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Prevention and Control of Ebola Virus Disease in Health Care Facilities with Limited Resources

Guide for FacilitatorsFebruary 2015

AuthorsChandrakant Ruparelia

Melanie Curless Polly Trexler Meredith Black

Jhpiego is an international, non-profit health organization affiliated with The Johns Hopkins University. For more than 40 years, Jhpiego has empowered frontline health workers by designing and implementing effective, low-cost, hands-on solutions to strengthen the delivery of health care services for women and their families. By putting evidence-based health innovations into everyday practice, Jhpiego works to break down barriers to high-quality health care for the world’s most vulnerable populations. Published by: Jhpiego Corporation Brown’s Wharf 1615 Thames Street Baltimore, Maryland 21231-3492, USA www.jhpiego.org © Jhpiego Corporation, 2015. All rights reserved. Authors: Chandrakant Ruparelia, MD, MPH, Senior Technical Advisor, Jhpiego Melanie Curless, RN, MPH, Infection Control Epidemiologist, Department of

Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital Polly Trexler, MS, CIC, Associate Director, Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital

Meredith Black, MPH, Infection Control Epidemiologist, Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital

In the development of these materials, the authors referred to the latest World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) recommendations for health care workers on preventing the transmission of Ebola Virus Disease in health care facilities. www.who.int/csr/disease/ebola/en/ www.cdc.gov/vhf/ebola/

Prevention and Control of Ebola Virus Disease in Health Care Facilities with Limited Resources: Guide for Facilitators i

TABLE OF CONTENTS ACKNOWLEDGMENTS .............................................................................................................. III

SECTION ONE: LEARNER'S GUIDE WORKSHOP DESCRIPTION ....................................................................................................... 1

Workshop Design ...................................................................................................................... 1

Workshop Syllabus .................................................................................................................... 2

INITIAL KNOWLEDGE ASSESSMENT QUESTIONS ................................................................. 5

CHECKLISTS FOR INFECTION PREVENTION AND CONTROL SKILLS ................................ 7

Using the Checklists .................................................................................................................. 7

CHECKLIST FOR HANDWASHING USING SOAP AND WATER .............................................. 8

CHECKLIST FOR HAND HYGIENE USING ALCOHOL-BASED HANDRUB/ 0.05% CHLORINE SOLUTION .................................................................................................. 10

CHECKLIST FOR PUTTING ON PPE ....................................................................................... 11

CHECKLIST FOR REMOVING PPE .......................................................................................... 13

CHECKLIST FOR COLLECTING BLOOD SAMPLES FROM SUSPECTED CASES OF EVD ....................................................................................................................................... 16

CHECKLIST FOR SHIPPING BLOOD SAMPLES OF SUSPECTED EBOLA CASES WITHIN A COUNTRY ................................................................................................................. 18

CHECKLIST FOR CONDUCTING SAFE AND DIGNIFIED BURIAL OF A PATIENT WHO DIED FROM EVD ............................................................................................. 20

WORKSHOP EVALUATION ...................................................................................................... 23

SECTION TWO: FACILITATOR'S GUIDE LEARNING APPROACH OVERVIEW ....................................................................................... 27

Before Starting This Workshop................................................................................................ 27

Learning Approaches .............................................................................................................. 27

Responsibilities of a Facilitator ................................................................................................ 28

Before the Workshop Begins ................................................................................................... 28

Preparing for the Session ........................................................................................................ 29

During the Session .................................................................................................................. 29

Administer the Initial Knowledge Assessment ......................................................................... 30

Utilize Session Plans ............................................................................................................... 30

Post-Training Follow-Up .......................................................................................................... 31

SESSION PLAN: DAY 1, SESSION 1 ....................................................................................... 32


Prevention and Control of Ebola Virus Disease in Health Care Facilities with ii Limited Resources: Guide for Facilitators
















INITIAL KNOWLEDGE ASSESSMENT ..................................................................................... 49

Using the Individual and Group Assessment Matrix ................................................................ 49

INITIAL KNOWLEDGE ASSESSMENT QUESTIONS ............................................................... 50

INITIAL KNOWLEDGE ASSESSMENT QUESTIONS: ANSWER KEY 52

INDIVIDUAL AND GROUP ASSESSMENT MATRIX ................................................................ 54

WORKSHOP FINAL KNOWLEDGE QUESTIONNAIRE ........................................................... 55

WORKSHOP FINAL KNOWLEDGE QUESTIONNAIRE: ANSWER KEY ................................ 59

Prevention and Control of Ebola Virus Disease in Health Care Facilities with Limited Resources: Guide for Facilitators iii

ACKNOWLEDGMENTS The authors would like to acknowledge the valuable assistance of The Johns Hopkins Hospital, Department of Hospital Epidemiology and Infection Control, in particular Dr. Lisa Maragakis, Director of Hospital Epidemiology and Infection Control, in the development of this learning resource package. The authors would also like to thank the following individuals who provided support in the preparation of these materials: Dr. Ron Magarick, Marion Subah, Kelly Curran, Dr. Emmanuel Otolorin, Dr. Blami Dao, Dr. Oniyire Adetiloye, and Dr. Willy Shasha, for reviewing and providing technical input on drafts of the materials; Dr. Harshad Sanghvi, Dr. Alain Damiba, and Nancy Caiola, for their overall guidance; Young Kim, for general publications support; Rebecca Elliott, for help in developing supporting materials, including the PowerPoint presentations; Dana Lewison, for editorial assistance; and Courtney Weber and Bekah Walsh, for desktop publishing support.

Prevention and Control of Ebola Virus Disease in Health Care Facilities with iv Limited Resources: Guide for Facilitators

Section One: Learner’s Guide

Prevention and Control of Ebola Virus Disease in Health Care Facilities with Limited Resources: Guide for Facilitators 1

WORKSHOP DESCRIPTION WORKSHOP DESIGN This competency-based, hands-on training workshop is designed to prepare health care providers (doctors, nurses, and midwives) and other health care workers in infection prevention and control (IPC) at health care facilities in the event of an Ebola Virus Disease (EVD) outbreak. This workshop builds upon the current IPC knowledge and skills of learners and prepares them, in as short a time as possible, to implement appropriate interventions for prevention and control of an Ebola outbreak. Training emphasizes doing, not just knowing, and uses competency-based evaluations of performance. Though designed as a 3-day, group-based workshop, this workshop can be offered as an on-site training involving all staff members of health care facilities that are likely to receive or are currently receiving patients infected with Ebola. Successful completion of the workshop is based on satisfactory performance of recommended IPC skills for managing patients with EVD. The workshop covers both knowledge and skills in infection prevention and control:

Initial knowledge assessment: To identify individual and group learning needs, learners will complete the initial knowledge assessment questionnaire.

Interactive presentations: Interactive classroom presentations are designed to cover key technical areas, for example, basic epidemiology of Ebola Virus Disease, Standard Precautions and Isolation Precautions, screening and isolation, hand hygiene, personal protective equipment, waste management, and safe and dignified burial.

Demonstration and practice of skills: The facilitators demonstrate essential IPC skills, for example, hand hygiene, putting on and removing personal protective equipment (PPE), and screening and isolation using checklists. This demonstration and practice are followed by hands-on practice under supervision and coaching by the facilitators. In this way, learners master the skills needed to perform the essential IPC skills included in the course. Both facilitators and learners use the same checklists to support clear performance expectations.

Final knowledge assessment: This assessment is used near the end of the skills training to measure learners’ progress in learning information using standardized, multiple-choice questions.

Assessment of skills acquired: Assessment of learners’ performance is a continuous process during the workshop. Each learner is assessed with a competency-based checklist that everyone uses during the workshop. In determining whether the learner is qualified, the facilitators will observe each learner for selected skills or activities. The learner must be rated “satisfactory” in each skill or activity to be evaluated as qualified.

Prevention and Control of Ebola Virus Disease in Health Care Facilities with 2 Limited Resources: Guide for Facilitators

The successful completion of the course is based on mastery of both the knowledge and skills components as well as satisfactory overall performance of key skills including hand hygiene and putting on and removing PPE. It is recommended that within 2–4 weeks of the workshop, learners working in their health facilities be observed and evaluated by a trained IPC supervisor or one of the facilitators with the same checklist used during the training workshop.

WORKSHOP SYLLABUS

Workshop Description This 3-day workshop is designed to prepare learners in IPC practices recommended for prevention and control of Ebola Virus Disease so they have the competencies to protect themselves, patients, and community members visiting the health facility through a competency-based approach to learning.

Workshop Goals To prepare health care workers in using appropriate infection prevention and control practices to prevent the spread of EVD while providing care and treatment to suspected/confirmed cases of EVD.

Learning Objectives By the end of the workshop, the learner will be able to:

Describe the epidemiology and clinical management of EVD.

List the Standard Precautions and Isolation Precautions recommended for EVD.

Effectively screen people coming to the health facility and isolate suspected/known cases of EVD.

