October 21, 2014

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By Lori Armstrong

As a nursing community, our thoughts are with both Nina Pham and Amber Vinson, the two nurses in Dallas who contracted Ebola after caring for a patient who died from this disease after returning from Liberia. These two new cases are the first confirmed transmissions of Ebola in the United States.

Nurses play such a critical role in the care of every patient. The treatment provided in situations such as these highlights the amazing work of nurses and the inseparable link between outstanding nursing care and patient care outcomes.

Ebola is a serious illness, and as a nurse myself, I understand and share the concerns that nurses and health care providers across the country have about Ebola. Texas Children’s is committed to providing the very best care to patients with suspected or confirmed Ebola while ensuring the safety of our caregivers. Nursing leaders are partnering with Infection Control and our physician colleagues to ensure the best protocols and procedures are in place, and I am confident that Texas Children’s Hospital is prepared.

Since suspected Ebola patients will be cared for by the nurses and physicians in the Emergency Centers, Pediatric ICUs, the Women’s Assessment Center, and in the Labor and Delivery Unit, it is unlikely that many of you will come in contact with an Ebola patient at the hospital. However, for those who may care for these patients, extensive training is being provided. We are so thankful to our dedicated colleagues in these areas for their participation in all the training and preparation that is ongoing.

We will support and protect our health care team

While caring for our patients remains our focus at Texas Children’s, we are also intensely focused on protecting our physicians, nurses and staff. Keeping each one of you safe as you care for these patients means that we will provide you with state-of-the-art personal protective equipment (PPE), extensive training and education in the use of PPE, and ongoing communication.

Personal protective equipment such as impervious jumpsuits or gowns, gloves, eye protection, facemasks and shoe covers are readily available and frontline employees are being trained on the proper use of this isolation equipment. We will use PPE practice drills as well as simulation to ensure competency of all employees who will be providing direct care to these patients.

Education and communication is of utmost importance, and we are doing everything possible to stay up to date with the latest information and share it with those who will be directly responsible for these patients’ care. As new information becomes available, leaders will work to quickly understand any new recommendations, make changes and communicate those changes to you.

Our preparedness has been tested

As mentioned, designated teams are in place and I am confident we are taking the right precautions to be prepared should an Ebola patient arrive at Texas Children’s. Two weeks ago when a patient who returned from Sierra Leone presented at our West Camus Emergency Center with a fever, the patient was immediately isolated and subsequently transferred to the PICU. The appropriate teams were notified and protocols were followed.

Our staff was ready and performed flawlessly. They were careful, deliberate and efficient, and the right care was provided. The patient was discharged several days later after a negative Ebola test. The entire leadership team and I are so proud of the way this team provided expert care and executed all of the appropriate protocols while supporting the patient, patient’s family and each other.

This is reassurance that we are well prepared to care for patients with Ebola.

We will keep you thoroughly informed

As professional nurses, I encourage all of you to stay up to date on the latest Ebola information we are sharing regarding our response and readiness.

Please check Connect regularly. You can also visit the external Connect news site at www.texaschildrensnews.org anytime. We also will continue posting information here on our Voice of Nursing blog. And as always, your nursing leaders and I are here to support each and every one of you and answer any questions you may have about our preparations.

The voice of nursing is especially critical during our preparation and planning for patients with Ebola. Therefore, your input, suggestions, questions and feedback are welcomed and appreciated. You will continue to play a vital role in the coming days, weeks and months.

I am honored to work among such compassionate, dedicated nurses. I have never been prouder of our team for taking such great measures to care for patients who need us most. You inspire me to be a better nurse and a better leader.

October 17, 2014

In a news conference held earlier today at the Capitol in Austin, Texas Governor Rick Perry announced initial recommendations for better containment and care of diagnosed Ebola patients in Texas.

Perry was advised by the 17-member Texas Task Force on Infectious Disease Preparedness and Response that he created earlier this month, days after the first case of Ebola was diagnosed in the U.S.

“One of the lessons learned over the last few weeks is the importance of having specialized facilities for bio containment and for training health care workers in order to manage the complex care required by patients with Ebola,” said task force member Dr. Peter Hotez who also is director of the Texas Children’s Center for Vaccine Development. “A key recommendation from the task force calls for the creation of such facilities.”

