Ebola Quick List TO DO Instructions:
For all patients with symptoms consistent with Ebola Virus Disease
(fever 101.5 F or 38.6 C, headache, diarrhea, vomiting, muscle pain)
and history of recent travel to West Africa (Sierra Leone, Liberia, Guinea, Nigeria)
within the past 21 days
and/or direct contact with person with confirmed diagnosis of Ebola:
1. Give patient a mask, priority triage and MD evaluation, place in a private
room with private bathroom if available (if not dedicated commode) and
door closed
2. Place SPECIAL ISOLATION PRECAUTIONS sign and PPE Sheet on door
(enclosed)
3. Use the Ebola bundled kit to don personal protective equipment (PPE) for
all room contact, reorder items as needed: fluid resistant/impermeable
gown, N95 respirator, face shield, gloves (2 sets).
4. Notify IMMEDIATELY
b. UC San Diego Health System (UCSD HS) Infection Prevention and
Clinical Epidemiology (IPCE) Unit Medical Director (page operator
619 543 6737)
a. House Supervisor
i. Ask Supervisor to request 24hr observer from ? to ensure
compliance with completing contact tracer list, wearing and
removing PPE, and Hand Hygiene.
ii. Supervisor to activate for Incident Command
c. San Diego Public Health Department (SDPH)
(619) 692-8499, after hours (858) 565-5255.
5. Initiate Ebola Contact Tracer List (template included, make copies)
For additional guidance, see the Activity Flow Diagram and the IPCE Sharepoint
link to current CDC guidance.
https://….
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Ebola Kit Contents:
1. Ebola Information Packet (UCSD reprographic ?)
a. Ebola Quick List To Do Instructions (this document)
b. CDC Ebola fact sheet
c. PPE Guidance Sheet (Post at room entrance)
d. SPECIAL ISOLATION PRECAUTIONS sign (Post at room entrance)
e. Ebola Activity Flow diagram
f. Ebola Contact Tracer TEMPLATE (Please make copies)
g. Ebola Fever Monitor Form TEMPLATE (Please make copies)
h. Ebola Lab testing Guidance Sheet
i. Ebola Cleaning, handling of trash and linen Guidance Sheet
j. Ebola Patient Placement Guidance Sheet
k. Ebola Patient Transport Guidance Sheet
2. Initial set of disposable PPE, UCSD Reorder guide below:
1 ???
N-95 Respirator Mask
2 ???
Full face shield with eye protection
3 ???
Regular nitrile gloves, all sizes, 2 sets of each
4 ???
Impermeable gown, 2 sets
5 ???
Knee length booties
6 ????
Biohazard Trash Bag, red
7 ?????
Specimen transport Biohazard bag
8
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Personal Protective Equipment (PPE) Use for Ebola patient:
All persons entering the patient room must wear:
Leg/shoe covers UCSD Reorder ???? Knee-length booties
Gown Fluid Resistant/Impermeable UCSD Reorder ???
Respirator N95 UCSD Reorder ???
Eye/face protection UCSD Reorder Full face shield with eye protection
Gloves UCSD Reorder ???? Regular nitrile gloves, all sizes
Removing (Remove IN the Patient’s Room
Donning (Don OUTSIDE the Patient Room)
or Anteroom when available)
o
o
o
o
o
1. Clean and Dry hands
1.
Remove 1st pair of Gloves
2. Leg/Shoe Covers (under the Gown)
IF INDICATED: BLOOD/STOOL/VOMIT on
Floor
3.
Impermeable
Gown
2.
3.
Face Shield
Gown and 2nd pair
of gloves. Hand hygiene.
4. If Leg/Shoe covers used remove and 2nd
pair of gloves. Hand hygiene.
4.
N95 Respirator
5.
N95 Respirator
6. Clean hands
5.
Full Face Shield
7. Dispose of all PPE in biohazard waste
6.
2 sets of gloves to
cover sleeve’s cuffs
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PPE must be carefully removed without contaminating one’s eyes, mucous membranes,
or clothing with potentially infectious materials, and must be discarded in a biohazard
red trash bag/can.
Hand hygiene must be performed immediately after removal of PPE.If at anytime you
believe you have contaminated your hands, hand hygiene is recommended prior to the
next step.
STOP
(Assigned/Dedicated
Personnel Only)
Gown, Impermeable
N95 Respirator
Full Face shield
Gloves, 2 pairs
Shoe/Leg covers (if
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stool/blood/vomit on floor)
Door closed
Suspect Ebola Patient Contact Tracer
Name of Contact
Observer:______________________________________________
Any person entering patient room must be listed below, list names once per day.
