Interim Guidance for Preparing Ebola Treatment Centers

Page Summary

Who this is for: State and local health departments and acute care hospitals designated as Ebola treatment centers

What this is for: Guidance to assist state and local health departments and acute care hospitals as they develop preparedness plans to serve as Ebola treatment centers

How this relates to other guidance documents/purpose: This guidance is intended to inform efforts by state and local health departments and healthcare facilities to prepare Ebola treatment centers, and includes a summary of the capability elements needed for those hospitals. Context for this guidance document is provided in CDC’s Interim Guidance for U.S. Hospital Preparedness for Patients with Possible and Confirmed Ebola Virus Disease: A Framework for a Tiered Approach. In addition, this guidance complements two other specific CDC guidance documents: Interim Guidance for Preparing Ebola Assessment Hospitals and Interim Guidance for Preparing Frontline Healthcare Facilities for Patients with Possible Ebola Virus Disease.

Key points

Ebola treatment centers are prepared to provide comprehensive care to people diagnosed with Ebola virus disease (EVD) for the duration of a patient’s illness.
Designation as an Ebola treatment center will be a decision made between state and local health authorities and the hospital administration, informed by the results of a CDC site visit conducted by an interdisciplinary team of subject matter experts.
Decisions to receive a confirmed Ebola patient should be informed by discussions with public health authorities and referring physicians, depending on the status of the patient.

Ebola treatment centers that provide comprehensive care to people diagnosed with Ebola virus disease (EVD) need specific competencies and resources. The purpose of this document is to clarify the specific elements of hospital readiness for hospitals designated to serve as Ebola treatment centers during the U.S. domestic response to the Ebola outbreak. Designating a facility as an Ebola treatment center should be a collaborative decision made between the state and local health authorities and the hospital administration. This decision will be informed by the results of a CDC site visit conducted by an interdisciplinary team of subject matter experts. Ideally, the site visit should occur once a facility has made preparations to accept patients with EVD (based on the criteria outlined below). During the site visit, the team assesses a hospital’s ability to meet minimum capabilities in each of the domains outlined in the table below. If critical gaps are identified, CDC will provide technical assistance to address these gaps and regular follow-up to the facility and to state and local health department authorities to help ensure the facility is capable of safely treating a patient with EVD. CDC and HHS will facilitate ongoing technical assistance and clinical consultation by facilities with recent experience caring for patients with EVD as needed. Hospital leaders, state and local health officials (or designees), and the site visit team members will determine the extent to which the capabilities for readiness have been adequately demonstrated. Other considerations include the effect on the hospital’s ability to provide other services while caring for patients with EVD.

Decisions to receive a confirmed Ebola patient should be informed by discussions with public health authorities and referring physicians, depending on the status of the patient. When a patient is confirmed to have EVD, and upon request of the health department and the treatment center, a CDC Ebola Response Team (CERT) will be deployed to provide technical assistance for infection control procedures, clinical care, and logistics of managing EVD patients. In addition, CDC is available 24/7 for consultation to treatment centers and state and local health departments by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 or via email at eocreport@cdc.gov.

The following table, based on current knowledge, summarizes the capabilities that Ebola treatment centers need to safely treat patients with EVD throughout the continuum of their illness. All Ebola treatment centers should conduct practice drills and correct any identified gaps.