Perry’s task force recommended state designation of Ebola Treatment Centers equipped to treat and care for adult patients with confirmed Ebola. These state-designated Ebola treatment facilities would be equipped to provide highly specialized infectious disease care, including infection control and protection of health care workers, decontamination, waste management, complex early stage experimental therapies, and various coordination and communication capabilities with local, state and federal partners.

The group specifically recommended University of Texas Medical Branch/ Galveston National Laboratory (UTMB/GNL) for the treatment and care of adult patients with Ebola. UTMB/GNL is a leading resource for all aspects of high consequence infectious diseases like Ebola. In a statement released by UTMB on Thursday, the organization said it has the expertise to safely and effectively care for Ebola patient needs, and there already is a plan in place for staffing and fluid decontamination. UTMB also houses a qualified incinerator.

Additional recommendations from the task force include:

  • Establishment of two Ebola Treatment Centers in Texas
  • Establishment of specialized patient transport teams
  • Expanded training of infectious disease protocols for health care workers
  • More testing labs for infectious disease
  • Increased authority for Department of State Health Services chief to issue Enforceable Control Orders

The task force will have its first hearing on October 23 to focus on medical and public health preparedness for initial identification and isolation of patients with Ebola or similar high-consequence infectious diseases and will submit initial assessments and recommendations by December 1 for consideration by Governor Perry and the Texas Legislature.

To view details of the task force’s recommendations, please visit here.

The task force has not made recommendations for the care of pediatric patients or pregnant women, but Hotez said they are studying the matter and will have additional recommendations soon. In the meantime, Texas Children’s is maintaining its focus on the preparedness plans already in place.

“The recommendations for adult care do not impact our planning and preparation,” said Texas Children’s Physician-in-Chief Dr. Mark Kline. “We will continue to train and over prepare our health care team to confidently treat any patient who exhibits symptoms of any potentially contagious disease.”

October 15, 2014

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This week, two health care workers at Texas Health Presbyterian Hospital in Dallas have tested positive for Ebola.

The Centers for Disease Control and Prevention (CDC) confirmed the first positive test on Sunday. The second positive test was confirmed by the state public health laboratory in Austin very early this morning. A confirmatory test will be conducted by the CDC today. Both health care workers helped care for Thomas Eric Duncan, the first person diagnosed with Ebola in the United States.

“This development is concerning to many, but it does not change what we are doing and have been doing at our own hospital,” said Texas Children’s President and CEO Mark A. Wallace. “We want to keep our patients and their families safe, but we’re also intensely focused on keeping our physicians, staff and employees as safe as possible as well. We remain very confident in our preparedness plan.”

To date, there are no confirmed cases of Ebola in Houston. And more specifically, there have been no confirmed cases of Ebola at Texas Children’s Hospital. Nonetheless, Texas Children’s is preparing thoroughly in the event that we do receive a patient with suspected Ebola symptoms.

Initial contact and protective equipment

The most hazardous times for a health care worker are the initial patient encounter at the Emergency Center or other entry point before the diagnosis is known, and during the removal of protective equipment used when caring for a known case.

“Our simulation training has emphasized proper protocol specifically at these time points,” said Texas Children’s Physician-in-Chief Dr. Mark Kline. “We know that the CDC protocols are effective when 100 percent of the protocols are followed 100 percent of the time.

“A single lapse in following proper procedure can lead to contamination and infection. When protocols are followed properly, every single time, the virus can be contained. That’s why we will continue to run simulations and ensure personnel in areas most likely to come into contact with an Ebola patient are properly trained to implement our protocols at all times.”

Training for targeted health care workers

Kline emphasized that training is both thorough and targeted. Staff who work in areas most likely to come into contact with a suspected Ebola patient are receiving the appropriate training to screen and/or care for these patients, according to staff specific roles. However, most staff and employees will never come in contact with an Ebola patient that may be treated here, so it is not necessary to train all clinical personnel.

And while there is deliberate preparation underway to ready the organization for a possible Ebola patient, leaders emphasize that staff and employees must remain focused on caring for all of our patients.

“Yes, it’s important to be prepared for the suspected Ebola patient who might walk into the hospital, but today, there are many other patients here who don’t have Ebola, and they need our focused care and attention,” said Executive Vice President John Nickens. “We continue to see thousands of patients every day across our system, and they need us to remain calm and focused on our mission of providing them with the best possible care.”