Date and
Print Full Name clearly
Type of
Service/Department
Time
contact:
MD/RN/Visitor,
etc.
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Staff Ebola Exposure 21 day Fever Monitor
Any person with unprotected exposure to a confirmed Ebola patient must monitor their fever
twice a day for 21 days.
If temperature is 99.0°F or above identified, staff should contact Occupational Health (858) 6571604
Staff: Return form to Occupational Health when completed
Name:
Department:
Name of index Patient:
AM Date/ Time / Temperature
Contact Number: (
Date Exposed:
)
PM Date/ Time / Temperature
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UC San Diego Health System Clinical Laboratories
Enhanced Precautions for Collection, Transport, and Testing of Clinical Specimens from
Patients with Suspected Ebola Virus Disease (EVD)
Introduction
The largest Ebola Virus outbreak in history is currently taking place in West Africa. Ebola is
caused by an enveloped RNA virus, which is sensitive to all standard laboratory disinfectants. It
can only be spread through direct contact of broken skin or mucous membranes with infectious
bodily fluids (blood, urine, feces, saliva, or vomit) from a symptomatic patient. It is not spread
by airborne contact like the most infectious viruses such as measles when a patient is
asymptomatic. It is less infectious than bloodborne HIV or hepatitis C virus so OSHA bloodborne
pathogens precautions will protect laboratory workers. To date, only two health care workers
and one patient from Liberia have been hospitalized in the US with no additional spread.
General Considerations:

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Routine clinical diagnostic testing should be limited to the absolute minimum necessary to
provide effective and timely treatment to the patient in order to minimize potential
exposure of health care workers to blood, body fluids, or other potentially infectious
materials.
Maintain communication among all members of the treatment team, including laboratory
workers, to ensure proper safety measures are taken to protect health care workers and
other patients from potential Ebola virus exposure. This includes notification of laboratory
staff PRIOR to specimen collection, clear labeling of specimens from patients with
suspected EVD, and documentation in hospital and laboratory information systems.
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All health care workers must maintain proper hand hygiene (washing hands with soap and
water for at least 20 seconds, or using an approved hand sanitizer). In addition, all health
care workers should take measures to cover any cuts, sores, or other breaks in the skin at all
times, or limit high-risk activities when these conditions are present.
Each laboratory section should perform a risk assessment of individual specimen collection,
transport, and testing activities that may pose an increased risk of exposure to laboratory
workers, and identify specific modifications of existing policies and procedures to mitigate
those risks.
UNDER NO CIRCUMSTANCE will testing be performed on any clinical specimen in the UC
San Diego Health System Clinical Laboratories to directly diagnose or “rule out” potential
EVD. Requests for EVD diagnostic testing will be referred to the San Diego County Public
Health Laboratory, which will coordinate specimen collection, packaging, and transport.
Specimen Collection and Transport Considerations:

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Clinical specimens may be safely collected from patients suspected of having EVD by STRICT
ADHERENCE to the OSHA standard precautions for bloodborne pathogens.
o Wear gloves and a fluid repellent or disposable lab coat or gown. DO NOT touch face,
mouth, nose, or eyes with gloved hands.
o Wear a full face shield or goggles.
 ENHANCED PRECAUTIONS: wear a surgical mask or N95 respirator covering the nose
and mouth.
o Dispose of all gloves and collection materials (wrappers, tubing, etc.) in biohazard
(contaminated) waste. Dispose of all sharps in an approved biohazard sharps container.
o Wash hands thoroughly with soap and water for at least 20 seconds immediately after
removing PPE.
For specific Ebola testing, collect a minimum of 4 mL whole blood with EDTA, SPS or citrate
in plastic tubes. Wipe each tube with a 10% bleach solution immediately after collection.
Place specimens in double biohazard specimen bags and store at 4oC until San Diego County
Public Health Service Laboratory personnel arrive. CDC submission forms and a Primary
Specimen Contact List will be required. DO NOT split, aliquot, transfer, or otherwise process
the specimen.
Clinical specimens from patients known or suspected of having EVD may be safely
transported by STRICT ADHERENCE to the OSHA standard precautions for bloodborne
pathogens.
o Transport clinical specimens in individual sealed specimen bags marked with the
biohazard symbol with sufficient absorbent material to absorb the entire contents of the
specimen.
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ENHANCED PRECAUTIONS: wipe each individual tube with a 10% bleach solution
immediately following collection.
 EHNANCED PRECAUTIONS: double-bag specimens for transport to the appropriate
laboratory for testing.
