[MUSIC] One very important component of caring for a patient requiring high level bio containment in the hospital is knowing when they have arrived, especially when that is unexpected. Because we've really appreciate the value of infection prevention, most health care facilities already have a screening process. And when outbreaks occur this process becomes even more robust. I asked her staff what they do here at Nebraska Medicine if someone screen positive through the point of entry screening protocols. >> In a hospital it's somewhat different. There's so many different points of entry and there's no one way to do it. Some hospitals do it manually. Others, like our hospital has a built in electronic medical record trigger which says ask them where they're coming from. But it's a little confusing because two years ago you were asking if they were in Liberia and then last year you were asking if they were in the Middle East because of MERS and this year it's Zika virus you're saying have you been to Brazil. The key is getting them early. The first clerk that meets them, the first nurse that meets them, you don't want someone sitting in the waiting room. You don't want someone going back into the exam room, or even getting admitted into the hospital, with some disease. So, whatever system you have set up, try to intersect early. >> And this was something early on that we worked really hard on is to assure that our screening processes would hopefully catch all those sorts of folks who perhaps may meet the case definition for somebody with Ebola virus. And it wasn't like we didn't have experience with this because for years, and years, and years we worked hard on just basic influenza. Making sure that we had a plan to catch people at the front entry gates, put a mask on them, mitigate risk for others in the zone they were in if they met those criteria of having influenza like symptoms, [COUGH] fever, upper respiratory problems, etc. So really it was just an expansion of that and we built the screening into our electronic health record which was fabulous because there was some decision support that we could put behind us. And it allowed us if somebody met the case definition with the travel questions. Then, also met the case definition with their symptom explanation. Then it would drive us towards, putting them in isolation right away, contacting various people. We had a process map tool, [COUGH] that we put in place for that, and we now have one for MERS as well, that really drives through every step of the process in the For example. And we also have one for the clinic, one for labor and delivery. And that really, I think is something we found to be very helpful is these tools and checklists. At two in the morning we wanted or Charge nurse to know, what are my resources? Where do I go? How do I do this? Who do I contact? So [COUGH] putting that together was very helpful and so we have a three room pod in the That, that charge nurse would quickly move people out and that would be where we staged them. And we have some barriers that we would put up. Security would be notified. Infectious Diseases would be notified to really help that Physician sort through whether or not this person met the case definition, truly, in order to push forward then to get laboratory testing and things like that. I think the other thing we learned very early is persons under investigation. Many times we'll likely rule out, and not be Ebola, but with the Ebola, until it builds up a level in your system, you may not launch a positive result of your testing. So therefore these folks had to be able to be kept in these areas for up to three days. Which has challenge. So you need a process for waste management. You can't just put things in the trash like usual for all that time. Obviously you want to be very careful when drawing lab test. You don't want to send all that to your core lab. So, there was a lot of work we did to really fine tune all the process steps. >> Then I asked, what would happen if there were many, or more than one? >> So, given that we have the three rooms that make it nice, so typically people come with what, family members. So, we had a space that we were going to go ahead and if there were family members that were symptomatic, we would probably keep them all together, depending on the acuity of the people involved. But if we needed more than one room we had more than one room. The other thing that the additional rooms in that pod allowed us was a place to put our waste, and a place to put on personal protective equipment and have all that readily available in that kind of partitioned zone area. So the other thing on our list are process would be to contact public health quickly if we had [COUGH] anybody with this person because really going back and tracing contacts was essential at that point regardless of whether we knew they were a virus positive or not yet we still needed to take that step to try to mitigate things. [MUSIC]