Demonstrate appropriate hand hygiene practices.

Appropriately put on and remove PPE recommended for EVD patient care.

Describe the management of pregnant and breastfeeding women during an Ebola outbreak.

Describe cleaning and disinfection of the patient care area and equipment used for suspected/ know cases of EVD.

Appropriately manage linen waste from known/suspected cases of EVD.

Describe key IPC steps during the following essential support functions during Ebola outbreaks:

a. Safe and dignified burial of human remains of EVD patients

b. Post-mortem examinations

c. Diagnostic laboratory activities


Manage people visiting health care facilities.

Manage exposure to Ebola virus via blood and body fluids.

Training/Learning Methods

Illustrated lectures and group discussion

Classroom demonstration

Individual and group exercise

Simulated practice and coaching

Training Materials

Reference manual: Preventing the Transmission of Ebola Virus Disease in Health Care Facilities with Limited Resources

Learner’s Guide

Facilitator’s Guide

Infection prevention equipment and materials

PowerPoint presentations

Learner Selection Criteria Learners for this workshop are health care workers at health care facilities.

Methods of Evaluation

Learner

Initial and final knowledge questionnaires

Hand hygiene and PPE skills evaluation

Workshop evaluation (to be completed by each learner)

Workshop Duration 3 days

Suggested Composition

24 Learners1

3 Facilitators

1 The workshop size will be limited by the available space (classroom and demonstration areas/rooms).

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INITIAL KNOWLEDGE ASSESSMENT QUESTIONS Instructions: In the space provided, print a capital T if the statement is true or a capital F if the statement is false.

EBOLA VIRUS DISEASE

1. A person exposed to the Ebola virus is contagious from the moment of exposure to the virus.

2. Human-to-human transmission of Ebola virus occurs through direct/indirect contact with blood and body fluids of an infected symptomatic person.

3. Bodies of patients who have died from EVD are highly infectious.

4. Ebola virus is secreted in breast milk and can potentially infect breastfed babies.

5. The incubation period of EVD is from 2–21 days before a person develops symptoms and signs after exposure.

6. The definition of a suspected case of EVD in health care facilities during outbreaks is any case that has tested positive during laboratory investigation.

IPC PRACTICES FOR PREVENTING EBOLA VIRUS DISEASE IN HEALTH CARE FACILITIES

7. Standard Precautions are designed for suspected or confirmed cases of Ebola Virus Disease.

8. Wearing recommended PPE is a critical IPC intervention for protecting health care workers managing patients with EVD.

9. An N-95 mask should be worn by all personnel entering the isolation room to prevent infection by the droplet route.

10. It is not necessary to wear double gloves during the care of EVD patients.

11. Each disease has only one route of transmission.

12. The single most important practice for reducing the transmission of infection within a health care facility is hand hygiene.

13. 0.05% chlorine solution can be used for hand hygiene during outbreaks in resource-limited settings when soap and running water or alcohol-based handrub is not available.

SCREENING AND ISOLATION FOR EBOLA VIRUS DISEASE AT THE HEALTH FACILITY

14. A well-designed screening form should capture history of exposure and signs and symptoms of Ebola Virus Disease to identify suspected cases of EVD.

15. The staff should wear personal protective equipment including double gloves, impermeable gown, face mask, and goggles or face shield during screening.


ENVIRONMENTAL CLEANING, PROCESSING LINEN, AND WASTE MANAGEMENT PRACTICES TO PREVENT TRANSMISSION OF EBOLA VIRUS DISEASE

16. 0.5% chlorine solution is a recommended disinfectant for cleaning Ebola Virus Disease patient care areas.

17. In order to prepare 0.5% chlorine solution from 5% household bleach, add 1 part of bleaching solution to 19 parts of water.

18. Dry sweeping, mopping, and dusting should never be used for cleaning patient care areas in a health facility.

19. Heavily soiled linen from EVD patient care should be sorted in the patient care area before further processing.

20. Any waste generated during the care of a patient with EVD should be considered contaminated.

21. Liquid contaminated waste could safely be disposed of in a pit latrine.

SUPPORT ACTIVITIES DURING EBOLA VIRUS DISEASE OUTBREAKS

22. Staff responsible for collecting blood samples from suspected cases of EVD should collect all supplies for collecting blood and wear recommended PPE before entering the isolation room.

23. Vacutainers containing blood should be wiped, wrapped in a paper towel, and then placed in a plastic container with a screw cap.

24. Patients dying of EVD should be handed over to relatives for immediate funerals.

PLANNING AND PREPAREDNESS FOR EBOLA VIRUS DISEASE OUTBREAKS

25. Coordination, communication, surveillance, and management of EVD cases are important components of managing Ebola outbreaks.


CHECKLISTS FOR INFECTION PREVENTION AND CONTROL SKILLS USING THE CHECKLISTS The checklists for infection prevention and control skills contain the tasks or activities performed by the staff in caring for patients with EVD. The checklists contain the key tasks, skills, and activities performed by the health care provider. The learner is not expected to perform all of the steps or tasks correctly the first time s/he practices them. Instead, the checklists are intended to:

Help the learner in learning the correct steps and the order in which they should be performed (skill acquisition); and

Measure progressive learning in small steps as the learner gains confidence and skill (skill competency).

Used consistently, the checklists help learners measure their progress and stay focused on the key steps or tasks. Furthermore, the checklists are designed to make communication (coaching and feedback) between the learner and facilitator easier and more objective and helpful. Because the checklist is used to help in developing skills, it is important that the rating (scoring) be done as carefully and objectively as possible. The learner’s performance of each step is rated as follows:

Place a “” in case box if step/task is performed satisfactorily, an “X” if it is not performed satisfactorily, or N/O if not observed. Satisfactory: Performs the step or task according to the standard procedure or guidelines Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines Not Observed: Step, task, or skill not performed by learner during evaluation by facilitator Not Applicable: Step, task, or skill not required to be performed by learner during evaluation

For the purpose of assessing learners’ performance and providing positive feedback and suggestions for improvement, the facilitator should consider each step individually during assessment. If the step is either not observed or unsatisfactorily performed, the facilitator should provide feedback to the learner. If all steps on the checklist are satisfactorily performed without missing any step, the learner is evaluated as competent.


CHECKLIST FOR HANDWASHING USING SOAP AND WATER

(To be used by Learners and Facilitators)



STEP/TASK CASES

PREPARATION

1. Ensure that clean water, either through a tap or a container with a pitcher, soap, and a personal towel or paper towels are available.

2. Ensure that there is a waste basket for disposal of paper towels.

WASHING HANDS

3. Turn on the tap and maintain a straight stream of water or use a pitcher to steadily pour water.

4. Avoid splashing clothes or other parts of the body.

5. Wet hands with water.

6. Apply enough soap to cover all hand surfaces.

7. Rub hands palm to palm using a circular motion.

8. Rub hands with the right palm over the left dorsum with interlaced fingers.

9. Change and rub hands with left palm over the right dorsum with interlaced fingers.

10. Rub hands palm to palm with fingers interlaced.

11. Clean the back of the fingers by rubbing interlocked fingers of both hands and bringing them under the opposing palm.

12. Clasp left thumb in right palm and perform rotational movement to rub left thumb.

13. Clasp right thumb in left palm and perform rotational movement to rub right thumb.

14. Perform rotational rubbing backward and forward with tips of clasped fingers of right hand in left palm.

15. Perform rotational rubbing backward and forward with tips of clasped fingers of left hand in right palm

16. Rinse hands with water.

17. Stop pouring water if using a pitcher.

18. Dry hands with a personal towel or a single-use paper towel.



STEP/TASK CASES

19. Use a towel to turn off the faucet.

20. Dispose of the towel in a waste container.

21. The whole procedure takes 40–60 seconds.


CHECKLIST FOR HAND HYGIENE USING ALCOHOL-BASED HANDRUB/ 0.05% CHLORINE SOLUTION



CHECKLIST FOR HAND HYGIENE USING ALCOHOL-BASED HANDRUB/

0.05% CHLORINE SOLUTION

STEP/TASK CASES

PREPARATION

1. Ensure availability of an alcohol-based handrub/0.05% chlorine solution in a container.

HAND HYGIENE USING ALCOHOL-BASED HANDRUB

2. Apply a palmful of the product (3–5 ml) in a cupped hand, covering all surfaces.

3. Rub hands palm to palm using a circular motion.

4. Rub hands with the right palm over the left dorsum with interlaced fingers.

5. Change and rub hands with left palm over the right dorsum with interlaced fingers.

6. Rub hands palm to palm with fingers interlaced.

7. Clean the back of the fingers by rubbing interlocked fingers of both hands and bringing them under the opposing palm.

8. Clasp left thumb in right palm and perform rotational movement to rub left thumb.

9. Clasp right thumb in left palm and perform rotational movement to rub right thumb.

10. Perform rotational rubbing backward and forward with tips of clasped fingers of right hand in left palm.

11. Perform rotational rubbing backward and forward with tips of clasped fingers of left hand in right palm

12. Once dry, your hands are safe.

13. The whole procedure takes 20–30 seconds.


CHECKLIST FOR PUTTING ON PPE (To be used by Learners and Facilitators)


CHECKLIST FOR PUTTING ON PPE

STEP/TASK CASES

PREPARATION

1. Check that: a. Scrub suit, appropriate size rubber boots, and hand hygiene supplies are

available. b. All PPE of the appropriate size that you need (gloves, plastic apron,

gown, mask or respirator, goggles or face shield, head cover/cap, and footwear) is available.

c. There is a designated area for putting on and removing PPE.