 UNDER NO CIRCUMSTANCE should clinical specimens from patients with EVD be
transported through the pneumatic tube system.
o Place bagged specimens inside a hard-sided container for transport in a vehicle or by a
commercial shipping company (NOTE: all Federal and international regulations must be
followed for clinical specimens shipped commercially).
Testing Considerations – General:

Routine testing of clinical specimens from patients with suspected or confirmed EVD may be
safely performed by STRICT ADHERENCE to the OSHA standard precautions for bloodborne
pathogens.
o Wear gloves and a fluid repellent or disposable lab coat or gown when handling clinical
specimens. DO NOT touch face, mouth, nose, or eyes with gloved hands.
 ENHANCED PRECAUTIONS: double-glove for high-risk manual procedures, as
determined by each laboratory section.
o Gloves should be changed frequently to avoid contamination of the laboratory
environment and other clinical specimens. Immediately remove PPE that becomes
grossly contaminated with blood or other potentially infectious materials and
immediately wash hands thoroughly with soap and water for at least 20 seconds.
Dispose of contaminated PPE in biohazard waste.
o Wear a full face shield or goggles during procedures that may produce splashes or
sprays. Acrylic or Plexi-glass splash guards may also be used.
 ENHANCED PRECAUTIONS: perform tasks that may generate aerosols in a certified
Class II biological safety cabinet (BSC). If a BSC is not available, then wear a surgical
mask or N95 respirator covering the nose and mouth during procedures that may
generate splashes or sprays (e.g. uncapping tubes, vortexing or mixing specimens,
pipetting or transferring liquid specimens, etc.), or any other high-risk activity.
 ENHANCED PRECAUTIONS: use a gauze pad saturated with 10% bleach solution to
open any tube or specimen container.
 ENHANCED PRECAUTIONS: use a certified Class II biological safety cabinet if
MANUAL testing is performed on clinical specimens from patients with EVD.
o All manufacturer-installed safety features must be in place for instruments used for
automated testing of clinical specimens.
Department-Specific Testing Considerations:
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Hematology, Coagulation, and Chemistry: testing should be limited to point-of-care testing
whenever possible; urinalysis may be limited to manual dipstick testing.
Hematology and Microbiology: whole blood smears for malaria, Gram stain, or other
microscopic testing should be air dried, fixed in methanol for 30 minutes and allowed to air
dry, and fixed on a heat block at 95oC for 1 hour in order to inactivate the specimen.
Microbiology:
o Bacterial testing of clinical specimens (other than blood cultures) from patients
suspected of having EVD should be restricted unless critically necessary for patient care.
o Disinfect blood culture bottles with 10% bleach solution upon receipt, and before and
after sampling bottles flagged as positive for bacterial growth. DO NOT perform
Verigene testing on positive blood cultures from patients with known or suspected EVD.
Perform Gram stains and subcultures in the BSC.
o Perform centrifugation only inside sealed centrifuge cups. Disinfect the cups after each
use with 10% bleach with a contact time of at least 5 minutes, followed by distilled
water or 70% ethanol.
o Seal all culture plates with tape and place inside labeled biohazard bags prior to
incubation.
o Perform all culture work-up inside a BSC.
Laboratory Disinfection and Waste Disposal Considerations:

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
NOTE: All clinical specimens from patients known to have confirmed EVD or other
hemorrhagic fever disease must be destroyed in accordance with Federal regulations.
UNDER NO CIRCUMSTANCE WILL ANY CLINICAL MATERIALS FROM A PATIENT WITH
CONFIRMED EVD OR OTHER HEMORRHAGIC FEVER DISEASE BE STORED, ARCHIVED,
FROZEN, OR OTHERWISE PRESERVED FOR LONG-TERM STORAGE.
ENHANCED PRECAUTIONS for disposal of laboratory waste associated with testing clinical
specimens from patients suspected of having EVD include:
o Wrap all waste (blood tubes, culture plates, etc.) in absorbent pads soaked with fullstrength bleach.
o Place wrapped waste in double red bags.
o Place red bags in rigid, hard sided container.
o Autoclave prior to disposal.
REPORT SPILLS/EXPOSURES IMMEDIATELY to a Lead Technologist, Supervisor, or Manager.
Isolate the area and alert other staff of the spill in order to limit potential exposure. Wear
all necessary PPE (gown, double gloves, goggles or face shield, and surgical mask or N95
respirator). Working from the outside of the spill inward, contain the spill with absorbent
material soaked in full-strength bleach until the spill is fully absorbed. Remove absorbent
material, and clean the area again with 10% bleach with a contact time of at least 5
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minutes, followed by distilled water or 70% ethanol. Dispose of cleaning materials and PPE
in double red bags and autoclave prior to disposal. Immediately wash hands with soap and
water for at least 20 seconds.
