Special Precautions Isolation Plan Environmental Services When page is received that suspect Ebola patient has arrived in ED: If the patient is not going to be admitted: Once patient is transferred to Decon room, ED vestibule will need to be cleaned Wipe down any high touch surfaces or anything that may have been touched by the patient Clean any spills or body fluids resulting from incident Mop the floor using #23 Once patient is transferred from ED a terminal clean will be required in the ED decon room 2 staff assigned to terminally clean the room (staff will have been through PPE training) Follow Special Precautions disposable scrubs, surgical gown, N 95 respirator, face shield, double gloves, knee high booties and shoe covers, etc. Room will be terminally cleaned following step by step directions (refer to document Terminal Cleaning F6/5 and ED Rooms Special Precautions ) If the patient is going to be admitted: Process 10 discharges in F6/5 (any staff) Prioritize F6/558 which will be used as 1 st patient room and F6/560 which will be used as 1 st doffing room Then proceed to F6/564 which will be converted to the mobile lab and F6/562 which will be used as the doffing room for the lab The remaining discharges will be processed as quickly as the existing patients are removed from the unit. Remove all trash receptacles from rooms except F6/558 which will keep the small can in the restroom and the roll out can. Put new gel and soap refills in all rooms regardless of how much is left in the dispenser upon discharge. These discharges will not require special PPE or precautions Stock F6/558 with the following items: 1 large bucket of bleach wipes 1 spray bottle of #23 quat 2 bottles of Clorox bleach cling Mop handle to be put in the tall cabinet next to the sink Red bags in all trash/recycling receptacles 1 roll of red bags to be stocked in the cabinet above the toilet Extra paper towels to be stocked in the cabinet above the toilet 1 pump alcohol gel dispenser to be left on the counter outside the patient room 1 small canister of bleach wipes to be left on the counter outside the patient room
Stock F6/564 with the following items: 1 large bucket of bleach wipes 1 spray bottle of #23 quat Mop handle to be put in the tall cabinet next to the sink 1 large, square biohazard can lined with a red bag 1 roll of red bags to be stocked in the cabinet above the toilet 1 pump alcohol gel dispenser to be left on the counter outside the patient room 1 small canister of bleach wipes to be left on the counter outside the patient room Stock F6/560 with the following items: 1 large bucket of bleach wipes 1 spray bottle of #23 quat Mop handle to be put in the tall cabinet next to the sink 4 large, square biohazard cans lined with a red bag 1 large, round biohazard can on wheels lined with a red bag 1 roll of red bags to be stocked in the cabinet inside the nurse server Stock F6/562 with the following items: 1 large bucket of bleach wipes 1 spray bottle of #23 quat Mop handle to be put in the tall cabinet next to the sink 2 large, square biohazard cans lined with a red bag 1 large, round biohazard can on wheels lined with a red bag 1 roll of red bags to be stocked in the cabinet inside the nurse server Stock F6/552 with the following items: 1 bottle of #51 bathroom cleaner 25 rags 2 large trash receptacles lined with black bags for discarding scrubs Contact MERI (Jim Fitzpatrick (608) 333 4811) Let them know that we have a suspected special precautions isolation case This will begin the process for obtaining licensing in transporting waste The longer we wait to start this process the longer we will have to hold all contaminated waste Once patient is transferred to Decon room, ED vestibule will need to be cleaned Wipe down any high touch surfaces or anything that may have been touched by the patient Clean any spills or body fluids resulting from incident Mop the floor using #23 Once patient is transferred from ED to F6/5 a terminal clean will be required in the ED decon room 2 staff assigned to terminally clean the room (staff will have been through PPE training)