2. Find a trained assistant to help you in putting on and removing PPE.

3. Tie back hair; for eye glasses, use anti-fog and secure with tape (or remove); remove jewelry/tie/ID/cell phone, etc.

4. Use the bathroom.

5. Wash hands with soap or use alcohol-based handrub.

6. Put on scrub suit and rubber boots in the changing room. If rubber boots are not available, wear closed, puncture- and fluid-resistant shoes with no laces or opening at top of foot.

7. Perform a BRIEFING to review plan for time in isolation area and ensure that all needed equipment is prepared.

Trained assistant reads the following step-by-step instructions and ensures that the health care worker putting on PPE follows them.

8. Perform hand hygiene with soap and water or alcohol-based handrub; if they cannot be made available, use the interim option of 0.05% chlorine solution.

9. If not wearing rubber boots, put on shoe covers.

10. Put on first pair of gloves (if you have a short cuff pair, put them on now).

11. Coverall suit: Put on coverall suit of an appropriate size to allow free movements. Gown: Put on gown and ensure it fully covers torso from neck to knees, arms to end of wrists, and wraps around the back.

12. Coverall suit: Zip up and fasten the zip and neck tabs of the suit. Gown: Fasten the gown at the back of the neck and waist.

13. Tuck cuff of the inner gloves under the sleeves of the gown.

14. Cut thumb holes at the border of the cuff of the gown and insert thumbs.


CHECKLIST FOR PUTTING ON PPE

STEP/TASK CASES

15. Medical mask: Put on, tie securely, and pinch the bridge of the nose to ensure that the mask is correctly positioned. N-95 respirator: a. Cup the respirator in hand with the nosepiece at fingertips. b. Allow the headbands to hang freely below hand. c. Position the respirator under chin with the nosepiece up. d. Pull the top strap over the head; rest it high at back of head. e. Pull the bottom strap over the head and position it around the neck

below the ears. f. Place fingertips of both hands at the top of the metal nosepiece and mold

the nosepiece (USING TWO FINGERS OF EACH HAND) to the shape of your nose. (Note: pinching the nosepiece using one hand may result in less effective respirator performance.)

g. Perform seal check: 1. Exhale sharply: If positive pressure builds inside, there is no leakage.

If pressure does not build, adjust the respirator. 2. Inhale deeply: If there is no leakage, the respirator will cling to the

face. If it does not, adjust the mask.

16. Put on head cover, ensuring that face, neck, and head to eyebrows are fully covered.

17. Spray face shield or goggles with anti-fog and wipe with clean cloth.

18. Put on face shield or goggles and tighten to fit head securely and hold head cover in place.

19. Put on a second pair of gloves (these should have a long cuff pulled over the sleeves of the gown or suit).

20. Put on apron and tie at the back.

21. Have the trained assistant check: a. All skin is covered. b. Comfort: health care worker is able to extend the arms, bend at the

waist, and do range of motions, and no skin shows during movement. c. Anything that is not in place, and correct.

If using a mirror, check all PPE and correct as needed.

22. Ensure that the trained assistant asks the health care worker in PPE to move arms up and down to ensure that no area of skin or mucous membrane is exposed.

23. Enter the isolation room or patient care area after clearance from the trained assistant.

24. DO NOT TOUCH OR ADJUST PPE once in the isolation area; any movement of PPE is considered a breach.


CHECKLIST FOR REMOVING PPE (To be used by Learners and Facilitators)


CHECKLIST FOR REMOVING PPE

STEP/TASK CASES

PREPARATION

1. Ensure that there is a separate area for removing PPE, other than the one used for putting on PPE. The location of the area for removing PPE is such that it allows the health care worker to move into a low-risk area when PPE is removed.

2. Prepare a container with 0.5% chlorine solution in which to place re-useable PPE to be reprocessed.

3. Prepare a container with 0.05% chlorine solution for hand hygiene if ABHR and/or soap and water are not available.

4. Have a waste bag in a rigid waste container (no lid) ready to safely place used, disposable PPE (depending on workflow, two may be needed).

5. Ensure that there is a trained assistant available to help in removing PPE.

6. The trained assistant completes the following tasks: a. Put on PPE: Gown, shoe covers, goggles or face shield, mask, double

gloves (one long cuff). b. Remind the HCW to avoid automatic actions that may put him/her at risk

(e.g., touching the face or forehead). c. Read aloud each step of the procedure. d. Ensure that the HCW repeats back the step he/she is about to perform

(talk back) and confirms completing the step. e. Observe and confirm visually that the PPE has been removed properly.

7. Minimize touching of PPE. Disinfect gloves after any contact.

8. Inspect the PPE to assess for visible contamination, cuts, or tears before starting to remove. Have the trained assistant spray the front and the back of the PPE with 0.5% chlorine solution, pointing the spray nozzle downward. Alternative: Trained assistant hands 0.5% chlorine solution to HCW to wipe front of PPE and gloves.

9. Decontaminate outer gloves with ABHR or 0.5% chlorine solution, ensuring that all surfaces of the gloved hands are cleaned.

10. Remove apron by pulling it away from the body and rolling contaminated front inward, and place it in the waste bag. DO NOT TOUCH THE FRONT OF THE APRON. If reprocessing apron, put it in the container with 0.5% chlorine solution.



STEP/TASK CASES

11. Inspect the PPE under the apron to assess for visible contamination, cuts, or tears. If any breach, spray or wipe the area with 0.5% chlorine solution. If no breach, move to the next step.

12. Disinfect outer gloves with ABHR or 0.5% chlorine solution, ensuring that all surfaces of the gloved hands are cleaned.

13. Remove outer gloves and place them in waste bag.

14. Inspect inner gloves to assess for cuts or tears. If any breach, spray or wipe the area with 0.5% chlorine solution, release thumb from the hole in the coverall suit, remove gloves, perform hand hygiene on hands, and put on clean gloves up to the edge of the cover all suit, If no breach, move to next step.

15. Remove face shield: by tilting the head slightly forward, grabbing the rear strap, and pulling it over the head, gently allowing the face shield to fall forward. OR Remove goggles: by lifting back of strap overhead, and pulling out and away. Place them in waste bag or, if reprocessing, put them in the container with disinfectant. Note: Avoid touching the front surface of the shield or goggles.

16. Disinfect inner gloves with ABHR or 0.5% chlorine solution, ensuring that all surfaces of the gloved hands are cleaned.

17. Remove head cover by grasping it from the back and pulling it away from head (not touching face or skin).


19. Remove gown: Grasp shoulders of gown and pull forward to break ties (or have trained assistant to undo ties at back). Roll gown so contaminated inside surface is contained. OR Remove coverall suit: Undo sticky tabs or ties (use mirror as appropriate): a. Lift chin. b. Find zip at the level of your belly and carefully trace your fingers up to

find the zip tab and fasteners with one hand. c. Hold outside of the top of suit at collarbone level near to zip line with the

other hand (do not let it go). d. Unzip or unfasten suit completely (still holding top near zip). e. Gently pull the side of the suit you are holding partially over the

shoulder. f. Perform rotating movement of the shoulders (one by one) to remove

coverall and carefully move coverall down body, turning inside out. g. Do a “moon-walk” to remove legs of suit over your boots. h. Carefully place in waste bag, touching only the inside. i. Avoid contact of scrubs with outer surface of gown or suit.


21. If wearing shoe covers, remove them using hands-free technique, if possible, and place them in waste bag, touching only the inside of the shoe covers.

22. Disinfect inner gloves with ABHR or 0.5% chlorine solution, ensuring that all surfaces of the hands are cleaned.



STEP/TASK CASES

23. Remove inner gloves.

24. Perform hand hygiene with ABHR or 0.05% chlorine solution, ensuring that all surfaces of the hands are cleaned.

25. Put on a new pair of gloves.

26. Remove mask: Undo bottom tie first, then top tie. Holding by top ties, lift away from face. OR Remove N-95 respirator: a. Tilt the head slightly forward. b. Grasp first the bottom elastic strap at back of the head and pull away

from the head and up and over. c. Then grasp the top elastic strap and pull away from the head and up and

over. Discard mask or respirator by holding the strap/tie without touching the front.

