[MUSIC] They would doff the PPE, using the same meticulous doffing process. And then the equipment would be disinfected. We'll talk more about that later. And render it safe for use on any subsequent patients. Laboratory diagnosis and monitoring, are also an integral part of caring for any patient. Safe practices for laboratory specimen transport, from the patient's room to the laboratory, will be very important. If you don't have laboratory capacity close to the patient's room. Here are some recommendations from our biocontainment experts to include the timing of laboratory testing. >> I would definitely tell them that they need to have a good procedure for how they're going to draw the lab. How they're going to get out of the room and how they're going to contain that package and clean that package off. So that they can transport it and they can transport it safely, they can put it in a cooler, get it to the lab where the lab will have already worked out their processes on how they're going to run that sample. The timing of our first process was of getting labs out of the room was we would draw the labs from the patient. And then we would have to wipe the labs and pulls off with bleach wipes, change our gloves several times in that process as well. And then we would hand it out or drop it into a bag directly outside the door. That was heat sealed, wiped with beach, and then it was put into another bag. Heat sealed and wiped with bleach. Then it was transported to what we call the dunk tank. And that dunk tank was filled with a disinfectant fluid that was passed through from inside the unit to outside the unit. And then it would have to sit in there for ten minutes. And then, it was carried over to the public health lab where it was run. And I don't think that process is necessary in fact, I know it's not. All you really need to do is once you've wiped the outside down with bleach. And you can get it into a cooler, and then it can be carried to the lab. >> In some instances, you may have to ship specimens to a public health laboratory at your regional or national level. And this should be done with great care. Following sound practices. The following is a video demonstrating how this is done here in the US. >> If we assumed that there's always a potential for a patient to enter a clinic or hospital. And fit the criteria for potentially Ebola patient or patient under investigation we would want you to be prepared. At the beginning of the PUI, the patient would need an appropriate specimen to be sent to the Nebraska Public Health Laboratory to essentially rule in or rule out whether they have the disease. But before that can begin, a call by the physician or care provider to the state epidemiologist is needed. If this truly is an official patient under investigation as determined by the epidemiologist. Then transportation becomes an exception to the division six point two rule. During public health emergencies law enforcement agents or other designated state officials with identification, may deliver specimens approved by the department of Health and Human Services as found in the 49 code of federal regulation. We will also be using a chain of custody form and whomever is handling the blood must sign or witness that verification of identity. Drivers licence is required for this process even if you think you the know the patient. With the appropriate PPE the nurse or designated staff member, would draw the blood or obtain this specimen based on the current testing method for Ebola by the Nebraska Public Health laboratory staff. This technology changes so there is a possibility of specimen types changing so make sure the person drawing the blood knows the samples that need to be drawn. This person would follow the standard CLSI best practices for phlebotomy. Take note that if you're using a syringe make sure you use the safe transfer device, and or any other safe device equipment to draw the blood. The caregiver draws the tubes of blood, and then labels the tubes with a label or handwritten with a pen and not a sharpy marker, as it will be removed when the blood is wiped down with alcohol. High five for information that needs to be on the tube. Name, date, medical records number, time, and drawers initials. It is a legal document, only the person drawing should label the tube. The tubes of blood should be wiped with bleach wipes and put into a bag using bleach wipes to hold the bag. Once the label tube has been wiped, it is placed into the first biohazard bag with an absorbent material enough to absorb the contents if a leak occurs. The bag is then wiped with bleach wipes. The second person in the warm area has a bigger biohazard bag and opens it ready to have the bag with the tubes drop into the second bag. This person then removes any excess air and wipes the bag clean and transfers this bag to the clean area, remembering to seal the bag. The clean area has all the materials ready to assemble the transport of the specimen, a category A box, a biohazard container with an orange lid. Bubble wrap inside of that biohazard container, frozen gelpaks, secure cable ties, and a blue Igloo cooler that is capable of being secured with cable ties. The biohazard bag received from the warm area is again wiped down bleach wipes. The third person, the assembler, puts the bag into a Tyvek bag that is cut-proof, tear, and pressure-proof. And, making sure that the air is released. The Tyvex bag goes into the silver thermal bag, with the ice pack that has been previously frozen. The thermal bag is then sealed, and put into the hard container with the orange top. The orange top container is then put into the category A cardboard box. The box is then sealed following the numbers on the cardboard sleeve of the container. The category A cardboard box is then put into the transport blue cooler, and the bubble wrap is added so that there's no movement of the orange topped container. There should be a requisition with this paperwork. And that material should be put into a plastic bag and packed on top of the category A box. The blue transport cooler is then sealed with the red zip ties and the number of each zip tie is recorded on the custody form. You will note that the pathogen is not written on the container nor does the category A box have written on it either. Only the symbol for infectious substance is labelled on the cooler and the box. The cooler is then handed off the person that will transport to Nebraska Public Health Lab for testing of a pathogen for this patient under investigation. The test results will then determine the next steps to follow. All specimens must be kept track up and be sent to the Nebraska Public Health Lab. The chain of custody must have an inventory of all samples drawn. >> Keeping the environment clean, will be key to controlling the transmission of highly infectious organisms. But you have to balance that, with the potential for staff exposure. At Nebraska Medicine, rather than risk the exposure of housekeeping staff. The care staff did all of the environmental cleaning and disinfection in the patients room. Using bleach and ensuring that cleaning was accomplished from the areas less contaminated to those that were more contaminated. In other words moving from clean to dirty. >> Again, we're fortunate in that we are a negative pressure unit with lots of air exchanges. So knowing the disease again, and knowing what is it going to take to kill it, we know that if we leave the unit standing, it will dry very much. And so, we give it two days to dry out. And so in that way, we use desecration to hopefully, get rid of any virus that may be on surfaces. Then our staff come in. And we have a process of wiping everything down with bleach. That we have a quality assurance person. So that would be an infection control practitioner who comes in with a checklist and makes sure that we touch every surface with the bleach wipes. After the bleaching's done then we hit it with UV light. And then we let it sit for another two days at that time the unit does look like its in a total mess because the bleach leaves a lot of residue. So then our environmental service's team come in and they do what we call the cosmetic clean. So they get rid of the mess we made of cleaning or de contaminating the unit. They do wear protective equipment, mainly because of the chemicals they're going to be using. But our leadership team we go in without PPE on to just show them that we feel confident that there's no Ebola virus in the unit at that time and it's safe for them to be there. >> This module lead you through the process to establish where you would place your highly infectious patient. Controlling the movement in and out of that area. How you would manage the infectious wastes, imaging and finally laboratory specimens. By now you should be thinking about how you would accomplish all these processes in your own facility. [MUSIC]
