Interim Guidance for U.S. Hospital Preparedness for Patients with Possible or Confirmed Ebola Virus Disease: A Framework for a Tiered Approach
Who this is for: State and local health departments, acute care hospitals, and other emergency care settings, including urgent care clinics.
What this is for: Guidance to assist state and local health departments, acute care hospitals, and other emergency care settings (including urgent care clinics) develop preparedness plans for patients with possible Ebola Virus Disease (EVD). This guidance does not address Ebola preparedness for primary care offices and other non-emergent ambulatory care settings. Guidance for these settings can be found at:http://www.cdc.gov/vhf/ebola/pdf/ambulatory-care-evaluation-of-patients-with-possible-ebola.pdf[PDF - 1 page].
How this relates to other guidance documents/purpose: This guidance serves as an overarching framework for three other specific CDC guidance documents: Interim Guidance for Preparing Frontline Healthcare Facilities for Patients with Possible Ebola Virus Disease; Interim Guidance for Preparing Ebola Assessment Hospitals; and Interim Guidance for Preparing Ebola Treatment Centers.
To create a coordinated, networked approach, state and local health officials, in collaboration with hospital executives, may identify healthcare facilities across the state to serve in one of three suggested roles outlined in this guidance document. Whereas every state is not obligated to adopt a three-tiered approach, all are strongly encouraged to identify Ebola assessment hospitals that can successfully manage a suspected or confirmed case of Ebola while awaiting transfer to an Ebola treatment center, or until an EVD diagnosis is ruled out, especially in states where there is not expected to be an Ebola treatment center. Designating assessment hospitals helps to ensure that PUIs have in-state access to care while awaiting potential transfer to an Ebola treatment center.
Specific CDC guidance for Frontline healthcare facilities, Ebola assessment hospitals, and Ebola treatment centers can be found athttp://www.cdc.gov/vhf/ebola/hcp/index.html.
Frontline Healthcare FacilitiesMost U.S. acute-care facilities that are equipped for emergency care (e.g., hospital-based emergency departments and other emergency care settings including urgent care clinics, and critical access hospitals) are in this tier. Frontline healthcare facilities do not include primary care offices and other non-emergent ambulatory care settings. Preparedness guidance for these settings can be found at: http://www.cdc.gov/vhf/ebola/pdf/ambulatory-care-evaluation-of-patients-with-possible-ebola.pdf[PDF - 1 page].
CDC’s Interim U.S. Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure recommends active monitoring by state and local public health agencies for all people who have a recognized potential exposure to Ebola within the previous 21 days. These persons will be directed to designated facilities for evaluation if they become ill. However it is also possible that patients with unrecognized EVD will present to a frontline healthcare facility without warning or rarely, patients may be temporarily referred to frontline healthcare facilities when it is not feasible to refer to an Ebola assessment or Ebola treatment center (e.g., based on distance, bed availability, or other considerations). Therefore, frontline healthcare facilities should be prepared to promptly identify and isolate patients who may have EVD and promptly inform the hospital/facility infection control program and state and local public health agency according to the CDC guidance for emergency departments. In some situations, frontline healthcare facilities may also arrange for Ebola testing at the nearest Laboratory Response Network (LRN) laboratory capable of performing testing for EVD, in accordance with the state’s plan. Frontline healthcare facilities are not expected to provide prolonged care (>12–24 hours) for a severely ill patient.
Specifically, frontline healthcare facilities should, in coordination with local and state health authorities, be able to:
Coordinated public health systems are in place to monitor people potentially exposed to Ebola (i.e., active and direct active monitoring). Public health authorities may identify persons under monitoring who need testing for Ebola if they develop compatible signs or symptoms, and may refer them to Ebola assessment hospitals. These persons will likely be previously identified as at some level of risk for EVD through airport screening[PDF - 2 pages]and will be actively monitored by public health authorities during the 21 days following travel to an affected country or other potential EVD exposure. Therefore, patients at high risk for Ebola should be referred primarily to Ebola assessment hospitals (or treatment centers) rather than frontline healthcare facilities. State and local public health authorities will coordinate closely with facilities when directing patients to a designated Ebola assessment hospital or Ebola treatment center.
Given current PPE shortages, Ebola treatment centers may not be able to procure in advance the amount of PPE needed for the entire time period to care for an Ebola patient. Therefore, at a minimum, to be ready to accept and care for EVD patients, hospitals will need sufficient Ebola PPE for at least 7 days. If hospitalization is anticipated to exceed 7 days, state and local health authorities, in collaboration with CDC, may provide or facilitate the procurement of additional PPE supplies. CDC Ebola Response Teams (CERTs) are ready to deploy to any Ebola treatment center to provide technical assistance for infection control procedures, clinical care, and logistics of managing EVD patients as soon as the health department or hospital requests assistance.
In addition, CDC is available 24/7 for consultation to hospitals and state and local health departments by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 or via email at firstname.lastname@example.org.
Guidance for Ebola Treatment Centers can be found at http://www.cdc.gov/vhf/ebola/hcp/preparing-ebola-treatment-centers.html.