​Dear Colleagues,

Reading the news about Ebola can be confusing.  So, we're committed to writing regularly about what is happening about our Ebola planning at UHN.  We are also receiving questions at EbolaQuestions@uhn.ca and we'll use these e-mails to answer those questions.  You'll need to forgive the length of the e-mail but we want to give you the information you have asked for: 

To begin: 

  • The routes of transmission of Ebola are contact with the blood and body fluids (eg. feces or vomit) of someone who has Ebola.  Ebola does not survive for extended periods of time outside the body on dry surfaces.  And, people do not transmit the disease before they begin to exhibit the symptoms of Ebola.  We believe it is fear that is motivating the quarantining of people in the U.S. who have returned from West Africa but have no symptoms of the disease.  And, as professionals, we need to use our skill and knowledge to evaluate our situation.  UHN is using precautionary principles in our planning and knowledge to help us make sound decisions. While we do not support quarantining our HCWs who have returned from West Africa, we do emphasize the importance of monitoring for symptoms of Ebola during the 21 day period after leaving the outbreak areas.

  • The precautionary approach requires that all body fluids be considered contagious; however clearly some such as non-bloody respiratory secretions and sweat have far less virus than others such as blood, vomit, diarrhea.  Secondly, the absence of clear body fluid contamination, the Ebola virus does not live for any appreciable amount of time on surfaces.  Sneeze particles do not have the necessary fluid to allow the virus to live easily outside the body.  Thirdly, Ebola does not cause respiratory symptoms.  We are so used to thinking of respiratory viruses that we worry about sneezes and coughing.  Instead, think of gastrointestinal pathogens.  We wouldn't worry about a patient with norovirus sneezing and contaminating surfaces because those are not the symptoms of norovirus and it is not a respiratory pathogen.  The same holds true for Ebola.

  • The training for the donning and doffing of PPE has been focused on the Emergency Departments at TGH and TWH and the ICU at TWH.  This is because our EDs are the likely areas where a suspected case of Ebola might present and we need staff there to feel ready to put on protective equipment, care for the patient in teams and take off the PPE without contamination.  The TWH ICU staff have been trained because a while ago we were the designated centre for repatriated Canadian healthcare workers with a confirmed case of Ebola and because this is where any confirmed case of Ebola at UHN will be admitted.

  • We will now be triaging from behind plexiglass shields in both EDs so that triage staff can be behind a barrier until travel history and symptoms can be determined.  We are asking that UHN staff not enter the rear doors of the Emergency Departments unless absolutely necessary and Security is looking at ways of making these access points secure.

  • Beginning in the summer, we have worked through a number of scenarios and included special training in areas such as our laboratories because the staff there would handle specimens from a suspected case and need to take special precautions.  If a case comes to Emergency and is then confirmed, the patient would need to be transported to the TWH ICU.  Movement of a confirmed case of Ebola would be done by the care team and Security staff members – all of whom would be in PPE throughout.  Our training has been focused on the people who will care for or support the care and movement of an Ebola case and we will continue to train and drill with these staff.

  • We are now working through the training necessary for screening in our outpatient clinics as per the revised directives which includes obtaining travel history, questions about symptoms and maintaining sufficient distance between the staff member and a patient until Ebola risk has been determined.

  • We have had questions about what we will be doing at the Toronto Rehab facilities.  At present, the directives which have come from the Province are aimed at getting the acute care sector ready because that is the most likely place that a case would appear.  We are working with staff at Toronto Rehab so that they identify any possible areas where someone with a travel history and symptoms could arrive.  This would be in outpatient clinics where patients come infrequently and may have travelled to West Africa within the past 21 days.  This is scenario is very unlikely – but it will be explored with Toronto Rehab staff.

  • We have had a number of questions about staff who will be caring for Ebola patients and whether they need to worry about their family and friends and whether they can live at home if they are caring for an Ebola patient.  During their work, all staff will be protected with PPE and various strategies to ensure safety during care.  All materials and PPE used by staff while caring for Ebola patients will be left in the isolation room and dealt with appropriately.  Staff will care for the patient in teams, train and drill in the donning and doffing of PPE and they will also have a trained observer with the teams to take staff through the PPE procedure each time.  There is no risk to people who are in contact with any member of the care team once they are outside the isolation room.

  • The Occupational Health and Safety Act requires you to report all hazards to your supervisor.  We want you to do this and we want you to also speak with Occupational Health & Safety if you think something is unsafe.  It is UHN's responsibility to keep everyone safe while at work and to take every reasonable precaution at all times.  This is why we are training and drilling with the PPE, working with our staff around the suggestions that you have around caring for an Ebola patient and ensuring that we will have a team ready to care for such a patient.  We are professionals – and together we can be ready, confident and safe.  As many of you know, health care workers have a limited right to refuse unsafe work. We have been asked about the right to refuse to work so for more information, please click - http://intranet.uhn.ca/departments/occ_health/index.asp

  • ​The Directives from Province of Ontario's Medical Officer of Health are posted on our Ebola Preparedness site at: http://intranet.uhn.ca/departments/infection_control/ebola_preparedness.asp

Kathy Sabo                         Dr. Susy Hota                    Dr. Jeff Singh​

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