Template:Harbor Ebola Precautions - Revision history

Andreawu: /* Harbor Ebola Precautions */

2022-10-12T00:29:38Z

Harbor Ebola Precautions

← Older revision		Revision as of 00:29, 12 October 2022
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	*As soon as the patient is identified as a PUI - they should go straight into isolation (in AED or PED, not RME), ideally one with a restroom inside the room; all further evaluation is done there.		*As soon as the patient is identified as a PUI - they should go straight into isolation (in AED or PED, not RME), ideally one with a restroom inside the room; all further evaluation is done there.
	*Residents should not be in a room with a PUI patient - only attendings and fellows acting as attendings should be involved in wearing PPE and entering a PUI room		*Residents should not be in a room with a PUI patient - only attendings and fellows acting as attendings should be involved in wearing PPE and entering a PUI room
	*Notify the infectious disease (ID) service ~~and infection control prevent (IPC)~~ that you have a PUI patient in the emergency department - they will guide further screening to determine if the patient can be cleared or not.		*Notify the infectious disease (ID) service that you have a PUI patient in the emergency department - they will guide further screening to determine if the patient can be cleared or not. ID will then notify infection control prevent (IPC).
	*PUI patients are not allowed to use the sink or toilet. Mechanical should bring a porta-potty for patient use if there is not one in the room.		*PUI patients are not allowed to use the sink or toilet. Mechanical should bring a porta-potty for patient use if there is not one in the room.
	*The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient. Nursing has a list of nurses who have volunteered to care for PUI patients.		*The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient. Nursing has a list of nurses who have volunteered to care for PUI patients.

Andreawu: /* Harbor Ebola Precautions */

2022-10-11T21:00:42Z

Harbor Ebola Precautions

Bchap23: /* Monkeypox */

2022-09-06T17:46:58Z

Monkeypox

← Older revision		Revision as of 17:46, 6 September 2022
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	* If get a call for positive test, double check patient is on the lab follow up lists.		* If get a call for positive test, double check patient is on the lab follow up lists.
	** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control		** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control
	* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval		* Treatment is tecovirimat (TPoxx) - experimental antiviral agent '''needs ID approval'''
	** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion		** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion
	** Obtain [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent.pdf written consent] or [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent-Spanish.pdf Spanish written consent]		** Obtain [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent.pdf written consent] or [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent-Spanish.pdf Spanish written consent]

Andreawu: /* Monkeypox */

2022-08-23T23:03:37Z

Monkeypox

← Older revision		Revision as of 23:03, 23 August 2022
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	* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval		* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval
	** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion		** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion
	** Obtain [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent.pdf written consent]		** Obtain [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent.pdf written consent] or [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent-Spanish.pdf Spanish written consent]
	*** Only available in English for now. Do verbal consent for other languages then have patient sign the English consent form		*** Only available in English and Spanish for now. Do verbal consent for other languages then have patient sign the English consent form
			** Write e-script using ‘misc prescription’
	** Fill out TNF form (prior-authorization form) and inform ED pharmacist		** Fill out TNF form (prior-authorization form) and inform ED pharmacist
	** RN to call OPD to have someone send Tpoxx from Outpatient Pharmacy to ED (can be RN or pharmacy tech		** RN to call OPD to have someone send Tpoxx from Outpatient Pharmacy to ED (can be RN or pharmacy tech

