Preparations and Training Continue at UCSF for Possible Patient Infected with Ebola

UCSF Medical Center continues to train nurses and physicians and inform front-line staff on what to do in case a patient with suspected or confirmed Ebola Virus Disease (EVD) arrives at its hospitals and clinics.

To date, no patients with EVD have been reported at UCSF, San Francisco or California.

Among the recent developments at UCSF:

• More than 100 physicians, nurses, clinical lab scientists and respiratory therapists have volunteered to serve patients with EVD;
• Training continues of these special assignment clinicians;
• The isolation unit at Mount Zion continues to be upgraded to ensure the safety of health care workers, other patients and the UCSF community;
• Several UCSF faculty have volunteered to go to West Africa, the hot zone of the epidemic;
• The electronic medical record system known as APeX has been updated to include screening protocols;
• More than 100 medical center and campus staff participated in a daylong retreat on Tuesday to coordinate planning efforts and to discuss outstanding issues yet to be resolved.

“At UCSF Medical Center we are committed to providing our patients and visitors with excellent care and services,” said Josh Adler, MD, chief medical officer at UCSF Medical Center. “We will continue collaborating with our colleagues around the country and will coordinate all of our efforts with the Centers for Disease Control and Prevention and both state and local health departments.”

Today, front-line medical center staff across the clinical enterprise began to screen all patients, and were informed how to isolate any patients who may be at risk for Ebola.

Screening questions at all portals of entry include:  “In the last 21 days have you traveled to Guinea, Liberia or Sierra Leone or had contact with someone who was sick with Ebola?” “Do you currently have a fever, headache, weakness, muscle pain, vomiting, diarrhea, stomach pain, unusual bleeding or bruising?”

If further testing of the patient is recommended, UCSF Medical Center will contact the San Francisco Department of Public Health (SFDPH), which will provide a more detailed epidemiological assessment. If necessary, the local health officer will then coordinate with California Department of Public Health (CDPH) and the U.S. Centers for Disease Control and Prevention (CDC) to pursue testing at CDC-approved laboratories.

During that time, the patient will be cared for at the Mount Zion isolation unit until the test results are available. 

In addition, UCSF faculty who venture to the West African countries to voluntarily treat patients with Ebola will be required to self-monitor for symptoms and to remain off the UCSF campus for 21 days after their last contact with an Ebola patient.

Positioned to Provide Inpatient Care

The University of California Office of the President on Oct. 24 informed CDPH that UCSF and the other four UC medical centers are positioned to provide inpatient care for Californians who have confirmed cases of Ebola if necessary.

CDPH continues to work with health officials to prepare for potential cases of Ebola in California and the Division of Occupational Safety and Health (Cal/OSHA) is providing updated, specific guidelines on the personal protective equipment (PPE), training and other measures that must be in place to protect workers’ health and safety.

The five UC medical centers are not identified as treatment centers for patients being transported into the United States by the U.S. State Department. Four hospitals in other parts of the country are already established as treatment centers for these repatriated U.S. citizens.

For its part, UCSF has been preparing since August for the possibility of a patient with Ebola arriving at UCSF Medical Center.

Teams at UCSF are working to ensure that the medical center is ready and able to treat a patient in a comprehensive way that protects health care workers, other patients and the UCSF community.

UCSF conducted a daylong retreat on Ebola involving key members representing a cross-section of the medical center and campus involved in preparation and response. The retreat was designed to further refine and standardize UCSF’s response to EVD. Teams are working in the following areas: staffing, cleaning and waste handling, communications, medication handling, work flows for inpatient, outpatient and laboratory areas, as well as security and safety.

“While our unit is ready to receive one patient, every day, UCSF is becoming more and more prepared to treat patients with a suspected or confirmed case of Ebola,” said Adrienne Green, MD, associate chief medical officer of UCSF Medical Center.

Training of Medical Center Staff

Importantly, only experienced faculty and staff who have volunteered to treat suspected or confirmed cases of EVD will do so at UCSF. UCSF has conducted practice drills in the Emergency Department, a walk-through and a tabletop exercise.

Students, trainees and postdoctoral scholars will not be part of the patient care teams of these patients to minimize exposure to the virus.

The 113 special assignment nurses, respiratory therapists, clinical lab scientists and physicians who have volunteered to treat these patients at UCSF have received initial training and will continue to receive refresher training in the care of EVD patients, the proper use of PPE and learn the policies and procedures designed to ensure their safety and the safety of others.

In addition, all nurses employed in the Department of Nursing at UCSF Medical Center have received mandatory education in the form of an online module on “Ebola essentials” based on the guidance of the CDC and other regulatory agencies. Further, another online module was completed by frontline medical center staff involved in screening and triage. Instructor-led classes have been held for special assignment nurses.

Safe Use of Equipment and Facilities

As was reported at the campuswide town hall on Oct. 24 led by UCSF Chancellor Sam Hawgood, MBBS, UCSF officials determined that the Mount Zion hospital Intensive Care Unit (ICU) is the best location for an isolation unit to care for a patient with EVD. The isolation unit has been constructed to include an anteroom for the safe and secure donning and removal of PPE.

The decision to establish an isolation unit at Mount Zion hospital was based on extensive research into the programs and units at Emory University, NIH and Nebraska medical centers – three hospitals that have successfully treated EVD patients – as well as an assessment of a UCSF location that would allow for the proper facilities, equipment and resources to ensure patient and employee safety. 

Notably, UCSF Medical Center is using PPE that meets or exceeds CDC standards and aligns with best practices from the University of Nebraska, NIH, and Emory medical centers.

Communicating to the UCSF Community

UCSF continues to communicate about its response and preparedness to all members of the University community as well as the public at large.

To date, UCSF has held two information sessions for clinicians, a town hall meeting for all faculty, staff and students and a meeting with UCSF Medical Center managers. The town hall presentation has been posted in its entirety online here. https://www.ucsf.edu/ebola.

The University has developed a website where information is updated as the situation unfolds. https://www.ucsf.edu/ebola

In addition, a special email account at [email protected] has been established where faculty, staff and students can ask questions or post comments.

Editor's note: Story updated with photos on Nov. 13, 2014

For more internal-facing stories from the UCSF community, please visit Pulse of UCSF.

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