Ebola: Maine Medical Center Separates Fact From Fiction

In an effort to help staff separate fact from fiction, this afternoon Maine Medical Center’s Communications and Marketing department sent out its first MMC Daily Briefing on Ebola and Infection Prevention.

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[We wanted staff to] know what we’re doing as an organization to prepare for the possibility of Ebola in Maine,” explained Matthew Paul, Director of Communications and Public Affairs. “It is vital that our staff feel both safe and informed so they can be confident at work, which will, in turn ensure that they can keep patients and visitors comfortable.”

The briefing began with a letter from August Valenti, MD, the hospital’s epidemiologist and Gwen Rogers, RN, director of infection prevention.

Dear Colleagues,

There is a lot of talk at Maine Medical Center and in the communities we serve about the Ebola virus. Today we want to provide you with the most current facts and information and introduce you to a new way to communicate about Ebola and other concerns. Before moving forward, please remember that:

• We do NOT have the Ebola virus at Maine Medical Center. We isolated a low-risk patient at the request of the Centers for Disease Control and Prevention (CDC), but that person was discharged after we determined Ebola was not present. Please remind anyone with questions or concerns that we are NOT currently treating – nor have we ever treated – a confirmed Ebola case.
• We are expanding and rolling out training to staff who would care for Ebola patients if the disease comes to our community.
•  Teams of clinical and non-clinical leaders are constantly monitoring our readiness. We are working with other MaineHealth members and state and federal agencies on a number of topics to ensure a coordinated approach to safe, high-quality care.

It is important that we all play a role in understanding the facts about this virus and our response. We will use this Daily Briefing to keep you up-to-date on any information that will help you provide care or support for those who are providing care.

The briefing continued with an update on precaution training.

Precaution training update

Maine Medical Center is committed to the safety and well-being of our patients and staff at all times. That is particularly true as we prepare for the potential spread of Ebola. We are going above and beyond standard U.S. guidelines in our efforts to protect people from becoming infected. We continuously evaluate the recommendations of both the Centers for Disease Control & Prevention (CDC) and the World Health Organization (WHO). When they differ, we always take the more conservative approach. You should also know:

• We are investing in stronger-than-required personal protective equipment (PPE).
• We have accelerated our scheduled and just-in-time training sessions to ensure we have enough staff prepared to treat patients without overtaxing you.

To date, we have trained more than 110 people in appropriate precautions and enhanced gowning and gloving procedures. Moving forward, the following groups will be provided training:

• All ED Staff
• All R4 Staff, to ensure we’re training everyone who works in the AVU
• All Critical Care Physicians (Medicine and Surgery)
• SCU Nurses, on a voluntary basis
• OB/Pediatrics Staff, on a voluntary basis
• All Advance Practice Providers (APP) in adult inpatient care
• All Hospitalists in Adult Inpatient Care
• Anesthesia Staff, as appropriate
• Respiratory Therapists who work in Critical Care
• Pulmonary Staff who work in Critical Care
• All Nephrologists and Dialysis Nurses
• EVS Staff, as appropriate

Learning from mistakes made in Texas

Today, a top health official in Texas apologized for “mistakes” in how Texas Health Presbyterian Hospital Dallas handled its first Ebola patient Thomas Eric Duncan, who died October 8. “Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes, Dr. Daniel Varga’s testimony to Congress reads. “We did not correctly diagnose his symptoms as those of Ebola.”

No other hospital, including Maine Medical Center, wants to find itself in that position. MMC’s Daily Briefing states that the hospital electronic medical records system has been updated with a “best practice alert that prompts Ebola-related screening questions at points of entry into Maine Medical Center and Maine Medical Partners, as well as in interactions with Home Health and Visiting Nurses.”

The briefing also listed Ebola symptoms.

Recognizing the symptoms of Ebola

The symptoms of Ebola are shared by a number of other potential conditions. However, it is important to look for the following symptoms – in addition to a patient’s travel history – when evaluating someone for suspected Ebola.

• Sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as:
  • Muscle pain
  • Headache
  • Vomiting
  • Diarrhea

Patients with severe forms of the disease may develop multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death.

More lessons learned

Two nurses who cared for Thomas Eric Duncan are now being treated for Ebola. Nina Pham, who is reportedly in stable condition, will be moved tonight to the National Institutes of Health facility in Bethesda, Maryland at the request of the Dallas hospital, which is supposedly consumed with monitoring dozens of employees for signs of illness. Wednesday night, the second nurse, Amber Vinson, arrived at Emory University Hospital in Atlanta, where two Ebola patients have been successfully treated.

To date, there has been no official report on exactly how the nurses were infected, but on Tuesday, National Nurses United issued a statement saying that, “There was no advanced preparedness on what to do with the patient, there was no protocol, there was no system.”

The virus that causes Ebola is not considered very contagious. The problem is, it’s very infectious, which means it doesn’t take much virus to cause Ebola.

MMC ended its first Ebola briefing by answering this question:

How is Ebola transmitted?

Ebola is transmitted through direct physical contact with the blood or body fluids of an infected symptomatic person or objects that have been contaminated with infected blood or body fluids. The virus that causes Ebola is often spread through families and friends because they come in close contact with blood or body fluids when caring for ill persons or while handling the bodies of people who have died from Ebola during funeral or burial rituals.

Exposure to Ebola can occur in health care settings if hospital staff are not wearing appropriate personal protective equipment, such as gloves, gowns and masks or when protective equipment isn’t carefully donned or removed. Careful cleaning of patients’ rooms and equipment and careful disposal of instruments, such as needles and syringes, is also important. Without adequate cleaning, people who have contact with virus remaining on room surfaces or equipment can become infected.

Changes to Ebola Protection Worn by U.S. Hospital Workers

Yesterday, The New York Times printed an interactive graphic describing changes in protective gear guidelines.

Continuing the conversation

Many hospitals in the United States claimed to be ready for Ebola but considering what has happened since Thomas Eric Duncan first visited the emergency room in Texas last month, many people aren’t feeling so confident. Maine Medical Center believes that continuing the conversation about Ebola will help strengthen confidence levels inside and outside the hospital.

“Maine Medical Center is incredibly proud of the commitment and compassion of our staff,” says Matthew Paul, “and will continue to provide them with helpful information and facts as often as we possibly can. Conversations that reinforce our commitment to safe, high-quality patient care are happening at all times across the medical center. As the public conversation about Ebola continues to evolve, we will be vigilant in providing training and ensuring our staff have the information that is necessary to help them care for our patients and protect themselves.”

Do you have confidence that your hospital is ready?  Not just Maine Medical Center, but other hospitals in Maine as well.

Key resources for Ebola information that were shared in the MMC briefing:
Centers for Disease Control Ebola website
World Health Organization Ebola website
Maine CDC website