Decontaminate work areas with a solution of 10% bleach with a contact time of at least 5
minutes, followed by a rinse of distilled water or 70% ethanol. Dispose of all cleaning
materials in biohazard waste.
Wash hands thoroughly with soap and water for at least 20 seconds before leaving the
laboratory.
Laboratory workers should maintain awareness of their own health conditions and report
any symptoms of fever, headache, nausea, vomiting, or diarrhea to a Supervisor or
Manager. Laboratory workers who report these symptoms to a Supervisor or Manager after
working with specimens from a known or suspected EVD patient may be advised not to
report for work, and referred to the Center for Occupational and Environmental Medicine
(COEM) for evaluation.
Ebola Lab Testing Guidance
DO NOT DRAW lab specimens for Ebola testing until the following are notified
 SD Public Health Department (619) 692-8499, after hours (858) 565-5255
 UCSD Microbiology laboratory (
Timeline of Infection
Within a few days after
symptoms begin
Diagnostic tests available (will be sent to CDC)
 Antigen-capture enzyme-linked immunosorbent assay
(ELISA) testing
 IgM ELISA
 Polymerase chain reaction (PCR)
 Virus isolation
Later in disease course or after
 IgM and IgG antibodies
recovery
Retrospectively in deceased
 Immunohistochemistry testing
patients
 PCR
 Virus isolation
Suggest testing for other conditions with similar presentation:
6. Malaria
7. Lassa fever
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Personal Protective Equipment
 Specimen Collection: Wear all recommended protective gear (gown, N95
respirator, face shield) PLUS double gloves
Specimen Transport:
 No need for person hand carrying specimens to wear PPE for specimen
transport.
 Double bag all specimens, ensuring outer bag is clean and has not come
into contact with exposed surfaces.
 Contact courier service for transportation of specimens to the microbiology
laboratory
 DO NOT use the pneumatic tube system to transport these specimens,
hand carry only.
Ebola Cleaning, handling of Trash/Linen Guidance
 CDC Interim Guidance for Environmental Infection Control in
Hospitals for Ebola Virus should be followed
(http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-inhospitals.html).
 Trash and Linen will be managed by EVS dedicated personnel and
should be separate from other clinical linen and waste.
 Dedicated medical equipment (preferably disposable, when possible)
should be used for patient care.
 All non-dedicated, non-disposable medical equipment used for patient
care should be thoroughly cleaned and disinfected with hospital
approved disinfectants and according to manufacturer’s
recommendations.
 All disposable items and linen in the patient’s room must be managed
as biohazardous waste.
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o When removing from room, place biohazard bag in a second
clean red bag held by another staff member with clean gloves
(i.e. double bag), to assure the outer bag is clean.
 Before exiting the patient room or care area, personal protective
equipment (PPE) should be carefully removed without contaminating
one’s eyes, mucous membranes, or clothing with potentially infectious
materials. Disposed of in a red biohazard trash bag/can.
 Daily and terminal cleaning is per usual hospital protocol by the
dedicated/assigned personnel.
o If gross contamination of the room is present, contact EVS for
blood/body fluid management.
o Health care workers or EVS workers performing environmental
cleaning and disinfection must wear all recommended PPE.
Patient Placement
for suspected/known Ebola disease
Isolation Precautions: CONTACT and DROPLET PRECAUTIONS
with eye protection
Place patient into: Burn Intensive Care Unit (room #? Negative
pressure, dedicated commode) or SCVC ICU (room#?/negative
pressure room)
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Patient Transport
for suspected/known Ebola disease
Patient Precautions: Cover patient from neck to toe with clean linen.
Transport with two biohazardous bags to use in case of vomiting (one
bag to contain emesis, second bag to double-bag)
In addition to clinical staff involved in the medical care of the patient,
TWO transport personnel are recommended:
1. Transporters having contact with the patient or patient bed must
wear personal protective equipment (PPE) during transport as
additional precaution. PPE must include the following: gown, N95
respirator, face shield, gloves.
2. One “designated chaperone” should accompany the transport
team to assist with opening doors, pushing elevator buttons, etc.
This individual should remain “clean” by not having contact with
the patient or the bed/equipment during transport. No PPE is to
be worn by this individual.
3. All clinical staff caring for the patient will wear PPE as described
above.
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