Andreawu: /* Monkeypox */

2022-08-23T21:13:01Z

Monkeypox

← Older revision		Revision as of 21:13, 23 August 2022
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	==Monkeypox==		==Monkeypox==
	* See [[Monkeypox]] for clinical info		* See [[Monkeypox]] for clinical info
	* See LAC DHS Expected Practice		* See [https://lacounty.sharepoint.com/sites/dhs-ccl/InfectiousDisease/Forms/AllItems.aspx?id=/sites/dhs-ccl/InfectiousDisease/Infectious%20Disease%20-%20Guidance%20for%20Prevention,%20Diagnosis,%20and%20Treatment%20of%20Monkeypox%20Disease%208-11-22.pdf&parente LAC DHS Expected Practice]
	** Consider in patients with travel history w/in 21d of symptom onset to West Africa, Europe (CDC link of [https://wwwnc.cdc.gov/travel/notices/alert/monkeypox#countries non-endemic countries] with cases)		** Consider in patients with travel history w/in 21d of symptom onset to West Africa, Europe (CDC link of [https://wwwnc.cdc.gov/travel/notices/alert/monkeypox#countries non-endemic countries] with cases)
	** Rash typically preceded by fever, lymphadenopathy, malaise, HA, and muscle aches, but not all patients have prodrome in current outbreak		** Rash typically preceded by fever, lymphadenopathy, malaise, HA, and muscle aches, but not all patients have prodrome in current outbreak
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	** Higher likelihood in MSM patients, presenting with lesions in the genital area		** Higher likelihood in MSM patients, presenting with lesions in the genital area
	* Move directly to a private room, cover rash; airborne (N-95) and contact precautions (gown), eye protection, gloves - order special precautions		* Move directly to a private room, cover rash; airborne (N-95) and contact precautions (gown), eye protection, gloves - order special precautions
	* Call ~~IPC x66532 and Micro~~ x66289 and get a monkeypox collection kit from Microbiology		* Call Lab x66289 and get a monkeypox collection kit from Microbiology
	* Unroof lesion to swab, try to get cutaneous and genital lesions. Need separate order for each swab.		* Unroof lesion to swab, try to get cutaneous and genital lesions. Need separate order for each swab.
	* Send out to Quest, 3days turnaround time		* Send out to Quest, 3days turnaround time
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	* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval		* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval
	** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion		** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion
			** Obtain [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent.pdf written consent]
			*** Only available in English for now. Do verbal consent for other languages then have patient sign the English consent form
			** Fill out TNF form (prior-authorization form) and inform ED pharmacist
			** RN to call OPD to have someone send Tpoxx from Outpatient Pharmacy to ED (can be RN or pharmacy tech

	* Educational Material		* Educational Material

Andreawu: /* Monkeypox */

2022-08-18T23:03:39Z

Monkeypox

← Older revision		Revision as of 23:03, 18 August 2022
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	* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval		* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval
	** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion		** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion

			* Educational Material
			** [http://publichealth.lacounty.gov/acd/Monkeypox.htm LA County Monkeypox]
			** [http://publichealth.lacounty.gov/media/monkeypox/docs/Monkeypox_IntimateContact.pdf LAC DPH Monkeypox]
			** http://publichealth.lacounty.gov/media/monkeypox/resources.htm#reduce
			** [https://www.cdc.gov/poxvirus/monkeypox/resources/print.html CDC Monkeypox]

Andreawu: /* Monkeypox */

2022-08-18T19:01:42Z

Monkeypox

← Older revision		Revision as of 19:01, 18 August 2022
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	** Vesicular or pustular rash, well-circumscribed, may be umbilicated or become confluent and progress over time to scabs. Could be in different stages.		** Vesicular or pustular rash, well-circumscribed, may be umbilicated or become confluent and progress over time to scabs. Could be in different stages.
	** Higher likelihood in MSM patients, presenting with lesions in the genital area		** Higher likelihood in MSM patients, presenting with lesions in the genital area
	* Move directly to a private room, cover rash; airborne (N-95) and contact precautions (gown) - order special precautions		* Move directly to a private room, cover rash; airborne (N-95) and contact precautions (gown), eye protection, gloves - order special precautions
	* Call IPC x66532 and Micro x66289 and get a monkeypox collection kit from Microbiology		* Call IPC x66532 and Micro x66289 and get a monkeypox collection kit from Microbiology
	* Unroof lesion ~~for~~ swab, try to get cutaneous and genital lesions. Need separate order for each swab.		* Unroof lesion to swab, try to get cutaneous and genital lesions. Need separate order for each swab.
	* Send out to Quest, 3days turnaround time		* Send out to Quest, 3days turnaround time
	* Put patient onto lab follow up list.		* Put patient onto lab follow up list.