Follow Special Precautions disposable scrubs, surgical gown, N 95 respirator, face shield, double gloves, knee high booties and shoe covers, etc. Room will be terminally cleaned following step by step directions (refer to document Terminal Cleaning F6/5 and ED Rooms Special Precautions ) Trained staff will follow the patient from the ED to F6/5 or direct admit through prisoner protocol route any elevators will be cleaned following patient transport (staff should don PPE prior to following patient being transported take bleach wipes, mop, red garbage can and chux pad) Bleach wipes are to be used in cleaning the elevators Floors are mopped with bleach wipes if there is a spill or exposure risk Bleach wipes are to be used to clean the patient transport device (bed, cart, wheelchair, etc.) Any trash, mops, rags, etc. used will be placed into a biohazard bag and placed in the doffing room in F6/560 (or whichever doffing room corresponds with the patient that used the elevator if there are more than one patient) Daily clean F6/5 isolation hallway Use the cart located in the F6/5 JC, this cart will be designated for F6/5 daily cleaning duties Make sure the janitor closet is stocked with bleach wipes, 10 rolls of red bags, extra buckets labeled with #23, 3 buckets of bleach wipes, 25 rags, 1 bundle of mops Make sure that housekeeper cart stored in F6/5 is stocked 1 roll of red bags, mop, #23 bucket, rags, bucket of bleach wipes Stock all gel and soap dispensers in hallway Empty trash at all nurse servers Dry mop hallway, wet mop as necessary using #3 Maintain empty rooms as you would daily clean in any empty room Follow general cleaning procedures to ensure that the hallway is maintained and stocked Daily clean F6/552 which will be used as a shower room. The Xenex machine will be used in the restroom and shower rooms daily. There will be #51 and rags stocked in the restroom of the shower room for staff to use for shower cleaning. However, we will still do a full clean of this room daily. Daily clean F6/570 which will be used for video monitoring, make sure restroom is cleaned every day. In addition, the Xenex machine will be used in the restroom and shower rooms daily. Daily clean F6/556 which will be used as the clean equipment room. Daily clean F6/554 which will be used as the PPE donning room. If patient family members occupy F6/558 on the first day this room will need to be discharge cleaned. Whether or not special precautions are followed for terminal
cleaning will depend on the condition of the family members who have been in the room. Sign the daily cleaning log to verify that the cleaning of the doffing rooms has been completed for the day Daily cleaning of doffing rooms Daily clean F6/560 and F6/562 (Full PPE required for cleaning these rooms this should be done during the trash removal so PPE will not need to be donned an additional time) At the start of daily cleaning spray the hoses and belts from the PAPR systems with #23. These will be located in a bin in the doffing room. After they have been sprayed let them sit for 5 minutes and then hang them from the IV pole located in the room so they can be hit with the UV light when the xenex machine is run Bleach wipe the IV pole and roll it to the 2 nd housekeeper standing in the hallway, cleaning the wheels as it crosses the red line Place the equipment in the clean equipment room and connect each PAPR to the corresponding charger for future use We will be responsible for emptying bio hazard trash from doffing room twice daily see trash removal process at end of document All bags will be double bagged and wiped down prior to leaving doffing room Coordinate with MERI (Jim Fitzpatrick (608) 333 4811) Any equipment moved into the doffing room needs to be cleaned Ventilator Equipment Move the equipment to the PPE doffing room. Use #23 to wipe down all surfaces of the equipment, including the wheels Leave machine in the room while the Xenex machine runs Move outside the PPE doffing room, cleaning the wheels as it crosses the red line. Place the equipment in the clean equipment room for storage. Portable X ray Equipment and Ultrasound Equipment Move the equipment to the PPE doffing room. Use #23 to wipe down all surfaces of the equipment, including the wheels Leave machine in the room while the Xenex machine runs Move outside the PPE doffing room, cleaning the wheels as it crosses the red line. Place the equipment in the clean equipment room for storage. CRRT Dialysis Next Stage Equipment Move the equipment to the PPE doffing room.
