9
10
10 (OSP)
Part
A
A
A
A
Activity
B
B
B
B
11
A
B
12
A
B
13
A
B
14
A
B
Performance Measure
Data Source
Time, in seconds, from active monitoring/direct active
monitoring (AM/DAM) patient’s arrival to placement in
isolation at assessment hospital (Goal: = <60 seconds).
*Note: This measure does not apply to assessment hospitals
addressing other special pathogens
Time, in minutes, it takes an assessment hospital to
identify and isolate a patient suspected with Ebola or other
special pathogen following emergency department triage,
as evidenced by a real-world case or no-notice exercise
(Goal: Within 5 minutes).
Proportion of health care facility and emergency medical
services (EMS) workers in PPE, of those that makes contact
with an AM/DAM suspected Ebola patient under
investigation (PUI) after health department notification to
the assessment hospital (Goal: 100%).
Proportion of health care facility and emergency medical
services (EMS) workers in PPE that a patient suspected of
an other special pathogen makes contact with after health
department notification to the assessment hospital or EMS
agency.
Number of health care facility and EMS workers in PPE that
an AM/DAM suspected Ebola patient makes contact with
after health department notification until isolation (Goal:
=<3).
*Note: This measure does not apply for assessment
hospitals addressing other special pathogens
Proportion of emergency department staff trained at least
annually in infection control and safety (Goal: 100%).
Proportion of intensive care unit staff trained at least
annually in infection control and safety (Goal: 100%).
Proportion of assessment hospitals that can access their
PPE supply (i.e., know location and have sufficient quantity
of unexpired supply) within 10 minutes of transfer
notification or arrival (if no notification) of a patient with
suspected Ebola or other special pathogen (Goal: 100%).
*Note: This measure does not apply to facilities addressing
other special pathogens
AH exercise or
coalition exercise,
or real world event
AH exercise or
coalition exercise,
or real world event
AH exercise or
coalition exercise,
or real world event
AH exercise or
coalition exercise,
or real world event
AH exercise or
coalition exercise,
or real world event
AH measure
AH measure
AH exercise
Develop Capabilities of Health Care Coalitions to Enable Their Members to Care for Ebola
Patients
Number
15
15 (OSP)
Part
A
A
Activity
C
C
Performance Measure
Data Source
Proportion of frontline facilities that receive information
from their coalition on the quantity and location of
personal protective equipment (PPE) supply within 8 hours
of a patient under investigation’s (PUI) arrival at a coalition
member facility (Goal: 100%).
Proportion of frontline facilities that receive information
from their coalition on the quantity and location of
personal protective equipment (PPE) supply within 8 hours
of a suspected patient arrival at a coalition member
facility.
Coalition exercise
Coalition exercise
10 | P a g e
�Number
Part
Activity
16
A
C
17
A
C
18
A
C
Performance Measure
Data Source
Proportion of frontline facilities that have received
coalition-funded training (Goal: 75%).
Proportion of EMS agencies engaged in all phases of the
Ebola and other special pathogen preparedness process, of
those required to execute the awardee’s CONOPs (Goal:
100%).
Proportion of coalitions within an awardee’s jurisdiction
that participate in the Health care-Associated Infection
(HAI)/Infection Control advisory group (Goal: 80%).
Coalition measure
Coalition and
awardee measure
Awardee measure
Support Regional Planning for the Development of a Regional Network for Ebola Patient Care
Number
Part
Activity
19
B
A
20
B
A
21
22
B
B
A
A
Performance Measure
Time from confirmation of patient with Ebola or other
special pathogen at assessment hospital or ETC to
notification by the health department and/or transferring
hospital (assessment hospital or ETC) to the health
department in the state/jurisdiction where the regional
Ebola and other special pathogen treatment center is
located about the need for patient transfer (Goal: Within
30 minutes).
Proportion of member states/jurisdictions in the region
that have participated in the development of the regional
CONOPS (Goal: 100%).
Proportion of states/jurisdictions in the HHS region for
which a current written and signed agreement is in place to
transfer patients from assessment hospitals or ETCs to the
regional Ebola and other special pathogen treatment
center (Goal: 100%).
Proportion of states/jurisdictions in the HHS region that
have demonstrated the ability to move a patient across
jurisdictions by ground or air to a regional Ebola and other
special pathogen treatment center, as evidenced by a
real-world event or participation in a multi-jurisdiction
exercise (Goal: 100%).
Data Source
AH or ETC exercise
Part B awardee
measure
Part B awardee
measure
Part B awardee
measure
Developing, Supporting and Maintaining Regional Ebola and other special pathogen
Treatment Centers
Number
23
24
Part
B
B
Activity
B
B
Performance Measure
Data Source
Proportion of rostered/covered staff at the regional Ebola
and other special pathogen treatment center that received
quarterly training in infection control and safety, and
patient care for a patient with Ebola or other special
pathogen (Goal: 100%).
Time it takes for the on-call team to report to the unit
upon notification of an incoming patient with Ebola or
other special pathogen, as evidenced by a real-world event
or no-notice exercise (Goal: 4 hours).
Regional ETC or other
special pathogen
treatment center
measure
Part B exercise or
real event
11 | P a g e
�Number
25
26
Part
B
B
Activity
B
B
Performance Measure
Data Source
Proportion of rostered/covered staff contacted by the
regional Ebola and other special pathogen treatment center
within 4 hours upon notification of an incoming patient
with Ebola or other special pathogen, as evidenced by a
real-world event or no-notice exercise (Goal: 100%).
