Ebola Virus Disease (EVD) Policy – Response and Infection Prevention and Control
Date: ______________________
Purpose
The purpose of the policy is to:
 Ensure preparedness in the event of a suspect or confirmed case of Ebola virus disease (EVD)
within the facility
 Guide the institutional response through assignment of actions and responsibilities in the event
of a suspect or confirmed case of EVD within the facility
References
 Centers for Disease Control and Prevention (CDC) Ebola Virus Disease
http://www.cdc.gov/vhf/ebola/index.html
 Minnesota Department of Health Ebola Virus Disease
http://www.health.state.mn.us/divs/idepc/diseases/vhf/
 CDC Ebola Virus Disease Information for Healthcare Workers
http://www.cdc.gov/vhf/ebola/hcp/index.html
o Diagnosis/Testing
o Specimen Collection, Transport, Testing, and Submission
o Transportation/Monitoring/Movement
o Protecting Healthcare Workers
o Evaluating Returned Travelers for EVD, US
o Checklist for Patients Being Evaluated for EVD, US
o Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety
Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola
Virus Disease in the United States
o Ebola virus disease Information for Clinicians in U.S. Healthcare Settings
o Safe Management of Patients with Ebola Virus Disease (EVD) in U.S. Hospitals
o Infection Prevention and Control Recommendations for Hospitalized Patients with
Known or Suspected Ebola Virus Disease in U.S. Hospitals
o Guidance for Safe Handling of Human Remains of Ebola Patients in U. S. Hospitals and
Mortuaries
o Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
o Ebola Preparedness Guidance – for hospitals, providers, EMS, healthcare coalitions
Background
 Ebola is a rare and deadly disease caused by infection with one of four viruses (Ebolavirus genus)
that cause disease in humans. Ebola infection is associated with fever of greater than 38.6°C or
101.5°F, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea,
abdominal pain, or unexplained hemorrhage.
 Ebola is spread through direct contact (through broken skin or mucous membranes) with blood
or body fluids (including but not limited to urine, saliva, feces, vomit, sweat, breast milk, and
semen) of a person who is sick with Ebola or contact with objects (such as needles and syringes)
that have been contaminated with these fluids. Ebola is not spread through the air or water. The
main source for spread is human-to-human transmission. Avoiding contact with infected
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persons (as well as potentially infected corpses) and their blood and body fluids is of paramount
importance.
Persons are not contagious before they are symptomatic. The incubation period (the time from
exposure until onset of symptoms) is typically 8-10 days, but can range from 2-21 days.
Additional information is available at http://www.cdc.gov/vhf/ebola/index.html.
Definitions
Ebola case definitions (CDC, updated September 4, 2014; www.cdc.gov/vhf/ebola/hcp/casedefinition.html )
 Person under investigation: patient with consistent symptoms and risk factors as follows:
o Clinical criteria: includes fever of greater than 38.6 degrees Celsius or 101.5 degrees
Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting,
diarrhea, abdominal pain, or unexplained hemorrhage; AND
o Epidemiologic risk factors within the past 21 days before the symptom onset such as:
 Contact with blood or other body fluids or human remains of a patient known to
have or suspected to have EVD;
 Residence in—or travel to—an area where EVD transmission is active
(www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distributionmap.html#areas) ; or
 Direct handling of bats or non-human primates from disease-endemic areas.
 Confirmed case: A patient with laboratory-confirmed diagnostic evidence of Ebola virus
infection
Policy
A. Infection Prevention and Control/Hospital Epidemiology takes the lead role to:
a. Engage the Ebola Response Team
b. Ensure that the most current EBV guidance by public health authorities is implemented
c. Ensure appropriate controls are in place to prevent EBV transmission within the facility
d. Provide EBV guidance to patients and visitors
B. Ebola Response Team
a. Purpose: to guide the institutional response, determine roles and responsibilities including a
Technical Advisor
b. The membership of the Ebola Response Team should include, at a minimum:
i. Infection Preventionist
ii. Administration: CEO, CNO, DON
iii. Chief Medical Officer
iv. Medical Director/Manager of Infection Prevention and Control
v. Infectious Diseases
vi. Emergency Department Manager
vii. Microbiology Laboratory Manager
viii. Environmental Services Manager
ix. Communications/Risk Manager
x. Occupational Health Manager
xi. Minnesota Department of Health (Ad Hoc Member)
c. The Team will meet to review and coordinate investigative, patient safety, and patient
management efforts.