Use bleach wipes to wipe down all surfaces of the equipment, including the wheels. Xenex the PPE doffing room with the equipment in the room. Move outside the PPE doffing room, cleaning the wheels as it crosses the red line. Place the equipment in the clean equipment room for storage. PAPR Belt and Battery Pack Will be disinfected with bleach wipes two times within the PPE doffing process. Place into the PAPR storage bin in the PPE doffing room. Spray the PAPR belt and battery pack with Quat #23, thoroughly wetting all surfaces. Wait 10 minutes. (The PPE doffing room will be cleaned during this time and waste removed.) Hang the PAPR belt from the IV pole within the PPE doffing room. Xenex the PPE doffing room. Bleach wipe the IV pole and roll to the red line to pass to second EVS worker, cleaning the wheels as it crosses the red line. Place the equipment in the clean equipment room. Connect each PAPR to the corresponding charger for future use. Run the Xenex machine following removal of waste and daily cleaning After the Xenex machine is run the IV pole that the belt and hoses are hung from should be wiped down with bleach and moved into the clean storage area for equipment, F6/556 Sign the daily cleaning log to verify that the cleaning of the doffing rooms has been completed for the day Discharge clean patient room, doffing room following discharge of patient Refer to document Terminal Cleaning F6/5 and ED Rooms Special Precautions Any staff that does any cleaning or disposing of waste requiring PPE for this isolation (ED, F6/5 discharge, elevator/following patient) need to be added to the patient room entry list These names need to go to Employee Health so staff can receive daily temperature monitoring and any other instructions given by Employee Health If patient is transferred to F6/5 via ambulance from an offsite clinic: Refer to Terminal Cleaning of Clinics Special Precautions document for dispatching staff to offsite clinic following preparation of CSC for admit Procedures for cleaning ambulance EMS WILL CLEAN AMBULANCE There will be supplies at the loading dock where the ambulance will drop off the patient to create a makeshift doffing area. Supplies will include: Red, biohazard barrel Red, biohazard bags
PPE kit (if PPE needs to be donned for transport) Bleach Wipes Purell Doffing Pad Any red bag waste generated by EMS will stored in the doffing room corresponding with the patient or put directly into a DOT container and into the shipping container located at the shipping dock *Trash removal process From patient room to doffing room Bags will need to be double knotted. Bags will then need to be sprayed with disinfectant (#23 quaternary cleaning solution) upon leaving patient room but before entering doffing room. o If there is excess liquid in the bag add a chux or absorbent material to soak up excess liquid. Upon entering doffing room Wiped down bags need to be placed inside of a 2 nd red, biohazard bag (knot up) and tied off using a double knot method. o The bags can then be stored in the doffing room until they are picked up for transport and/or storage (3x daily). o EVS will transport biohazard bags for storage and transport. Before being transported through the hospital the bags will then be picked up from the doffing room (person transporting bags at this point will don full PPE). This person will then wipe down or spray the exterior of the 2 nd bag with disinfectant before depositing the bag into the Category A shipping container. This container is a cardboard exterior lined with a bag, then a 39 gallon hard side red container and then lined with an additional bag. The bags from the doffing area can be placed inside the inner most bag. o An EVS employee will bring the Category A container on a moveable cart or dolly. The cart will be parked directly across the red line so the employee who has donned full PPE can set it into the container without having to risk contamination or dirty the clean area. The EVS employee who brought the container will not need to don full PPE but gloves are necessary. Before leaving the unit the container needs to be sealed by the person in the clean space who does not have on full PPE. The inner most bag will be sealed with a zip tie. Then the hard sided container will be sealed with the closing bar enclosed in the container. Then the outermost bag will be sealed with a zip tie. Finally the exterior cardboard container will be shut. At this point the container can be removed from the unit. Moving Category A container onto shipping container o Once the container is sealed it can be transported to the loading dock for storage or removal. The container will either be placed directly onto a truck for removal or into a storage container that will be stored on the loading dock.
*Hazardous pharmaceutical waste should be placed in a separate Category A container and labeled dual waste. This container will be shipped to a different facility for disposal. * Trash removal We will not be adding a disinfectant to the inside of the single biohazard bag for the following reasons: 1. Spraying into an Ebola contaminated biohazard bag could generate aerosols containing Ebola virus, thus putting the healthcare worker at greater risk for contaminating themselves and also contaminating the surrounding environment. 2. Pouring a liquid disinfectant into an Ebola contaminated biohazard bag creates a greater possibility of fluid overload in the bag and a greater risk to healthcare workers if the bag were to break, spilling the contents of the bag. **All staff that has to don PPE to do any sort of cleaning for a suspected patient needs to have their names added to the patient room entry list. This list will be given to Employee Health so staff can receive daily temperature monitoring and any other instructions given by Employee Health. F6/5 Layout
Prisoner Protocol Routes ED to E5/2 Elevator
E5/5 Elevator to F6/5
Obtain all Ebola supplies from storage and arrange according to images below. PPE Doffing Rooms F6/560, F6/562 (priority) and F6/566 Garbage bags should be all red biohazard bags.
Alcoves of rooms F6/558, F6/560, F6/562, F6/564, F6/566 and F6/568
Patient rooms F6/558 (priority) and F6/568