Time until a regional Ebola and other special pathogen
treatment center is ready to admit a patient with
confirmed Ebola or other special pathogen (adult or
pediatric patient), as evidenced by an exercise or actual
patient transfer (Goal: Within 8 hours of notification).
Part B exercise or
real event
Part B exercise or
actual patient
transfer
12 | P a g e
�Ebola Measures
Part A
Data Element
Description
Number
Part
Activity
Measure
1
A
Activity A: Develop a Concept of Operations.
Time, in minutes, it takes from an assessment hospital’s notification to
the health department of the need for an inter-facility transfer of a
patient confirmed with Ebola or other special pathogen to the arrival of a
staffed and equipped EMS/inter-facility transport unit, as evidenced by a
no-notice exercise or real-world event.
Reporting
Element
Data Source
Metrics
Goal
Definitions
*Note: This measure does not apply for awardees/facilities addressing other
special pathogens
Assessment Hospital
Coalition or Assessment Hospital Exercise or Real-World Event
Start Time: Time the health department was notified by the assessment
hospital, or time from the health department’s decision, of the need for
an inter-facility transfer.
Stop Time: Time of arrival of a staffed and equipped EMS/inter-facility
transport unit.
Within 240 minutes or 4 hours
Assessment Hospital: Pre-designated facilities that are prepared to
receive and isolate a patient under investigation (PUI) for Ebola and care
for the patient until an Ebola diagnosis can be confirmed or ruled out and
until discharge or transfer is completed.
EMS/Inter-facility transport unit: Entities identified in the awardee’s
CONOPS responsible for the transport and patient care during transport of
an actively monitored or directly actively monitored (AM/DAM) patient to
an Ebola assessment facility or to provide inter-facility transport (i.e.,
from a frontline facility to an Ebola assessment/treatment facility or
from an Ebola assessment facility to an Ebola treatment facility).
No-notice exercise: Unannounced exercise, including drills, functional,
and full-scale exercises.
Data Element
Description
Number
Part
Activity
Measure
2
A
Activity B: Assure Readiness of Ebola Treatment Centers.
Proportion of rostered/covered staff that are trained in safely donning
and doffing personal protective equipment (PPE).
Ebola Treatment Center
Reporting
Element
Data Source
Ebola Treatment Center
13 | P a g e
�Data Element
Description
Metrics
Numerator: Total number of rostered/covered staff that completed
training.
Denominator: Total number of rostered/covered staff.
100% of rostered/covered staff
Rostered/covered Staff: Individuals that have been pre-identified to
provide ongoing care and treatment to patients with confirmed Ebola or
patient under investigation (PUI).
Donning: The administration or act of putting on PPE.
Doffing: The removal of used PPE; this is a high-risk process that requires
a structured procedure, a trained observer, and a designated area for
removal to ensure protection.
Trained: Individuals who have completed Ebola/infection control and
safety training to specifically include proper donning (putting on PPE) and
doffing (taking off PPE) methods. See CDC PPE training guidance.
PPE: Devices or equipment designated to provide protection while
providing care for a confirmed or suspected patient with Ebola.
Goal
Definitions
Data Element
Description
Number
Part
Activity
Measure
3
A
Activity B: Assure Readiness of Ebola Treatment Centers.
Time it takes for all rostered/covered staff to receive just-in-time (JIT)
training, upon notification of a patient with Ebola or other special
pathogen at the regional Ebola and other special pathogen treatment
center.
Ebola Treatment Center
Reporting
Element
Data Source
Metrics
Goal
Definitions
Ebola Treatment Center Exercise or Real-World Event
Start Time: Time of notification (in hours and minutes) of a patient
confirmed with Ebola or other special pathogen at the regional Ebola and
other special pathogen treatment center.
Stop Time: Time all rostered/covered staff completed JIT training (in
hours and minutes).
Within 72 hours
*Note: Recommendation from facilities that have successfully treated Ebola
is for JIT training to be completed within 24 hours.
Notification: The ETC receives notification from the health department
that the regional Ebola and other special pathogen treatment facility in
their region received a confirmed patient.
Rostered/covered Staff: Individuals that have been pre-identified to
provide ongoing care and treatment to patients with confirmed Ebola or
patient under investigation (PUI).
Just-In-Time (JIT) training: Training that is conducted as a refresher to
prepare for a patient with Ebola or other special pathogen, including
donning and doffing, facility-specific protocols and procedures, and
care/treatment protocols.
14 | P a g e
�Data Element
Description
Number
Part
Activity
Measure
4
A
Activity B: Assure Readiness of Ebola Treatment Centers.
Time until an Ebola treatment center is ready to admit a patient with
Ebola or other special pathogen as evidenced by an exercise or actual
patient transfer.
Ebola Treatment Center
Reporting
Element
Data Source
Metrics
Goal
Definitions
Ebola Treatment Center Exercise or Real-World Event
Start Time: Time the ETC was notified (in hours and minutes) that a
patient confirmed with Ebola or other special pathogen was admitted to
the regional Ebola and other special pathogen treatment center in their
region.
Stop Time: Time ETC is ready to admit a patient with Ebola or other
special pathogen (in hours and minutes).
Within 72 hours (upon notification of a patient confirmed with Ebola or
other special pathogen at a regional Ebola and other special pathogen
treatment centers)
*Note: Recommendation from facilities that have successfully treated Ebola
is for ETCs to be ready to admit a patient within 24 hours.
Notification: The ETC receives notification from the health department
that the regional Ebola and other special pathogen treatment center in
their region received a confirmed patient.
Data Element
Description
Number
Part
Activity
Measure
5
A
Activity B: Assure Readiness of Ebola Treatment Centers.
