Thank you, all for sharing your institutional practices. Is anyone doing any psychological screening as part of the baseline assessment?

Thank you
Lisa

Lisa A. Foster, MS, ANP-BC
Clinical Director
Employee Occupational Health Services
Beth Israel Deaconess Medical Center
110 Francis St, Suite 6C
Boston, MA 02215
617-632-7805
2014-15 Flu Vacciniation Portal address:
https://portal.bidmc.org/Intranets/Clinical/Flu-and-Norovirus-Central-2014-2015/Flu/Vaccination/FormsAllLanguages.aspx

-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of mcoh-eh-request@mylist.net
Sent: Wednesday, October 22, 2014 6:22 PM
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Today's Topics:

1. Re: Medical clearance for Ebola PPE (Swift, Melanie)
2. Re: Medical clearance for Ebola PPE (Hudson, T. Warner)

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Message: 1
Date: Wed, 22 Oct 2014 21:55:54 +0000
From: "Swift, Melanie" <melanie.swift@Vanderbilt.Edu>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Medical clearance for Ebola PPE
Message-ID:
<984BE23843F0DE4EBE652D6EE07600BE1D8FB6A9@ITS-HCWNEM104.ds.vanderbilt.edu>

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In this particular application, other issues also come to mind. Insulin pumps could not be accessed, for example. Anyone with a condition causing urinary frequency or urgency would have difficulty. It reminds me very much of the BSL 4 containment requirements, where egress is delayed and people must be in the suits for long periods.

I've put calls in to Emory and NIH to see what they do for clearance.

Melanie Swift, MD
Director, Vanderbilt Occupational Health Clinic http://occupationalhealth.vanderbilt.edu

From: MCOH-EH [mailto:mcoh-eh-bounces+melanie.swift=vanderbilt.edu@mylist.net] On Behalf Of Shea, Joann
Sent: Wednesday, October 22, 2014 4:45 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Medical clearance for Ebola PPE

Here is ours...just a brief one page screening. We are using the PAPRS with hoods and full body suit. We are just doing a brief screening and our RN then meets with those with positive responses. We had three HCWs who could not participate today. They can elect to see the ARNP if they still want to participate so we can do additional testing and examination.

[TGH_employee health serv-color]
JoAnn Shea, ARNP, MS, COHN-S
Director, Employee Health and Wellness
P.O. Box 1289, Tampa, FL 33601 Mobile: 813-789-3441 Work: 813-844-7692 FAX: 813-844-8144

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Adamo, Philip
Sent: Wednesday, October 22, 2014 5:18 PM
To: MCOH/EH
Cc: MCOH/EH
Subject: Re: [MCOH-EH] Medical clearance for Ebola PPE

Hi Deb
I am at an Ebola task force meeting and just raised this issue. After listening to one of the physician training the nurses he expressed that many complain about being warm, sweaty and anxious. We must be careful about applying a federal form on more than a respirator issue. My thoughts are:
1. Pregnant health care workers should not work in that PPE.
2. HCW with chronic skin conditions should not be expected to be in the PPE for extended times.
3. HCW with medical conditions that are at risk for dehydration should not work with that level of PPE 4. General question to ask prior to training is do you want to be evaluated by EHS?

At this time we are making this a volunteer based training.

I welcome others to contribute to this conversation.
Phil Adamo M.D.
UMass Memorial Health Care

Sent from my iPhone

On Oct 22, 2014, at 5:08 PM, "Foley MD, Deborah" <DFoley@NCH.ORG<mailto:DFoley@NCH.ORG>> wrote:
Is anyone developing a medical evaluation tool to help determine an employee's ability to work in the PPE recommended for Ebola patient care? We think that a nurse may be in the gear for up to a 4 hour shift. I am considering the long form respiratory questionnaire as a possibility. What are others thinking?

