1397. Preparedness, Evaluation and Care of Pediatric Persons under Investigation (PUI) for Ebola virus Disease (EVD):  Experience from a Pediatric Designated Care Facility
Session: Poster Abstract Session: All Things Ebola
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • DeBiasi - ID Week 2015 Ebola Poster 10-4-2-15.pdf (284.2 kB)
  • Background: The world’s largest Ebola outbreak in 2014-15 highlighted that evaluation and care of pediatric persons under investigation (p-PUI) presents additional challenges for which consensus guidelines have not yet fully emerged. This study describes pediatric-specific components of a comprehensive multidisciplinary Institutional Response Plan (IRP) evolved from direct evaluation and management of multiple p-PUIs in a designated pediatric facility. 

    Methods: Children’s National Medical Center is a freestanding pediatric referral center located in close proximity to five international airports. EVD response was prioritized and implemented beginning August 1, 2014, using a system-wide IRP to screen, isolate, transport, monitor, and treat p-PUI. Following delivered care of four inpatient p-PUI, the IRP was further optimized for pediatric-specific challenges.

    Results: Between September and November 2014, four p-PUI pts aged 7 -11 years with US entry from 3-14 days prior were admitted for up to 3 days in full isolation precautions. Ultimate discharge diagnoses included severe malaria with hyperparasitemia (2), respiratory viral infection (1), and osteomyelitis (1). The initial IRP focused on pt screening, staff education and training on personal protective equipment and inter-facility pt transport.  Staffing care models evolved from exclusively critical care to include blended hospitalist, and neonatal/pediatric critical care physicians and nurses.  Public Relations was directly integrated for appropriate messaging for staff and families at screening, intake and isolation. Detailed debriefing after each inpatient p- PUI identified unique challenges in care of p-PUI, requiring input from Language, Child Life and Family Services. Novel solutions included (1) a dedicated Special Isolation Unit (SIU) with unique features for pediatric pts, (2) a unique modular retrofitted ambulance transport solution allowing rapid and effective decontamination, and (3) a multicomponent telemedicine solution to allow safe and effective multidisciplinary consultation and parent-child interaction while limiting exposure. 

    Conclusion: Unique aspects of pediatric Ebola PUI evaluation and treatment must be carefully developed and implemented in institutions caring for pediatric pts suspected or proven to have EVD.

    Roberta De Biasi, MD, MS, FIDSA, FPIDS1,2, Xiaoyan Song, PhD, MBBS3,4, Krista Cato, RN5, Tara Floyd, RN5, Linda Talley, MS, BSN, RN, NE-BC,6, Kathleen Gorman, RN7, Martha Parra, MSN, RN8, Venkat Shankar, MD9, Denice Cora-Bramble, MD, MBA10, Craig Sable, MD11 and David Wessel, MD12, (1)Pediatrics & Microbiology/Immunology/Tropical Medicine, George Washington University School of Medicine, Washington, DC, (2)Division of Pediatric Infectious Diseases, Children's National Medical Center/Children's Research Institute, Washington, DC, (3)George Washington University School of Medicine, Washington, DC, (4)Infection Control and Epidemiology, Children's National Medical Center, Washington, DC, (5)Nursing, Children's National Medical Center, Washington, DC, (6)Chief Nursing Officer, Children's National Medical Center, Washington, DC, (7)Chief Operating Officer, Children's National Medical Center, Washington, DC, (8)Clinical Support Services, Children's National Medical Center, Washington, DC, (9)Critical Care Medicine, Children's National Medical Center, Washington, DC, (10)Chief Medical Officer, Children's National Medical Center, Washington, DC, (11)Cardiology and Telemedicine, Children's National Medical Center, Washington, DC, (12)Chief Medical Officer and Critical Care Medicine, Children's National Medical Center, Washington, DC

    Disclosures:

    R. De Biasi, None

    X. Song, None

    K. Cato, None

    T. Floyd, None

    L. Talley, None

    K. Gorman, None

    M. Parra, None

    V. Shankar, None

    D. Cora-Bramble, None

    C. Sable, None

    D. Wessel, None

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