Staff Health and Support - PowerPoint Presentation

Slide1

Staff Health and Support

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

This presentation is current

as of December, 2014. This presentation contains materials from Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), and World Health Organization (WHO).

version 12.03.2014

Preparing Healthcare Workers to

Work in

Ebola Treatment Units (

ETUs)

in Africa

Slide2

Learning Objectives

Describe strategies to avoid dehydration, heat stress, heat stroke, malaria, and other health risks both inside and outside the

ETUIdentify actions to take if you suspect you have had an Ebola virus exposure

Describe specific measures you can take before, during, and after deployment to maintain physical and emotional health

Recognize when to access physical or emotional care and other support for healthcare workers (HCWs)

Slide3

Pre-Deployment

Slide4

Risks Undertaken by Healthcare Workers

Know Before You GoRisk can be reduced with simple actions

Procedures that protect healthcare worker safety are effective in greatly reducing risk of Ebola virus infectionProcedures need to be understood and followed by everyone

Reduce all risks to your health—not just Ebola virus infectionMalaria and other vector-borne diseasesHeat illness

Gastrointestinal illness (e.g., typhoid, acute diarrheal illness)Severe fatigue and sleep deprivationBloodborne pathogensAny illness will provoke concerns for EVDConsequences for you and colleagues

Slide5

Prepare Physically

Consult travel medicine physician for travel related medical issues

Consult personal physician for management of existing medical issuesComplete a health screeningCheck recommended vaccinations and get them before

arrival (including typhoid vaccine)Check CDC’s Yellow

BookPrevent malaria and dengueInitiate malaria prophylaxisBring and use insecticide-treated bed netsConsider using insect repellent Pregnant women should not deploy

Slide6

Prepare Mentally

Read all materials providedThink about and prepare for work in a resource-limited setting and exposure to disturbing scenarios (e.g., death, grief, fear)After training, mentally

rehearse and re-rehearse actions you will need to take, especially donning and doffing personal protective equipment (PPE)

Discuss with family and friends the practices and procedures you will undertake to remain safeThey need to be reassured and confident that you are taking actions for safety

Think through fears and concerns, and satisfy yourself that you have strategies to reduce or allay them

Slide7

During Deployment

Slide8

Taking Care of Yourself and Watching Out for Other ETU Staff

Get enough restEliminate mistakes due to fatigueMany ETUs have a compulsory one-day break per week

Aim for at least 7–8 hours of sleep every 24 hours

Walk, stretch, exercise as circumstances allow and be sure to hydrate

Discuss, share, commiserate with other staff—Open dialogue helps people struggling to come forward with health concernsDesignate or identify the health and safety lead for your ETU

Slide9

Prevent Other Illnesses and Other ConditionsStay Healthy

Personal hygieneMSF policy

of no physical contact of any kind, at any time, is prudent

Cough etiquette - cover cough with elbowFrequent handwashing - soap/water or alcohol-based hand sanitizer but use

soap/water if visibly soiledPrevent gastrointestinal illnessCarefully prepare and store food, obtain food from trusted sourcesRinse fruits and vegetables in chlorinated waterDrink only safe water and ice (chlorinated, filtered, or boiled)Keep rodents out of living spaceCover food and water containersLeave no crumbs or other bits of food on floor Block small entrances that rodents can enter

Slide10

Malaria Prevention

Malaria is extremely common in West Africa10-50% of general population is parasitemicMalaria can quickly cause severe illness or death even with appropriate treatment

Take recommended malaria prophylaxis faithfully—it is highly effective

Use insecticide-treated netsConsider using insect repellent

(will also help prevent other vector-borne diseases, such as dengue)

Slide11

Environmental Conditions

Expect temperature range 80–95oF (26–35o

C) with high humidityConditions inside high-risk PPE will be significantly hotter

100% humidity Almost no ability to evaporate sweat to self-cool

ETUs typically restrict time in PPE to less than 2 hours, and sometimes less than 1 hour—exit before you need toIf you feel faint or unable to concentrate fully—exit and doff PPE at once

Slide12

Heat Illness

Heat illness is preventableGood team management, buddy

system, and experienced staff can prevent heat illnessLocal staff are also susceptible to heat

illness—watch and support them

Early symptoms are mild but can become severe/life-threateningIn the ETUKnow heat illness symptoms, and monitor yourself and your buddyGradually build up to working in the heat while wearing PPERotate staff between jobs that require PPE and those that do not

Slide13

Heat Illness Spectrum

Heat Illness Can Be Severe

Heat cramps (mildest)

Heat

exhaustionHeat stroke (most severe)Core temperature>38o

C or 100.6o F>40.5o

C

or 104.9

o

F

Skin temperature

Normal

Normal or cool

and clammy

Hot and dry

(50% of cases)