C. Information included in this policy is subject to change based on needs to fit the appropriate
response and changing guidance from public health authorities
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Procedure
A. Overview for any patient evaluated for suspect of confirmed EBV:
 Complete CDC “Checklist for Patients Being Evaluated for Ebola Virus Disease (EBV) in the United
States” www.cdc.gov/vhf/ebola/pdf/checklist-patients-evaluated-us-evd.pdf
 Notify Infection Prevention and Control Department
 Notify the Minnesota Department of Health at 651-201-5414
 Initiate appropriate infection prevention and control measures
B. Identification/notification
 Infection Prevention and Control receives notification of suspect or confirmed EBV patient in the
facility
 Upon the identification of a suspect or confirmed case of EBV, the infection preventionist will
notify the Minnesota Department of Health and the Ebola Response Team
 Ebola Response Team’s Technical Advisor confirms the EBV case definition using CDC guidance
C. Follow Infection Prevention and Control Measures
CDC guidance: www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
Use Standard, Contact, and Droplet precautions in the care of suspected and confirmed Ebola patients.
HCP should wear: gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield),
and a facemask. Additional personal protective equipment (PPE) might be required in certain situations
(e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment),
including but not limited to double gloving, disposable shoe covers, and leg coverings; contact Infection
Prevention and Control for guidance. Avoid aerosol-generating procedures. If clinically essential, PPE for
these procedures should include respiratory protection (N95 respirator or PAPR); perform in an Airborne
Infection Isolation Room (AIIR).
1. Patient placement:
 Place patient in a single patient room (containing a private bathroom) with the door closed
 Maintain a log of all persons entering the patient's room
2. Personal protective equipment (PPE)
 All persons entering the room should wear at least:
o Gloves
o Gown (fluid-resistant or impermeable)
o Eye protection (goggles or face shield) – one time use only; discard upon leaving room
o Facemask
Upon exit from the patient room or care area, carefully remove PPE without contaminating the
eyes, mucous membranes, or clothing with potentially infectious materials. Either discard or
clean and disinfect reusable PPE according to the manufacturer instructions and hospital
policies. Perform hand hygiene immediately after removal of PPE.
Additional PPE may be required in certain situations (e.g. copious amounts of blood, other body
fluids, vomit, or feces present in the environment or if performing aerosol-generating
procedures) such as:
 Double gloving
 Disposable shoe covers
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Leg coverings
N95 respirator or PAPR for aerosol-generating procedures
*Refer to CDC guidance for instructions on donning and safe removal of PPE*
3. Patient care equipment
 Use dedicated medical equipment (preferably disposable, when possible) for the provision
of patient care
 All non-dedicated, non-disposable medical equipment used for patient care should be
cleaned and disinfected according to manufacturer’s instructions and hospital policies
4. Patient care considerations
 Limit the use of needles and other sharps as much as possible
 Limit phlebotomy, procedures, and laboratory testing to the minimum necessary for
essential diagnostic evaluation and medical care
 All needles and sharps should be handled with extreme care and disposed in punctureproof, sealed containers
 Avoid aerosol-generating procedures
 Limit HCP only to those essential for patient care
o Maintain a log of persons entering the patient’s room
5.
Aerosol-generating procedures
 Avoid aerosol-generating procedures
 If performing aerosol-generating procedures, use a combination of measures to reduce
exposures from aerosol-generating procedures when performed
 Visitors should not be present during aerosol-generating procedures
 Limit the number of HCP present during the procedure to only those essential for patient
care and support
 Conduct the procedures in a private room and ideally in an Airborne Infection Isolation
Room (AIIR) when feasible. Room doors should be kept closed during the procedure except
when entering or leaving the room, and entry and exit should be minimized during and
shortly after the procedure.