Leaders in Nursing, Critical Care, Emergency Medicine, Infection Control and other areas meet daily, constantly assessing the most current information available from the CDC and the World Health Organization to refine our plan appropriately. They echo Nickens’ emphasis on remaining calm and purposeful.

“There is a lot of hysteria out there right now,” Kline said. “But our staff and employees are educated. They understand science. We are health care providers, and as such, it’s our responsibility to spread facts, not hysteria. We have an opportunity here to be educated ambassadors and share correct, purposeful information.”

Where to find more information

Texas Children’s Ebola response and readiness information is updated regularly on Connect, so check back often for the latest information. Click below for previous articles

Oct. 4. – Suspected Ebola case tested at West Campus, result negative
Oct. 2. – Texas Children’s confident, prepared in face of Dallas Ebola concern
Sept. 17 – Texas Children’s prepared but not anticipating Ebola virus

Also, current, accurate information can be found online on the websites for the Centers for Disease Control and Prevention (www.cdc.gov) and the World Health Organization (www.who.int).

October 2, 2014

On Tuesday, the Centers for Disease Control and Prevention (CDC) confirmed the Ebola diagnosed in the United States.

“An adult patient who traveled recently from Liberia to Dallas became ill and was admitted to a hospital there,” said Texas Children’s Hospital Physician-in-Chief Dr. Mark Kline.

“Having this case in Dallas, only 270 miles away, might engender fear, especially among health care workers who come in contact with patients who might have a suspected case of Ebola, but the factors that led to this epidemic in West Africa are not present here in Texas or the United States.”

Kline emphasized the U.S. will never suffer the kind of Ebola epidemic that Africa is experiencing today because of the hygienic conditions here and, in particular, because of the infection control practices in U.S. hospitals. Texas Children’s leaders remain confident about our preparedness plans should we receive a patient with Ebola at one of our sites.

“We’ve concentrated our efforts on the main portals of entry to the hospital and the system – for example, the Emergency Center and our primary care practices across the community,” Kline said. “We’ve gone from passively screening with posted signage to active screening. Every child and family is being asked specifically ‘Have you traveled in the past 21 days? If so, has any of that travel been to West Africa and, specifically, to the countries that have been impacted by Ebola?’ ”

If the answer to those questions is “yes,” Texas Children’s has a plan in every setting for moving the child and the family to an isolated area for further evaluation.

How Texas Children’s has prepared

Texas Children’s leaders in Infection Control, the Emergency Centers, Critical Care, Emergency Management, Texas Children’s Pediatrics and other areas monitor daily Ebola updates and recommendations from the CDC and the World Health Organization. They regularly assess Texas Children’s preparedness as it relates to the most current information, and there is a plan in place in the unlikely event we receive a patient with the disease.

Preparation has included:

  • Simulation exercises and thorough education in areas that may be a point of entry for a patient with Ebola symptoms.
  • Development of specific protocol outlining the steps we will take should we receive a patient with Ebola symptoms, including designated isolation rooms in the Emergency Centers and the PICUs.
  • Securing an inventory of appropriate personal protective equipment (PPE), including full-coverage protective suits, which have been deployed to Texas Children’s Main and West campuses, Pavilion for Women and transport services (Kangaroo Crew).

“We’re doing everything we can to make certain that if we see a case of Ebola we will not have secondary cases among health care workers or among the other patients and families we serve,” Kline said.

“I’m very, very confident that with all of the policies and procedures and infection control precautions we have in place we will maintain our ability to care for patients and families and to care for one another as well.”

Important facts to remember about Ebola

Most of the population in West Africa doesn’t have Ebola.
As of September 30, there had been about 6,500 cases of Ebola diagnosed in Guinea, Liberia, Senegal and Sierra Leone. However, more than 20 million people live in these countries. This means fewer than 1 percent (.03 percent) have the virus – 99.97 percent of the residents in these countries do not have Ebola.

Diagnosis occurred in Dallas, but the disease source is still in Liberia.
Tuesday’s news revolves around the first case of Ebola that was diagnosed in the U.S. However, the source of transmission originated in Liberia – not here. Nothing has changed about the epidemiology of this virus in the U.S.

Ebola is not a highly infectious disease.
Ebola is a bloodborne pathogen – it is not transmitted like the flu or other airborne viruses. It is spread only when symptoms are present.

The CDC is the best source of information, not the media.
The best way to allay any concerns is to educate yourself. The most current information about Ebola is available online from the Centers for Disease Control and Prevention.