Ebola Virus Disease (EVD)
Infection Prevention Guidelines
Adapted from the CDC and the CDNA
Hayden McDonald – Infection Prevention & Surveillance CNC
Jane Tomlinson – Infection Prevention & Surveillance Nurse
Coordinator
What is Ebola?
• Q: What is Ebola?
• A: Ebola virus is the cause of a
viral haemorrhagic fever disease.
Symptoms include: fever,
headache, joint and muscle aches,
weakness, diarrhoea, vomiting,
stomach pain, lack of appetite,
and abnormal bleeding.
Symptoms may appear anywhere
from 2 to 21 days after exposure
to Ebola virus although 8-10 days
is most common.
Transmission
•
Q: How is Ebola transmitted?
•
A: Ebola is transmitted through direct contact with
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Blood
Secretions
Organs
Other bodily fluids. And
Through indirect contact with;
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Environments contaminated with such fluid
• Transmission through sexual contact may be possible for up to 7 weeks after clinical recovery.
•
Q: Can I get Ebola from a person who is infected but doesn’t have any symptoms?
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A: No. Individuals who are not symptomatic are not contagious. In order for the virus to be transmitted, an individual
would have to have direct contact with an individual who is experiencing symptoms.
Signs and Symptoms to watch for
• Sudden onset of symptoms
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Influenza like illness
Fever > 38°C
Myalgia
Fatigue
Headache
• 2nd stage
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GIT – Vomiting, diarrhoea
Neuro – headaches, confusion
Vascular cutaneous – maculopapular rash
Respiratory – sore throat, cough
• Additionally
– Septic shock-like syndrome
– Multi organ failure
– Profuse internal and external bleeding
Questions for Triage
Patients presenting to ED with fever >=38°C
1.
Have you been travelling outside Australia in the last 21 days?
2.
If YES, did you travel to Africa?
3.
If YES, did you visit any of the following countries
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Liberia
Nigeria
Guinea
Sierra Leone
IF YES then take IMMEDIATE ACTION!
1)
IMMEDIATELY – Patient to wear N95 mask (include any accompanying family/carer)
2)
Admit patient immediately to ISOLATION (Resus 3 – negative pressure) and commence Contact &
Droplet precautions as designated
3)
Notify Director of Emergency or designated deputy
4)
Director of Emergency to notify
1)
2)
3)
4)
Department of Health 1300 651 160
Infectious Diseases Specialist (via switch)
Admitting officer
CEO during business hours, After Hours – Exec on call
IF YES then take IMMEDIATE ACTION!
Part 2
5.
Isolate Ambulance entrance - Hospital to go on Bypass (is this necessary at TNH??)
6.
Transfer to RMH as soon as safe to do so.
7.
ONLY if clinically indicated and ONLY after notification to Department of Health should Pathology
tests be taken.
8.
DO NOT under any circumstances use a Blood Gas Machine for pathology testing
General principles for managing EVD
1)
If patient’s condition requires immediate intervention to preserve life then manage in isolation in
Emergency with an aim of stabilisation for transport.
2)
If the patient is clinically stable arrange immediate transfer to Royal Melbourne Hospital. (we do not
have appropriate Critical Care isolation rooms)
170ml / 1 Litre water
Provides 5000ppm
Possible EVD
1)
Personal Protective Equipment
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Scrubs
Balaclava
Eye protection
N95 (P2) mask
Plastic Apron
Disposable Gown
Gloves – 2 pairs (1 long, 1 regular)
Long disposable over boots
Ensure dedicated or disposable equipment is used for the
patient
e.g. stethoscope, thermometer etc.
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Waste
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Designated yellow bin with liner (for incineration)
All waste including lined to be bagged inside room and
placed in bin for incineration
Decontaminate external surfaces with Divercleanse solution
(possible ‘sprayer’ to ensure full coverage)
Cleaning
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Divercleanse (bleach/detergent 5000ppm = 170ml / 1 Litre)
Ensure all surfaces are disinfected using Divercleanse
solution on entry and exit of room
Utilise disposable equipment whenever possible
Donning PPE
1)
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Change into surgical scrubs (top and pants for men and women – no dresses
Apply disposable Balaclava
Apply disposable impervious long sleeve gown
Apply plastic apron
Apply disposable overshoes
Apply N95 (P2) mask – Fit check
Apply protective googles
Apply non sterile gloves
Apply 2nd pair of gloves - long sleeve gloves (use sterile gloves in the interim)
Enter patient room
Note that details of all persons entering the isolation room must be recorded by a dedicated staff member who will
assist staff in donning and doffing PPE.
Doffing PPE
In patient room
1) Remove external (long sleeve) glove
2) Remove Plastic Apron
3) Remove overshoes
In Ante room
1) Remove gown from shoulders and neck turning inside out and finally remove gloves and roll into a bundle
2) Discard into clinical waste
3) Perform hand hygiene
4) Remove balaclava
5) Remove goggles or face shield from behind head
6) Remove mask from behind head (do not touch front of mask)
7) Perform hand hygiene
Pathology sampling
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Collect only after discussion with Department of Health
Collect blood (EDTA) and respiratory swab (Ebola and Malaria testing)
2 person procedure
Pre-label specimens
Immediately double bag and place into rigid transport container (supplied from Healthscope) and label
Hand deliver to Pathology Specimen Reception – pre notification required
Healthscope to package and send to VIDRL