Proportion of rostered/covered staff contacted by hospital within 4 hours
of a patient confirmed with Ebola or other special pathogen admission to
a regional Ebola and other special pathogen treatment center.
Ebola Treatment Center
Reporting
Element
Data Source
Metrics
Goal
Definitions
Ebola Treatment Center Exercise or Real-World Event
Numerator: Number of rostered/covered staff contacted within 4 hours of
notification of a patient with confirmed Ebola at the regional Ebola and
other special pathogens treatment center.
Denominator: Total number of rostered/covered staff.
100% of rostered/covered staff
Rostered/covered Staff: Individuals that have been pre-identified to
provide ongoing care and treatment to patients with confirmed Ebola or
patient under investigation (PUI).
Confirmation: Laboratory-confirmed diagnostic evidence of Ebola virus or
other special pathogen.
Contact: The hospital successfully contacted the staff members (and
received a response) by phone, email, or automated alert system.
15 | P a g e
�Data Element
Description
Number
Part
Activity
Measure
6
A
Activity B: Assure Readiness of Ebola Treatment Centers.
Proportion of rostered/covered staff contacted that indicated they are
able to report to fulfill Ebola or other special pathogen-related staffing
needs within 72 hours.
Ebola Treatment Center
Reporting
Element
Data Source
Metrics
Goal
Definitions
Ebola Treatment Center Exercise or Real-World Event
Numerator: Number of rostered/covered staff able to report within 72
hours to fulfill Ebola or other special pathogen-related staffing needs.
Denominator: Total number of rostered/covered staff contacted.
100% of contacted rostered/covered staff
Rostered/covered staff: Individuals that have been pre-identified to
provide ongoing care and treatment to patients with confirmed Ebola or
patient under investigation (PUI).
Contact: The hospital successfully contacted the staff members (and
received a response) by phone, email, or automated alert system.
Data Element
Description
Number
Part
Activity
Measure
7
A
Activity B: Assure Readiness of Ebola Treatment Centers.
Proportion of Ebola Treatment Centers (ETCs) that can access their PPE
supply (i.e., know location and have sufficient quantity of unexpired
supply) within 10 minutes of transfer notification or upon the patient’s
arrival (if no notification) of a patient suspected of Ebola or other special
pathogen.
Ebola Treatment Center
Reporting
Element
Data Source
Metrics
Goal
Definitions
Ebola Treatment Center Exercise or Real-World Event
Numerator: Number of ETCs that can access their PPE supply within 10
minutes of transfer notification or upon the patient’s arrival (if no
notification) of patient suspected with Ebola or other special pathogen.
Denominator: All ETCs in an awardee’s jurisdiction.
100% of Ebola Treatment Centers
Transfer Notification: The ETC receives notification from the health
department, assessment hospital, or EMS of an incoming patient
suspected of Ebola or other special pathogen.
PPE Access: The ability to identify the location and have sufficient
quantity of unexpired supply of PPE at the patient care location(s) (e.g.,
emergency department, intensive care unit, Ebola treatment unit).
Sufficient: The extent to which the availability of PPE supplies meets the
pre-identified needs (i.e., CDC Ebola guidelines, needs assessment,
CONOPS).
16 | P a g e
�Data Element
Description
Number
Part
Activity
Measure (Ebola)
8
A
Activity B: Assure Readiness of Assessment Hospitals.
Time, in seconds, from active monitoring/direct active monitoring
(AM/DAM) patient’s arrival to placement in isolation at assessment
hospital.
This measure does not apply for assessment hospitals addressing other
special pathogens
Assessment Hospital
Measure (OSP)
Reporting
Element
Data Source
Metrics
Goal
Definitions
Assessment Hospital Exercise or Coalition Exercise, or Real-World Event
Start Time: Time in minutes and seconds of AM/DAM patient’s arrival at
assessment hospital.
Stop Time: Time in minutes and seconds of AM/DAM patient’s placement
in isolation at assessment hospital.
Less than or equal to 60 seconds
AM/DAM: Active monitoring means that the state or local public health
authority assumes responsibility for establishing regular communication
with potentially exposed individuals, including checking daily to assess for
the presence of symptoms and fever, rather than relying solely on
individuals to self-monitor and report symptoms if they develop. Direct
active monitoring means the public health authority conducts active
monitoring through direct observation.
Isolation: Precautions that are taken in a health care facility to prevent
the spread of an infectious agent from an infected or colonized patient to
susceptible persons. Isolation practices can include placement in a
private room or with a select roommate, the use of protective barriers
such as masks, gowns and gloves, a special emphasis on handwashing
(which is always very important), and special handling of contaminated
articles.
Data Element
Description
Number
Part
Activity
Measure
9
A
Activity B: Assure Readiness of Assessment Hospitals.
Time, in minutes, it takes an assessment hospital to identify and isolate a
patient suspected with Ebola or other special pathogen following
emergency department triage, as evidenced by a real-world case or nonotice exercise.
Assessment Hospital
Reporting
Element
Data Source
Metrics
Goal
Assessment Hospital Exercise or Coalition Exercise, or Real-World Event
Start Time: Time of the initiation of an emergency room triage in minutes
and seconds.
Stop Time: Time the patient is placed in isolation in minutes and seconds.
Less than or equal to 5 minutes
17 | P a g e
�Data Element
Description
Definitions
No-notice exercise: Unannounced exercise, including drills, functional,
and full-scale exercises.
Data Element
Description
Number
Part
Activity
Measure (Ebola)
10
A
Activity B: Assure Readiness of Assessment Hospitals.
