With so much for hospitals to manage in their Ebola preparedness efforts, details related to technology may get lost in the shuffle. Here's a short list of precautions to consider related to the devices being used to treat, or support treatment of, known or suspected Ebola patients. This list would also apply to scenarios involving other very high-risk infectious diseases.
Use Needlestick-Prevention Devices
Needlestick-prevention devices should be used in all areas of the hospital, but they are especially important when dealing with Ebola patients. Make sure that all areas likely to be used for treating Ebola patients have a full complement of those devices. Also, try out your needlestick-prevention devices to make sure their protective features can be safely engaged when staff are double- or triple-gloved, which they're likely to be when treating these patients.
Sharps containers should be readily available in all areas where Ebola patients are treated. Staff should be trained to dispose of and replace sharps containers well before they risk becoming overfilled. Overflowing sharps containers create one of the greatest risks for needlestick injuries.
Ensure Effective Cleaning and Disinfection of Reusable Devices
Reusable medical equipment like patient monitors, infusion pumps, ventilators, and beds will require careful cleaning and disinfection if used during the care of Ebola patients. Contact your device manufacturers for specific instructions related to their devices. Make sure to account for any reusable accessories associated with these devices, such as patient monitoring cables, ultrasound probes, and bed remote controls. Also, determine whether devices have internal components like filters or tubing that may become contaminated. Use appropriate precautions when removing or otherwise touching these components.
Investigate the use of disposable drapes to cover medical devices in Ebola treatment areas (if practical) to ease the burden of device cleaning and disinfection following patient treatment. Clear plastic sheeting may be an alternative if disposable drapes will cover essential displays.
Safely Manage Dialysis Equipment
Some Ebola patients are likely to require dialysis, either continuous renal replacement therapy or conventional hemodialysis. Since these procedures involve circulation of patient blood through the dialysis equipment, the risk of device contamination is higher than with other devices. Instruct staff to pay close attention to device pressure alarms and other signs that dialysis tubing may be leaking (e.g., into the device). Consider replacing transducer protectors—which are designed to keep blood from contaminating the device's pressure transducers—following treatment and during cleaning and disinfection of the device. Keep in mind that some transducer protectors may be located inside the machine and should also be replaced following treatment. The U.S. Centers for Disease Control and Prevention offers detailed and helpful guidance for safely performing acute hemodialysis on Ebola patients.
Prepare for Autoclaving of Discarded Devices and Other Waste
Most hospitals will be required to autoclave discarded medical devices and other waste prior to transport for off-site incineration. Examine your on-site autoclaving capacity and determine whether it can handle the likely volume from medical devices and other waste associated with your Ebola patients. Investigate other options to expand your capacity, like acquiring additional autoclaving units, as part of your preparedness planning. Also, make sure to provide for safe transport of contaminated equipment and other waste to the autoclaving area. This should include planning for appropriate protection for autoclaving staff.
The care of Ebola patients produces a tremendous amount of waste. Hospitals should expect to have up to eight 55-gallon drums of waste per day per patient treated for Ebola. This added volume of waste should be considered in your waste sterilization and removal planning.
Ensure Safe Setup and Use of Suctioning Equipment
Patient suction is typically set up with a dual-canister system so that overflow waste flows into the second canister rather than leaking from the primary canister. Examine your suction setups in any area likely to be used for treating Ebola patients, and make sure that they are fully set up with dual-canister configurations. Test these systems to make sure that overflow liquid effectively transitions to the secondary canister. Also make sure that you have an adequate supply of suction canisters on hand and that your staff are fully trained in the safe disposal of the canisters.
Effectively Clean and Disinfect Channeled Endoscopic Devices
The cleaning and disinfecting of channeled endoscopic devices like bronchoscopes can be particularly challenging. Some of these devices require use of special adapters to flush liquids through their channels during disinfection. Make sure that you are fully prepared for disinfecting channeled endoscopic devices that are likely to be used for Ebola patients. Contact the manufacturer of your endoscope reprocessors to make sure that you have the correct adapters for each channeled endoscopic device likely to be used for Ebola patients.
Consider setting aside a dedicated section of your sterile processing area for handling contaminated equipment like endoscopes; remember to arrange for safe transport of such equipment to your sterile processing area. Also plan for appropriate protection for staff in the sterile processing area who are handling the contaminated instruments.
Consider Video Communication with Patients
Although Ebola patients need the support of their family members and other loved ones, it is unfortunately not safe to allow those individuals to enter the patient's room because of the obvious cross-contamination risks. Also, not all healthcare professionals caring for or supporting the care of Ebola patients need to be in direct contact with them. Consider setting up a two-way video and audio communication system (like, for example, the systems used for telemedicine) to allow a limited number of family members and other loved ones who are not under quarantine restrictions to communicate with Ebola patients. The same system can be used for healthcare professionals who do not need to be in physical contact with the patients.