UC-San Diego Medical Center officials expect to be part of California’s ramped-up preparedness efforts to treat patients with Ebola. A series of initiatives launched in the past six months to improve the safety and effectiveness of care at hospitals around the state to respond to the deadly virus raging in West Africa is culminating this month.
CDC announced last week that 35 hospitals nationally — including four in Northern California — have been designated as Ebola treatment centers. Several hospitals in Southern California — including the University of California-San Diego Medical Center — are expected to achieve CDC designation as Ebola treatment centers in the coming weeks.
The designated California hospitals are the University of California-San Francisco Medical Center, the University of California-Davis Medical Center, Kaiser Oakland Medical Center and Kaiser South Sacramento Medical Center.
The University of California-San Diego Medical Center was expected to have a site visit from CDC officials last week in order to obtain designation as an Ebola treatment center, said Chief Medical Officer Angela Scioscia.
“It’s a reflection of all the preparation we’ve been doing over the summer and fall,” Scioscia said.
Preparedness efforts at UCSD Medical Center include converting a cardiac catheterization unit at the end of an isolated hallway into a two-bed infectious disease care unit and modifying the space to optimize care for highly infectious diseases such as Ebola. Hospital officials created an Ebola Response Task Force, a core group of physicians, nurses, respiratory therapists and others to care for Ebola patients, providing team members with training and drills on response and equipment. Staff members in the emergency department and outpatient clinics received training on how to screen patients for Ebola, as well as proper protocols on what to do with suspected cases, Scioscia said.
The new infectious disease care unit also has equipment and trained personnel to conduct basic laboratory tests so any blood products won’t leave the unit, which also has a separate ventilation system. Confirmation of Ebola disease is conducted at a facility in Los Angeles, Scioscia added.
UC-San Diego Designated as Receiving Center
In October, UC-San Diego Medical Center, along with the state’s four other UC medical centers, was designated as a receiving center for patients in the state with confirmed cases of Ebola by the California Department of Public Health. The five facilities hold weekly conference calls on preparedness and training, Scioscia said.
To ensure availability of personal protective equipment — known as PPE — the five UC medical centers are coordinating to potentially share equipment if there is a confirmed case of Ebola in the state.
“The PPE has been challenging,” Scioscia said. “We meet all the standards of the CDC on protective equipment but there are some pieces on back order. We are working different suppliers and collaborating with other UC medical centers on inventory.”
Further complicating matters, protective equipment is necessary in training and drills and cannot be re-used. “The amount of PPE you go through with a team is quite significant and we are going through some of the equipment just though training,” Scioscia said.
Nurses Lobby for Training, Protection
Concerns about protective gear and training prompted the California Nurses Association, the Oakland-based union representing registered nurses, to stage demonstrations and strikes at hospitals around the state this fall.
“We knew we had to bring attention to the importance of being prepared,” said Bonnie Castillo, director of the Registered Nurse Response Network at the CNA.
Castillo said the case of Thomas Eric Duncan, a Liberian national who became the first Ebola patient diagnosed in the United States on Sept. 30 and who died a week later, accelerated can’s actions. Two nurses treating Duncan at Texas Health Presbyterian Hospital in Dallas contracted Ebola and were later cured of the disease.
“In order to have an effective response, you have to be prepared,” Castillo said. “The only way to do that is make sure every hospital knows what to do.”
In response to the CNA actions, Cal/OSHA last month updated its guidance for hospitals to include requirements on Ebola preparedness that go beyond CDC recommendations. All PPE issued to workers at risk for Ebola virus must cover all parts of the body and protect against the passage of fluids, according to the guidance. Additionally, hospitals must provide battery-powered air-purifying respirators during any aerosol-generating procedure, such as an intubation. Respirators must include full cowls or hoods to protect all areas of the face, head, neck and upper torso, the guidance states.
Hospitals not in compliance with the new rules can face undetermined penalties.
The new rules are important to protect nurses and other front-line caregivers from exposure to a highly infectious disease, Castillo said. “Now there is still no uniformity,” Castillo said. “That’s why these new Cal/OSHA guidelines are so important. We have a mandate and a threshold. We can ensure that these rules are being enforced.”
The California Hospital Association is still reviewing the new Cal/OSHA guidance, said Jan Emerson-Shea, spokesperson for the hospital association.
“We support recommendations grounded in science,” Emerson-Shea said, adding that the association views CDC as the expert on the issue of Ebola preparedness and response.
Scioscia said hospitals are having conversations with Cal/OSHA and the CDPH about the new guidance. These talks include what protective equipment must be provided to caregivers in emergency departments, she said.
Airborne Classification Triggers New Requirements
The guidance states, in regard to ED planning: “If isolation and transfer procedures and protocols, along with engineering and work practice controls, are insufficient to prevent employee exposure, the employer must ensure that employees at risk of exposure use appropriate PPE including respiratory protection.”
Respiratory protection is unique to the Cal/OSHA rules. The guidance states that respiratory protection is necessary because patients severely ill with Ebola can release small liquid particles through coughing or vomiting. Procedures such as intubation and suctioning can also release these small particles, the guidance states.
“There are discussions about the airborne classification,” Scioscia said. “That is fundamental because it triggers a whole different set of requirements.”
Michael Jackson, an ED nurse at UC-San Diego-Hillcrest Medical Center and a CNA member, said all ED nurses should have access to this protective gear. “I haven’t seen any additional protective gear,” Jackson said. “We are hoping to see changes in the next few weeks with these new Cal/OSHA rules. We know there has been a backlog in equipment.”
Scioscia said safety is the utmost concern.
“We want to ensure safety and not add potential risk,” she said. “A collaborative nature across the state is very important.”