JOINT STATEMENT FROM THE AMERICAN HOSPITAL ASSOCIATION, THE AMERICAN MEDICAL ASSOCIATION AND THE AMERICAN NURSES ASSOCIATION: As our nation’s strategy to address the Ebola virus continues to evolve, hospitals and their partners in nursing and medicine are coming together to emphasize that a solution-oriented, collaborative approach to Ebola preparedness is essential to effectively manage care of Ebola patients in the U.S. Ensuring safe care for patients, healthcare workers, and communities demands the combined efforts of inter-professional, state, and federal organizations. In addition to domestic efforts to prepare for and treat Ebola, an enhanced focus on the part of the United States and the international community to contain the outbreak in West Africa is fundamental to stopping the spread of this virus.

Hospitals, physicians, and nurses have the same goals in addressing any Ebola case: to ensure that all hospital and clinical staff are able to safely provide high-quality, appropriate, patient care. We are committed to ensuring that nurses, physicians and all frontline healthcare providers have the proper training, equipment and protocols to remain safe and provide the highest quality care for the patient. As the Centers for Disease Control and Prevention (CDC) updates the protocols and procedures involved with patient care and personal protective equipment, we will review and share updated guidance with our collective memberships as it becomes available.

Our nation’s hospitals, physician and professional nursing organizations remain in communication with one another and with our nation’s public health institutions at the local, state and national levels. We are committed to maintaining a strong collaborative effort to address this public health threat.

In a call with nurses nationwide, the Centers for Disease Control and Prevention (CDC) announced revised emergency preparedness and treatment guidelines to prevent transmissions of Ebola in the United States. The changes come after two nurses from Texas Health Presbyterian Hospital in Dallas became infected with Ebola while caring for Thomas Eric Duncan. Duncan had recently traveled to Dallas from Liberia and died from the disease on Oct. 8.

“At this difficult time, we continue to offer our support to the two nurses, their families, colleagues and communities,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.

“We also offer our support to the brave nurse who publicly revealed that a lack of clarity, protocols and guidance contributed to system issues at Texas Health Presbyterian Hospital, critical lapses that have been acknowledged by hospital officials.

“Today’s CDC call was a step in the right direction. However, while we understand this is a rapidly evolving situation, we are concerned that today’s call did not fully address to our satisfaction concerns we have heard from our members.

“Clinical health care settings, such as hospitals, are unpredictable environments. Instead of variability, we need clear-cut standards and guidelines in place that nurses and health care team
members can follow consistently to ensure the highest levels of care and protection for patients and health care professionals.

“ANA advises the CDC to provide the following information quickly to ensure the safety of workers, patients and communities:

• Clear and specific standards for personal protective equipment (PPE) at the point of patient presentation as well as diagnosis.
• Emphasis on current or revised training techniques proven to be effective for proper use of PPE.
• Full disclosure of findings of events at Texas Health Presbyterian Hospital that can be used to improve practices and prevent further infections.
• More rapid dissemination of any changes to procedures, guidelines and recommended care.

“Further, ANA recommends that health care organizations adopt PPE standards that have been demonstrated to provide effective protection for nurses and other health care workers in the clinical setting when caring for Ebola patients, such as those used by Doctors Without Borders and the protocols developed by Emory University Hospital.

“CDC officials plan to release revised PPE recommendations in the near future. Once the recommendations are released, ANA will review them and provide additional feedback, as necessary.

“While we believe nurses are obligated to care for patients in a non-discriminatory manner, with respect for all individuals, we also recognize there may be limits to the personal risk of harm nurses can be expected to accept as an ethical duty.

“We strongly encourage nurses to speak up if they believe there is inadequate planning, education or treatment related to providing care to these or any patients, and seek to resolve any conflicts of risk and responsibility swiftly. Nurses should have the right to refuse an assignment if they do not feel adequately prepared or do not have the necessary equipment to care for Ebola patients.

“ANA believes that a solution-oriented, collaborative approach that includes interprofessional, state and federal organizations is essential to manage care of Ebola patients effectively in the United States.

“Additionally, appropriate funding for public health and preparedness must be addressed in order to ensure that response systems and infrastructure are in place to respond to any emergency situation.

“As we address these important issues related to the U.S. Ebola response, we must also keep focused on the global response needed to address the crisis in West Africa. Until we have sufficient systems and resources there to appropriately manage patient care and stop its spread, Ebola will remain a global concern.”

Department of Health: The Pennsylvania Department of Health (PADOH) has been monitoring the Ebola outbreak since it began earlier this year and will continue to do so – particularly in light of the first case being confirmed in the US. The department is in continuous contact with the Centers for Disease Control and Prevention (CDC), county and municipal health departments across the state, hospital and medical associations, individual healthcare facilities, EMS providers, and other partners to monitor the situation. The PADOH will support the investigation of any suspect cases and provide guidance and information on infection control protocols and procedures to ensure the health and safety of all healthcare workers, patients, visitors and the general public. Additionally, PADOH continues to share important information and CDC advisories and alerts to healthcare professionals to heighten awareness of possible cases, request reporting of any suspect cases and reiterate infection control procedures. Click for more information.

