Happy Halloween from DEHS

DEHS staff - Halloween 2014 - click to enlarge

Dealing with the human remains of ebola patients

CDC guidance for Human Remains at Hospitals and Mortuaries.

PPE Medical Examiner

Virginia Department of Health Guidelines for Coroners.

A recent article from the CDC on  the Postmortem stability of  Ebola virus, and viral RNA suggests that humans who die of EVD can harbor active virus on the skin surface for 7 days, and viral RNA in the tissues for substantially longer (approx. 9 weeks). Additionally, it determined mucosal swabbing was equally as effective as tissue biopsies for sample testing. Blood continues to have the highest viral titer. - Thanks to Shawn Wilson -HCME for the information. 

http://www.bioseal.com/

Heat Sealed body bags are recommended.

Medical Examiners Guide for Bioterrorism and infectious agents - CDC

Ebola guidance for clinics and bleach dilution

Department of Health and Human Services has offered guidance for best practices for clinics and ambulatory care centers dealing with Ebola.

Several questions about the appropriate bleach dilution for cleaning up Ebola.  A 1:10 ratio of fresh bleach to water is the recommended dilution.  Do not mix in any other chemicals.  Use in a well ventilated area.  Bleach is an eye, skin and respirator irritant.

Canadian Guidelines:

SUSCEPTIBILITY TO DISINFECTANTS: Ebolavirus is susceptible to 3% acetic acid, 1% glutaraldehyde, alcohol-based products, and dilutions (1:10-1:100 for ≥10 minutes) of 5.25% household bleach (sodium hypochlorite), and calcium hypochlorite (bleach powder)^{Footnote48 Footnote49 Footnote50 Footnote62 Footnote63}. The WHO recommendations for cleaning up spills of blood or body fluids suggest flooding the area with a 1:10 dilutions of 5.25% household bleach for 10 minutes for surfaces that can tolerate stronger bleach solutions (e.g., cement, metal) ^Footnote62. For surfaces that may corrode or discolour, they recommend careful cleaning to remove visible stains followed by contact with a 1:100 dilution of 5.25% household bleach for more than 10 minutes.

For spills with more organic matter DEHS has consistantly recommended a contact time of 30 minutes.

Videos on donning and doffing from Emory University

USA Today article

Emory University Website:  Login and acceptance of Disclaimer is required.  The Emory Healthcare Ebola Preparedness Protocols full site/materials Disclaimer is available at at www.emoryhealthcare.org/ebolaprep.

Donning PPE procedure 10/21/2014

New CDC guidelines on Ebola PPE procedures

NY Times PPE comparison

1. Original PPE recommendations from CDC
2. New Minimum PPE (level-2) N-95, tyvek jump suit, water resistant gown, booties at calf height, double gloves, detachable hood, face shield.  Croc footwear optional 
3. Full PPE (level -3)  Water Impermeable, tear resistant suit - HEPA PAPR, taped durable gloves, suit and booties.

CDC combined the best practices from hospitals successfully treating patients at Emory, Nebraska and NIH with the protocols used by Doctors without Boarders. 

Key points via
John Hick, MD 
Emergency Medicine MC 825
Hennepin County Medical Center

1. simple masks no longer recommended - N95 or PAPR only (so this does require fit-testing unless PAPR is used - this is probably the biggest surprise of the document though a good move - but for public safety agencies may be an issue)
2. all skin covered
3. hood to cover head (but not hood integrated into suit due to issues with traction from suit that can cause gapping at forehead apparently)
4. aprons to be worn when dealing with significant body fluids
5. emphasis on monitoring of PPE process - note that monitor is also to be in PPE (minus respiratory protection)
6. gowns must cover to calf
7. note footwear issues - some have recommended crocs for comfort and ease of cleaning as opposed to boots.  

CDC guideline summary

NY Times summary of updated PPE procedures

CBS News Comparison of PPE levels - This was done prior to the CDC revision.





PPE procedure for  Medical workers in Abola treatment areas - WSJ  approx. 2 min.

Safe U - Ebola Virus and additional resources.