27. Disinfect new inner gloves with ABHR or 0.5% chlorine solution, ensuring that all surfaces of the gloved hands are cleaned.

28. Clean first boot/shoe by: Spraying: Trained assistant sprays front, back, and bottom with 0.5% chlorine solution. Step clean boot/shoe into low-risk area while other foot remains in isolation area. OR Wipes: While keeping feet in isolation area, sit on a clean chair positioned in the low-risk area. Use 0.5% chlorine solution to clean first boot/shoe top, sides, and lastly bottom before stepping first boot into low-risk area.

29. Clean second boot/shoe by: Spraying: Trained assistant sprays front, back, and bottom with 0.5% chlorine solution. Step clean boot/shoe into low-risk area. You are now standing in the low-risk area. OR Wipes: Lift second foot that is in isolation area. Use 0.5% chlorine solution to clean second boot/shoe top, sides and lastly bottom before stepping into low-risk area. You now have both feet in the low-risk area. In addition: 0.5% chlorine foot bath may be positioned at exit of isolation area (but tops of boots should still be wiped down).

30. Disinfect gloves with ABHR or 0.5% chlorine solution, ensuring that all surfaces of the gloved hands are cleaned.

31. Remove gloves and place in waste bag.

32. Perform hand hygiene on bare hands with ABHR or soap and water.


CHECKLIST FOR COLLECTING BLOOD SAMPLES FROM SUSPECTED CASES OF EVD2



CHECKLIST FOR COLLECTING BLOOD SAMPLES FROM SUSPECTED CASES OF EVD

STEP/TASK CASES

PREPARATION

1. Before entering the patient’s room, assemble all necessary equipment: a. Assemble equipment for collecting blood. b. Assemble equipment for preventing infections (equipment for hand

hygiene, personal protective equipment, waste management materials). c. Fill out patient documentation for the sample. d. Assemble materials for packaging the samples. e. Ensure that assistant wearing gloves stays outside the room.

2. Put on all personal protective equipment (PPE): a. Wear rubber boots or shoe covers. b. Wear mask and goggles or face shield. c. Wear head cover. d. Perform hand hygiene. e. Wear gloves.

COLLECTING THE BLOOD SAMPLE

3. Organize supplies on a trolley near the patient’s bed.

4. Identify and prepare the patient.

5. Select the site for drawing blood, preferably at the bend of the patient’s elbow.

6. Apply a tourniquet around the patient’s arm.

7. Ask the patient to form a fist so that the veins are more prominent.

8. Disinfect the area where you will insert the needle using 70% alcohol or other available antiseptic.

9. When using a vacuum extraction system with holder, insert the blood collector tube into the holder.

10. Anchor the vein by holding the patient’s arm and placing your thumb below the place where you want to inject the needle.

11. Draw the blood.

2 Adapted, with the permission of the publisher, from: How to Safely Collect Blood Samples from Persons Suspected to Be Infected with Highly Infectious Blood-Borne Pathogens (e.g. Ebola), Geneva, World Health Organization, 2014, http://www.who.int/csr/resources/publications/ebola/blood-collect-en.pdf?ua=1; accessed September 22, 2014.


CHECKLIST FOR COLLECTING BLOOD SAMPLES FROM SUSPECTED CASES OF EVD

STEP/TASK CASES

12. When blood starts to flow, ask the patient to open his/her hand.

13. As soon as enough blood has been collected (minimum 5 ml), release the tourniquet before withdrawing the needle.

14. Gently withdraw the needle. Do not point the needle at yourself or anyone else.

15. Remove the blood collector tube from the holder and put it into the rack.

16. Place the needle in a leakproof, puncture-resistant sharps container.

17. Stop the bleeding and clean the skin.

18. Take the blood tube from the tray and wipe the blood tube with a disposable paper towel.

19. Put all other items that came into contact with blood into the infectious waste bag for destruction.

20. Protect the sample from breaking during transport by wrapping the tube of blood in a paper towel.

21. Ask the designated assistant (wearing gloves) to approach the patient room, without entering, holding an open, plastic, leakproof packaging container.

22. Place the wrapped tube of blood into the plastic, leakproof packaging container being held by the assistant. Do not touch the outside of the plastic leakproof packaging container with your gloves.

23. Have the assistant tightly close the top of the plastic, leakproof packaging container and prepare the blood sample for transport (see Checklist for Shipping Blood Samples).

24. Remove personal protective equipment very carefully, as described in the Checklist for Removing PPE.

25. Perform hand hygiene with soap and water or alcohol-based handrub.

26. Appropriately label and send blood sample(s) to the laboratory or prepare for shipping.


CHECKLIST FOR SHIPPING BLOOD SAMPLES OF SUSPECTED EBOLA CASES WITHIN A COUNTRY3



CHECKLIST FOR SHIPPING BLOOD SAMPLES OF SUSPECTED EBOLA CASES

WITHIN A COUNTRY

STEP/TASK CASES

PREPARING THE SHIPPING EQUIPMENT (BEFORE HANDLING SAMPLE)

1. Manage logistics: a. Identify name and phone number/email of responsible person at National

Reference Laboratory and lead epidemiologist/medical officer at Ministry of Health.

b. Verify schedule/timetable for company transporting the sample.

2. Assemble equipment for packaging sample: a. Packaging material b. Additional items if refrigeration is necessary c. Shipping/transporting information (receiver’s contact information,

questionnaire with patient information, laboratory form or letter, waterproof marker)

3. Locate the sample.

PREPARING THE SAMPLE

4. If the sample is in a plastic, leakproof primary container, skip to Packaging the Sample. If the sample is NOT in a plastic, leakproof primary container, follow the steps below.

5. Put on a gown, face protection (face shield or goggles and mask), and gloves (over cuffs).

6. Protect the sample from breaking during transport by wrapping the tube of blood in a paper towel or cushioning material.

7. Ask a designated assistant (who is wearing gloves) to approach you with the unscrewed, plastic, leakproof primary packing container.

8. Place the wrapped tube of blood into the plastic, leakproof primary packaging container, being careful not to touch the outside of the primary packaging container with contaminated gloves.

3 Adapted, with the permission of the publisher, from: How to Safely Ship Human Blood Samples from Suspected Ebola Cases within a Country by Road, Rail and Sea, Interim Guideline, Geneva, World Health Organization, 2014, http://apps.who.int/iris/bitstream/10665/137549/1/WHO_EVD_Guidance_Lab_14.3_eng.pdf, accessed February 4, 2015.


CHECKLIST FOR SHIPPING BLOOD SAMPLES OF SUSPECTED EBOLA CASES WITHIN A COUNTRY

STEP/TASK CASES

9. Have the designated gloved assistant tightly close the plastic, leakproof primary packaging container. When closed, the outside of the primary tube can be disinfected.

10. Have both the person preparing the sample and the assistant remove their personal protective equipment.

11. Put contaminated items into a bag for infectious waste for destruction.

12. Perform hand hygiene (both persons).

PACKAGING THE SAMPLE

13. Prepare the rigid shipping box by inserting the inner lining into it.

14. Open the secondary leakproof container.

15. Insert the absorbent material into the box.

16. Wrap the primary container with cushioning material.

17. Place the primary container(s) into the secondary container.

18. Close the secondary container.

19. If refrigeration is not necessary, place the secondary container into the lined, rigid shipping box and proceed to Step 21.

20. If refrigeration is necessary: a. Place the secondary leakproof container into a Styrofoam container and

surround it with ice packs; and b. Place the Styrofoam container into the rigid shipping box.

21. Put the laboratory form/letter and epidemiological questionnaire into an envelope.

22. Close the top of the box or boxes and tape the box(es) closed.

MARKING AND LABELING THE BOX

23. Write the name and addresses on the box.

24. Write the name and telephone number of the contact person at the National Reference Laboratory on the box.

25. Place the Infectious Substance label on the box.

26. Verify that the orientation arrows are on the box (mandatory on opposite sides of the box when total volume of infectious substances exceeds 50 ml).

FINALIZING THE SHIPMENT

27. Contact the National Reference Laboratory to inform them that samples have been sent.

28. Obtain a shipping and tracking receipt and store it in a safe location for 2 years.


CHECKLIST FOR CONDUCTING SAFE AND DIGNIFIED BURIAL OF A PATIENT WHO DIED FROM EVD4



CHECKLIST FOR CONDUCTING SAFE AND DIGNIFIED BURIAL OF A PATIENT WHO DIED

FROM EVD

STEP/TASK CASES

1. Prior to departure, compose the team and prepare disinfectants. The team: • There are 4 members of the team wearing full PPE for the field situation:

– 1 sprayer, wearing full PPE – 1 technical supervisor, not wearing PPE – 1 communicator, a person who interacts with the family and community – 1 religious representative, not wearing PPE

Disinfectants: • 0.05% chlorine solution for hand hygiene • 0.5% chlorine solution for disinfection

2. Assemble all necessary equipment: a. Assemble body bag to hold the body of the deceased. b. Assemble all necessary equipment to prevent infection. c. For hand hygiene: soap and water or alcohol-based handrub solution or

0.05% chlorine solution d. Personal protective equipment: disposable, non-sterile gloves, a pair of

heavy-duty gloves, rubber boots, coverall suit, goggles, and mask

For waste management: a. Hand sprayer containing 0.05% chlorine solution b. Back sprayer containing 0.5% chlorine solution c. Leakproof infectious waste bags: one for disposable and one for

reusable materials

4 Adapted, with the permission of the publisher, from: Field Situation: How to Conduct Safe and Dignified Burial of a Patient Who Has Died from Suspected or Confirmed Ebola Virus Disease, Geneva, World Health Organization, October 2014, http://apps.who.int/iris/bitstream/10665/137379/1/WHO_EVD_GUIDANCE_Burials_14.2_eng.pdf?ua=1, accessed December 6, 2014.