Thanks,
Deborah Foley MD
Employee Health and Safety
Northwest Community Healthcare
Arlington Heights IL
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Message: 2
Date: Wed, 22 Oct 2014 22:21:47 +0000
From: "Hudson, T. Warner" <TWHudson@mednet.ucla.edu>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Medical clearance for Ebola PPE
Message-ID:
<2134A5387858914BBE80D079ECF6880C3BD60C74@SOPEXMB2.ad.medctr.ucla.edu>
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Not a bad idea. Some considerations as follows highlighted

Occupational Health Considerations: Working with HFV
Preparation prior to caring for Ebola patients

* Undergo PPE training (including donning and doffing PPE) and CAPR.

* Review the possible impact of Ebola on your own health, especially for individuals with chronic diseases and / or taking medication.

* Considerations include pregnancy, immune suppressing conditions and medications, difficulty donning and doffing PPE, poorly controlled seizures or narcolepsy, claustrophobia, planned surgery, chemotherapy, current illness which could be confused with Ebola.

* Ensure vaccines are up to date; especially influenza

* Train to provide care for Ebola patients wearing the correct personal protective equipment (PPE) and become proficient and comfortable with this.

* Understand the travel restrictions for "known exposures and contacts" with Ebola patients.

* Wear scrubs only under PPE.

While on Ebola care duty

* Your temperature will be checked twice daily and logged by Infection Prevention officer.

* If temperature or any possible Ebola symptoms, or any potential exposure, contact Medical Director of Infection Prevention on call: Dr. XXXXX or Dr. XXXXXX)

* Make a daily check in call to Occupational Health at xxxxxxxxxx while on Ebola Response Team duty.

Preparation prior to returning to non-Ebola UCLA patient care duties

* Undertake an "Exit Exposure Review" by Occupational Health officer.

* Employees should be aware that current CDC guidelines indicate that asymptomatic persons with "Close Contact" (defined below) should not travel by commercial conveyance (airlines, ships, trains) for 21 days after last contact.

* Healthcare workers in Ebola facilities who observe strict infection control measure with consistent and appropriate PPE use are not considered as having "close contact".

* Brief interactions, such as walking by a person or through a hospital, do not constitute close contact.

* For health care workers classified as "no known Ebola exposure", there will still be medical surveillance for 21 days as follows:

1. Self-monitoring: daily symptom review and twice daily temperature check for 21 days following return from West Africa.

2. Daily contact with local Occupational Health

3. Notification of Infection Prevention on the presentation of any symptoms.

* Health care workers who appropriately use PPE in the presence of known cases should also understand the potential for risk that may arise from unprotected contact with asymptomatic, or individuals assumed ill with another disease, who develop EVD a few days later.

* Medical surveillance during the 21 days following last exposure will include risk assessment for direct patient contact . Decisions regarding fitness for duty will be locally determined and coordinated with local Infectious Disease and Infection Control hospital/clinic personnel, and based on characteristics of patient population, scope of services and setting of services provided by clinician.
Close contact is defined as

* being within approximately 3 feet (1 meter) of an EVD patient or within the patient's room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations<http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html>); or

* having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.

* Individuals with brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact and no travel restrictions apply, however should self-monitor for 21 days following last exposure.

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health UCLA Health System and Campus Office 310.825.9146 Fax 310.206.4585 Pager 800.233.7231 ID 27132 E-mail twhudson@mednet.ucla.edu<mailto:twhudson@mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces+twhudson=mednet.ucla.edu@mylist.net] On Behalf Of Foley MD, Deborah
Sent: Wednesday, October 22, 2014 2:08 PM
To: 'MCOH/EH'
Subject: [MCOH-EH] Medical clearance for Ebola PPE

Is anyone developing a medical evaluation tool to help determine an employee's ability to work in the PPE recommended for Ebola patient care? We think that a nurse may be in the gear for up to a 4 hour shift. I am considering the long form respiratory questionnaire as a possibility. What are others thinking?

Thanks,
Deborah Foley MD
Employee Health and Safety
Northwest Community Healthcare
Arlington Heights IL
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