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==[[Harbor:Ebola|Harbor Ebola]] Precautions==

*Never enter a room with an Ebola PUI (Person Under Investigation) without full Ebola level PPE.
*The definition of a PUI is simple - possible exposure to Ebola and subjective complaints consistent with Ebola infection (basically viral syndrome symptoms or abdominal pain or bleeding). No fever or other visible findings are required to classify the patient as a PUI patient.
*Currently countries identified as travel locations we should be concerned about are coded into the "ID Risk Screen" the routers perform and you can find on Cerner under "Provider Notes"
**As of October 2022, outbreak is isolated in Uganda
*There are other ways to be exposed to Ebola virus: including sexual intercourse with a patient who has recovered from an Ebola infection.
*As soon as the patient is identified as a PUI - they should go straight into isolation (in AED or PED, not RME), ideally one with a restroom inside the room; all further evaluation is done there. 
*Residents should not be in a room with a PUI patient - only attendings and fellows acting as attendings should be involved in wearing PPE and entering a PUI room
*Notify the infectious disease (ID) service that you have a PUI patient in the emergency department - they will guide further screening to determine if the patient can be cleared or not. ID will then notify infection control prevent (IPC).
*PUI patients are not allowed to use the sink or toilet. Mechanical should bring a porta-potty for patient use if there is not one in the room.
*The policy of the County of Los Angeles is that any provider may decline to care for a PUI patient. Nursing has a list of nurses who have volunteered to care for PUI patients.
*Extreme care should be taken in any situation where a PUI patient may undergo a procedure that aerosolizes body fluids - the best PPE in this case is a PAPR unit - which is a helmet with a positive pressure fan. 
*Call the OCN to obtain a PAPR and PPE equipment for Ebola, put out a log to record who goes in and out of a PUI room.
*In the top drawer of the Ebola PPE cart is a binder that has step by step instructions for getting into and out of PPE for both the treating provider and that provider's "buddy".  We will plan more training to refresh everyone on this.
*UCLA Medical Center in Westwood will be our referral center for patients who cannot be cleared in a reasonable timeframe' or become confirmed Ebola patients. The decision for the timing of transfer will be made in conjunction with the infectious disease consultant.
*EMS has a special unit to transport such patients - make sure they're aware that you have a PUI or confirmed case of Ebola.

==Monkeypox==
* See [[Monkeypox]] for clinical info
* See [https://lacounty.sharepoint.com/sites/dhs-ccl/InfectiousDisease/Forms/AllItems.aspx?id=/sites/dhs-ccl/InfectiousDisease/Infectious%20Disease%20-%20Guidance%20for%20Prevention,%20Diagnosis,%20and%20Treatment%20of%20Monkeypox%20Disease%208-11-22.pdf&parente LAC DHS Expected Practice]
** Consider in patients with travel history w/in 21d of symptom onset to West Africa, Europe (CDC link of [https://wwwnc.cdc.gov/travel/notices/alert/monkeypox#countries non-endemic countries] with cases)
** Rash typically preceded by fever, lymphadenopathy, malaise, HA, and muscle aches, but not all patients have prodrome in current outbreak
** Vesicular or pustular rash, well-circumscribed, may be umbilicated or become confluent and progress over time to scabs. Could be in different stages. 
** Higher likelihood in MSM patients, presenting with lesions in the genital area
* Move directly to a private room, cover rash; airborne (N-95) and contact precautions (gown), eye protection, gloves - order special precautions 
* Call Lab x66289 and get a monkeypox collection kit from Microbiology 
* Unroof lesion to swab, try to get cutaneous and genital lesions. Need separate order for each swab. 
* Send out to Quest, 3days turnaround time
* Put patient onto lab follow up list. 
* Inform patient to self isolate until all lesions scabbed over
* If get a call for positive test, double check patient is on the lab follow up lists. 
** Lab will inform LA County Public Health and HUCLA Infection & Prevention Control
* Treatment is tecovirimat (TPoxx) - experimental antiviral agent '''needs ID approval'''
** For painful lesions preventing ability to do ADLs (unable to urinate/defecate, eat/drink), intraocular lesion
** Obtain [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent.pdf written consent] or [https://www.cdc.gov/poxvirus/monkeypox/pdf/Attachment-1-Informed-Consent-Spanish.pdf Spanish written consent] 
*** Only available in English and Spanish for now. Do verbal consent for other languages then have patient sign the English consent form
** Write e-script using ‘misc prescription’ 
** Fill out TNF form (prior-authorization form) and inform ED pharmacist
** RN to call OPD to have someone send Tpoxx from Outpatient Pharmacy to ED (can be RN or pharmacy tech

* Educational Material
** [http://publichealth.lacounty.gov/acd/Monkeypox.htm LA County Monkeypox]
** [http://publichealth.lacounty.gov/media/monkeypox/docs/Monkeypox_IntimateContact.pdf LAC DPH Monkeypox]
** http://publichealth.lacounty.gov/media/monkeypox/resources.htm#reduce
** [https://www.cdc.gov/poxvirus/monkeypox/resources/print.html CDC Monkeypox]