Use past experience with MERS, Ebola to prep for latest coronavirus

January 28, 2020

Accreditation & Quality Compliance Advisor - Volume 14 Issue 5

Dig out your plan for screening for MERS-CoV, Ebola, measles or any other infectious disease and update it with the latest information from the Centers for Disease Control and Prevention (CDC) on the newly identified 2019 Novel Coronavirus (2019-nCoV) that originated in China.

Patients with fever and acute respiratory illness should be asked for a detailed travel history and anyone under investigation should also be provided a mask, be isolated and hospital personnel should observe standard, contact and airborne precautions and use eye protection such as goggles or a face shield, says the CDC.

Healthcare providers also should be prepared to report the case to the CDC using a patient under investigation (PUI) form, says the CDC.

The new virus has been compared to MERS-CoV and SARS-CoV. The CDC says the process for evaluation and the PUI form to report suspected cases remains unchanged from the ones used with MERS-CoV, which was the virus of concern in 2015.

While the CDC is still determining how the virus is transmitted, the agency is recommending “a cautious approach to patients under investigation for 2019 Novel Coronavirus. Such patients should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed, ideally an airborne infection isolation room if available.” Also immediately notify not only your healthcare facility’s infection control personnel, but also the local health department.

The CDC reported January 21 that the first U.S. case of 2019-nCoV had been confirmed in Washington state. Since then, at least four more cases have been confirmed in the U.S. and others are being investigated. There are at least 2,800 confirmed cases in China with more than 80 deaths reported, according to the Washington Post on Monday. Cases have also been identified in Europe, Japan and several other countries.

The virus was originally believed to spread from animal to person, but the CDC says there are signs that limited person-to-person infection is happening. Scientists, however, are unclear about how the virus spreads between people.

The CDC said it has been preparing for the U.S. arrival of 2019-nCoV for weeks, including:

Alerting clinicians on January 8 to be on the lookout for patients with respiratory symptoms and a history of travel to Wuhan, China.
Developing guidance for clinicians for testing and management of 2019-nCoV, as well as guidance for home care of patients with 2019-nCoV.
Developing a diagnostic test to detect this virus in clinical specimens, accelerating the time it takes to detect infection. Currently, testing for this virus must take place at the CDC, but in the coming days and weeks, the CDC will share these tests with domestic and international partners.

On January 17, the CDC began implementing public health entry screening at San Francisco (SFO), New York (JFK), and Los Angeles (LAX) airports. This week, the agency will add entry health screening at Atlanta (ATL) and Chicago (ORD) airports.

The CDC has activated its Emergency Operations Center to better provide ongoing support to the 2019-nCoV response.

Coronaviruses are a large family of viruses, some causing respiratory illness in people and others circulating among animals including camels, cats and bats. Rarely, animal coronaviruses can evolve and infect people and then spread between people, such as has been seen with Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). When person-to-person spread has occurred with SARS and MERS, it is thought to happen via respiratory droplets with close contacts, similar to how influenza and other respiratory pathogens spread.

During the MERS-CoV outbreak in 2015, Inside the Joint Commission, one of the precursors to Inside Accreditation and Quality, offered these tips for provider preparedness, provided by Jennifer Cowel, RN, MHSA, a former nurse surveyor as well as former Joint Commission director of service operations and now CEO of Patton Healthcare Consulting.

Stay up to date on the latest information about signs and symptoms, diagnostic testing and case definitions for the virus. CDC guidance can be found here: https://www.cdc.gov/coronavirus/2019-nCoV/clinical-criteria.html
Review your infection control policies and CDC infection control recommendations for:

Assessment and triage of acute respiratory infection patients.

Patient placement.

Visitor management and exclusion.

Personal protective equipment (PPE) for health care personnel.

Source control measures for patients (e.g., put facemask on suspect patients).

Requirements for performing aerosol generating procedures.

Bring out your previous infectious disease influx plan. Update the screening section to get a more complete travel history of patients. “After the update, you will need to communicate this to your caregivers and front-line staff. Ensure the communication mechanisms are in place in the event you have a suspected case.”
Be complete with screening process: In addition to asking about travel history, each intake process should include questions about the patient’s contact with infected individuals. “These are important in diagnosing infectious patients. Train intake staff. Consider sharing the CDC alerts with front-line staff and your clinics who might be the first to see a potentially infectious patient,” Cowel says.
Promptly implement source control for potential patients before transport or upon entry to the facility and triage according to facility plans (e.g., place in private room) for evaluation. Leverage your Ebola preparedness plans to inform your isolation and transfer procedures to other hospitals, if needed, and in assessing the needed PPE, laboratory testing capabilities and protections for workers and other patients.
Know how to report a potential case or exposure to facility infection control leads and public health officials. Check with your local public health authority, says Cowel.
Know who, when and how to notify and when to seek evaluation by occupational health staff following an unprotected exposure (i.e., not wearing recommended PPE) to a suspected or confirmed patient.

Other considerations, as presented by Robert Emery, DrPH, a professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health, in 2015:

Educate all staff in the hospital. “If you don’t educate some, then there will be some who will be scared and then rumors start,” notes Robert Emery, DrPH, a professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at UTHealth School of Public Health. “The broader the net for education the better off you’ll be.”
Review your waste disposal protocols. Just as waste generated during the course of caring for Ebola patients had to be handled separately from other medical waste, so too might waste from treating a coronavirus patient. It’s a new disease and you may need to work with your medical waste vendor to determine if any special packaging or other handling is needed.
Assess risk and evaluate what precautions might be needed in outpatient versus inpatient settings. For example, with Ebola, an orthopedic clinic has a lower likelihood of seeing a potential patient than a primary care physician or clinic, Emery observes. But just in case, provide some basic education, including signs and symptoms and what to do if a patient is suspected of having a contagious illness.
Drill your staff on what to do. Can we clearly identify the patients who might meet the case definition for a coronavirus patient? If a patient presents, “Do we have a mask and where are we putting them next?” asks Emery.
Update signs used at front desks and intake areas. Be sure to update screening questions when patients are scheduled by telephone, Emery says.
Make sure you have stockpiles. Given the unknown route of transmission and the recommended PPE, you likely can use the existing stockpiles already deployed during previous concerns, at least for the short term. Review what you have on hand.

Other resources for help in reviewing your plan and educating staff: