At RSNA, tips for Ebola preparedness

November 25, 2014 in Medical Technology

The media hype around Ebola may have subsided in recent weeks, but that doesn’t mean preparedness for hospitals and medical practices is any less essential when it comes to this deadly virus. At RSNA on Dec. 2, radiologists will learn about CDC guidelines and strategies to help imaging professionals manage the right response to Ebola.

[See also: Ebola case highlights lack of planning]

On Tuesday morning (7:15-8:15 a.m., in room E352) Carolyn Meltzer, MD, associate dean at Emory University School of Medicine, will lead a panel discussion about current CDC requirements and other rules relevant to radiology practices with regard to Ebola screening.

[See also: Ebola cases put focus on health IT needs]

Specifically, they’ll explore what’s billed as “a unified approach to considerations involved in medical imaging” for patients with the virus.

Emory has firsthand experience with Ebola, having successfully treated medical missionaries Kent Brantly, MD, and Nancy Writebol earlier this year. In this session, Meltzer and her colleague, Bruce Ribner, MD, an infectious disease physician and epidemiologist at Emory, will explore the “imperative to rapidly develop and disseminate standard operating procedures for point-of-care imaging procedures,” according to RSNA.

After all, radiology facilities “may be key entry points for the evaluation of outpatients and emergency department patients,” so having airtight screening and isolation procedures is key.

Meltzer recently co-authored a report with David A. Bluemke, MD, director of the department of radiology and imaging sciences at the NIH Clinical Center – who will also be speaking on the morning panel Dec. 2.

Published in the online edition of the journal Radiology, the study spotlights their protocols and recommendations for Ebola preparedness training, in the hopes of preventing another situation like the one in Dallas this fall, when Liberian Thomas Eric Duncan was sent home after miscommunication at Texas Health Presbyterian Hospital, only to return later in much worse condition, and later die from the virus.

“Medical imaging does not provide diagnosis of Ebola virus disease, but patient assessment in the emergency department and treatment isolation care unit is likely to require imaging services,” said Bluemke, in a press statement.

The basic role of imaging when it comes to Ebola care is to exclude other diagnoses and assess complications of the virus when it’s present.

As with any medical professional handling potential Ebola patients, radiologists should conduct medical imaging exams in a specialized isolation unit. Portable X-ray units and bedside ultrasound imaging have been used in such biocontainment units.

Radiology departments, meanwhile, should draw up standard operating procedures for doing imaging in isolation – details of which will vary, depending on the equipment available, whether the facility has wired or wireless image transmission and the complexity of the exam.

Two strategies exist for this type of screening, according to Bluemke’s and Meltzer’s study. In the first, radiologic technologists don’t enter the patient’s room – the “hot room,” instead staying in an anteroom (the “warm room”) offering equipment usage instructions for the nurses or physicians in isolation.

In the second approach, technologists do enter the hot room, helping to operate the equipment – a strategy that may be necessary when the radiology equipment is more complex.

They stress that every effort should be made to perform X-ray procedures in isolation, rather than transporting patients to the radiology department. Doing so would require many additional precautions. For example, the patient transportation route must be coordinated with the hospital’s infection control team.

In addition, disinfection of radiology procedure rooms requires many hours and may prohibit diagnostic treatment of other patients in the facility, they point out. CT and MRI equipment are not designed for imaging of patients with Ebola, since tiny crevices and moving parts are extremely difficult to protect with plastic covers, and bodily fluids can accumulate in narrow recesses inaccessible to surface cleaning.

“Radiology staff directly involved in the care of patients with Ebola virus disease need to be identified and educated regarding procedures of the isolation unit and regarding appropriate donning and doffing of correctly-sized personal protective equipment,” said Bluemke. “Open and frequent communications are essential.”

“For example, at Emory University Hospital, open town hall information sessions, the wide dissemination of standardized screening protocols, and close intra- and interdepartmental communication have supported a safe environment in caring for patients with Ebola virus,” said Meltzer.

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