EBOLA PREPAREDNESS - FREQUENTLY ASKED QUESTIONS

Stony Brook University Hospital is one of eight New York State hospitals identified by Governor Andrew M. Cuomo to treat patients with Ebola. As a regional resource, we can expect that other hospitals and healthcare facilities will call on Stony Brook Medicine for our expertise and assistance. 

While most people are at low risk for getting Ebola, we’re taking the threat of this rare and often deadly disease very seriously. Now that two healthcare workers in Texas have been diagnosed with the disease, it’s only natural for you to wonder what we’re doing here at Stony Brook Medicine to protect our employees and patients. 

Rest assured, we’re following the latest (Centers for Disease Control and Prevention) CDC protocol and guidelines —and beyond — and we’re taking every precaution to ensure the safety of our patients and staff. 

Here are answers to some of the most frequently asked questions that we’ve received: 

Is Stony Brook’s staff trained and ready to respond in caring for Ebola patients?

Yes. Patients who come to us for care at Stony Brook Medicine rely on all of us for our expertise and our commitment to provide the highest standard of service to our community. As such, our work force is skilled and competent with the latest best practices. Stony Brook has developed comprehensive training plans for a dedicated group of nurses and physicians to care for Ebola patients. These skilled individuals will be the assigned providers for care delivery. Untrained personnel will not be providing care for patients in the isolation unit. 

How is Stony Brook identifying patients who might have Ebola?

Our triage process has been made even more robust so that we can quickly handle patients who may have the virus. This includes establishing a patient’s travel history as well as identifying signs and symptoms that the patient is presenting with. Should a patient be identified by the triage process, the patient will immediately be moved into the Critical Care Emergency Department (CCED) Room 4 for further evaluation and management. 

If an inpatient is showing signs/symptoms of Ebola, what happens next?

All patients are being screened for possible risk of the Ebola virus. If we suspect that a patient may have Ebola, our staff will immediately request the attending Infectious Diseases physician on call. Isolation protocols will take place immediately, and our Incident Command Center will be activated.

The Command Center team will work closely with all staff in direct and indirect contact with the patient to ensure that all safety protocols are followed. Other Stony Brook physician experts are also on call 24/7, including Hematology, Medical Intensive Care, Interventional Radiology and the Chief Medical Officer.

How is Stony Brook identifying possible Ebola patients at its outpatient care sites?

Patients who have symptoms of influenza-like illness — fever, headache, vomiting, unexplained bleeding, cough, rash or difficulty with breathing — and have recently traveled internationally will be separated from others in a pre-designated area so that they may be queried by clinical staff.

If history and symptoms are identified, the clinic staff will notify EMS personnel and Stony Brook’s Emergency Department (ED) of the need for a patient transfer and make them aware of the risks before EMS responds.

If a patient needs to be transferred to another hospital’s ED, a call will be made first to Stony Brook’s Transfer Center, which will contact the Suffolk County Department of Health to facilitate communications with the receiving ED and, if needed, the responding EMS agency.

What is the process for transferring patients throughout the hospital?

When a patient who is infected with the Ebola virus needs to be transferred from the ED to a unit for medical isolation, the patient will be completely covered and accompanied by staff wearing personal protective equipment. Additional staff members, including Security, will join the team to protect the pathway as the patient is being moved. Once the patient is on the inpatient unit, the elevator used will be taken out of service for decontamination. And once the patient is in his or her room, a care team will be assigned and will remain on the unit with the patient.

In the event of a suspected or confirmed case of Ebola, where will these patients be placed?

We have reserved two patient rooms on 9 North for any inpatients that are suspected or infected with the virus. If a patient comes to the ED and needs to be admitted, the patient will be held in the ED until the indicated room is emptied and cleaned (if occupied).

The Medical Intensive Care Unit (MICU) will activate an additional attending physician if a patient infected with Ebola is admitted. The MICU nurses will take care of sick or suspected cases on 9 North, and the nurses on 9 North will help with logistics, including limiting the flow of only those necessary personnel, and cordoning the treatment area.