Andreawu: /* Monkeypox */

2022-08-18T18:55:06Z

Monkeypox

← Older revision		Revision as of 18:55, 18 August 2022
Line 36:		Line 36:
	* If get a call for positive test, double check patient is on the lab follow up lists.		* If get a call for positive test, double check patient is on the lab follow up lists.
	** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control		** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control
	* Treatment is tecovirimat (TPoxx) - antiviral agent needs ID approval		* Treatment is tecovirimat (TPoxx) - experimental antiviral agent needs ID approval
	** For painful lesions preventing ability to do ADLs		** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion

Andreawu: /* Monkeypox */

2022-08-18T18:47:48Z

Monkeypox

← Older revision		Revision as of 18:47, 18 August 2022
Line 36:		Line 36:
	* If get a call for positive test, double check patient is on the lab follow up lists.		* If get a call for positive test, double check patient is on the lab follow up lists.
	** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control		** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control
	* Treatment is tecovirimat (TPoxx) - antiviral agent		* Treatment is tecovirimat (TPoxx) - antiviral agent needs ID approval
			** For painful lesions preventing ability to do ADLs

Andreawu: /* Monkeypox */

2022-08-18T18:44:49Z

Monkeypox

← Older revision		Revision as of 18:44, 18 August 2022
Line 22:		Line 22:

	==Monkeypox==		==Monkeypox==
	* See [[Monkeypox]]		* See [[Monkeypox]] for clinical info
			* See LAC DHS Expected Practice
	** Consider in patients with travel history w/in 21d of symptom onset to West Africa, Europe (CDC link of [https://wwwnc.cdc.gov/travel/notices/alert/monkeypox#countries non-endemic countries] with cases)		** Consider in patients with travel history w/in 21d of symptom onset to West Africa, Europe (CDC link of [https://wwwnc.cdc.gov/travel/notices/alert/monkeypox#countries non-endemic countries] with cases)
	** Rash typically preceded by fever, lymphadenopathy, malaise, HA, and muscle aches		** Rash typically preceded by fever, lymphadenopathy, malaise, HA, and muscle aches, but not all patients have prodrome in current outbreak
	** Vesicular or pustular rash, well-circumscribed, may be umbilicated or become confluent and progress over time to scabs		** Vesicular or pustular rash, well-circumscribed, may be umbilicated or become confluent and progress over time to scabs. Could be in different stages.
	** Higher likelihood in MSM patients, presenting with lesions in the genital area		** Higher likelihood in MSM patients, presenting with lesions in the genital area
	* Move directly to a ~~negative-pressure~~ room, cover rash; airborne (N-95) and contact precautions (gown)		* Move directly to a private room, cover rash; airborne (N-95) and contact precautions (gown) - order special precautions
	* Call IPC x66532 and Micro x66289 and get a monkeypox collection kit from Microbiology		* Call IPC x66532 and Micro x66289 and get a monkeypox collection kit from Microbiology
	** Call LAC Acute Communicable Disease Control (weekdays 8:30A-5P 213-240-7941, ~~after hours 213-974-1234~~ and ~~ask~~ for ~~the physician on call) [http://publichealth~~.~~lacounty~~.~~gov/acd/Monkeypox~~.~~htm~~ LA County ~~Monkeypox]~~		* Unroof lesion for swab, try to get cutaneous and genital lesions. Need separate order for each swab.
			* Send out to Quest, 3days turnaround time
			* Put patient onto lab follow up list.
			* Inform patient to self isolate until all lesions scabbed over
			* If get a call for positive test, double check patient is on the lab follow up lists.
			** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control
			* Treatment is tecovirimat (TPoxx) - antiviral agent

← Older revision		Revision as of 21:00, 11 October 2022
Line 1:		Line 1:

	==[[Harbor:Ebola\|Harbor Ebola]] Precautions==		==[[Harbor:Ebola\|Harbor Ebola]] Precautions==