Proportion of health care facility and emergency medical services (EMS)
workers in PPE, of those make contact with an AM/DAM suspected Ebola
patient under investigation (PUI) after health department notification to
the assessment hospital and/or EMS Agency.
Proportion of health care facility and emergency medical services (EMS)
workers in PPE that a patient suspected of an other special pathogen
makes contact with after health department notification to the
assessment hospital or EMS agency.
Assessment Hospital
Measure (OSP)
Reporting
Element
Data Source
Metrics
Goal
Assessment Hospital Exercise or Coalition Exercise, or Real-World Event
Numerator: The number of health care facility and EMS workers in PPE
while in contact with an AM/DAM Ebola patient (or patient suspected of
an other special pathogen) after notification to an EMS agency or
assessment hospital.
Denominator: The total number of health care facility and EMS workers in
contact with an AM/DAM Ebola patient, after notification to an EMS
agency or assessment hospital.
100% of health care facility and EMS workers
*Note that the goal is for no health care or EMS worker to be without PPE
while in contact with an AM/DAM suspected Ebola patient after notification.
Definitions
AM/DAM: Active monitoring means that the state or local public health
authority assumes responsibility for establishing regular communication
with potentially exposed individuals, including checking daily to assess for
the presence of symptoms and fever, rather than relying solely on
individuals to self-monitor and report symptoms if they develop. Direct
active monitoring means the public health authority conducts active
monitoring through direct observation.
Notification: Communication of a PUI or suspected patient to an
assessment hospital.
Start time: The assessment hospital or EMS agency receives notification
from the health department of an incoming patient suspected of Ebola or
other special pathogen, or patient’s arrival (if no notification).
Stop time: When discharge or transfer is completed.
Data Element
Description
Number
Part
Activity
11
A
Activity B: Assure Readiness of Assessment Hospitals.
18 | P a g e
�Data Element
Description
Measure (Ebola)
Number of health care facility and EMS workers in PPE that an AM/DAM
suspected Ebola patient makes contact with after health department
notification until isolation.
This measure does not apply for assessment hospitals addressing other
special pathogens
Assessment Hospital
Measure (OSP)
Reporting
Element
Data Source
Metrics
Goal
Definitions
Assessment Hospital Exercise or Coalition Exercise, or Real-World Event
Number of health care facility and EMS workers in PPE that make contact
with an AM/DAM suspected patient between the time of notification and
isolation.
Less than or equal to 3
AM/DAM patients: Active monitoring means that the state or local public
health authority assumes responsibility for establishing regular
communication with potentially exposed individuals, including checking
daily to assess for the presence of symptoms and fever, rather than
relying solely on individuals to self-monitor and report symptoms if they
develop. Direct active monitoring means the public health authority
conducts active monitoring through direct observation.
Isolation: Precautions that are taken in a health care facility to prevent
the spread of an infectious agent from an infected or colonized patient to
susceptible persons. Isolation practices can include placement in a
private room or with a select roommate, the use of protective barriers
such as masks, gowns and gloves, a special emphasis on handwashing
(which is always very important), and special handling of contaminated
articles.
Start time: The assessment hospital or EMS agency receives notification
from the health department of an incoming patient suspected of Ebola or
other special pathogen, or patient’s arrival (if no notification).
* Note: Health care facility and EMS involve all hospital or EMS personnel in
the facility or transport unit in either clinical or non-clinical roles
Data Element
Description
Number
Part
Activity
Measure
12
A
Activity B: Assure Readiness of Assessment Hospitals.
Proportion of emergency department staff trained at least annually in
infection control and safety.
Assessment Hospital
Reporting
Element
Data Source
Measure
Goal
Assessment Hospital
Numerator: Number of emergency department staff trained at least
annually in infection control and safety.
Denominator: Total number of emergency department staff.
100% of emergency department staff
19 | P a g e
�Data Element
Description
Definitions
Infection control and safety: Policies and procedures used to minimize
the risk of spreading infections, especially in health care facilities (e.g.
identification/isolation principles, clinical protocols for laboratory and
patient care while in PPE, and bodily fluid clean-up/containment).
Data Element
Description
Number
Part
Activity
Measure
13
A
Activity B: Assure Readiness of Assessment Hospitals.
Proportion of intensive care unit staff trained at least annually in
infection control and safety.
Assessment Hospital
Reporting
Element
Data Source
Metrics
Goal
Definitions
Assessment Hospital
Numerator: Number of intensive care unit staff trained at least annually
in infection control and safety.
Denominator: Total number of intensive care unit staff.
100% of intensive care unit staff
Infection control and safety: Policies and procedures used to minimize
the risk of spreading infections, especially in health care facilities (e.g.
identification/isolation principles, clinical protocols for laboratory and
patient care while in PPE, and bodily fluid clean-up/containment).
Data Element
Description
Number
Part
Activity
Measure
14
A
Activity B: Assure Readiness of Assessment Hospitals.
Proportion of assessment hospitals that can access their PPE supply (i.e.,
know location and have sufficient quantity of unexpired supply) within 10
minutes of transfer notification or arrival, if no notification, of a patient
suspected with Ebola or other special pathogen.
Assessment Hospital
Reporting
Element
Data Source
Metrics
Goal
Assessment Hospital Exercise
Numerator: Number of assessment hospitals that can access their PPE
supply within 10 minutes of transfer notification or arrival, if no
notification, of a patient suspected with Ebola or other special pathogen.
Denominator: Number of assessment hospitals in the awardee’s
jurisdiction.
