Ebola Update
The risk of a patient with Ebola being treated in a BC hospital remains low, however with healthcare workers occasionally returning from Africa with suspected cases, BCNU is now advising members at Ebola designated sites* to use a fit-tested N95 respirator when caring for a patient with a SUSPECTED or confirmed case of Ebola.
This advice differs from the current BC policy, which requires only that a surgical mask be worn and makes the N95 optional in the routine care of a lower transmission risk patient (that is, patients without symptoms of vomiting or diarrhea).
All members have the right to ask for / use a fit tested N95 respirator.
Rationale for Respiratory Protection
Based on the current literature, it is BCNU's view that there is no scientific certainty regarding how the virus is transmitted. There is concern that Ebola can be aerosolized through means other than aerosolizing-generating medical procedures. In addition, changes in patients' conditions can happen quickly without the time to put on a higher level of respiratory protection the moment it's needed. That's why BCNU is recommending the use of a fit-tested N95 respirator or higher at all times when dealing with a suspected or confirmed case of Ebola.
The Province of Ontario and the American Centers for Disease Control require the use of the N95 respirator. However, BC has yet to adopt this policy.
In addition to using the N95 respirator, members on units designated to receive Ebola patients should be insisting that health authorities provide them with the necessary personal protective equipment and training required to safely care for Ebola patients. Training should include practice drills and simulated exercises as well as instruction in the protocols for Ebola care. Simulation exercises are key to identifying and correcting gaps in protocols and procedures.
It is also imperative that all healthcare workers conduct a point of care risk assessment prior to beginning any patient care.
If you are asked to care for a patient with a suspected or confirmed case of Ebola, you should only do this work if you have been provided with proper equipment, have been trained in its use and are knowledgeable about the care protocols for Ebola patients.
If you think it's unsafe to provide care
If you haven't been provided with appropriate staffing levels, or proper equipment, including the N95 respirator or haven't received training in the use of personal protective equipment: Stop the assigned work and immediately notify your supervisor or employer that you can't provide care until your safety concern is resolved. We recommend you also notify your site administrator.
Once notified, your supervisor/manager must immediately investigate and either remedy the unsafe situation or advise you if they don't think your concerns are valid.
If the situation remains unresolved and you still believe that it is unsafe to provide care, your supervisor/manager must investigate the matter in your presence along with a worker representative of the Joint Occupational Health and Safety Committee or a worker who is selected by the BCNU. This is why it's important that you are aware of who your representative is on the worksite Joint Occupational Health and Safety Committee, as well as who your worksite steward is.
If that investigation does not resolve the matter and you continue to think it's unsafe to provide care, you and your supervisor/manager must immediately notify WorkSafeBC who must investigate the matter without undue delay and issue whatever orders are deemed necessary. The number for WorkSafeBC is 1-888-621-7233. More information on the Refusal of Unsafe Work can be found in Section 3.12/3.13 of the BC Occupational Health and Safety regulation.
Resources
CDC Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing)
http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html
CDC Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present with Possible Ebola Virus Disease
http://www.cdc.gov/vhf/ebola/hcp/ed-management-patients-possible-ebola.html
Ontario Ebola Virus Disease Directive #1 - Revised October 30, 2014
http://www.health.gov.on.ca/en/public/programs/emu/ebola/docs/evd_directive_1_20141030.pdf