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EBOLA HUMAN RESOURSE MANAGEMENT IN HOSPITALS

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EBOLA HUMAN RESOURSE MANAGEMENT IN HOSPITALS

  1. 1. EBOLA : HUMAN RESOURCE MANAGEMENT Education Training Deployment and Sensitization Major (Dr) Shashi Kant Sharma Dept of Hospital Administration Armed Forces Medical College Pune Maharashtra
  2. 2. Scheme of Thought • References • Introduction • Risk Assessment • Tiered approach for deployment • Special areas in hospital • Recommendation for preventing transmission • Psychosocial Support • Model training programme • Conclusion
  3. 3. References • Ministry of Health and Family Welfare Guidelines • National Institute of Virology Guidelines • World Health Organization Guidelines • CDC Guidelines on control of Ebola
  4. 4. Introduction • Ebola Virus Disease (EVD) infections among healthcare workers : almost every outbreak • Devastating effects on healthcare systems and the communities they serve • Infection control is a key strategy in stopping the Ebola epidemic
  5. 5. RISK OF TRANSMISSION HEALTHCARE & COMMUNITY Two factors help determine the level of risk in community and healthcare settings: – Ebola transmission risk in community – Risk from suspected or confirmed Ebola patients under care in a given facility
  6. 6. COMMUNITY RISK • Linked community transmission • In unlinked community transmission • Low risk • High risk
  7. 7. Healthcare Facility Risk • Low risk • High risk
  8. 8. Facility risk Ebola Rx Units Communityrisk Liberia Sierra Leone, Guinea Countries with no or linked transmission Facility taking care of cases Countries with no or linked transmission
  9. 9. Tiered Approach • Prepare • Identify • Evaluate • Front Line Health Care Facilities • Ebola Assessment Hospitals • Ebola Treatment Centers • Emergency Department
  10. 10. Frontline Healthcare Facilities • Rapidly identify and triage patients • Isolate any patient • Immediately notify the hospital/ facility ICC/ state & local public health agencies • Transfer patient to an Ebola Assessment Hospital • Ensure no delay in the care
  11. 11. Resources Needed 1/2 • Number of staff with direct patient contact • Cross-training • Demonstrate proficiency : putting on (donning) & taking off (doffing) of PPE • Infection control practices and proper waste management • Ongoing training
  12. 12. Resources Needed 2/2 • Practice drill and correct any identified gaps • Continuous staff input • Prolonged care (>12–24 hours) : UNLIKELY • Plans for PPE supplies • Plans for Inter facility Transport
  13. 13. Ebola Assessment Hospitals • Receive and isolate a patient • Functioning as an Ebola assessment hospital • Transport patients with confirmed EVD to an Ebola Treatment Center • States: not planning Ebola Treatment Centers • 96 hours of evaluation and care
  14. 14. Ebola Treatment Centers • Comprehensive care • Functioning as an Ebola Treatment Center • Decisions to receive a confirmed Ebola patient • Training : functional exercise of core processes
  15. 15. Emergency Dept Evaluation & Management • Risk of transmission of Ebola virus • Majority febrile patients to ED do not have EVD • Administrative and environmental controls
  16. 16. Triage Recommendations 1/2 • Immediately upon entrance to the ED or in advance of entry: exposure history • Signs or symptoms • Isolate the patient • Log book : personnel who enter the patient’s room.
  17. 17. Triage Recommendations 2/2 • Clinically stable : face shield/ surgical face mask/ impermeable gown/ two pairs of gloves • Notify the Hospital Infection Control Program and other appropriate staff • PPE put on : Additional history & performing physical examination & routine diagnostics & interventions
  18. 18. Pregnant Women With EVD • Prepared to screen patients for Ebola • Obstetric management • Healthcare workers who are pregnant • Pregnant women with known or suspected Ebola should be hospitalized
  19. 19. How EVD Affects : Pregnant Women Mupapa K, Mukundu W, Bwaka MA, et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis. 1999;179(suppl 1):S11-S12. • Limited evidence : increased risk of severe illness and death • Previous outbreaks in Africa : infants born to mothers with Ebola have not survived -------------------------------------------------------------------
  20. 20. Infection Control : Labor & Delivery Units • High likelihood of exposure to large amounts of blood & body fluids • Method of Delivery to Consider : No data exist to suggest • Breastfeeding Restrictions : women with Ebola should not breastfeed. --------------------------------------------------------------------------------------------------------- Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007;196 (suppl 2):S142- S147.
  21. 21. Hemodialysis in Patients with EVD • Efforts to minimize direct blood exposure • CRRT preferred peritoneal dialysis • Performed in the patient’s isolation room.
  22. 22. Establishing Vascular Access for Dialysis • Patients may have DIC • Subclavian site: avoided • Hemodialysis/CRRT machine : dedicated for use
  23. 23. Safe Handling of Human Remains • Personnel who perform PM care in hospitals & mortuaries • Trained personnel • Handling of human remains kept to a minimum. • Autopsies: avoided
  24. 24. Preparation of the Body • Wrapped in a plastic shroud • Leave any intravenous lines or endotracheal tubes • Leak-proof plastic bag :150 μm thick & zippered closed • Another leak-proof plastic bag : 150 μm thick & zippered closed • Transported to the morgue.
  25. 25. Mortuary Care • Do not perform embalming • Do not open the body bags • Do not remove remains from the body bags • Mortuary care personnel should wear PPE • Bagged bodies :placed directly into hermetically sealed casket.
  26. 26. Recommendations for Prevention of Transmission • Patient Placement – Single patient room – Log book – Posting personnel at the patient’s door • Personal Protective Equipment • Patient Care Equipment – Dedicated medical equipment
  27. 27. • Patient Care Considerations – Limit the use of needles – Phlebotomy, procedures, laboratory testing should be limited – disposed in puncture-proof • Hand Hygiene • Environmental Infection Control • Safe Injection practices
  28. 28. Aerosol Generating Procedures  Avoid AGPs  Visitors should not be present  Limiting the number of HCP  Private room and ideally in an Isolation Room  Room doors should be kept closed during the procedure  HCP should wear appropriate PPE  Environmental surface cleaning
  29. 29. Monitoring and Management sick leave policies for HCP that are non-punitive  Stop working and immediately wash  Immediately contact health/supervisor  Monitoring twice daily for 21 days Potentially Exposed Personnel Visitors Avoid entry of visitors  Scheduled & controlled Comply with precautions
  30. 30. Psychosocial Support  Strict bio‐security measures  Risk of being contaminated  Common symptoms can be mistaken for ebola  High mortality rate  symptoms of ebola and rapid deterioration  The tension between public health priorities and the wishes of the patients  Stigmatization
  31. 31. Target Group • Patients • Affected communities • Staff • Volunteers
  32. 32. Model Training & On-site Orientation The suggested training consist of 3 components 1. Combined training 2. Breakout sessions 3. Walk around
  33. 33. Combined Training for all Staff • Suggested Duration: 04 hrs • Learn the audience’s learning expectations of the training • Current situation overview • What all should know about Ebola • Essentials of PPE/Case management/ Environmental • Include demonstrations and trials of PPE • What’s the strategy to stop the outbreak
  34. 34. Breakout Sessions Targeted Trainings 2 hrs
  35. 35. Walk Around : 02 Hrs • Look at patient flows/ Holding spaces/ Changing areas/ Waste flows/ PPE storage. • Lead by Medical & Nursing Director • Mock patient run through & establish processes going forward. • Demonstration of the monitoring and evaluation tool.
  36. 36. Conclusion

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