Screening before entry to ICU (or with any ICU team contact) with regard to transfer from ED, wards, OR, recovery room and other hospitals | • A screening tool will be developed and kept up to date • Hospital team members responsible for screening will always use the most current version of the tool to screen potential cases of Ebola • All hospital team members performing screening will be appropriately trained to use the most secure screening process • All potential cases of Ebola will be screened with the up-to-date tool and critical care hospital team members will be informed of the screening test result before any physical contact occurs • All patients admitted to the ICU who are from a high-risk area or have had potential contact with Ebola will receive appropriate ongoing screening • The screening result will be readily accessible to hospital team members | • 6 | • 5 | • 1 yes 4 no |
Response team activation | • There should be an easy and rapid way to activate a response that would not overburden hospital team members who are also called on to provide care and manage the patient’s treatment • The activation will ensure that only essential personnel are notified and expected to respond • Dedicated response teams will be available to secure and manage any individual who has a positive screening test for Ebola. The team will be immediately available regardless of patient location or time of day | • 3 | • 3 | • 3 in progress |
PPE | • Hospital team members will perform a risk assessment before donning PPE • There will be a clear process of donning and doffing appropriate PPE that will protect hospital team members while caring for patients with potential or confirmed Ebola • All equipment used in the process of donning and doffing will be available and easily accessible • Hospital team members will be proficient with the donning and doffing of PPE before any patient encounter or entering an Ebola precaution room • Hospital team members will recognize when the clinical scenario changes and they must escalate their level of PPE | • 5 | • 5 | • 1 no 4 in progress |
Managing postexposure to virus through body fluids | • There will be clear definition of an unprotected exposure • Hospital team members will recognize when exposure has occurred • Hospital team members will be proficient in taking immediate actions if exposure to body fluids occurs • There will be appropriate facilities available to decontaminate hospital team members if exposed • Hospital team members exposed to bodily fluids will be informed of the procedure to follow over the ensuing days • All hospital team members who help manage a patient with Ebola complete monitoring, even if there was no unprotected exposure | • 6 | • 5 | • 3 no 2 in progress |
Patient placement, room setup, logging and signage | • The most suitable rooms to manage the treatment of patients with suspected or proven Ebola will be selected and then redesigned and equipped if required • Appropriate signage will be posted in the event of a suspected or confirmed case • Entries and exits of all hospital team members and visitors will be logged | • 3 | • 2 | • 1 yes 1 no |
Intrahospital patient movement | • Hospital team members will be able to determine the most suitable room placement for any patient with suspected or confirmed Ebola • Measures will be in place to optimize early recognition of deterioration of a patient’s condition to ensure safe transfer • The transport process will be clearly defined and will only include essential staff • There will be a clear and simple process to assemble the team required to transport the patient. Team members involved in the transport will be readily available at all times • Team members will be proficient, given their respective roles and responsibilities during the transport | • 5 | • 5 | • 2 no 3 in progress |
Interhospital patient movement | • The critical care team will be informed of any patient(s) with suspected or proven Ebola who might require ICU admission • There will be a clear process in place to ensure that the community hospitals receive all necessary information to initiate safe transport • There will be a plan of transport from entry point at our hospital to the ICU, which will minimize the risk of contamination • There will be a clear process in place to ensure that the transfer of care in the ICU occurs safely for both the patient and staff | • 4 | • 2 | • 2 no |
Critical care management | • Hospital team members will be supported in their decisions to withhold interventions to minimize the risk of spreading infection • Hospital team members will modify their clinical assessment to provide the best possible patient care while minimizing the risk of contamination • Hospital team members will modify noninvasive and invasive monitoring to provide the best possible patient care while minimizing the risk of contamination • There will be a clear process in place to perform chest radiography and electrocardiography • Hospital team members will take appropriate measures to decrease the risk of exposure to body fluids • Hospital team members will avoid using aerosol-generating procedures whenever possible • Hospital team members will take measures to safely obtain central access when required • Hospital team members will safely draw blood • Critical care staff will be aware of any laboratory testing that cannot be obtained for patients with suspected or proven Ebola • Sharps will be safely handled and disposed of • Hospital team members will consider cardiopulmonary resuscitation in the appropriate setting. Hospital team members will not perform cardiopulmonary resuscitation in end-stage Ebola virus disease • Hospital team members will consider dialysis in the appropriate setting, and measures will be taken to minimize the contamination risk • ECMO will not be offered in patients with proven Ebola • Hospital team members will consider using nasogastric and feeding tube in the appropriate clinical setting, and the insertion procedures will minimize the risk of contamination • The procedure used to handle food will minimize the risk of contamination • Hospital team members will be proficient in the management of sudden terminal events • There will be a plan detailing the management of obstetric patients and newborns • Policies and procedures for transfusion of blood products will be clearly documented • There will be a clear process to decide and plan discharge from hospital | • 19 | • 11 | • 5 yes 5 no 1 in progress |
Ebola-specific diagnosis and treatment | • Hospital team members will order the most suitable test to diagnose Ebola • Physicians will order and have access to the most appropriate therapy to target Ebola virus disease | • 2 | • 0 | • |
Critical care staffing issues | • There will be sufficient staff available at all times with the required expertise and PPE training to provide patient care and maintain the patient area • The roles and responsibilities of hospital team members directly or indirectly involved in the care of patients with suspected or proven Ebola will be clearly defined • Hospital team members who have cared for patients with Ebola will monitor themselves for signs of infection | • 3 | • 3 | • 2 no 1 in progress |
Visitation and contacts | • Visitation rights will be clearly defined • Support will be provided to patients and their family members • There will be a clear process on how to manage the treatment of anyone who has had unprotected contact with a patient with suspected or confirmed Ebola • There will be a clear process on how to screen visitors to the ICU and manage the treatment of any visitor who tests positive for Ebola • There will be a clear process on how to manage the treatment of any visitor who has a positive screening test for Ebola | • 5 | • 4 | • 4 no |
Waste management, environmental cleaning, management of linens | • Waste will be safely removed from the room • Processes will be in place to handle spills • Processes will be in place to clean and disinfect surface areas • Measures will be taken to avoid contamination and facilitate cleaning • There will be a clear process in place to handle and clean used linen • Processes will be in place to clean and disinfect nondisposable equipment | • 6 | • 5 | • 1 yes 3 no 1 in progress |
Postmortem | • There will be a clear process in place to handle a deceased patient | • 1 | • 1 | • 1 in progress |
Conflict resolution | • There will be a clear process in place to respond to family members/visitors who refuse to cooperate with the established policies • There will be a clear process in place to respond to patients who are uncooperative and/or aggressive | • 2 | • 2 | • 2 no |
Communication | • There will be a clear process of communication to ensure that hospital and departmental leaders collaborate • There will be a clear process of communication, which will ensure that hospital team members are well informed and up to date • Communication will be established with other institutions designated as Ebola centres | • 3 | • 2 | • 2 in progress |
| Totals | 73 | 55 | 8 yes 29 no 18 in progress |