Ebola virus disease Keep Safe, Keep Serving Ebola and the Academic - - PDF document

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Ebola virus disease Keep Safe, Keep Serving Ebola and the Academic - - PDF document

Sep 22, 2023 136 likes •377 views

5/22/2015 Ebola virus disease Keep Safe, Keep Serving Ebola and the Academic Medical Center Response Disclosures None 1 5/22/2015 Contributions Hernando Garzon, MD Ami Waters, MD Ethel Wu, MD Roadmap Background on

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5/22/2015 1

Ebola virus disease

“Keep Safe, Keep Serving” Ebola and the Academic Medical Center Response

Disclosures

  • None
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5/22/2015 2

Contributions

  • Hernando Garzon, MD
  • Ami Waters, MD
  • Ethel Wu, MD

Roadmap

  • Background on Ebola
  • Keep Safe, Keep Serving
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Viral Hemorrhagic Fevers

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Transmission – Contact, Droplet, Airborne

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How infectious is Ebola, really?

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Clinical course Ebola PCR, and Ab ELISA

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Ebola Outbreaks – Key Interventions

  • Case Identification - Early
  • Transportation – Safely
  • Isolation – prevents transmission
  • Care – Supportive- Can we do more? (Mortality –

Africa 60-70%, US/EU 21%)

  • Contact Tracing – Identifies new cases early
  • Safe Burials – 50% of infections happen with

handling dead bodies

  • Health Promotion – Outreach and education of

prevention measures

Care - Supportive

  • Standing orders

– Hydration (ORS vs IV) - >2-3 liters/d – Co-Artem x 3d – Cefixime x 5d – Tylenol, Omeprazole

  • Limited symptomatic care

– Antiemetics, Narcotics, Anxiolytics, etc.

  • Diagnostics

– Ebola PRC – Malaria RDT – iSTAT or lab supported Lytes, CBC, LFTs

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Ebola Treatment Units - Structure

Ebola Treatment Unit – 80-100 Beds

  • Human Resources

– 80-120 staff (10-15 or more international)

  • 30-45 clinical staff (MDs, RNs, etc)
  • 40-80 support staff (hygienists, logistics, psychosocial,

drivers, cooks, burial teams, etc)

– >100 more peripheral support staff

  • Water – 100 liters/pp/pd (2500 gallons per day)
  • Chlorine – 0.7kg/pp/pd (70 Kg per day) (6 tons
  • ver 6 months)
  • PPE – 100 suits, hoods/pd
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ETU work environment

  • Working in full PPE

– 45-60 minutes work cycle – High temp and humidity environment – Challenge with hearing, vision, dexterity, documentation, communication – 1.5 liter sweat loss in 60 minutes!

  • Ave 2 cycles in treatment area per

shift

  • No continuous monitoring or meds

(IV)

  • Very limited monitoring (VS,

diagnostics)

Treatment outside west Africa

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Ebola Mortality

West Africa – 60-70% Elsewhere – 21% (5/24)

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Non Ebola Consequences of Ebola

  • Indirect Mortality - Untreated/undiagnosed Medical

problems

– Estimates of one preventable medical death for every Ebola death

  • Food Security

– Farms abandoned, decrease food availability

  • Child Protection

– >3000 orphaned children

  • Stigmatization/Distrust

– Recovered patients with reintegration issues. Workers shunned by communities

  • Restricted Travel
  • Economic collapse

– Estimate of $2 Billion lost in trade, commerce, etc

Roadmap

  • Background on Ebola
  • Keep Safe, Keep Serving
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UCSF Global Health Fellowship: Going to the Last Mile

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The Canary in the Coal Mine: Ebola Virus

“The reasons to shore up health systems between epidemics are both moral and those of vital self-

  • interest. Ebola is

signaling a new call to

  • action. We ignore this

canary at our own peril.”

  • -2013-14 UCSF Global

Health Fellow Alexandra Stanculescu, MD, blog post May 2014

A Stand in Solidarity

“The idea that some lives matter less is the root of all that's wrong with the world.”- Paul Farmer

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From Paper to Practice Rivercess County

  • No ETU
  • Lack of infrared thermometers,

PPE at facilities

  • Community Disbelief of Ebola

and rampant myths of its spread

  • Lack of trust of healthcare

workers

  • Inadequate community

awareness on Ebola Viral Disease (EVD)

  • Very remote with poor road

conditions

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Protecting those who Serve: Healthcare workers

  • In Liberia, 370 health

care workers infected

  • 178 of these died
  • 28% of workers never

trained in IPC

  • 26% uncomfortable

with identification of a suspected Ebola patient

Introducing Concepts & Putting into Practice

  • Ebola Basics and

Context of Outbreak

  • Triage and Isolation

Practices

  • Donning and Doffing

PPE

  • Chlorine Preparation
  • Waste Management
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Small Group Exercises Building Confidence

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Taking it one step further Facility Mapping and Action Plans

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Keep Safe, Keep Serving

  • 200 Healthcare workers
  • 40 health facilities
  • Two counties
  • Participants scored 91%
  • n the post-test
  • Monthly follow-ups
  • Centralized training is

NOT enough, requires

  • ngoing mentorship

and supervision

“I learned a lot about Ebola I have never learned

  • before. It is my first time.”

“I would like to see the training established in all districts.”

“I like this training and I want to see change in the near future.”

“Ebola Virus kills. We need more training days.”

“I would like to see regular supply of equipment for facility such as PPE and constant training on Ebola.”

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Applying concepts Identifying limitations

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The End of a Mission? Or the Beginning of Another? Questions?