CDC: Sequence for Putting on Personal Protective Equipment

CDC: Checklist for Being Evaluated for Ebola in the US

CDC: Ebola Virus Screening

The Centers for Disease Control and Prevention (CDC) announced on Oct. 12 that a nurse employed by Texas Health Presbyterian Hospital in Dallas has tested positive for Ebola.  She is in stable condition and is currently in isolation.  The nurse was a member of the heath care team that provided care to Thomas Eric Duncan while he was in isolation in the hospital.  Duncan, who traveled to Texas from Liberia, died from Ebola on Oct. 8.  The nurse wore full protective gear while caring for Duncan.  CDC officials report that a breach in protocol may have occurred at some point.  They are looking closely at high-risk procedures that were performed on Duncan.

“We offer our support to the nurse, her family, colleagues and community at this difficult time,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN.

“We urge all hospitals and health care workers to engage in comprehensive education and preparedness activities in order to ensure the safety of the public and health care professionals.  We have the utmost confidence that health care providers are eager to take part in learning protocols that will protect health care workers and keep patients safe.

“However, it is essential that the CDC quickly investigate and fully share the findings surrounding the care of Thomas Eric Duncan to help health care providers understand any further precautions needed to prevent transmission of the disease.  It is only through rapid review and learning from this situation that we will prevent further incidents from happening.

“We will continue to work with the CDC and other health care agencies to accelerate the education of health care professionals about appropriate infection control and other protocols.”

ANA has shared CDC resources with its members, including instructions about how to put on and safely remove personal protective equipment.  ANA is encouraging its members to participate in a call being hosted by the CDC on Oct. 14.

The ANA is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent and state nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

The first case of Ebola Virus Disease (Ebola) diagnosed in the United States was reported to CDC by Dallas County Health and Human Services on September 28, 2014, and laboratory-confirmed by CDC and the Texas Laboratory Response Network (LRN) laboratory on September 30. The patient departed Monrovia, Liberia, on September 19, and arrived in Dallas, Texas, on September 20. The patient was asymptomatic during travel and upon his arrival in the United States; he fell ill on September 24 and sought medical care at Texas Health Presbyterian Hospital of Dallas on September 26. He was treated and released. On September 28, he returned to the same hospital, and was admitted for treatment.

The purpose of this HAN Advisory is to remind healthcare personnel and health officials to:

(1) increase their vigilance in inquiring about a history of travel to West Africa in the 21 days before illness onset for any patient presenting with fever or other symptoms consistent with Ebola;

(2) isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting Ebola symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions (gowns, facemask, eye protection, and gloves); and

(3) immediately notify the local/state health department.

Please disseminate this information to infectious disease specialists, intensive care physicians, primary care physicians, and infection control specialists, as well as to emergency departments, urgent care centers, and microbiology laboratories.

Background: The first known case of Ebola with illness onset and laboratory confirmation in the United States occurred in Dallas, Texas, on September 2014, in a traveler from Liberia. The West African countries of Liberia, Sierra Leone, and Guinea are experiencing the largest Ebola epidemic in history. From March 24, 2014, through September 23, 2014, there have been 6,574 total cases (3,626 were laboratory-confirmed) and 3,091 total deaths reported in Africa. Ebola is a rare and deadly disease caused by infection with one of four viruses (Ebolavirus genus) that cause disease in humans. Ebola infection is associated with fever of greater than 38.6°C or 101.5°F, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage. Ebola is spread through direct contact (through broken skin or mucous membranes) with blood or body fluids (including but not limited to urine, saliva, feces, vomit, sweat, breast milk, and semen) of a person who is sick with Ebola or contact with objects (such as needles and syringes) that have been contaminated with these fluids. Ebola is not spread through the air or water. The main source for spread is human-to-human transmission. Avoiding contact with infected persons (as well as potentially infected corpses) and their blood and body fluids is of paramount importance. Persons are not contagious before they are symptomatic. The incubation period (the time from exposure until onset of symptoms) is typically 8-10 days, but can range from 2-21 days. Additional information is available at http://www.cdc.gov/vhf/ebola/index.html.

Recommendations: Early recognition is critical to controlling the spread of Ebola virus. Consequently, healthcare personnel should elicit the patient’s travel history and consider the possibility of Ebola in patients who present with fever, myalgia, severe headache, abdominal pain, vomiting, diarrhea, or unexplained bleeding or bruising. Should the patient report a history of recent travel to one of the affected West African countries (Liberia, Sierra Leone, and Guinea) and exhibit such symptoms, immediate action should be taken. The Ebola algorithm for the evaluation of a returned traveler and the checklist for evaluation of a patient being evaluated for Ebola are available at http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf and http://www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf.

