Patients with Ebola Virus Disease (EVD) may initially present to outpatient facilities, including physicians' offices, clinics, and urgent care settings. According to local health authorities, staff can safely manage these patients through appropriate screening of febrile patients and by observing recommended isolation and infection control procedures. "We plan for the worst, and we hope for the best," says Dawn Terashita, MD, Los Angeles County Department of Public Health, Acute Communicable Diseases Unit.
Educate and Prepare
- Staff should be educated on the signs and symptoms of the disease, the protocol for screening patients, isolation precautions, mandatory use of personal protective equipment, and the importance of prompt notification to physicians regarding high-risk patients.
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The following links offer general information on Ebola that can be used to help educate staff. The Joint Commission special edition "Quick Safety" alert includes important information for health care professionals as well as guidance for assessing your office's emergency operations plan.
- Joint Commission Quick Safety Alert - Issue Seven, October 2014: Preparing for Ebola response in U.S. health care facilities
- Frequently Asked Questions (FAQ) Ebola Virus Disease (Ebola)
Screen
- Post notices at the entrance to the clinic or office and near check-in informing patients of the Ebola outbreak. List the symptoms of EVD and ask patients to notify staff of any recent travel in West Africa.
- All febrile patients should be asked about recent travel, whether presenting to the office in person or when scheduling appointments via phone or email.
- Patients screening positive for symptoms and risk factors who contact your office via phone or email should be asked to remain at home until further arrangements can be made.
- If the patient meets the clinical criteria for EVD, physicians at the Acute Communicable Disease Control unit will consult with the patient, arrange for transport to an appropriate hospital and make notifications to receiving clinicians.
Isolate
- Immediately place any suspected EVD patient in a private room with the door closed. Patients who are not nauseous or vomiting should be offered a face-mask.
- Implement "Standard, Contact and Droplet" precautions. Post a sign on the door notifying staff of isolation precautions and listing the appropriate personal protective equipment that must be worn: mask, goggles or face shield, gown (fluid-resistant/impermeable) and gloves.
- Restrict entry of staff and post a sign-in sheet on the door to identify all staff who enter the room.
- Monitor compliance with the use of personal protective equipment.
Evaluate
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Take a more complete history of travel and identify potential exposures to Ebola patients in healthcare facilities, at home, at funerals or elsewhere in the community.
- Algorithm for assessment and management of persons with suspect EVD (see page 3 of this document)
- If risk is perceived to be present, do not draw blood or conduct medical procedures unless absolutely necessary. Avoid aerosol-generating procedures.
Report and Coordinate
- Outpatient physicians must report suspected EVD cases to their local health department's Acute Communicable Disease Control unit. LA county physicians can call 213-240-7941 (business hours) or 213-974-1234 (after hours only). Physicians are available 24 hours a day, 7 days a week for consultation.
- For more on the signs, symptoms, transmission, and prevention of Ebola Virus Disease, visit the following resources:
Authored by
CAP's Risk Management & Patient Safety Department
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.