CHECKLIST FOR CONDUCTING SAFE AND DIGNIFIED BURIAL OF A PATIENT WHO DIED FROM EVD

STEP/TASK CASES

3. Arrival: Prepare burial with family and evaluate risks: a. Complete pre-departure preparation: Have pre-departure meeting, greet

the family members and offer condolences, identify family representative, and contact local faith representative.

b. Obtain the formal agreement of the family before proceeding. c. Follow burial guidelines based on the religion of the deceased. d. Verify that the grave is dug or send selected people in advance. e. Involve family members in every procedure as much as possible. f. Allow pictures. g. Dignified burial of a Christian patient:

- Respect the family’s requests. - Allow the family to carry out final rituals using non-touch techniques. - Provide a symbol of dignity and clothing. - Involve a religious leader in the procedure. - Allow offering of prayers, blessings, speeches, etc. - Identify burial site and prepare appropriate label for the grave. - Allow the family to put certain items in the grave as desired. - Allow the family members to throw the first soil.

h. Dignified burial of a Muslim patient: - Identify a Muslim religious leader in the community. - Respect the family’s requests. - Allow dry ablution of the body if requested. - Cover body with cloth before placing body in the bag and later in the

grave. - Shroud body in a cloth according to the religious leader’s advice. - Have a female member of the team manage a female deceased

patient. - Use a white body bag for Muslim patients.

4. Put on all PPE: a. Wear rubber boots, perform hand hygiene, put on coverall suit and

plastic apron, put on face mask and goggles, put hood up, make thumb hole in the suit, put on inner gloves under the cuff of the coverall, and put on outer gloves.

b. Assess and identify location for placing the body. c. Choose bag of correct size. d. Place coffin, if available, outside of the house. e. Identify places used by the deceased for cleaning and disinfection later.

5. Place the body in the body bag: • At least two members of the burial team wearing PPE enter the house:

a. Collect samples for confirmation of the cause of death. b. Place open body bag on the floor. c. Do not spray, wash, or embalm the body. d. Manipulate the body only as needed. e. Lift and place the body in the body bag. f. Close the body bag. g. Disinfect the outside of the bag.


CHECKLIST FOR CONDUCTING SAFE AND DIGNIFIED BURIAL OF A PATIENT WHO DIED FROM EVD

STEP/TASK CASES

6. Place the body bag in a coffin where culturally appropriate: a. Team members wearing PPE place body in the coffin. b. Put patient’s clothes and other objects in the coffin. c. Allow one family member to close the coffin. d. Disinfect the coffin. e. Respect the grieving time requested by the family. f. Decontaminate the coffin.

7. Sanitize the family’s environment: a. Dispose of any sharps used on the deceased patient. b. Clean all areas with water and detergent and disinfect with suitable

disinfectant. c. Gather all linen used by the deceased for disposal and replace with new

items.

8. Remove PPE, manage waste, and perform hand hygiene: a. Disinfect boots without removing them. b. Remove apron. c. Remove outer gloves. d. Remove coverall. e. Remove goggles from behind. f. Remove mask from behind. g. Remove inner gloves. h. Ensure that all PPE items are placed in appropriate bags. i. Wash hands.

9. Wear gloves and transport the coffin or the body bag to the cemetery: a. Utility gloves are sufficient to handle coffin. b. Family members should also wear gloves. c. Provide enough time to the family members for grieving. d. Allow some family members to sit with coffin in the rear of the car. e. Ensure that the front cabin is used only by the team members.

10. Burial at cemetery: Place coffin or body bag into the grave: a. Manually carry coffin or body bag to the grave. b. Place it on the ropes. c. Slowly lower the coffin/body bag into the grave. d. Respect any final rituals.

11. Burial at cemetery: Engage community for prayers: a. Respect the family members’ desires and needs. b. Have the family members close the grave. c. Have the family members wash their hands with 0.05% chlorine solution.

12. Return to the hospital or team headquarters: a. Organize the incineration of the single-use equipment at the hospital or

in another designated place. b. Process reusable equipment for reuse. c. At the end of the day’s work, remove the rubber boots and disinfect with

0.5% chlorine solution.


WORKSHOP EVALUATION (To be completed by Learners)

Please indicate on a 1–5 scale your opinion of the following workshop components: 5-Strongly Agree 4-Agree 3-No Opinion 2-Disagree 1-Strongly Disagree

WORKSHOP COMPONENT RATING

1. The initial knowledge questions helped me to study more effectively.

2. I am now confident in putting on and removing PPE recommended for Ebola patient care.

3. I am now confident in effectively assisting my fellow health care workers in putting on and removing recommended PPE for Ebola patient care.

4. The training approach used in this workshop made it easier for me to learn infection prevention and control practices for EVD.

5. The facilitators clearly stated the learning objectives.

6. The facilitators communicated clearly and effectively.

7. The information presented in the workshop was new to me.

8. The facilitators demonstrated enthusiasm in the subjects they taught.

9. The sessions were well-organized.

10. The facilitators asked questions and involved me in the sessions.

11. The content of the workshop was useful to my work.

12. The workshop made me feel more competent or skillful in my work.

13. I feel prepared for working with EVD patients and know what needs to be done to prevent transmission of EVD in my facility.

Additional Comments (use additional pages if needed)

What topics, if any, should be added to improve the workshop? Why?

What topics, if any, should be deleted to improve the workshop? Why?

The length of the workshop (3 days) was: (circle one) 1) Too long 2) Too short 3) Just right

Section Two: Facilitator’s Guide


LEARNING APPROACH OVERVIEW BEFORE STARTING THIS WORKSHOP This workshop will be conducted in a way that is different from traditional training courses. First of all, it is based on the assumption that people participate in the workshop because they:

Are interested in the topic

Wish to improve their knowledge or skills, and thus their job performance

Desire to be actively involved in workshop activities To be effective, facilitators must use appropriate training strategies, particularly “hands-on” training techniques, which are best reflected in this ancient Chinese proverb. The training approach used in this workshop stresses the importance of the cost-effective use of resources and application of relevant educational technologies including humane training techniques. The latter encompass the use of anatomic models and equipment used for infection prevention, or simulation in a model isolation room, to minimize risk to the learners and patients, and also to facilitate learning.

LEARNING APPROACHES Mastery learning: 100% of those trained master the desired competencies and are able to demonstrate the desired performance by the end of the workshop. Adult learning principles: 1) Training builds on the learners’ abilities and is designed or revised to recognize the learners’ experience and expertise; 2) Training is designed and continuously revised to ensure that it is efficient, effective, and relevant; 3) Training actively involves the learners in setting their learning goals and assessing their progress. Apprenticeship: Also called “cognitive apprenticeship,” focuses on making complex skills easy for a learner to observe and learn. In the cognitive apprenticeship process:

The mentor (or trainer) demonstrates steps and models behaviors for the apprentice (or learner);

The mentor explains his/her decisions and thought processes while he/she works;

The apprentice (learner) practices alongside the mentor, getting continual mentoring/coaching; and

Over time, as the apprentice (learner) becomes more competent, she/he performs more and more independently.

Humanistic: Reduces learner stress, and protects the safety and dignity of the learners and clients involved in the learning process. This involves practicing and mastering clinical services in

What I hear, I forget; What I see, I remember; What I do, I understand.

Confucius


simulation before working with clients, to reduce the risk of client harm or discomfort, and increases learner confidence by having learners practice in a safe environment. Modular: Allows instructors and learners to focus on one topic at a time, build on their current knowledge base, and move to the next course with more confidence and competence.

RESPONSIBILITIES OF A FACILITATOR

Remember the six P’s: Proper prior planning prevents poor performance.

Utilize participatory learning methods.

Be proficient in the related clinical tasks skill(s) according to the validated checklist(s).

Facilitate effectively.

BEFORE THE WORKSHOP BEGINS Communicate with co-facilitators and programmers before the workshop begins to discuss and assign the following administrative responsibilities:

Assign facilitation of teaching sessions, demonstrations, return demonstrations, and clinical simulations. (Each facilitator will be responsible for ensuring that all needed resources, equipment, and supplies are available for any sessions assigned to him/her.)

