October 15, 2014

Ebola Preparedness
Dear Colleagues,
TUHS is working diligently on preparedness for the screening, diagnosis and management of patients
with Ebola.
Emergency preparedness is not a new concept for this organization. We have the experience and
expertise to treat many kinds of infectious diseases like Ebola. To assure consistently effective
performance of all Temple University Health System (TUHS) entities, experts in infectious diseases
and in the delivery of high quality health care from across the Health System met yesterday to review
protocols currently in place and to identify areas in which clarification in procedure is still indicated. As
with any communicable disease, the safety of our patients and staff are our highest priority.
We are guided by detailed CDC recommendations and publications regarding Ebola, which are
continuously updated based on the latest information (www.cdc.gov). We are fortunate to have local
infectious disease experts, as well, including hospital epidemiologists Dr. Peter Axelrod and Dr.
Richard Tepper. Dr. Eileen Farnon, who has recently joined Temple University Physicians and has
extensive experience with Ebola, has just returned from West Africa where she was a consultant for
the World Health Organization. Dr. Herbert Cushing, the new CMO at TUH, is also a specialist in
infectious diseases. This depth of personal experience has already provided TUHS with a wealth of
information with which to systematize protocols and plans based on best practices.
Situation
On September 30, 2014, the CDC confirmed the first case of Ebola diagnosed in the United States in
a person who travelled to Texas from West Africa. He died on October 8, and on October 10, a health
care worker who provided care for him tested positive for Ebola. A second nurse at the same hospital
has also tested positive for Ebola. Medical and public health officials are responding to these events,
as are hospitals and clinics across the country. Thus far, no other cases have been diagnosed in the
U.S.
Temple University and TUHS are working closely together to prepare a unified approach to screen,
diagnose and manage patients with Ebola. We are identifying our strengths, addressing any gaps,
and standardizing proven protocols to assure preparedness. We are taking a careful, thorough and
comprehensive approach.

Continued

Background
Ebola, previously known as Ebola hemorrhagic fever, occurs in humans and nonhuman primates.
There are five identified Ebola virus species, four of which are known to cause disease in humans.
Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of
the Congo. Since then, outbreaks have appeared sporadically in Africa, the most recent of which is in
West Africa, in the countries of Sierra Leone, Liberia and Guinea.
According to the CDC, Ebola is spread through direct contact with broken skin or mucous membranes
with exposure to blood or body fluids, including urine, saliva, sweat, feces, vomit, breast milk and
semen; and with equipment contaminated with the virus, such as needles and syringes. Ebola is not
spread through the air or by water, or in general, by food.
Assessment
A great deal of work has already been done across the Health System to assure a coordinated
readiness program. The meeting yesterday convened approximately 60 multidisciplinary experts from
across the enterprise, and included representation from nursing; infection control; TPI; TUP; TU
student health services; administrators, physicians and providers from each hospital; emergency
preparedness; environmental services; laboratory; security; human resources; and communications,
to name a few.
The following items were discussed: screening criteria; activation algorithms; designated nursing
units at each entity; transfer considerations; personal protective equipment; laboratory testing for
diagnosis and ongoing care; training and drills; waste removal; the role of the CDC and state and
local agencies; evolving recommendations; and next meeting information.
Recommendations
Recommendations are based on CDC updates and information that is available from Emory,
Nebraska, and other centers with advanced isolation units and experience in managing patients with
Ebola. They continue to be updated and are not meant to preclude procedures and protocols being
implemented in each department and entity across TUHS.
We are utilizing the CDC screening criteria for points of entry, including the emergency departments,
ambulatory clinics, and the student health center. Screeners are being trained to identify high risk
patients. In the event that a patient is identified as high risk, personal protective equipment and
isolation procedures will be implemented immediately for health care providers, the patient, and
individuals accompanying the patient. Isolation is a priority, as is correct protocol for transport of the
patient to the appropriate predetermined designated isolation areas in the emergency departments
and on the units. Individual clinics are determining entity-specific protocols for isolation and transport.
Continued

MedHost and Epic have screening capabilities that have been or are being implemented across the
system. There are additional points of entry, including preadmission testing and outpatient procedure
areas that require additional consideration for screening, and appropriate protocols for these areas
are being discussed.
The type of personal protective equipment needed was discussed at length. The ED physicians and
infection control departments are collaborating to assure that we stock the appropriate equipment in
the appropriate designated locations in appropriate quantities. Training of ED and designated
personnel on the recommended use of this equipment has already started and will continue. Staffing
plans for isolation areas, ancillary personnel and physicians are underway.
Trainees, including any type of student, resident and fellow, may participate in education and
decisions regarding Ebola patients, but are not to come into direct contact with them. Direct contract
by health care personnel needs to be kept to the vital minimum.
Laboratory testing was discussed, in terms of collecting the specimen for diagnostic testing and the
protocol for safely packaging the specimen for transfer to state testing facilities. Other diagnostic tests
will be performed by the laboratory as point of care testing, or on designated equipment, to avoid
contamination and exposure. Specimen management is also being clarified. We are following CDC
protocols and recommendations for waste containment and removal.
We are working with the state and local agencies to assure that our efforts are coordinated with those
of other organizations and consistent with the state and local departments of health. By the end of the
month, staff at all TUHS entities will have an opportunity to participate in emergency preparedness
drills to confirm protocols and proficiencies.
Conclusions
There are many efforts underway across the Health System to assure preparedness for the
management of the Ebola patient and their families. This is a complex preparation, with many
scenarios. At this point, there are identified areas requiring additional clarification and these are all
being addressed in a thoughtful manner based on the evidence at hand and the expertise of our
health care providers. There are several subgroups working on specific protocols and plans. We are
meeting again on Friday morning, and will continue to meet until we are as fully prepared as possible.
I will provide periodic updates. In the interim, if you have concerns that we are not addressing, please
contact me.
Sincerely,

Susan L. Freeman, MD, MS