Am I at risk of contracting Ebola if I come to the hospital?

According to the CDC, people who are at risk include those who are in direct contact with:

• Bodily fluids (blood, saliva, urine, feces, sweat, semen, mucus, vomit, breast milk and other fluids) of someone who is sick with or who has died of Ebola
• Objects that have come into contact with the Ebola virus, such as needles and medical supplies
• Blood or other fluids or the meat of infected animals

Most people who have not had these types of direct contact are at low risk. However, if you have traveled out of the country within the past 21 days, or have been in contact with someone who has, and you have any of these signs — fever, headache, vomiting, joint/muscle aches, weakness, diarrhea, stomach pain, unexplained bleeding, cough, rash or trouble breathing — you should immediately seek medical care.

For a complete list of Ebola symptoms, visit the CDC website.

Is anything being done in high-traffic areas of the hospital to encourage people to take precautions and self-report if they are experiencing symptoms and have recently traveled?

We have placed helpful “What to do” signage in prominent locations on Levels 4 and 5 of the hospital. These signs feature a message letting people know that if they are feeling ill with influenza-like symptoms and have an international travel history, they should wear a face mask that can be obtained from the reception area and that they should report their health status to a healthcare worker immediately. Similar signage is planned for all our outpatient care sites as well.

How is Stony Brook Medicine training staff to ensure their safety?

What type of personal protective equipment (PPE) is being used? Stony Brook is following CDC guidelines, as well as the experience of Doctors Without Borders that has set the “gold standard” on Ebola safety. For persons entering the patient room with known or suspect Ebola virus, Stony Brook’s policy is to wear two sets of gloves (an inner liner and longer outer glove), a fluid-resistant or impermeable suit (the same type used by hazardous materials decontamination teams) and powered air purifying respirators (PAPR) with full hood and face protection. Disposable shoe covers will go over the suit’s foot.These guidelines apply to anyone who could potentially be exposed to infectious agents, including those involved with direct and indirect patient care.

To protect all hospital employees who have direct or indirect patient contact, Stony Brook is ramping up its use of protective equipment, training and education. Several initiatives — all following CDC guidelines — are underway. First, training for a N95 respirator mask fit, putting on and removing personal protective equipment (PPE), as well as general knowledge of safety processes, is underway. In addition, a skilled competency module is being developed to ensure that staff can perform the necessary skills.

Training is being rolled out first for clinical and support staff at the main “points of entry” into the hospital. However, as we fully understand that patients could present at any location throughout the hospital or its outpatient sites, the next phase of preparedness includes training for employees in areas such as information desks and procedural areas.

Stony Brook is the community’s safety net provider and is often the place where other hospitals send their most complex cases. In the event that other area hospitals have patients with Ebola, what is Stony Brook’s role?

In addition to serving as one of eight designated hospitals to treat Ebola patients in New York State, Stony Brook has taken the lead to meet with the Suffolk County Commissioner of Health and other major county agencies on Ebola-readiness – including notification of public health officials and law enforcement agencies, identification and monitoring of contacts, management of waste products, social service support for families and others in need related to these patients, security and assistance from law enforcement officials, coordination of clinical and support services across the region, and the dissemination of information to the public and healthcare providers to reflect the most accurate real-time information and recommendations. Healthcare facilities in the area are incorporated into this planning, as well as the Nassau-Suffolk Hospital Council.

What other types of preparedness activities or drills are being conducted to help ensure the safety of employees, our patients and our community?

Drills and training exercises are being conducted for staff to practice guidelines and protocols so that all those who are in direct or indirect patient contact feel confident and prepared to handle any patient suspected of or confirmed with the Ebola virus. In addition, extensive scenarios have been developed by our Ebola Preparedness Team, representing a number of areas throughout the hospital, to identify what is to be done and by whom to ensure rapid identification, isolation and management of patients. And, Emergency Management has developed a “training cart” with resources for onsite training, which includes the use of personal protective equipment (PPE) for staff.