100% of Assessment Hospitals
20 | P a g e
�Data Element
Description
Definitions
Assessment Hospital: Pre-designated facilities that are prepared to
receive and isolate a PUI for Ebola and care for the patient until an Ebola
diagnosis can be confirmed or ruled out and until discharge or transfer is
completed.
Transfer Notification: The ETC receives notification from the health
department, assessment hospital, or EMS of an incoming patient
suspected of Ebola or other special pathogen.
PPE Access: The ability to identify the location and have sufficient
quantity of unexpired supply of PPE at the patient care location(s) (e.g.
emergency department, intensive care unit, Ebola treatment unit).
Sufficient: The extent to which the availability of PPE supplies can meet
the pre-identified needs (i.e., CDC Ebola guidelines, needs assessment,
CONOPS).
Data Element
Description
Number
Part
Activity
15
A
Activity C: Develop Capabilities of Health Care Coalitions to enable their
members to care for Ebola patients.
Proportion of frontline facilities that receive information from their
coalition on the quantity and location of personal protective equipment
(PPE) supply within 8 hours of a patient under investigation’s (PUI) arrival
at a coalition member facility.
Proportion of frontline facilities that receive information from their
coalition on the quantity and location of personal protective equipment
(PPE) supply within 8 hours of a suspected patient arrival at a coalition
member facility.
Frontline Facility
Measure (Ebola)
Measure (OSP)
Reporting
Element
Data Source
Metrics
Goal
Definitions
Coalition Exercise
Numerator: Number of frontline facilities that receive information about
PPE quantities and locations of PPE from their coalition within 8 hours of
a patient under investigation’s (PUI) arrival at a coalition member’s
facility.
Denominator: Total number of frontline facilities in the coalition.
100% of frontline facilities
Frontline Facility: Frontline facilities are hospitals and other health care
providers that are not designated Ebola assessment hospitals or Ebola
treatment centers that have the possibility of a suspected Ebola or other
special pathogen patient encounter if a patient were to access the health
care system.
21 | P a g e
�Data Element
Description
Number
Part
Activity
16
A
Activity C: Develop Capabilities of Health Care Coalitions to enable their
members to care for Ebola patients.
Proportion of frontline facilities that have received coalition-funded
training.
Coalition
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Coalition
Numerator: Total number of frontline facilities that received coalitionfunded training.
Denominator: Total number of frontline facilities in the coalition.
75% of frontline facilities received coalition-funded training
Frontline Facility: Frontline facilities are hospitals and other health care
providers that are not designated Ebola assessment hospitals or Ebola
treatment centers that have the possibility of a suspected Ebola patient
encounter if a patient were to access the health care system outside of
the active monitoring/direct active monitoring program.
Data Element
Description
Number
Part
Activity
17
A
Activity C: Develop Capabilities of Health Care Coalitions to enable their
members to care for Ebola patients.
Proportion of EMS agencies engaged in all phases of the Ebola and other
special pathogen preparedness process, of those that are required to
execute the awardee’s CONOPs that are.
Coalition
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Coalitions and awardee
Numerator: Number of EMS agencies engaged in all phases of Ebola and
other special pathogen preparedness process, of those required to
execute the awardee’s CONOPs.
Denominator: Number of EMS agencies that are required to execute the
awardee’s CONOPs
100% of EMS agencies
EMS agencies required to execute the awardee’s CONOPS: EMS agencies
that will provide 9-1-1 emergency medical services to suspect Ebola
patients’ homes or other locations; inter-facility EMS agencies that will
transport suspect or confirmed patients with Ebola between frontline
health care facilities, assessment hospitals, Ebola treatment centers,
regional Ebola and other special pathogen treatment centers, and
airports.
All Phases of the Ebola and other special pathogen Preparedness Process:
All Phases includes planning, training, exercising, and responding with
other Ebola preparedness partners.
22 | P a g e
�Data Element
Description
Number
Part
Activity
18
A
Activity C: Develop Capabilities of Health Care Coalitions to enable their
members to care for Ebola and other special pathogen patients.
Proportion of coalitions within an awardee’s jurisdiction that participate
in the Health care-Associated Infection (HAI)/Infection Control
advisory group
Coalition
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Awardee
Numerator: Number of coalitions participating in the HAI Advisory group.
Denominator: Number of coalitions within an Awardees jurisdiction.
80% of coalitions participate in HAI Advisory Group
HAI Advisory Group: An advisory committee charged with making
recommendations on the prevention of health care-associated infections.
Part B
Data Element
Description
Number
Part
Activity
19
B
Activity A: Supporting regional planning for the development of a regional
network for Ebola and other special pathogen patient care.
Time from confirmation of patient with Ebola or other special pathogen
at assessment hospital or ETC to notification by the health department
and/or transferring hospital (assessment hospital or ETC) to the health
department in the state/jurisdiction where the regional Ebola and other
special pathogen treatment center is located about the need for patient
transfer.
Part B awardee
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Assessment Hospital, Ebola Treatment Center or Part B Exercise
Start Time: Time of confirmation of patient with Ebola or other special
pathogen in minutes and seconds.
End Time: Time of notification by the Health Department and/or
transferring hospital (assessment hospital or ETC) to the health
department in the state/jurisdiction where the regional Ebola and other
special pathogen treatment center is located about the need for patient
transfer (in minutes and seconds).
Within 30 minutes
Confirmation: Laboratory-confirmed diagnostic evidence of Ebola virus or
other special pathogen.
Data Element
Description
Number
Part
20
B
23 | P a g e
�Data Element
Description
Activity
Activity A: Supporting regional planning for the development of a regional
network for Ebola and other special pathogen patient care.
