Ebola and triage

[edmurse02]

I apologize in advance for you all having to even see the word ebola again. The hospital I work at has finally stepped up to the plate regarding PPE for the staff. We have gone from surgical gown and mask +hairnet to now having ordered some hazmat suits with full hoods and n95 masks. The change in policy literally happened over night. I assume this is because the CDC changed their guidelines. Anyway, here is my concern: The hospital I work for has a small, approx 5x7 foot room for me to evaluate/triage patients. It is my responsibility, as most of you already know, to screen the patients for fever/flu like symptoms/travel out of the country and what not. There is currently no discussion or plans to implement any form of protection for the staff working in this small closet of a working area from potential ebola patients. We seem to be heading in the right direction for treatment once they are identified, but the process of evaluating them is really hanging us out to dry. I am having trouble finding any information specifically about what other hospitals are doing for the triage of these patients. I understand that the virus is contact/droplet, but I don't have any control what so ever of determining when these people may vomit or sneeze in my closet of a workspace. I mentioned my concern to my supervisor. Her response was that I had no reason to be concerned as long as I was 3 feet away. Easy for her to say... I explained to her that I really felt unsafe being completely unprotected out in the waiting room, screening every person to walk through the door for a deadly virus. She confirmed I would not lose my job if I refused the assignment, but I would hate to have to do that to my fellow team members. Sorry if this is dragging on. I just need advice. It unnerves me to see the CDC spraying a side walk outside of an ebola patients' apartment in full hazmat with respirators, and I am suppose to screen for them in my scrubs. Thanks to any replies.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We are screening people before they enter the triage room,..we have a sign posted asking people to "stop here",...the pt is asked immediately about fever, and travel to Africa within the last 21 days. If the pt answers yes to both questions, they are instructed to walk out of the ED and staff in PPE direct the pt around to our hazmat entrance where we have staff in full PPE awaiting the pt. There we have a separate entrance to an anteroom then the pt room with negative airflow. We treat these pts just like any hazmat pt. They are not allowed into the triage room or the waiting area until screened.

[zmansc, ASN, RN]

As part of our "infectious disease blah, blah, blah protocol" we addressed triage as such (not word for word but you will get the jist):

1) Regarding PPE, the triage nurse will continue as they have in the past. Our assumption is it is very unlikely that we will ever have to implement these procedures, but in the unlikely case that we do, we will do so as soon as we have a high risk patient identified.

2) The triage nurse will ask all patients about ebola like symptoms (fever, etc), and travel to or exposure to someone who has traveled to an ebola infected area. If a patient meets this criteria then:

-- A) The triage nurse will immediately have the patient put on a mask and gloves.

-- B) The triage nurse will also put on at minimum a mask and gloves. At their discretion the triage nurse can also put on any amount of additional PPE they feel is necessary up to a full suit. The reason this is considered appropriate (mask & gloves) is typically the patient is not spewing copious amounts of bodily fluids at this point. If the patient was projectile vomiting, then yea, I'd don the suit, but typically, fever, malaise, etc., not necessary. Personally, I'd probably add a gown, just as an extra layer of protection, but not a full suit and a PAPR unless fluid was a flyin'.

-- C) Triage nurse will notify back ER that we have a person under investigation which will start the preparation for the treatment room and will be connected to a provider to discuss PUI. At this point, all hell will break loose in the hospital with call ins of additional staff, volunteers to treat PUI being reassigned, etc. During this process (we have one designated room, so if it's occupied that pt has to be moved, room cleaned, setup, staff assignments changed, etc.) triage will be keeping the pt in the closed triage room which is not much bigger than yours. Again likely pt just has fever, not bleeding or projectile vomiting, so this is a reasonable trade-off to keep the contamination from the rest of the hospital. If the pt was oozing blood out of every pore, projectile vomiting, and loosing 10+L of fluid a day (as emory said their patients have), then I would go full suit here.

-- D) Triage nurse will continue with full triage as normal, and wait until given clearance to bring patient back (treatment room has been made available, hallways cleared of potential contacts, etc. Pt will be placed in wheelchair and wheeled back to treatment room. Care turned over to treatment team.

-- E) Triage nurse and anyone else who came in contact with patient will start decontamination procedure, and will then be placed in 21 day monitoring program preemptively. Triage room will be close, temporary triage room established until triage room has been decontaminated.

Probably some overkill in this, however we would rather err on the side of caution.

Hope that helps...

[Christy1019, ASN, RN]

We are screening people before they enter the triage room,..we have a sign posted asking people to "stop here",...the pt is asked immediately about fever, and travel to Africa within the last 21 days. If the pt answers yes to both questions, they are instructed to walk out of the ED and staff in PPE direct the pt around to our hazmat entrance where we have staff in full PPE awaiting the pt. There we have a separate entrance to an anteroom then the pt room with negative airflow. We treat these pts just like any hazmat pt. They are not allowed into the triage room or the waiting area until screened.

We pretty much do the exact same thing as this.