Obtain all supplies and equipment (flip charts, markers, projector for presentations, simulation models and materials, etc.) that are needed for the workshop. Although this task is often delegated, one facilitator should double-check that the materials are indeed present and in working order.

If clinical practice is included, meet with managers and health workers of the clinical practice site to review learning goals, required clinical resources, and expectations of staff.

Prepare or adapt the session plans to the context as needed. Preparation of what you teach and how you teach it is just as important as the actual teaching. Although it takes time, careful preparation will help you feel confident as a facilitator. Before the workshop, reading the session plans helps the facilitator discover what she/he knows and can do, as well as what she/he may have forgotten or needs to “refresh.” If the assigned instructor is not present, a substitute facilitator would have a prepared session plan to guide her or him. Using session plans assists the facilitator in organizing all of the details of each session and reminds the facilitator of key points to highlight.

Note: It is the responsibility of each facilitator to ensure that his/her knowledge and skills are up to date, and behaviors are appropriate.


Read the Reference Manual thoroughly to be sure that it is in agreement with current policies and practice guidelines in the target country. The manual is based on globally accepted, evidence-based information that countries should strive to adopt in their policies/guidelines. However, if this has not yet occurred in this particular setting, modifications may be necessary. Consult other facilitators and program members as needed to resolve discrepancies with national policies and flag them so that they may be easily referenced during the training.

Review the Facilitator’s Guide for other preparation details.

For each facilitator, make a copy of the:

Facilitator’s Guide

Learner’s Guide

Reference Manual or other materials

For each learner, make a copy of the:

Learner’s Guide

Reference Manual or other materials

Pre- and post-workshop assessment forms (in the Facilitator’s Guide) at the time of the assessment

PREPARING FOR THE SESSION

Read the content of each session thoroughly.

Review any learning activities (e.g., group work, activities, and demonstration at stations) and checklists needed for the session.

Review the suggested session plan, learning objectives, and presentation graphics for the session. Emphasize those parts of the session plan that are relevant to the learners’ needs. This will depend on the experience, skill, and knowledge level of the learners—as a group and as individuals—and how much time is available.

Plan how much time to devote to each learning activity. The workshop schedule and session plans are included as a reference or guide; they can be tailored as long as objectives are met.

Set up the classroom in a way that encourages interactive learning (e.g., chairs may be arranged in a “U” shape) the day before the workshop or earlier. The room and all facilitators should be ready when learners arrive.

DURING THE SESSION Encourage active participation and utilize learners as co-facilitators as much as possible without being disruptive to the course.


ADMINISTER THE INITIAL KNOWLEDGE ASSESSMENT Before beginning the workshop, have learners complete a pre-workshop assessment. The objectives of this assessment are to:

Assess what the learner knows about the workshop topics.

Identify topics that may need additional emphasis during the workshop.

Alert the learner to the content that will be presented in the workshop.

Assist in evaluating the workshop later.

UTILIZE SESSION PLANS During the workshop, using a session plan helps you to organize all of the details of the session.

Reflecting on Each Session

Debrief: Review daily evaluation forms with the other facilitators and program managers and discuss which parts of the session went well and which parts may require modification or a different approach in the future. Document this in the evaluation section of the session plan.

Assign action items: Modify session plans, activities, and presentation graphics as needed.

Investigate any topics that were brought up during the session that were not adequately addressed at the time. Share the information with learners in the following session, as appropriate. Use this review as an important means of assessing learner progress as well as the effectiveness of the training methods used.

Assessment of Learners During a workshop, continually develop and assess learners’ knowledge, skills, and behavior (as underlying attitudes are difficult to assess) through the use of checking questions, exercises, and activities. Assessment is used formatively—for learning, with feedback, to help the learners learn more and make progress toward the workshop objectives. Results are also used for summative assessment (evaluation), to make a decision about the learner taking the next step. For example, results can help to decide if a learner is ready to work with clients in a clinical setting, or if the learner has achieved competency in the desired performance and may be qualified.

Administer the Final Knowledge Assessment After learners complete the session objectives (the knowledge update component of the workshop), learners will complete a final knowledge assessment. This might be provided before moving into clinical practice, or it might be provided at the very end of the workshop.

Checklists and knowledge assessments should NOT be modified because they have been developed following evidence-based recommendations and validated by a group of experts.


The objectives of this written assessment are to:

Assess what knowledge the learner has gained about the workshop topics.

Identify topics that may need additional emphasis during the clinical practicum or during follow-up.

Practical Assessment The learners will use the provided checklists during practice, and the assessor will later use the checklists to assess each learner’s competence in a simulated setting. Typically during a workshop, the facilitator will use a checklist for practice and evaluation of performance, and a pre-, mid-, and final knowledge assessment (or just a pre- and final assessment). The facilitators need to document the learners’ performance in the provided documentation tools or forms. Throughout the learning experience, facilitators and learners keep track of progress in gaining competence in the clinical services being taught by using the checklists found in the Learner’s Guide. This is a joint activity, just as developing competency is a shared responsibility. Being able to use the checklist on oneself and with others is also useful in the transfer of learning.

POST-TRAINING FOLLOW-UP The training process is not complete until a learner has demonstrated mastery of all workshop content. This means that he or she is consistently able to demonstrate performance that is safe and effective. The time taken to achieve competency is dependent on a variety of factors including opportunity to practice, quality of coaching in the clinical environment, the learner’s past clinical background, and attitudes. The facilitator must ensure that there is an active plan in place to monitor follow-up practice at the learner’s workplace until the learner achieves all training competencies. When available, use technology to accomplish some of the follow up activities, for example, phone calls, emails, and SMS text messages. When the learner can correctly perform the newly acquired skills in a simulated setting according to the checklist, that learner can then practice providing that service with actual clients in a clinical setting. Only by practicing with real patients/clients in a clinical setting can a learner achieve competency; proficiency will come later, after she/he has delivered the service in the workplace over time.


SESSION PLAN: DAY 1, SESSION 1 DAY: 1 SESSION NUMBER: 1 DURATION: 30 MINUTES

Topic: Welcome Learner, Introductions, and Overview of the Workshop

Session objectives: • Welcome the learners • Facilitate introduction of the learners • Provide an overview of the workshop (course goals and objectives, agenda, and learning

materials)

Methods and Activities Materials/Resources

Welcome the learners (5 minutes) Representative from the organization sponsoring the workshop or the head of the facility and facilitators welcome learners to the workshop. Learners’ introduction (15 minutes) Provide the following instructions to the learners: 1. Tell your name, title, and the number of years of service as health

care providers. 2. Tell one of your individual strengths that helps you keep working

during this outbreak. 3. Tell one thing that you would like to learn about Ebola during this

workshop. 4. Facilitators also introduce themselves following the same

instructions as above. As learners introduce themselves, have other learners welcome each person by giving a round of applause. When all learners and facilitators have introduced themselves, once again welcome everyone to the workshop. Overview of the workshop (5 minutes) • Using a prepared flip chart/PowerPoints, review the goals and

objectives of the workshop. • Ask learners to review the agenda using the Learner’s Guide or

agenda written on a flip chart. Answer learners’ questions regarding the schedule, breaks, and classroom activities.

• Introduce the learning materials and briefly tell learners how each item will be used.

Ground rules (5 minutes): Review key ground rules with the learners

and invite a few learners to add to the list. Summary: Summarize the session by telling the learners that this workshop is all about learning by doing, and they should be ready for a lot of hands-on activities.

• LCD projector • PowerPoint presentation • Flip chart • Markers • Prevention and Control of

Ebola Virus Disease in Health Care Facilities with Limited Resources Learning Resource Package, containing Reference Manual and Learner’s Guide



Topic: Initial Knowledge Assessment and Correcting Answers

Session objective: • To assist learners in assessing their knowledge related to the content of the workshop


Introduction: Tell learners that now they will complete an initial knowledge assessment questionnaire. The main objective of the initial knowledge assessment is to assist both the learners and facilitators to find out the level of information learners bring to the workshop, both as individuals and as a group. This will motivate learners to focus on the content covered during the workshop and help facilitators decide on key information to cover. Distribute copies of the questionnaire. Give the following instructions: • There are 25 true/false questions. • Time limit: 30 minutes. • There is no need for learners to write their names on the

questionnaire. Instead, put a 6-digit number to identify their questionnaire.

• Once the learners have completed their questionnaires, collect their answer sheets and randomly redistribute them to all learners.

• Provide correct answers as learners will score the responses. • Have learners count the correct responses and write the score on

the top of the questionnaire. Summary: Tell learners that they should play close attention to all of the content covered during the workshop but focus more on the areas where they were not able to give a correct response. Also tell learners that in answering the true/false questions there is a big element of guessing.

