It seems a wave of three viruses could wreak havoc on emergency rooms, but the physicians and staff at St. Luke’s Hospital are preparing for whatever comes this way, whether it’s Ebola, Enterovirus or influenza.

“We are planning and preparing for any of these three conditions,” said Alison Owens, MD, Medical Director of St. Luke’s Hospital Emergency Department. “If a patient exhibits symptoms of these illnesses and comes to the ED, we will be prepared.”

As the hospital gears up to vaccinate staff against the annual flu, St. Luke’s is also preparing for the latest newsmakers: Ebola and EV-D68, a shorter name for Enterovirus.

With an outbreak of Ebola that has spread from West Africa to the US, St. Luke’s Hospital Emergency staff is acutely aware and preparing to provide a basic medical screening of all patients seeking care, including those who may have an infectious disease. The screening includes a travel history, a brief medical history and detection of any symptoms of illness, Owens said.

Ebola symptoms include fever, headache, joint and muscle aches, sore throat, and weakness, followed by vomiting, diarrhea and stomach pain. Some patients may also experience skin rash, red eyes, and internal and external bleeding.

“The hospital is always prepared for emergencies, but we are reviewing state and federal guidelines, infection prevention procedures and the detailed checklist provided by the Centers for Disease Control and Prevention that provides guidance should we suspect Ebola,” she added.

According to Lori Oliver, RN, ED nurse manager, the size and scope of St. Luke’s Hospital limit our ability to treat a patient with Ebola. “Should a patient present with suspicion of Ebola, we will follow the CDC’s plans for transferring a patient to a facility that is equipped and staffed to handle Ebola,” Oliver said.

Regular drills help St. Luke’s Hospital prepare and plan for disasters such as bioterrorism, a mass casualty, even infectious diseases like Ebola. The hospital held a drill earlier this week to ensure we have considered all aspects of operating the hospital should we encounter an infectious disease like Ebola, said Ken Shull, St. Luke’s chief executive officer.

While national and international health authorities are working to control an outbreak, St. Luke’s Hospital is following universal precautions for infection prevention, which includes the use personal protective equipment (PPE) such as gloves, gowns, face masks, and safe handling of potentially contaminated materials.

The community should be aware that we are asking all patients about their international travel history as well as their symptoms when they arrive at the Registration area, Shull said. “Should anyone have a fever, we may ask them to wear a mask or wait in the Triage

Room while here. This is to protect our patients and staff.

“We are also asking the public to use only the emergency/outpatient entrance if they are coming to St. Luke’s for medical attention,” Shull added. “With the flu season upon us, we believe it’s best to initiate visiting restrictions sooner than later, so we’re asking visitors to stay home if they have a cough, fever or sore throat. Also, no one under 18 should visit the hospital without checking with the nursing supervisor. We are taking these precautions for everyone’s health and safety.”

The healthcare industry has been encouraged to “think Ebola” since two nurses in Texas tested positive for the disease after caring for a patient who died 10 days after his hospitalization.

St. Luke’s will provide additional staff training and plans to implement the ‘buddy system’ for dressing and removing personal protective equipment, according to Megan Parker, RN, the hospital’s Infection Preventionist. While vaccinating staff against the flu, Parker is also providing hospital staff with regular updates from the Centers for Disease Control (CDC).

According to CDC officials, Ebola is spread through direct contact with a sick person’s blood or body fluids or by contact with contaminated objects or infected animals. Ebola is not transmissible during the incubation period, which is usually 8-10 days (before onset of fever) but could range from 2-21 days. The risk of person to person transmission is greatest during the later stages of illness when viral loads are highest. There are no antivirals currently available for treating Ebola, but key interventions include: providing intravenous fluids and balancing electrolytes; maintaining oxygen status and blood pressure; and treating other infections as they occur.

In addition to Ebola, St. Luke’s Emergency team may see a patient with symptoms of EV-D68, a serious respiratory illness that has affected hundreds of children across the United States. Owen said the virus usually starts like a common cold, with symptoms of sneezing, runny nose and cough. However, some patients will develop a severe cough, have difficulty breathing and / or develop a rash. Patients affected can also have fever or wheezing.

If the ED physician suspects a child has EV-D68, appropriate plans will be made to transport the patient immediately to a higher level of care available in larger facilities, Dr.

Owens explained. “To diagnose this virus, we’d have to send the test out and wait two days for results.”

Like Ebola, there are no specific treatments for this virus other than plenty of rest, fluids and over-the-counter medications that will help ease symptoms. As the disease progresses, young patients who are hospitalized will require supportive respiratory assistance and access to pediatric intensivists.

“Anyone can get infected with enterovirus,” Oliver said, but infants, children and teenagers are more likely to become sick because they haven’t yet built up immunity.

Like healthcare providers across the country, St. Luke’s Hospital and local physicians’ offices are planning precautionary measures to protect the health of our community.

“The best defense is careful planning and preparation,” Shull said. “And we appreciate the public’s understanding and support in these efforts.”

 

– article submitted by Kathy Woodham