Proportion of member states/jurisdictions in the region that have
participated in the development of the regional CONOPS.
Part B awardee
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Part B awardee
Numerator: Number of states/jurisdictions within a region that
participated in the development of the regional CONOPS.
Denominator: Number of states/jurisdictions in the region.
100% of states/jurisdictions in the region
Participation: The involvement in the development, implementation,
exercising, and sustainment of the regional CONOPS.
Data Element
Description
Number
Part
Activity
21
B
Activity A: Supporting regional planning for the development of a regional
network for Ebola patient care.
Proportion of states/jurisdictions in the HHS region for which a current
written and signed agreement is in place to transfer patients from
assessment hospitals or ETCs to the regional Ebola and other special
pathogen treatment center.
Part B awardee
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Part B awardee
Numerator: Number of States/jurisdictions with a current written and
signed transfer agreement.
Denominator: Number of states/jurisdictions in the HHS region.
100% of states/jurisdictions
Transfer Agreement: Written, signed document that denotes a formal
willingness to transfer patients from assessment hospitals or ETCs to
regional Ebola and other special pathogen treatment centers.
Data Element
Description
Number
Part
Activity
22
B
Activity A: Supporting regional planning for the development of a regional
network for Ebola patient care.
Proportion of states/jurisdictions in the HHS region that have
demonstrated the ability to move a patient across jurisdictions by ground
or air (including ground transfers from aircraft and to facility) to a
regional Ebola and other special pathogen treatment center, as evidenced
by a real-world event or participation in a multi-jurisdiction exercise.
Part B awardee
Measure
Reporting
Element
24 | P a g e
�Data Element
Description
Data Source
Metrics
Goal
Definitions
Part B Exercise or Real-World Event
Numerator: Number of states/jurisdictions in the HHS region that have
demonstrated the ability to move a patient across jurisdictions by ground
or air (including ground transfers from aircraft and to facility) to a
regional Ebola and other special pathogen treatment center, in a realworld event or exercise (tabletop exercise, at a minimum).
Denominator: Number of states/jurisdictions in the HHS region.
100% of states/jurisdictions
Not applicable.
Data Element
Description
Number
Part
Activity
23
B
Activity B: Developing, supporting, and maintaining regional Ebola and
other special pathogens treatment centers.
Proportion of rostered/covered staff at the regional Ebola and other
special pathogen treatment center that received quarterly training in
infection control and safety, and patient care for a patient with Ebola or
other special pathogen.
Regional Ebola and other special pathogen treatment center
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Regional Ebola and other special pathogen treatment center
Numerator: Number of rostered/covered staff that received quarterly
training in infection control and safety, and patient care for a patient
with Ebola.
Denominator: Number of rostered/covered staff.
100% of rostered/covered staff
Rostered/covered staff: Individuals that have been pre-identified to
provide ongoing care and treatment to patients with confirmed Ebola or
patient under investigation (PUI).
Infection control and safety: Policies and procedures used to minimize
the risk of spreading infections, especially in health care facilities (e.g.
identification/isolation principles, clinical protocols for laboratory and
patient care while in PPE, and bodily fluid clean-up/containment).
Data Element
Description
Number
Part
Activity
24
B
Activity B: Developing, supporting, and maintaining regional Ebola and
other special pathogens treatment centers.
Time it takes for the on-call team to report to the unit upon notification
of an incoming patient with Ebola, as evidenced by a real-world event or
no-notice exercise.
Regional Ebola and other special pathogen treatment center
Measure
Reporting
Element
Data Source
Part B Exercise or Real-World Event
25 | P a g e
�Data Element
Description
Metrics
Start Time: Time (in hours and minutes) of notification of on-call team
that a confirmed patient with Ebola is being transferred to their facility
in a real-world event or no-notice exercise.
Stop Time: Time (in hours and minutes) for the on-call team to report to
the unit.
4 hours
On-call team: Group of individuals that are pre-designated to staff the
Ebola treatment unit at the time of the patient’s scheduled arrival.
Notification: The regional Ebola and other special pathogen treatment
center receives notification from the health department or another
health care facility that a patient confirmed with Ebola or other special
pathogen is being transferred to their facility.
No-notice exercise: Unannounced exercise, including drills, functional,
and full-scale exercises.
Goal
Definitions
Data Element
Description
Number
Part
Activity
25
B
Activity B: Developing, supporting, and maintaining regional Ebola and
other special pathogens treatment centers.
Proportion of rostered/covered staff contacted by the regional Ebola and
other special pathogen treatment center within 4 hours upon notification
of an incoming patient with Ebola, as evidenced by a real-world event or
no-notice exercise.
Regional Ebola and other special pathogen treatment center
Measure
Reporting
Element
Data Source
Metrics
Goal
Definitions
Part B Exercise or Real-World Event
Numerator: Number of rostered/covered staff contacted by the regional
Ebola and other special pathogen treatment center within 4 hours upon
notification of an incoming patient with Ebola or other special pathogen.
Denominator: Total number of rostered/covered staff at the regional
Ebola and other special pathogen treatment center.
100% of rostered/covered staff
Notification: The regional Ebola and other special pathogen treatment
center receives notification from the health department or another
health care facility that a confirmed patient with Ebola is being
transferred to their facility.
Rostered/covered staff: Individuals that have been pre-identified to
provide ongoing care and treatment to patients with confirmed Ebola or
patient under investigation (PUI).
Contact: The hospital successfully contacted the staff member (and
received a response) by phone, email, or automated alert system.
No-notice exercise: Unannounced exercise, including drills, functional,
and full-scale exercises.