	*Never enter a room with an Ebola PUI (Person Under Investigation) without full Ebola level PPE.		*Never enter a room with an Ebola PUI (Person Under Investigation) without full Ebola level PPE.
	*The definition of a PUI is simple - possible exposure to Ebola and subjective complaints consistent with Ebola infection (basically viral syndrome symptoms or abdominal pain or bleeding). No fever or other visible findings are required to classify the patient as a PUI patient.		*The definition of a PUI is simple - possible exposure to Ebola and subjective complaints consistent with Ebola infection (basically viral syndrome symptoms or abdominal pain or bleeding). No fever or other visible findings are required to classify the patient as a PUI patient.
	*Currently countries identified as travel locations we should be concerned about are coded into the "ID Risk Screen" the routers perform and you can find on Cerner under "Provider Notes"		*Currently countries identified as travel locations we should be concerned about are coded into the "ID Risk Screen" the routers perform and you can find on Cerner under "Provider Notes"
			**As of October 2022, outbreak is isolated in Uganda
	*There are other ways to be exposed to Ebola virus: including sexual intercourse with a patient who has recovered from an Ebola infection.		*There are other ways to be exposed to Ebola virus: including sexual intercourse with a patient who has recovered from an Ebola infection.
	*As soon as the patient is identified as a PUI - they should go straight into isolation (in ~~AAED~~ or PED, not RME); all further evaluation is done there.		*As soon as the patient is identified as a PUI - they should go straight into isolation (in AED or PED, not RME), ideally one with a restroom inside the room; all further evaluation is done there.
	*Residents should not be in a room with a PUI patient - only attendings and fellows acting as attendings should be involved in wearing PPE and entering a PUI room		*Residents should not be in a room with a PUI patient - only attendings and fellows acting as attendings should be involved in wearing PPE and entering a PUI room
	*Notify the infectious disease service that you have a PUI patient in the emergency department - they will guide further screening to determine if the patient can be cleared or not.		*Notify the infectious disease (ID) service and infection control prevent (IPC) that you have a PUI patient in the emergency department - they will guide further screening to determine if the patient can be cleared or not.
	*PUI patients are not allowed to use the sink or toilet. Mechanical should bring a porta-potty for patient use.		*PUI patients are not allowed to use the sink or toilet. Mechanical should bring a porta-potty for patient use if there is not one in the room.
	*The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient. Nursing has a list of nurses who have volunteered to care for PUI patients.		*The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient. Nursing has a list of nurses who have volunteered to care for PUI patients.
	*Extreme care should be taken in any situation where a PUI patient may undergo a procedure that aerosolizes body fluids - the best PPE in this case is a PAPR unit - which is a helmet with a positive pressure fan~~. We will receive additional training on these in the future~~.		*Extreme care should be taken in any situation where a PUI patient may undergo a procedure that aerosolizes body fluids - the best PPE in this case is a PAPR unit - which is a helmet with a positive pressure fan.
	*~~There is~~ a ~~cart in the AAED that contains all of the~~ PPE equipment ~~to care~~ for a ~~PUI patient. It is currently across from the B side desk~~ in ~~the AAED,~~ and ~~looks like all the other yellow PPE carts. We are in the process~~ of ~~having it marked with~~ a ~~large "E" to distinguish it from the other PPE carts~~.		*Call the OCN to obtain a PAPR and PPE equipment for Ebola, put out a log to record who goes in and out of a PUI room.
	*In the top drawer of the Ebola PPE cart is a binder that has step by step instructions for getting into and out of PPE for both the treating provider and that provider's "buddy". We will plan more training to refresh everyone on this.		*In the top drawer of the Ebola PPE cart is a binder that has step by step instructions for getting into and out of PPE for both the treating provider and that provider's "buddy". We will plan more training to refresh everyone on this.
	*The instruction book also contains a log to record who goes in and out of a PUI room.
	*UCLA Medical Center in Westwood will be our referral center for patients who cannot be cleared in a reasonable timeframe' or become confirmed Ebola patients. The decision for the timing of transfer will be made in conjunction with the infectious disease consultant.		*UCLA Medical Center in Westwood will be our referral center for patients who cannot be cleared in a reasonable timeframe' or become confirmed Ebola patients. The decision for the timing of transfer will be made in conjunction with the infectious disease consultant.
	*EMS has a special unit to transport such patients - make sure they're aware that you have a PUI or confirmed case of Ebola.		*EMS has a special unit to transport such patients - make sure they're aware that you have a PUI or confirmed case of Ebola.

	~~M. Peterson 5/8/15~~



	==Monkeypox==		==Monkeypox==