Sweat rate

Increased

Increased or decreased

Decreased

Urine

output

Normal

Oliguria

Anuria

Gastrointestinal

Thirst

Nausea +/- vomiting

Nausea and

vomiting

Cardiovascular

Tachycardia

Hypotension

+/- Circulatory collapse

Central nervous system

None

Uncoordinated, irritable,

or confused

Delirium

/ seizures/ coma

Other

Thirst

Renal

failure, Liver failure, DIC

Slide14

What to Do When a Buddy is Ill from the Heat

Exit high-risk z

one immediatelyFollow appropriate doffing procedures, never cut corners

Notify supervisorMove your buddy to a cooler, shaded area

Provide cool drinking water, if able to drinkFan and mist your buddy with waterApply ice, if available (ice bags or ice towels)IF YOUR BUDDY IS NOT ALERT or seems confused, this may be heat strokeApply ice as soon as possibleTake vital signs and treat as indicatedhttp://www.aafp.org/afp/2005/0601/p2133.html

Slide15

Suspected Ebola Virus Exposure

Exposure is unlikely if appropriate precautions are rigorously followedAll ETUs should have a clear chain of command and instructions on what to do if an employee is

exposedIf exposure is suspected

DO NOT PANICImmediately stop workingFollow post-exposure protocol

Safely exit from high-risk zone and safely doff PPE (crucial) Report ANY concerns immediately to clinician-in-charge, who will assess riskManagement of suspected exposure is evolving, but typically would include isolation with possible evacuation, if feasibleExperimental, unproven treatments have been used in some exposed persons, with uncertain effect

Slide16

Actions to be Taken on the SpotSummary of MSF Guidelines

Needlestick or similar injury

Immerse exposed site in 70% alcohol for 30 seconds or 0.5% chlorine for three minutesLeave

high-risk zone, doffing PPE correctlyWash affected area with soap and clean water

Rinse with clean running water for 30 secondsContact with body, body fluids, or other contaminated material of a patient with EbolaEyes: flush with copious non-chlorinated clean water, Ringer’s lactate, or salineMouth or nose: rinse with 0.05% chlorine solution, but do not swallowBroken skin: rinse with 0.5% chlorine solution, then wash with soap and clean water

Slide17

Accidental ExposureOther Considerations

Exposed persons should be monitored for 21 daysHIV prophylaxis, if indicatedHepatitis B vaccination, if indicated

You should already be fully vaccinatedPossible evacuation Discuss policy with your deploying organization before you leave

CDC guidelines: exposed persons should not travel on commercial conveyances (planes, boats, buses, etc.)

Conduct a post-event analysis of what went wrong so corrective action can be taken

Slide18

After a Suspected Ebola Virus Exposure

Monitor your temperature in accordance with the protocol for your ETU For your own well-being and the safety of your team members, discuss any symptoms you experience with the staff member designated by your

ETUKnow how to contact the medical director (or other person responsible for healthcare workers’ health issues) of the organization that deployed you to

the ETUFollow all protocols for monitoring and notificationKnow the plan in case of an Ebola virus exposure or symptoms

Slide19

Maintaining Mental Health and Resilience

Be aware of normal emotional and physical reactions to an extremely stressful situation (anger, fatigue, etc.)

Rest, sleep, eat, be activeAsk for additional rest if neededDo something you enjoy Talk with colleagues, and watch out for

them, tooBe aware that healthcare workers often have

symptoms that cause anxiety (e.g., GI illness, respiratory illness, fatigue)Rest if you feel unwellTalk it over with colleagues

Slide20

After Deployment

Slide21

Re-entry into Your Former LifeA

ssuming you have no known exposure and are asymptomatic

CDC recommendations: No need to

isolate or quarantine yourselfMonitor yourselfTake your temperature twice a day for 21 days, starting before you depart for home

Watch for other symptoms, like severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhagingFor fever (>38o C or 100.4o F) symptoms, seek medical care, and contact the organization that deployed you to the ETUNotify the healthcare facility where you are seeking care before you arrive that you recently returned from working in an ETUCDC recommendations available at www.cdc.gov/ebolaExpect to have emotional reactionAttend scheduled post-deployment meetings/debriefsCounselor visit mandatory in some

programs—don’t fight this, most find it helpfulFamily or friends might be apprehensive; provide reassuranceAccept that your work has been courageous and important

Slide22

Summary

Pre-deployment preparation includes training, health assessments, vaccination

, malaria prophylaxis, and attention to mental preparedness and healthHeat illness and dehydration are serious risks while wearing PPE in tropical conditions

Adhere to recommendations for rest as well as time restrictions for working in

the ETU while wearing PPEEbola virus exposure is unlikely if appropriate precautions are rigorously followed, but know what to do if it happensPay attention to mental and physical health during and after deployment

Slide23

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

http://www.cdc.gov/vhf/ebola