Henry M. Wu, MD; Jessica K. Fairley, MD; James Steinberg, MD; Phyllis Kozarsky, MD
Acknowledgment: The authors thank Drs. Colleen Kraft and Penny Castellano and Esther Baker, Betsy Hackman, Deena Gilland, Diane Woods, and Linda Young for their support.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2312.
Requests for Single Reprints: Henry M. Wu, MD, 550 Peachtree Street NE, Medical Office Tower 7, Atlanta, GA 30308; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Wu, Fairley, and Kozarsky: 550 Peachtree Street NE, Medical Office Tower 7, Atlanta, GA 30308.
Dr. Steinberg: 550 Peachtree Street NE, Medical Office Tower 5, Atlanta, GA 30308.
Author Contributions: Conception and design: H.M. Wu, J.K. Fairley, P. Kozarsky.
Drafting of the article: H.M. Wu.
Critical revision of the article for important intellectual content: H.M. Wu, J.K. Fairley, J. Steinberg, P. Kozarsky.
Final approval of the article: H.M. Wu, J.K. Fairley, J. Steinberg, P. Kozarsky.
Administrative, technical, or logistic support: H.M. Wu, J.K. Fairley.
Wu HM, Fairley JK, Steinberg J, Kozarsky P. The Potential Ebola–Infected Patient in the Ambulatory Care Setting: Preparing for the Worst Without Compromising Care. Ann Intern Med. 2015;162:66-67. doi: 10.7326/M14-2312
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Published: Ann Intern Med. 2015;162(1):66-67.
Table. Considerations When Planning for the Management of Patients With Possible Ebola in the Ambulatory Care Setting
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Mahesh Devnani, MBBS, MHA, MHA
Assistant Professor of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
December 24, 2014
Involving non-clinical hospital staff is necessary for successful Ebola strategy
Wu and colleagues (1) have provided valuable description of handling ‘person under investigation’ (PUI) for Ebola Virus Disease (EVD) in ambulatory settings. These guidelines also hold value in formulating policies to handle other infectious diseases in ambulatory settings.It is noteworthy that Emory engaged various stakeholders in planning and implementation of these guidelines including hospital administrators, environmental services and security. Often such engagements mainly involve clinical staff and the non-clinical employees viz. housekeeping, security, engineering etc. are either left out of such deliberations or have very minimal engagement. The housekeeping employees are usually less educated and skilled, and more prone to occupational injuries in comparison to other category hospital staff (2). But despite being involved in high risk activities like cleaning of rooms and transportation of waste which potentially brings them in contact of PUI’s body fluids, they receive comparatively less attention and training during crisis situations, putting them at higher risk. Keeping in view their low level of knowledge and education, and higher propensity to injuries, it is prudent to engage them early on in EVD planning process. This not only provides them the required knowledge, skills and resources but also boost their confidence in employer. Research show that the employee’s confidence in employer and their perception of the value of their role in the overall organization’s response improve their willingness to work during such situations (3). Hence it is also important that hospital leadership makes every hospital employee aware of the value of their role in fight against EVD.While engaging housekeeping staff in such discussions, one should consider the fact that many housekeeping employees in US hospitals are native Spanish speakers with limited English speaking skills. Special training session in Spanish and/or educational material printed in Spanish have been suggested for effective communication with such staff (4).In conclusion, an effective EVD response in hospital settings requires an active and inclusive approach involving all stakeholders.References1. Wu HM, Fairley JK, Steinberg J, Kozarsky P. The potential Ebola virus-infected patient in the ambulatory care setting: preparing for the worst without compromising care. Ann Intern Med. [Epub ahead of print 21 October 2014] doi:10.7326/M14-23122. Salwe K, Kumar S, Hood J. Nonfatal occupational injury rates and musculoskeletal symptoms among housekeeping employees of a hospital in Texas. J Environ Public Health. 2011;2011:382510. [PMID: 21776437] doi: 10.1155/2011/3825103. Devnani M. Factors associated with the willingness of health care personnel to work during an influenza public health emergency: an integrative review. Prehosp Disaster Med. 2012;27:551-66. [PMID: 23031432] doi: 10.1017/S1049023X120013314. Mannix R. Interactions with Spanish-speaking housekeeping personnel regarding radiation safety issues. RSO Magazine. 2004;9:11-15.
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