Patients in whom a diagnosis of Ebola is being considered should be isolated in a single room (with a private bathroom), and healthcare personnel should follow standard, contact, and droplet precautions, including the use of appropriate personal protective equipment (PPE). Infection control personnel and the local health department should be immediately contacted for consultation.

The following guidance documents provide additional information about clinical presentation and clinical course of Ebola virus disease, infection control, and patient management:

• Guidelines for clinicians in U.S. healthcare settings are available at http://www.cdc.gov/vhf/ebola/hcp/clinician-information-us-healthcare-settings.html.
• Guidelines for infection prevention control for hospitalized patients with known or suspected Ebola in U.S. hospitals are available at http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
• Guidelines for safe management of patients with Ebola in U.S. hospitals are at http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html.

The case definitions for persons under investigation (PUI) for Ebola, probable cases, and confirmed cases as well as classification of exposure risk levels are at http://www.cdc.gov/vhf/ebola/hcp/case-definition.html.

Persons at highest risk of developing infection are:

• those who have had direct contact with the blood and body fluids of an individual diagnosed with  Ebola – this includes any person who provided care for an Ebola patient, such as a healthcare provider or family member not adhering to recommended infection control precautions (i.e., not wearing recommended PPE
• those who have had close physical contact with an individual diagnosed with Ebola
• those who lived with or visited the Ebola-diagnosed patient while he or she was ill.

Persons who have been exposed, but who are asymptomatic, should be instructed to monitor their health for the development of fever or symptoms for 21 days after the last exposure. Guidelines for monitoring and movement of persons who have been exposed to Ebola are available at http://www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html.

Diagnostic tests are available for detection of Ebola at LRN laboratories as well as CDC. Consultation with CDC is required before shipping specimens to CDC. Information about diagnostic testing for Ebola can be found at http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-specimen-collection-submission-patients-suspected-infection-ebola.html.

Healthcare personnel in the United States should immediately contact their state or local health department regarding any person being evaluated for Ebola if the medical evaluation suggests that diagnostic testing may be indicated. If there is a high index of suspicion, U.S. health departments should immediately report any probable cases or persons under investigation (PUI)  (http://www.cdc.gov/vhf/ebola/hcp/case-definition.html) to CDC’s Emergency Operations Center at 770-488-7100.

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

Please see the health alert as provided by the PA Department of Health and pertaining to Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children. Click here.

The 2014 Ebola outbreak is the largest in history currently affecting countries in West Africa. While Ebola does not pose a significant risk to the United States, our nursing colleagues in these countries are courageously providing care for those in need. According to the World Health Organization (WHO), the outbreak continues to “evolve in alarming ways, with the severely affected countries struggling to control the escalating outbreak against a backdrop of severely compromised health systems, significant deficits in capacity, and rampant fear.” (WHO Ebola Response Roadmap) ANA is committed to supporting efforts to address this horrific outbreak.

Read more.

The Centers for Disease Control and Prevention (CDC) is working closely with the Colorado Department of Public Health and Environment (CDPHE) and Children’s Hospital Colorado to investigate a cluster of nine pediatric patients hospitalized with acute neurologic illness of undetermined etiology. The illness is characterized by focal limb weakness and abnormalities of the spinal cord gray matter on MRI. These illnesses have occurred since August 1, 2014 coincident with an increase of respiratory illnesses among children in Colorado. The purpose of this HAN Advisory is to provide awareness of this neurologic syndrome under investigation with the aim of determining if children with similar clinical and radiographic findings are being cared for in other geographic areas. Guidance about reporting cases to state and local health departments and CDC is provided. Please disseminate this information to infectious disease specialists, intensive care physicians, pediatricians, neurologists, radiologists/neuroradiologists, infection preventionists, and primary care providers, as well as to emergency departments and microbiology laboratories.