26 | P a g e
�Data Element
Description
Number
Part
Activity
26
B
Activity B: Developing, supporting, and maintaining regional Ebola and
other special pathogens treatment centers.
Time until a regional Ebola and other special pathogen treatment center
is ready to admit a patient confirmed with Ebola and other special
pathogen (adult or pediatric patient), as evidenced by an exercise or
actual patient transfer.
Regional Ebola and other special pathogen treatment center
Measure
Reporting
Element
Data Source
Metrics
Goals
Definitions
Part B Exercise or actual patient transfer
Start Time: Time (in hours and minutes) that the regional Ebola and other
special pathogen treatment center is notified of the need to transfer and
admit a patient with confirmed Ebola or other special pathogen.
Stop Time: Time (in hours and minutes) when the regional Ebola and
other special pathogen treatment center is ready to admit the patient.
Within 8 hours of notification
Not applicable.
27 | P a g e
�Part A: IMPACT
Data Element
Description
Number
Part
Activity
Measure
27a
A
Impact
Reporting
Element
Data Source
Goal
Metrics
Please rate your level of agreement with each of the following
statements:
A. My state/jurisdiction, including coalitions, frontline health facilities,
and inter-facility transport providers, was prepared for an Ebola event
in or before July 2014.
Awardee
Definitions
Awardee
N/A
1 – Not prepared
2 – Slightly prepared
3 – Moderately prepared
4 – Adequately prepared
5 – Very prepared
Frontline Facility: Frontline facilities are hospitals and other health care
providers that are not designated Ebola assessment hospitals or Ebola
treatment centers that have the possibility of a suspected Ebola patient
encounter if a patient were to access the health care system outside of
the active monitoring/direct active monitoring program.
Inter-facility transport providers: Staff that supports the transport
between two entities, for example, between an assessment hospital and
an ETC.
Data Element
Description
Number
Part
Activity
Measure
27b
A
Impact
Reporting
Element
Data Source
Goal
Please rate your level of agreement with each of the following
statements:
B. My state/jurisdiction, including coalitions, frontline health facilities,
and inter-facility transport providers, is prepared for an Ebola event
after July 2014
Awardee
Awardee
Mean above 4.0 or 100% of awardees are Adequately Prepared or Very
Prepared
28 | P a g e
�Data Element
Description
Metrics
1 – Not prepared
2 – Slightly prepared
3 – Moderately prepared
4 – Adequately prepared
5 – Very prepared
Frontline Facility: Frontline facilities are hospitals and other health care
providers that are not designated Ebola assessment hospitals or Ebola
treatment centers that have the possibility of a suspected Ebola patient
encounter if a patient were to access the health care system outside of
the active monitoring/direct active monitoring program.
Inter-facility transport providers: Staff that supports the transport
between two entities, for example, between an assessment hospital and
an ETC.
Definitions
Data Element
Description
Number
Part
Activity
Measure
28a
A
Impact
Reporting
Element
Data Source
Metrics
Goal
Definitions
Please provide a written response in 250 words or less:
A. Describe the impact of the Hospital Preparedness Program Ebola
Preparedness and Response Activities Funding) on the overall
preparedness of your state/jurisdiction for an Ebola or other special
pathogen event. This may include capabilities developed as a result of
funding or guidance from this program or other synergies you
experienced. In addition, describe any impacts translate to allhazards preparedness.
Awardee
Awardee
Free Text Narrative
Not Applicable
Not Applicable
Data Element
Description
Number
Part
Activity
Measure
28b
A
Impact
Reporting
Data Source
Please provide a written response in 250 words or less:
B. Describe any remaining gaps in the overall preparedness of your
state/jurisdiction for an Ebola or other special pathogen event. Note:
Gaps are not limited to the existing capabilities.
Awardee
Awardee
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�Data Element
Description
Metrics
Goal
Definitions
Free Text Narrative
Not Applicable
Not Applicable
Part B: IMPACT
Data Element
Description
Number
Part
Activity
Measure
29a
B
Impact
Please rate your level of agreement with each of the following
statements:
Reporting
Element
Data Source
Metrics
A. My region was prepared for an Ebola event in July 2014.
Awardee
Goal
Definitions
Awardee
1 – Not prepared
2 – Slightly prepared
3 – Moderately prepared
4 – Adequately prepared
5 – Very prepared
N/A
Not Applicable
Data Element
Description
Number
Part
Activity
Measure
29b
B
Impact
Please rate your level of agreement with each of the following
statements:
Reporting
Element
Data Source
Metrics
Goal
Definitions
B. My region is now prepared for an Ebola event.
Awardee
Awardee
1 – Not prepared
2 – Slightly prepared
3 – Moderately prepared
4 – Adequately prepared
5 – Very prepared
Mean above 4.0 or 100% of awardees Adequately Prepared or Very
Prepared
Not Applicable
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�Data Element
Description
Number
Part
Activity
Measure
30a
B
Impact
Please provide a written response in 250 words or less:
A. Describe the impact of the Hospital Preparedness Program Ebola
Reporting
Data Source
Metrics
Goal
Definitions
Preparedness and Response Activities Funding) on the overall
preparedness of your region for an Ebola or other special pathogen
event. This may include capabilities developed as a result of funding
or guidance from this program or other synergies you experienced. In
addition, describe any impacts translate to all hazards preparedness.
Awardee
Awardee
Free Text Narrative
N/A
Not Applicable
Data Element
Description
Number
Part
Activity
Measure
30b
B
Impact
Please provide a written response in 250 words or less:
Reporting
Element
Data Source
Metrics
Goal
Definitions
Describe any remaining gaps in the overall preparedness of your region
for an Ebola or other special pathogen event. Note: Gaps are not limited
to existing capabilities.