Ebola Treatment Center Capability	Capability Description	Minimum Capability in Place? Y/N1
Facility Infrastructure- Patient Room(s)	Hospital has a private room with in-room dedicated bathroom or covered bedside commode, is equipped with dedicated patient-care equipment and has available separate areas immediately adjacent to patient room: one for putting on (donning) of personal protective equipment (PPE) and one for taking off (doffing) of PPE. These areas must be large enough to allow a trained observer to safely and effectively supervise donning and doffing of PPE.
Patient Transportation	The state and local public health agency, emergency medical services (EMS) provider(s), and the hospital have collaborated on the development of interfacility transportation plans that include identification of transport provider(s) with adequate training and PPE to safely transport a patient. Appropriate plans are in place for safe intrafacility patient transfer from ambulance entrance to treatment unit.
Laboratory	Laboratory procedures/protocols, dedicated space, if possible, possible point-of-care testing, equipment, staffing, reagents, training, and specimen transport are in place. See CDC’s Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Persons Under Investigation.
Staffing	Readiness plans include input from a multidisciplinary team of all potentially affected facility departments, including clinical and nonclinical departments, and staff. Staffing plans have been developed to manage several weeks of clinical care. Staffing includes dedicated critical care nurses, physicians, environmental services, infection control practitioners, laboratory staff, and respiratory services personnel designed to minimize the number of staff with direct patient contact. The facility has a process for continuous staff input from those who may or may not be directly involved in EVD patient care, including from employee unions, and has addressed employee safety questions and concerns.
Training	A limited number of staff should have direct contact with patients. All staff that will be involved in patient care or supporting patient care have been appropriately trained for their role. Staff members who are involved in patient care have demonstrated proficiency in donning and doffing of PPE, proper waste management, infection control, and safe transport of lab specimens. Ongoing training program is in place and breaches in infection control are addressed through retraining. Teams have conducted a functional exercise of core processes. For more information, see CDC’s Information for Healthcare Workers and Settings.
PPE	Given current PPE shortages, hospitals may not be able to procure in advance the amount of PPE needed for the entire time period to care for an Ebola patient. Therefore, at a minimum, to be ready to accept and care for EVD patients, hospitals will need sufficient Ebola PPE for at least 7 days. If hospitalization is anticipated to exceed 7 days, state and local health authorities, in collaboration with CDC, may provide or facilitate the procurement of additional PPE supplies. Staff that are involved in patient care or supporting patient care have successfully drilled and demonstrated proficiency on donning/doffing. The overall safe care of Ebola patients in a facility must be overseen by an onsite manager at all times. Each step of every PPE donning/doffing procedure must be supervised by a trained observer to ensure proper completion of established PPE protocols. Additional information regarding PPE supplies and how to increase access to PPE is available online.
Waste Management	Hospital should have secured the services of a waste management vendor capable of managing and transporting Category A infectious substances and have appropriate containers and procedures for the safe temporary storage of Category A infectious substances. Staff are trained in the correct use of PPE and are trained in the proper handling and storage of Category A infectious substances at the facility. If a vendor capable of transporting Category A infectious substances has not been arranged, hospitals may consider sequestering medical waste until the patient’s Ebola test result becomes known. At that time, if the patient is confirmed to have EVD, arrangements must be made with a vendor capable of managing for the waste as a Category A infectious substance; if the patient is ruled out for EVD, waste can be handled according to routine procedures in compliance with local waste management ordinances. For more information, see: Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus.
Worker Safety	Worker safety programs and policies are in place. The hospital is in compliance with all federal or state occupational safety and health standards applicable to reducing employee exposure to the Ebola virus. Hospital has a program for ensuring direct active monitoring of all healthcare workers involved in direct patient care to ensure monitoring for 21 days post last exposure. This monitoring should be done in coordination with local and state public health agencies.
Environmental Services	Hospital has a program in place to clean and disinfect patient care areas and equipment, including use of an Environmental Protection Agency-registered hospital disinfectant with a label claim of potency at least equivalent to that for a non-enveloped virus, such as norovirus, rotavirus, adenovirus, and poliovirus. Hospital has staff trained in correct cleaning and disinfection of the environment, safe practices, and correct use of PPE; and cleaning staff are directly supervised during all cleaning and disinfection. For more information, see Information for Healthcare Workers and Settings.
Clinical Competency	Staff members who will be involved in managing the patient are familiar with the clinical protocols for management of EVD patients and have access to consultation from experienced clinical EVD specialists. For more information, see EVD Treatment.
Operations Coordination	The hospital has a practiced emergency management structure and a plan and methods for routinely communicating with relevant local and state public health agencies, emergency management authorities, its healthcare coalition (if appropriate), and the hospital’s employees, patients, and community to ensure coordination of the response and communication regarding any persons under investigation for Ebola and patients that are being treated for EVD in the facility.
State/Hospital selection as an Ebola treatment center	The hospital and the state public health department, as the hospital’s regulatory authority, have agreed that the facility is ready to serve as an Ebola treatment center.