Background

The CDPHE, Children’s Hospital Colorado, and CDC are investigating nine cases of acute neurologic illness among pediatric patients. The cases were identified during August 9–September 17, 2014 among children aged 1–18 years (median age 10 years). Most of the children were from the Denver metropolitan area. All were hospitalized. Common features included acute focal limb weakness and specific findings on magnetic resonance imaging (MRI) of the spinal cord consisting of non-enhancing lesions largely restricted to the gray matter. In most cases, these lesions spanned more than one level of the spinal cord. Some also had acute cranial nerve dysfunction with correlating non-enhancing brainstem lesions on MRI. None of the children experienced altered mental status or seizures. None had any cortical, subcortical, basal ganglia, or thalamic lesions on MRI. Most children reported a febrile respiratory illness in the two weeks preceding development of neurologic symptoms. In most cases, cerebrospinal fluid (CSF) analyses demonstrated mild-moderate pleocytosis (increased cell count in the CSF) consistent with an inflammatory or infectious process. CSF testing to date has been negative for enteroviruses, including poliovirus and West Nile virus. Nasopharyngeal specimens were positive for rhinovirus/enterovirus in six out of eight patients that were tested. Of the six positive specimens, four were typed as EV-D68, and the other two are pending typing results. Testing of other specimens is still in process. Eight out of nine children have been confirmed to be up to date on polio vaccinations. Epidemiologic and laboratory investigations of these cases are ongoing.
The United States is currently experiencing a nationwide outbreak of EV-D68 associated with severe respiratory disease. The possible linkage of this cluster of neurologic disease to this large EV-D68 outbreak is part of the current investigation. CDC is seeking information about other similar neurologic illnesses in all states, especially cases clustered in time and place. CDC has particular interest in characterizing the epidemiology and etiology of such cases.

Recommendations

• Patients who meet the following case definition should be reported to state and local health departments:
  Patients ≤21 years of age with

1) Acute onset of focal limb weakness occurring on or after August 1, 2014;

AND

2) An MRI showing a spinal cord lesion largely restricted to gray matter.

• State and local health departments should report patients meeting the case definition to CDC using a brief patient summary form (www.cdc.gov/non-polio-enterovirus/investigation/). State health departments should send completed summary forms to CDC by email at limbweakness@cdc.gov.
• Providers treating patients meeting the above case definition should consult with their local and state health department for laboratory testing of stool, respiratory, and cerebrospinal fluid specimens for enteroviruses, West Nile virus, and other known infectious etiologies.
• Health departments may contact CDC for further laboratory and epidemiologic support by phone through the CDC Emergency Operations Center (770-488-7100), or by email at limbweakness@cdc.gov. Confirmation of the presence of EV-D68 currently requires typing by molecular sequencing.

For more information: Please visit the CDC enterovirus website (http://www.cdc.gov/non-polio-enterovirus/) for general information about enterovirus infections, including EVD-68, and for up-to-date guidance about infection control measures. For information about poliovirus, please visit the CDC poliovirus website (http://www.cdc.gov/vaccines/vpd-vac/polio/in-short-both.htm). For information about West Nile Virus, please visit the CDC West Nile Virus website (http://www.cdc.gov/westnile/). State and local health departments with questions should contact the CDC Emergency Operations Center (770-488-7100).
The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

This message was distributed to state and local health officers, state and local public health lab directors, public information officers, epidemiologists, HAN coordinators, and clinician organizations.

The Pennsylvania State Nurses Association (PSNA), representing more than 215,000 registered nurses (RNs) in the Commonwealth, invites professional nurses, nursing students and the community to attend a Town Hall meeting on Thursday, October 9, 2014. The Town Hall allows PSNA to share current legislative priorities and practice concerns affecting Pennsylvania’s nurses. The event will be held at the University of Scranton’s DeNaples Center (407A, The Rev. Bernard R. McIlhenny Ballroom) and will run from 6:00 pm to 8:30 pm.

The meeting, sponsored by PSNA and PSNA District 4 will give nurses the opportunity to discuss issues including safe staffing, violence against health care workers and APRN scopes of practice.  A question and answer period will be included. Guest speakers include Senator John Blake (D-22), Representative Marty Flynn (D-113), PSNA Chief Executive Officer Betsy M. Snook and PSNA Director of Government Affairs Kevin J. Busher.

“PSNA looks forward to the open dialogue the Town Hall creates,” said PSNA Chief Executive Officer Betsy M. Snook, MEd, BSN, RN. “Face-to-face communication allows us to better understand nurses’ needs and effectively advocate for the profession.”

For more information, contact Kevin J. Busher at 717-798-8908.

PSNA is pleased to announce the unveiling of our Young Nurse Professionals group. Young professionals have a clear vision of their ideal work setting, community and future. As you know, they also have a heavy work schedule, leaving them just a few hours of free time. This group is a simple, fun solution to using their time to advance their careers! With the Young Nurse Professionals, they can build a community of peers, discuss career-related concerns, provide insight into the needs of new RNs and make their community a better place to live.

Now we need your help as we work to build a team of new nurse colleagues. Are you — or do you know — a young RN that:

•  Feels passionate about active volunteerism?
• Understands the importance of career networking?
• Desires to expand their professional horizons?

Interested RNs can contact PSNA headquarters at communications@psna.org. We can’t wait to hear from you!

Register Today for Our First Event!

Where: The Vineyard at Hershey

When: Friday, October 17  /  5 – 8 pm

Who: Young Nurse Professionals (up to 5 years in practice)

What: A fun evening of wine tasting, networking and karaoke

Cost: Just $10!!

Click to register