Infection Prevention Ebola Viral Disease (EVD)

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Infection PreventionEbola Viral Disease (EVD)

EBOLA PREPAREDNESS PLAN

04/19/2023


Healthiest Communities2

INTRODUCTION TO EBOLA VIRUS DISEASE (EVD)

An epidemic viral infection effecting multiple countries in West Africa including:

–Liberia–Sierra Leone–Guinea



04/19/2023

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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

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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

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GENERAL PATIENT CARE AND PRECAUTIONS

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



Ebola Virus Disease

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• 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



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

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Transmission of EVD

• Unlike most viral illnesses, transmission is only possible from symptomatic patient

• Increasingly infectious as patient becomes sicker

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Risk AssessmentEVD Risk Level Criteria

No Risk• No travel to or residence in affected

country/area• No contact with EVD patient caregiver

Low Risk

• Household member of EVD patient• Brief direct contact (e.g. hand shake) with an

EVD patient without PPE• Healthcare workers who have been in care area

of EVD patients without recommended PPE

High Risk

• Needle stick or mucous membrane exposure to blood/body fluid from EVD patient

• Direct skin contact with skin, blood, or body fluid from EVD patient

• Processing blood/body fluids from EVD patient without appropriate PPE

• Direct contact with dead body in Ebola-affected area without appropriate PPE

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



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



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.



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



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



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



Laboratory Specimens

• Education specific to lab will be provided to ensure safety of lab personnel



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



If the use of sharp objects cannot

be avoided:



ENVIRONMENTAL CLEANING &

MANAGEMENT OF LINEN



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



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



POST-MORTEM CARE AND TRANSFER OF BODIES

The processes will be determined by the Local Health Department or CDC

Contact local health department for instructions



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/publi

cations/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

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.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/



Infection Prevention Ebola Viral Disease (EVD)

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