 HCP should wear gloves, a gown, disposable shoe covers, and either a face shield that fully
covers the front and sides of the face or goggles, and respiratory protection that is at least
as protective as a NIOSH certified fit-tested N95 filtering facepiece respirator or higher (e.g.,
powered air purifying respiratory or elastomeric respirator) during aerosol generating
procedures.
 Conduct environmental surface cleaning following procedures (see section below on
environmental infection control).
 If re-usable equipment or PPE (e.g. powered air purifying respirator, elastomeric respirator,
etc.) is used, it should be cleaned and disinfected according to manufacturer instructions
and hospital policies.
 Collection and handling of soiled re-usable respirators must be done by trained individuals
using PPE as described above for routine patient care
6. Hand hygiene
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HCP should perform hand hygiene frequently, including before and after all patient contact,
contact with potentially infectious material, and before putting on and upon removal of PPE,
including gloves
Healthcare facilities should ensure that supplies for performing hand hygiene are available
7. Environmental infection control
CDC guidance: www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html
 Diligent environmental cleaning and disinfection and safe handling of potentially
contaminated materials is paramount, as blood, sweat, emesis, feces and other body
secretions represent potentially infectious materials
 Cleaning must precede disinfection
 HCP performing environmental cleaning and disinfection should wear recommended PPE
(described above) and consider use of additional barriers (e.g., shoe and leg coverings) if
needed. Face protection (face shield or facemask with goggles) should be worn when
performing tasks such as liquid waste disposal that can generate splashes.
 Follow standard procedures, per hospital policy and manufacturers’ instructions, for
cleaning and/or disinfection of environmental surfaces, equipment, textiles, laundry, food
utensils and dishware
8. Safe injection practices
 Follow safe injection practices as specified under Standard Precautions
9. Duration of infection control precautions
 Determine duration of precautions on a case-by-case basis, in conjunction with the public
health authorities
10. Monitoring and management of potentially exposed personnel
 Persons with percutaneous or mucocutaneous exposures to blood, body fluids, secretions,
or excretions from a patient with suspected EVD should
o Stop working and immediately wash the affected skin surfaces with soap and water.
Mucous membranes (e.g., conjunctiva) should be irrigated with copious amounts of
water or eyewash solution
o Immediately contact occupational health/supervisor for assessment and access to
postexposure management services for all appropriate pathogens (e.g., human
immunodeficiency virus, hepatitis C, etc.)
 Follow policies for monitoring and management of potentially exposed HCP:
o HCP who develop sudden onset of fever, intense weakness or muscle pains,
vomiting, diarrhea, or any signs of hemorrhage after an unprotected exposure (i.e.
not wearing recommended PPE at the time of patient contact or through direct
contact to blood or body fluids) to a patient with EVD should
1. Not report to work or should immediately stop working
2. Notify their supervisor
3. Seek prompt medical evaluation and testing
4. Notify the Minnesota Department of Health
5. Comply with work exclusion until they are deemed no longer infectious to
others
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o For asymptomatic HCP who had an unprotected exposure (i.e. not wearing
recommended PPE at the time of patient contact or through direct contact to blood
or body fluids) to a patient with Ebola
1. Should receive medical evaluation and follow-up care including fever
monitoring twice daily for 21 days after the last known exposure.
2. Ensure twice daily contact with exposed personnel to discuss potential
symptoms and document fever checks
3. HCP may continue to work while receiving twice daily fever checks, based
upon hospital policy and discussion with local, state, and federal public
health authorities.
Follow sick leave policies for HCP (on-punitive, flexible and consistent with public health
guidance)
o Ensure that all HCP, including staff who are not directly employed by the healthcare
facility but provide essential daily services, are aware of the sick leave policies
11. Monitoring, management, and training of visitors
 Restrict all visitors into the patient’s room; exceptions may be considered on a case-by-case
basis
 Maintain a log of all visitors entering the patient’s room
 Visitors should be:
o Screened for EVD (e.g., fever and other symptoms) before entering or upon arrival
to the hospital
o Instructed ( before entry into the patient care area) on hand hygiene, limiting
surfaces touched, and use of PPE
o Assessed for ability to comply with infection prevention and control precautions
o Restricted to the patient room and an immediately adjacent waiting area
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