[MCOH-EH] Medical clearance for Ebola PPE

[Smith, Emma]

I have some concerns regarding the potential for side splashes with the face shields we have due to incomplete face covering. The disposable hoods tend to have gaps as well, which we are taping, but I'm just concerned that our face protection is not adequate. Wondering if others are experiencing this and how you may have resolved this. Any suggestions from this group would be much appreciated.

Emma S. Smith, RNC, COHN
Employee/Occupational Health Coordinator
Mount Nittany Medical Center
1800 East Park Avenue
State College, PA 16803
Phone: (814) 234-6731
Pager: 1202
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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Hudson, T. Warner
Sent: Wednesday, October 22, 2014 6:22 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Medical clearance for Ebola PPE

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 at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces+twhudson=mednet.ucla.edu at 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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