Awardee
Awardee
Free Text Narrative
N/A
Not Applicable
31 | P a g e
�Glossary
All Phases of the Ebola and Other Special Pathogen Preparedness Process: All Phases
includes planning, training, exercising, and responding with other Ebola preparedness
partners.
Actively monitored or directly actively monitored (AM/DAM): Active monitoring means that
the state or local public health authority assumes responsibility for establishing regular
communication with potentially exposed individuals, including checking daily to assess for the
presence of symptoms and fever, rather than relying solely on individuals to self-monitor and
report symptoms if they develop. Direct active monitoring means the public health authority
conducts active monitoring through direct observation.
Assessment Hospital: Pre-designated facilities that are prepared to receive and isolate a PUI
for Ebola and care for the patient until an Ebola diagnosis can be confirmed or ruled out and
until discharge or transfer is completed.
Confirmation: Laboratory-confirmed diagnostic evidence of Ebola virus or other special
pathogen.
Contact: The hospital successfully contacted the staff member (and received a response) by
phone, email, or automated alert system.
Doffing: The removal of used PPE; this is a high-risk process that requires a structured
procedure, a trained observer, and a designated area for removal to ensure protection.
Donning: The administration or act of putting on PPE.
EMS agencies required to execute the awardee’s CONOPS: EMS agencies that will provide 91-1 emergency medical services to suspect Ebola patients’ homes or other locations; interfacility EMS agencies that will transport suspect or confirmed patients with Ebola between
frontline health care facilities, assessment hospitals, Ebola treatment centers, regional Ebola
and other special pathogen treatment centers, and airports.
EMS/ Inter-facility transport unit: Entities identified in the awardee’s CONOPS responsible
for transport of an actively monitored or directly actively monitored (AM/DAM) patient to an
Ebola assessment facility or to provide inter-facility transport (i.e., from a frontline facility to
an Ebola assessment/treatment facility or from an Ebola assessment facility to an Ebola
treatment facility).
Frontline Facility: Frontline facilities are hospitals and other health care providers that are
not designated Ebola assessment hospitals or Ebola treatment centers that have the
possibility of a suspected Ebola patient encounter if a patient were to access the health care
system outside of the active monitoring/direct active monitoring program.
Health care Associated Infection (HAI)/Infection Control Advisory Group: An advisory
committee charged with making recommendations on the prevention of health careassociated infections.
32 | P a g e
�Infection control and safety: Policies and procedures used to minimize the risk of spreading
infections, especially in health care facilities (e.g. identification/isolation principles, clinical
protocols for laboratory and patient care while in PPE, and bodily fluid cleanup/containment).
Inter-facility transport providers: Staff that supports the transport and patient care during
transport between two locations, for example, between an assessment hospital and an ETC.
Isolation: Precautions that are taken in a health care facility to prevent the spread of an
infectious agent from an infected or colonized patient to susceptible persons. Isolation
practices can include placement in a private room or with a select roommate, the use of
protective barriers such as masks, gowns and gloves, a special emphasis on hand washing
(which is always very important), and special handling of contaminated articles.
Just-In-Time (JIT) training: Training that is conducted to as a refresher to prepare for a
patient with Ebola or other special pathogen, including donning and doffing, facility-specific
protocols and procedures, and care/treatment protocols.
No-notice exercise: Unannounced exercise, including drills, functional, and full-scale
exercises.
Notification: The definition of notification may vary relative to the context of the measure.
On-call team: Group of individuals that are pre-designated to staff the Ebola treatment unit
at the time of the patient’s scheduled arrival.
Participation: The involvement in the development, implementation, or sustainment of the
regional CONOPS.
PPE: Devices or equipment designated to provide protection while providing care for a
confirmed or suspected patient with Ebola.
PPE Access: The ability to identify the location and have sufficient quantity of unexpired
supply of PPE at the patient care location (e.g., emergency department, intensive care unit,
Ebola treatment unit).
Sufficient: The extent to which the availability of PPE supplies meets the pre-identified
needs (i.e., CDC Ebola guidelines, needs assessment, CONOPS).
Rostered/covered Staff: Individuals that have been pre-identified to provide ongoing care
and treatment to patients with confirmed Ebola or patient under investigation (PUI). The use
of the terms “rostered” or “covered” varies from facility to facility.
Trained: Individuals who have completed Ebola and other special pathogen infection control
and safety training to specifically include proper donning (putting on PPE) and doffing (taking
off PPE) methods. See CDC PPE guidance.
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�Transfer Agreement: Written, signed document that denotes a formal willingness to transfer
patients from assessment hospitals or ETCs to regional Ebola and other special pathogen
treatment centers.
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�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures (May 2017)
Hyperlink
A link, or reference, to another resource on the Internet.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures (May 2017)
Creator
An entity primarily responsible for making the resource
ASPR
Subject
The topic of the resource
General
Description
An account of the resource
Hospital Preparedness Program (HPP) Measure Manual: Implementation Guidance for Ebola Preparedness Measures (May 2017)
Date
A point or period of time associated with an event in the lifecycle of the resource
2017-05-01
Contributor
An entity responsible for making contributions to the resource
2023-10-31 by J. Mundy, removed from phe website.
Archived
Assessment Facility
CONOPS
Ebola
Federal
Frontline Facility
Healthcare Coalition
Public Health
R-Lead
Regional Treatment Center
Special Pathogens
State Treatment Center