• Copies of the initial knowledge assessment

• Flip chart with instructions for learners to complete the initial knowledge assessment



Topic: Chapter 1: Overview of Ebola Virus Disease

Session objectives: By the end of the session, learners will be able to: • Identify their strengths and fears about caring for patients with EVD • Describe basic epidemiological information about EVD • List key facts about care of suspected/confirmed case of EVD • Identify criteria and instructions for patient discharge


Introduction (10 minutes) • Ask learners to work in groups of three. (For this activity, you do not

have to move learners but ask three learners sitting next to each other to form a group.)

• Tell learners that they have 5 minutes to complete the group assignment.

• Ask each group to identify and write two personal strengths and two personal fears they have about working at health facilities during an EVD outbreak.

• Have several groups share their strengths and fears. • Summarize the activity by saying that this workshop will help the

learners better protect against accidental exposure to infectious blood and body fluids as they care for the patients with EVD, and address some of their fears.

Content (30 minutes) Ask learners to share their experiences about receiving the first patient of EVD at their facility—how the case was identified and how the case was managed. If they have never received a case, ask a question about how they will receive a case of EVD. Present the basic technical content on Ebola Virus Disease using a PowerPoint presentation. At the end, introduce learners to the key recommended IPC practices during an Ebola outbreak that will be discussed in detail during this course. Summary (5 minutes): Summarize the session by asking the learners to write one of the most important facts that they learned about Ebola during the presentation. Ask several learners to share what they learned during the session.

• PowerPoint presentations for Chapter 1



Topic: Chapter 2: Infection Prevention and Control Practices for Preventing Ebola Virus Disease in Health Care Facilities

Session objectives: By the end of the session, learners will be able to: • Describe the disease transmission cycle • Describe the chain of transmission of Ebola Virus Disease • Describe key components of Standard Precautions for prevention of Ebola Virus Disease • Describe Transmission-Based Precautions for prevention of Ebola Virus Disease


Introduction (15 minutes) Hand Hygiene Exercise: The purpose of this exercise is to emphasize the importance of performing hand hygiene correctly, following recommended steps. Give each learner a pair of examination gloves. Give each learner 3–5 ml of washable color (yellow or blue color will work well); ask learners to rub on this color, considering it is as an alcohol-based handrub, without looking at their hands. Ask learners to stop after 20–30 seconds. Pair them up and ask learners to look at each other’s gloved hands and see what area of the gloved hand was left without being smeared with color. Tell learners that any area that was not smeared with color would not be clean if they were using alcohol-based handrub instead. Next, ask learners to remove the gloves the way they do it. Have learners observe each other’s hands for any discoloration of skin that would indicate contamination of hands, potentially with blood and body fluids of the patients. Emphasize that hand hygiene is recommended even after removing the gloves. Emphasize that hand hygiene is the single most important intervention for prevention and control of EVD in the health care facility and also in the community. As you tell the learners that you will be covering Transmission-Based and Standard Precautions during this session, state the session objectives. Content Transmission-Based Precautions (25 minutes) Present the content with PowerPoint slides, using participatory training methods. Review the key IPC practices during an Ebola outbreak. Summary (5 minutes): Summarize the presentation by emphasizing that hand hygiene, use of recommended PPE, and following methods of environmental cleaning are very effective in reducing the transmission of EVD.

Flip charts with key messages on: • Hand hygiene • Use of gloves • Use of PPE • Safe injection practices

and handling of sharps Supplies for stations



Topic: Chapter 3: Screening and Isolation for Ebola Virus Disease at the Health Facility

Session objectives: By the end of the session, learners will be able to: • Describe screening at the health facility as a key intervention for prevention and control of EVD • Describe the components of effective isolation of suspected, probable, and confirmed

cases of EVD • Design workflow for EVD in a health facility


Introduction (5 minutes): Introduce the topic by asking questions about key strategies to prevent and control EVD in a health care facility. When learners mention screening and isolation, state the objectives of the session as listed above. If no one mentions screening and isolation, tell the learners that screening and isolation are one of the key interventions and state the objectives of the sessions.

Present the content with PowerPoint slides, using a participatory approach. (45 minutes)

Summary (10 minutes): Ask learners to share at least one of the most important messages from the session. Involve several learners to draw out main points covered during the session.

• PowerPoint presentations for Chapter 3



Topic: Chapter 4, Hand Hygiene

Session objectives: By the end of the session, learners will be able to: • List five moments for hand hygiene • Describe hand hygiene in the context of an Ebola outbreak • Describe hand hygiene methods • Perform hand hygiene using soap and water, alcohol-based handrub, and 0.05% chlorine solution • Describe strategies to improve hand hygiene at the heath facility


Introduction (5 minutes): Open the session by stating that hand hygiene is the single most effective intervention for prevention of health care-associated infections including viral hemorrhagic fevers like EVD. State the objectives of the session.

Present the content using PowerPoint slides, using a participatory approach. (35 minutes)

Demonstrate the following:

• Handwashing using soap and water • Hand hygiene using alcohol-based handrub • Hand hygiene using 0.05% chlorine solution

Have learners follow the demonstration using the checklist for hand hygiene from the Learner’s Guide. Emphasize the importance of performing each step properly.

Emphasize that the key steps remain the same for washing hands with soap and water, alcohol-based handrub, or 0.05% chlorine solution.

Summary (5 minutes): Ask learners to take a piece of paper and write two of the most important things they learned about hand hygiene that they did not know before. Ask several learners to share what they learned and ensure that key points about hand hygiene are covered.

• PowerPoint presentation for Chapter 4

• Checklist for hand hygiene from Learner’s Guide

• Supplies for handwashing and hand hygiene



Topic: Chapter 5: Guidance for the Use of Personal Protective Equipment for Managing Suspected/Confirmed Cases of Ebola Virus Disease

Session objectives: By the end of the session, learners will be able to: • Describe the PPE recommended for managing patients with EVD at the health care facility • Describe principles of effective PPE use for managing patients with EVD • Describe the roles and responsibilities of a trained assistant • Put on and remove PPE for managing patients with EVD as per WHO guidance • Follow recommendations to avoid health-related illnesses while wearing PPE


Introduction (5 minutes): Introduce the session by asking questions about the route of transmission of Ebola virus as well as how the virus enters the body. Tell learners that it is critical that health care workers wear appropriate PPE while caring for patients with EVD. State the objectives of the session. Present the content using PowerPoint slides using a participatory approach. (25 minutes) Demonstrate the use of PPE following the checklists for putting on and removing PPE. Have a co-facilitator play the role of a trained assistant as you demonstrate wearing PPE as per the checklist. (45 minutes) Have learners follow the demonstration using the checklists for putting on and removing PPE. Emphasize the importance of performing each step properly. Answer learners’ questions as you demonstrate. Discussion: Lead the discussion on tips for being an effective assistant to help fellow health care workers in correctly putting on and safely removing PPE. Summary (10 minutes): Summarize the session by asking a series of questions to draw out the main points of the presentation. For example, the importance of a trained assistant, ensuring that no skin or mucous membranes are exposed after putting on PPE, and disinfecting gloved hands every time PPE is touched during removal.

• PowerPoint presentation on Chapter 5

• Checklists for putting on and removing PPE

• Scrub suits • PPE and hand hygiene:

05% chlorine solutions, soap and water, alcohol-based handrub, supplies, waste containers, and sharps disposal boxes

• Hand-operated spray for chlorine solution



Topic: Chapter 6: Infection Prevention and Control Practices for Managing Ebola Virus Disease in Pregnant and Breastfeeding Women and Their Babies

Session objectives: By the end of the session, learners will be able to: • Describe IPC practice recommendations for managing pregnant women with EVD • Describe obstetric practice recommendations for managing labor and delivery in pregnant women

with EVD • Recommend breastfeeding practices for women and babies infected with EVD


Introduction (5 minutes): Ask learners questions about signs and symptoms that are common to EVD or pregnancy. Further ask what they think about the risk of death among pregnant women with EVD during labor and delivery. State the objectives of the session. Present the content using PowerPoint slides using a participatory approach. (25 minutes) During the presentation, refer the learners to the flowcharts in Chapter 6. Answer learners’ questions as you demonstrate. Summary (10 minutes): Summarize the main point of the presentation using the following activity. Choose several statements on obstetric practices and ask learners if they will follow the same practices to manage labor and delivery in women with EVD. For example: “Perform artificial rupture of membrane” “ Perform episiotomy” “Give misoprostol for prevention of postpartum hemorrhage”

• PowerPoint presentation on Chapter 6

• Checklists for putting on and removing PPE

• Scrub suits • PPE and hand hygiene:

05% chlorine solutions, soap and water, alcohol-based handrub, supplies, waste containers, and sharps disposal boxes

• Hand-operated spray for chlorine solution



Topic: Group Activity: Screening and Isolation

Session objectives: By the end of the session, learners will be able to: • Describe principles and processes for screening and triage during an Ebola outbreak • Plan and implement screening and isolation procedures for EVD in the health facility • Design effective workflow in the health facility for managing patients with EVD


Introduction (5 minutes) Ask learners questions about how the cases of Ebola Virus Disease are identified in their facilities currently. Once a few learners respond to the questions, state the objectives of the sessions. Divide learners into teams of four or five. Group Work (45 minutes) Group work instructions: • Time: 30 minutes for group work and 5 minutes for presentation • Working in your groups, design a patient flow and workflow for

an EVD isolation area at your health facility • In your workflow, ensure the following:

- High- and low-risk areas - Patient entry and exit - Staff entry and exit - Area to put on and remove PPE - Collection and transport of waste and high-risk items - Preparation and transport of human remains

Summary (10 minutes): Summarize the group work by emphasizing the key components of the patient flow, workflow, and high- and low-risk areas.