Ebola Signs and Symptoms:  Asia One News

Ebola Virus and the University of Minnesota - Safe U site on Ebola  -

CDC will be updating guidelines for PPE and care and treatment of Ebola Patients soon.

Signs and symptoms - Global Nation

Ebola: Donning and Doffing - U of Nebraska

The University of Nebraska - ebola information has developed a more comprehensive donning and doffing procedure than the preliminary CDC guidelines.  So far none of their medical personnel has come down with any Ebola symptoms while treating an infected patient who survived.

Donning PPE for Ebola Patients - U of Nebraska

Nice additions- More comfortable respirators, Booties, Neck covering.
Removing jewelry- wearing washable shoes. Making sure to hydrate prior to entering.

Doffing PPE for Ebola Patients - U of Nebraska

Nice additions: Using multiple gloves for removing PPE.  Supplying a disposable mat for standing.
Bleach wiping crock footwear.  Shower after doing the work.  Do vitals and hydrate.

Report on U of Nebraska Ebola treatment ward.  - Lincoln Journal Star.  August 6, 2014.

Emory University Video - Donning and Doffing

The Emory University procedure is different than the U of Nebraska protocol.  Doffing occurs in the patient room.  There is a buddy system to help with removal of the outer apron.  The decontamination and doffing procedure for the assistant is not shown.   

Ebola information

WCCO Ebola photo - CDC

Link to John's Hopkins Ebola Forum archived webcast 10/14/2014 (3 hours).

Link to Agenda and speakers at the Forum

CIDRAP links on Ebola - Center for Infectious Disease Research and Policy - U of MN

1.       The Centers for Disease Control and Prevention “Interim

Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public
Safety Answering Points (PSAPs) for Management of Patients with Known
or Suspected Ebola Virus Disease in the United States”
http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-911-public-safety-answering-points-management-patients-known-suspected-united-states.html

A number of people have asked MDH about whether PSAPs should do
screening of callers. The guidance listed above addresses this issue
under the “Key Points” section.

2.       Because we have received many questions about procedures and
products for cleaning and disinfection, we are including the
Occupational Safety and Health Administration fact sheet on  “Cleaning
and Decontamination of Ebola on Surfaces”
https://www.osha.gov/Publications/OSHA_FS-3756.pdf  This fact sheet
includes a link to the listing of EPA-Registered Disinfectants
http://www.epa.gov/oppad001/chemregindex.htm ; select List G
(Norovirus) for products that are effective against Ebola.

3.       The Centers for Disease Control and Prevention/Assistant
Secretary for Preparedness and Response “Detailed Emergency Medical
Services (EMS) Checklist for Ebola Preparedness”
http://www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf

We also encourage you to check the CDC and MDH Ebola websites
frequently for updated information:

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

http://www.health.state.mn.us/divs/idepc/diseases/vhf/index.html

NY times How hospital workers are supposed to treat an Ebola Patient Safely.

Ken Kerns appointed to Assistant Vice President, UHS at the University of Minnesota

Ken Kerns has been appointed to the position of Assistant Vice President, University Health and Safety (UHS).  Ken will begin in his new role on November 24, 2014.

The AVP is responsible for the development, implementation, administration, facilitation, and monitoring of health, safety, and preparedness policies and programs for the University of Minnesota system.  The position works collaboratively with faculty, academic administrators, and staff to support academic and research excellence while developing and sustaining a culture of safety and compliance.  University Health and Safety was recently expanded, and now includes the Department of Environmental Health and Safety, the Office of Occupational Health and Safety, Facilities Management Safety, the Department of Emergency Management, and the Building Code Division.

Ken comes to us from Tulane University, where he has served for the past three years as the Assistant Vice President for Environmental Health and Safety.  During his tenure, he has successfully strengthened partnerships with the academic community and has guided his team toward a more effective organization with a focus on excellence and service.  Prior to Tulane, he served at Iowa State University for sixteen years as the Associate Director of Environmental Health and Safety, specializing in radiation safety, emergency management, and physical safety.  He also continues to consult on a periodic basis for the International Atomic Energy Agency, a role he has maintained since 1997.  He received his B.S. in Zoology from Weber State College, and his M.S. in Zoology from Iowa State.