Optimal Medical Imaging Achievable for Patients with Ebola

By Evonne Acevedo Johnson

While a hospital's standards of practice for isolating and caring for patients with Ebola virus infection are not likely to be directed toward radiology staff, an early point of contact might be an outpatient imaging clinic, according to a presenter of a special interest session on Tuesday.

David A. Bluemke, M.D., Ph.D., director of radiology and imaging sciences and senior investigator at the National Institute of Biomedical Imaging and Bioengineering, spoke during a session "Radiology Preparedness and Ebola Virus Disease." He cited a case in which a patient who later presented with Ebola virus disease had initially visited a local emergency department, where he underwent CT imaging to rule out appendicitis.

In preparing for dealing with patients with Ebola, Dr. Bluemke said, imaging staff should consider which staff to train and how imaging equipment will be distributed—whether it will be transported, used once and immediately decontaminated, or remain in the isolation unit for the duration of the patient's care. "When you take a unit and park it there, you have to consider how that will affect the rest of the hospital," he said. The potential effects of decontaminant agents like isopropyl alcohol, bleach and vaporized hydrogen peroxide on valuable radiologic equipment should also be considered, he said.

Also presenting during Tuesday's session was Bruce S. Ribner, M.D., M.P.H., a professor of medicine at the Emory School of Medicine and Department of Medicine, Division of Infectious Diseases, in Atlanta. Hailed last month in TIME magazine as "America's Top Ebola Doctor," Dr. Ribner has spent 12 years overseeing the development of Emory's serious communicable disease unit, funded by the Centers for Disease Control (CDC). His team has cared for Emory's four patients with Ebola, all of whom have survived the disease.

"The key to survival is aggressive supportive care, but this is extremely labor-intensive," Dr. Ribner said. "We have one nurse to one patient so they can respond rapidly to changes and adjust their care accordingly. These nurses support patients with nutrition, physical therapy, self-care and—I cannot emphasize this enough—emotional support."

With the high mortality rates in West Africa, depression is very common in patients with Ebola virus disease, Dr. Ribner explained. "Patients have told us, 'I thought you were just bringing me back here to the U.S. so I could die on American soil.'"

David A. Bluemke, M.D., Ph.D., Bruce S. Ribner, M.D., Carolyn C. Meltzer, M.D.

Donning, Doffing of Protective Equipment Presents High Risk

Central venous catheters for controlling fluid loss in treating Ebola patients, Dr. Ribner said. At a minimum, radiology support would include ultrasound to aid in catheter placement and tip location and chest radiography to distinguish acute respiratory distress, fluid overload and infectious or chemical pneumonia.

"We believe one of the highest risks occurs during donning and doffing of personal protective equipment, or PPE," Dr. Ribner said. All donning and doffing of PPE is observed by another team member, he said, and there are checklists posted in the affected rooms to remind staff of the proper protocols.

In addition, Emory's model dictates that ancillary staff are not permitted in patient's room unless absolutely required—they remain in the anteroom and guide nurses through the process of using equipment, including ultrasound and radiography units.

Session moderator Carolyn C. Meltzer, M.D., Associate Dean for Research at Emory University School of Medicine, noted that educating the healthcare team is as important as educating the public. "Initially, some of the staff who were parking patients' cars chose to wear face masks, and that was probably not the best way to welcome them to the hospital," Dr. Meltzer said. "There were also vendors who refused to service the equipment at our unit. These personnel can be made part of the team with proper communication so it's a little less dramatic."

"There's perception and there's science," Dr. Ribner said. "Our message is that we have expertise in treating patients with serious infectious diseases, we are trained and prepared for these patients and we will protect our patients, our staff and our communities."

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