Infection Prevention Ebola Viral Disease (EVD)

1. Infection PreventionEbola Viral Disease (EVD) EBOLA PREPAREDNESS PLAN

2. INTRODUCTION TO EBOLA VIRUS DISEASE (EVD) An epidemic viral infection effecting multiple countries in West Africa including: • Liberia • Sierra Leone • Guinea

4. How Does Ebola Cause Disease? • Virus enters the body via infected blood/body fluid in contact with a mucosal surface or a break in intact skin • Virus replicates in many different cell types throughout the body • Strong cytokine/inflammatory response

5. How Does Ebola Cause Disease? • Endothelial damage, increased vascular permeability and shock • End organ damage and multi-organ dysfunction • Diffuse intravascular coagulopathy (DIC) with platelet and coagulation factor consumption leads to hemorrhage • IgM antibodies starts forming in 2 day and IgG antibodies form in 5-8 days post infection. Immunologic response correlates with survival

6. Isolation Practices: after positive infection screen • Place a mask on the patient until placed in isolation room • Airborne isolation • Environmental cleaning and disinfection of equipment • Appropriate waste disposal • Injection safety and prevention of sharps injuries GENERAL PATIENT CARE AND PRECAUTIONS

7. Ebola Virus Disease • Incubation 2-21 days • - In the current outbreak, in 90% of patients for whom information is available, <15 days • Case fatality ratio 24-89% • 54.9% for current outbreak • Average time between symptom onset and death is 7 days • Average time from symptom onset to recovery is 15 days

8. Transmission of EVD • EVD is transmitted through direct contact with blood or other body fluids of a symptomatic patient • Urine, breast milk, semen, saliva and tears may also carry risk – especially during later stages of illness • Whole virus has never been isolated from sweat of EVD patient • Risk of transmission from contaminated surfaces is exists, but is low and can be further reduced with appropriate cleaning and disinfection

9. Transmission of EVD • Unlike most viral illnesses, transmission is only possible from symptomatic patient • Increasingly infectious as patient becomes sicker

10. Risk Assessment Centers for Disease Control and Prevention, www.cdc.gov/vhf/ebola

11. PPE • A disposable coverall to cover clothing and exposed skin • N95 mask and eye protection (disposable goggles or face shield) to prevent splashes to the nose, mouth and eyes • Closed, puncture and fluid resistant shoe covers to avoid contamination with blood or other body fluids or accidents with misplaced, contaminated sharp objects. • Impervious shoe covers will be used • Gloves- double Education will be provided to all caregivers on use of PPE including donning and doffing of PPE

12. Taking off PPE • Use the Buddy System • Remove the most contaminated PPE items first. • Hand hygiene must be performed immediately after glove removal • Perform hand hygiene whenever ungloved hands touch contaminated PPE items • Be careful to avoid any contact between the soiled items (e.g. gloves, gowns) and any area of the face (i.e. eyes, nose or mouth) or skin • Discard disposable items in a biohazardous container located inside the room. Nothing is to be removed from the room until treated with bleach and double bagged in a manner to ensure no contamination to outside bag.

13. Hand hygieneHow to perform hand hygiene: • Clean your hands by rubbing them with an alcohol based formulation, as the preferred mean for routine hygienic hand antisepsis if hands are not visibly soiled • It is faster, more effective, and better tolerated by your hands than washing with soap and water. • Wash your hands with soap and water when hands are visibly dirty or visibly soiled with blood or other body fluids or after using the toilet

14. Visitors • Visitors will be restricted as determined by Public Health Department or  the CDC. • Only essential staff members will be allowed in the patient care room

15. Laboratory Specimens • Limit testing only to those essential to diagnosis and care • All specimens will be double bagged and will be hand carried. No pneumatic tubes to be used for transport • CDC will guide EVD specific testing including packaging and transportation

16. Laboratory Specimens • Education specific to lab will be provided to ensure safety of lab personnel

17. Safe Injection Practices • Limit the use of needles and other sharp objects as much as possible. • Limit the use of phlebotomy and laboratory testing to the minimum necessary for essential diagnostic evaluation and patient care

18. If the use of sharp objects cannot be avoided:

19. ENVIRONMENTAL CLEANING &MANAGEMENT OF LINEN

20. Cleaning and Disinfecting • Environmental surfaces or objects contaminated with blood, other body fluids, secretions or excretions should be cleaned and disinfected as soon as possible using bleach wipes • Cleaning should always be carried out from “clean” areas to “dirty” areas, in order to avoid contaminant transfer

21. Management of Linen • When handling soiled linen from patients, use gloves, impervious gown, closed shoes (e.g., boots) and facial protection (mask and goggle or face shield) • No exposed skin • Linen used on patients or in patient rooms will be placed in the bio-hazardous waste container located in the patient room

22. The processes will be determined by the Local Health Department or CDC Contact local health department for instructions POST-MORTEM CARE AND TRANSFER OF BODIES

23. Sources: • http://www.cdc.gov/vhf/ebola/hcp/guidance-safe-handling-human-remains-ebola-patients-us-hospitals-mortuaries.html • http://www.cdc.gov/vhf/ebola/ • http://www.who.int/csr/resources/publications/ebola/evd-guidance-summary/en/ • http://www.who.int/csr/disease/ebola/protective-measures-staff/en/ • WHO Power Point titled “Key Measuresfor Prevention and Control of Ebola Virus Disease” by Dr. Sergey Eremin presented on September 16, 2014