Interim Guidance for Preparing Ebola Assessment Hospitals

Key Points

1. Ebola assessment hospitals are prepared to receive and isolate a PUI for EVD and care for the patient until an Ebola diagnosis can be confirmed or ruled out and until discharge or transfer is completed.
2. The decision to function as an Ebola assessment hospital will be made between state and local health authorities and the hospital administration.
3. Ebola assessment hospitals should be prepared to transport patients with confirmed EVD to an Ebola treatment center. Transfer decisions should be informed by discussions among public health authorities and referring and accepting physicians on a case-by-case basis, depending on the status of the patient and the capacity of the Ebola assessment hospital.
4. All states, particularly those that are not planning to designate in-state Ebola treatment centers, should consider identifying Ebola assessment hospitals to ensure that anyone with symptoms and travel history consistent with EVD can be cared for until an Ebola diagnosis is confirmed or ruled out.
5. Ebola assessment hospitals should be able to provide up to 96 hours of evaluation and care for PUIs until the diagnosis is either confirmed or ruled out and until discharge or transfer is completed.

Ebola assessment hospitals are prepared to receive and isolate a PUI for EVD and care for the patient until an Ebola diagnosis can be confirmed or ruled out. This guidance is intended to inform efforts to prepare hospitals identified as Ebola assessment hospitals and includes a summary of the capability elements needed for those hospitals. It provides information for both state and local health departments as well as healthcare facilities serving in this role. Functioning as an Ebola assessment hospital will be a decision made between state and local health authorities and the hospital administration. All states, particularly those that are not planning to designate Ebola treatment centers, should consider identifying Ebola assessment hospitals to ensure that anyone with relevant travel/exposure history and signs or symptoms consistent with EVD can be appropriately cared for until an Ebola diagnosis is confirmed or ruled out. States should consider selecting enough Ebola assessment hospitals to provide adequate geographic coverage across the state and avoid extended transport times of more than 1–2 hours if possible, particularly from areas that have a large number of returning travelers.

Public health authorities may refer patients to Ebola assessment hospitals if they have traveled to an Ebola-affected area or had potential exposure to someone with EVD within the past 21 days and have developed signs and symptoms of EVD. Airport screening may have already identified these people as at risk for EVD. If so, they will have been actively monitored on a daily basis by public health authorities during the 21 days following travel to a country with widespread Ebola transmission or other potential Ebola exposure (for example, contact with a person with EVD). Travelers arriving from affected countries receive a CARE (Check and Report Ebola) kit that includes instructions to monitor their temperature and general health daily and immediately report any Ebola-symptoms to public health authorities. Ebola assessment hospitals may also receive patients transferred from frontline healthcare facilities that are not prepared to provide evaluation, arrange for testing, and care for PUIs. State and local public health authorities will coordinate closely with facilities when directing patients to an Ebola assessment hospital. Ebola assessment hospitals should ensure there is no delay in the care for these patients by being prepared to test, manage, and treat alternative etiologies of febrile illness (malaria, influenza) as clinically indicated.

Illness among people who are under active monitoring because of potential exposure to Ebola is likely to be detected early in the clinical course. These patients are therefore likely to present for evaluation with mild symptoms such as isolated fever. Public health authorities will be promptly directing those people to Ebola assessment hospitals for evaluation as soon as they report one or more symptoms. Initial isolation and evaluation of these clinically stable patients can be performed using personal protective equipment (PPE) and infection control practices according to the CDC’s guidance for clinically stable PUIs. Since these patients may also present with more severe symptoms or may exhibit vomiting, copious diarrhea, or obvious bleeding, Ebola assessment hospitals should be equipped and ready to implement use of PPE recommended for the care of hospitalized patients and ensure their staff is trained in its appropriate use.

Also, to confirm or rule out an EVD diagnosis in a PUI may take up to 72 hours or longer and require an additional 12 to 24 hours for specimen transport, testing, and identification of another facility for transfer (if needed). Ebola assessment hospitals should therefore be prepared to provide care for a PUI, including those with a high level of clinical suspicion for Ebola, for up to 96 hours. Ebola assessment hospitals complement state-designated Ebola treatment centers, which will care for and manage laboratory-confirmed Ebola patients through the full course of the illness. CDC has previously released Discharge Guidance for People Under Investigation for Ebola. Decisions regarding when to transport a PUI to an Ebola treatment center should be made on a case-by-case basis, informed by discussions among public health authorities and referring and accepting physicians, depending on the status of the patient and the capacity of the Ebola assessment hospital. Transport providers should be informed of the patient’s status and have appropriate training and PPE to safely transport a patient to an Ebola treatment center. The state plan also may include plans to transfer the patient out of state based on the patient’s risk and severity of illness and the geographic location of Ebola treatment centers. CDC Ebola Response Teams (CERTs) may be deployed to the Ebola assessment hospital to provide technical assistance for infection control procedures, clinical care, and logistics of managing a patient with EVD.

Ebola assessment hospitals should be able to provide up to 96 hours of evaluation and care for PUIs until the diagnosis is either confirmed or ruled out and until discharge or transfer is completed. The following table summarizes guidance on minimum capabilities that Ebola assessment hospitals should have in place before receiving PUIs. State health officials are responsible for ensuring the readiness of Ebola assessment hospitals in their states. All Ebola assessment hospitals should conduct practice drills and correct any identified gaps.

¹ Minimum capability can be considered adequate if all elements in the capability description are sufficiently met.