In 2005, the Centers for Disease Control and Prevention and World Health Organization put us on alert for the Avian Flu. We were told we were at threat for a widespread pandemic imported from Asia and other countries. Indeed, we read about the spread of this disease. The TV news stations stirred the "fear" pot daily reporting the number of cases abroad and the danger we were all in. Discussions regarding the use of rebreathing masks, especially fitted, were all over the news. Some people went to army surplus stores and stockpiled these. When news of the vaccine broke, those same people spent hours searching for a source, and, once found, stocked enough for their entire family.
Fortunately, this disease did not spread, as forecasted, in this country, and we lazy, complacent Americans leaned back and put our feet upon our desks scoffing at dire predictions regarding various diseases and potential epidemics. Regardless of CDC's efforts to get everyone vaccinated against the flu, the percent of Americans paying attention to these efforts and complying with the CDC's recommendations remains low…perhaps, to some, alarmingly so.
We have become "non-believers" when it comes to protective vaccines. Perhaps if we had experienced the epidemics in other countries, we would be less so.
Recently, in exploring and researching information regarding childhood immunizations, I found a statement coming out of a healthcare committee studying the influenza vaccine and childhood immunization vaccinations of healthcare workers. In this article, the committee members asserted that the United States, for the most part, imports its diseases from other countries. Our immunization rates for these diseases are significantly higher than other nations, however, there are "pockets" of Americans, such as the Amish communities and reservations, where immunization is not practiced, thus putting these populations "at risk" should they be exposed to someone with the disease. Indeed, the measles epidemic in the Amish community in Ohio was traced to a person who had come in from Europe where he had contacted the disease.
Having just researched the above, it was with alarming recognition that I viewed the television reports of the gentleman from Liberia coming into this country sick with Ebola. Other admissions across the country are patients who have been flown here after becoming ill. It appears that we are importing this deadly disease.
What can surgery centers do to protect their patients and staff?
• Screen the patient during the preop call. Ask them, "Have you or a member of your immediate family traveled outside the US in the last 30 days?" If yes, inquire as to where the travel occurred.
• Query the patient about a fever or flu-like symptoms. Ask them if they have been around someone who is sick with flu-like symptoms in the last 30 days?
Ask who and the extent/type of contact.
• Query the patient, specifically, about his having a fever, or someone with whom he has contact having a fever.
• If your center doesn’t make those preop calls, meet with your admitting office and set up a process by which these become questions that are asked at the time of admission.
• Teach the people performing the admitting process how to take a temperature with your skin or ear probe. If un-educated persons in Liberia can learn to do this, surely your admitting staff can learn how to perform this task.
• Where the answers to the above questions, are a "yes," develop a protocol for safely dispensing of the patient. If the person is febrile, or is experiencing other symptoms, remove him, to the extent possible from other patients and staff. Alert his physician advising him of the questions and responses. Follow his orders to either discharge the patient with instructions to go to the hospital for follow-up or call an ambulance for immediate transfer.
Recently, while working with a particular surgery center, I was advised the admitting office was not qualified, nor were they staffed to perform the above task. This particular center wanted to bypass those questions, and especially, never take a temperature citing lack of training, experience and time. Ergatz! In the face of a potential exposure to Ebola, I assert we cannot afford NOT to train the staff and NOT to take the time! This group suggested that the preop nurses should be managing this process. So….risk the exposure of the admitting staff and add the potential exposure of the preop nurse(s)??? Really?
Again, as a group, meet. Discuss the risks. Review the disease, symptoms and risks. Discuss the logistics. Take on that this is something that has to be done, and is best done on the initial patient contact, which is at the admitting desk. Taking that on, then explore methods and avenues to make it happen. Perhaps, posting a nurse at admitting, or having a nurse assigned on a daily basis, to go to admitting when a patient is being admitted to ask the questions and take the temperature. For many centers this would mean bringing on additional preop staff. Is there a CMA or LPN who could perform these duties and who would call for the RN only if a positive result or answer is found?
In the face of the Ebola pandemic it is crucial that the ASC staff and leaders stay alert to the seriousness of this crisis. We cannot afford to keep our heads buried in the sand thinking, "it doesn't apply to us." IT APPLIES TO ALL OF US! We need to do our part to prevent the spread of and to control this disease.
Begin a QA/PI study identifying the number of your patients who HAVE traveled outside the US in the last 30 days. This will illustrate to you the degree of mobility present among your patient population and will emphasize the importance of tracking such travel. Some surgery centers ask this question as a matter of course during their initial preoperative contact.
In closing, you cannot be too vigilant — always!
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