• LCD projector • PowerPoint presentation • Copies of the case study



Topic: Chapter 7: Environmental Cleaning, Processing Linen, and Waste Management Practices to Prevent Transmission of Ebola Virus Disease

Session objectives: By the end of the session, learners will be able to: • Prepare the desired concentration of chlorine bleach • Describe methods of general environmental cleaning and cleaning practices for EVD • Describe methods for cleaning of patient care equipment for EVD


Introduction (5 minutes) Ask learners about current practices of cleaning and disinfection of patient care items and areas. What are the current practices for processing linen? State the objectives of the session using PowerPoint slides on environmental cleaning and processing of patient care items and instruments. Content (25 minutes): Present technical information with PowerPoint slides, using interactive training methods. Demonstrate the steps for making the desired concentration of chlorine solution from a given concentration. Show commonly available cleaning supplies in your facility. Summary (10 minutes): Summarize the session by telling that this workshop is all about learning by doing, and learners should be ready for a lot of hands-on activities. Emphasize that Ebola can spread from contaminated patient care items and the environment and that cleaning and handling of linen are VITAL components of prevention.

• LCD projector • PowerPoint presentation • Flip chart • Markers • Prevention and Control

of Ebola Virus Disease in Health Care Facilities with Limited Resources Learning Resource Package, containing Reference Manual and Learner’s Guide

• Supplies for preparing 0.5% chlorine solution

• Cleaning supplies used in the facility



Topic: Chapter 7: Environmental Cleaning, Processing Linen, and Waste Management Practices to Prevent Transmission of Ebola Virus Disease

Session objective: By the end of the session, learners will be able to: • Implement recommendations for waste disposal during Ebola outbreaks • Describe general practices for processing linen used in EVD care


Introduction (5 minutes) Lead a discussion on current waste management practices in the health facility and what changes have been made since the start of the Ebola outbreak in the country. Presentation (20 minutes): Using a PowerPoint presentation, discuss key practices about waste management during an EVD outbreak including flow of waste, safety when transporting and handing EVD waste, and effective disposal. Group discussion (15 minutes): Collecting, storing, and transporting waste at the facility. Start discussion using following points: 1. Current practices for collecting waste 2. Methods for storing waste 3. Transportation of waste to the final disposal site, who does it,

and what precautions are taken by the worker 4. Major challenges faced and what do the group members

propose to address the challenges 5. Changes that need to be implemented to manage waste at

health facilities during an Ebola outbreak

Summary (5 minutes): Summarize the presentation by asking learners to provide one recommendation for health care waste management at the health facility during an Ebola outbreak.

• LCD projector • PowerPoint presentation • Flip chart • Markers • Materials for exercise as

described in the instructions



Topic: Chapter 8: Support Activities during Ebola Virus Disease Outbreaks Session objectives: By the end of the session, learners will be able to: • Describe key steps in arranging safe and dignified burial of human remains • Identify safe practices for laboratory personnel in facilities managing EVD cases • Describe key steps in management of persons/health care workers exposed to EVD


Introduction (5 minutes) This session is conducted in two parts. Part 1: Safe and dignified burial of human remains (30 minutes) Introduce the session by asking learners about the current practices of managing human remains, if the practices have changed since the Ebola outbreak, and how the current practice results in increased transmission. State the objectives of the session. Using the PowerPoint presentation for Chapter 8, present the content using interactive training methods. Ask learners to refer to the checklist on safe and dignified burial in the Learner’s Guide. Emphasize the importance of having trained teams for burial, being respectful of the family members and community, following religious ceremonies, not allowing relatives and others to handle the human remains, and putting on and removing recommended PPE correctly. Summarize the session by asking a series of questions to draw out the main points. Part 2: Safe practices for laboratory personnel handling blood samples from patients with EVD and managing persons/health care workers exposed to EVD (20 minutes) Introduce the session by asking learners about how blood and other samples are collected from patients with EVD, packed, and transported to higher-level laboratories. State the objectives of the session. Review the content using the PowerPoint presentation. Answer learners’ questions and emphasize the need for meticulous compliance with recommended IPC practices. Summary (5 minutes): Summarize the session by emphasizing key IPC points covered during the session, involving the learners in the summary.

• LCD projector • PowerPoint presentation • Supplies for collecting

blood samples • Supplies for packaging

blood samples for transport • PPE • Hand hygiene supplies



Topic: Practice putting on and removing PPE

Session objective: By the end of the session, learners will be able to: • Put on and remove PPE using the recommended steps


Introduction (10 minutes): Tell learners that for the rest of the afternoon they will practice putting on and removing PPE. Skills Practice (145 minutes) Instructions for the learners:

• Work in teams of two. • Create an area for putting on PPE, and organize supplies on a

table. Draw a line on the floor to separate the high-risk area from the low-risk area.

• Use the checklists for putting on and removing PPE given in the Learner’s Guide.

• One of the team members will be a trained assistant who will: - Follow the instructions in the checklist. - Read the steps of putting PPE. - Ensure that the health care worker is correctly putting on the

PPE. - Ensure that no area of the skin or mucous membrane is

exposed before the health care worker is allowed to go into the EVD patient care area.

• The second member will practice putting on PPE, following the instructions given by the trained assistant.

• Once the health care worker has put on all the PPE correctly, the trained assistant will now follow the instructions and put on the recommended PPE.

• The person playing the role of the trained assistant will now help the health care worker to remove the PPE by reading the instructions from the checklist as well as following each step.

• Next, the team members will change roles. • Continue to practice until the end of the day. Facilitators move from team to team and coach and assess the learners as they practice. Summary (15 minutes): Summarize the practice session by involving learners in identifying some challenges they faced and how they resolved them. Emphasize the importance of the trained assistant in ensuring that skin and mucous membranes are fully covered and PPE is put on and removed safely without contaminating the skin or mucous membranes.

• Hand hygiene supplies • PPE • Waste containers • Chlorine solutions:

0.05% and 0.5%


SESSION PLANS: DAY 3, SESSION 1 DAY: 3 SESSION NUMBER: 1 DURATION: 45 MINUTES

Topic: Chapter 9: Planning and Preparedness for Ebola Virus Disease Outbreaks

Session objective: By the end of the session, learners will be able to: • Describe the key components of planning and preparedness at health care facilities during an

Ebola outbreak (including selection of appropriate isolation room and management of patient flow)


Introduction (5 minutes) Ask learners what happened in preparing their facility to respond to the Ebola outbreak. Ask if they are satisfied with the preparation and what they would have done differently. Announce the topic and state the objective of the session. Using the PowerPoint slides, review the key components of planning and preparedness with the focus on the health care facility. (20 minutes) Discuss the main activities under each of the following components of planning and preparedness at health facilities (15 minutes): 1. Coordination 2. Surveillance 3. Communication 4. Case identification and management 5. IPC 6. Management of regular services Once you have finished the discussion, tell the learners that, while all components are important, you want them to focus on patient flow within the facility as it is a key intervention to prevent transmission of infections. Building upon the screening and isolation exercise, ask learners to work in small groups of four or five and develop a patient flow (movement of the patient from entry to exit).

Provide instruction for group work:

• You have 20 minutes to complete the work. • Develop a patient flow that is designed such that it will minimize the

risk of patient contact with other persons.

Once learners have completed the group work, lead the discussion to make sure that learners have included key points in the flowchart and cover the points that are not addressed. Alternatively, lead the discussion on patient flow as an important step in planning and preparedness at the facility using patient flow drawn on the flip chart in advance. Summary (5 minutes): Summarize the session by asking each group to share one of the most important things that they learned about planning and preparedness for an effective response to Ebola outbreak.

• LCD projector • PowerPoint slides



Topic: Post-Workshop Questionnaire

Session objective: • To evaluate learners’ knowledge at the end of the workshop


Introduction: Tell learners that this workshop is coming to an end and facilitators as well as the program managers are interested in knowing how much they all have learned. It is natural that learners also are interested in knowing if they have gained all of the required knowledge. Learners will complete a post-workshop questionnaire. Unlike the initial knowledge questionnaire, this one has multiple-choice questions. Distribute copies of the questionnaire. Give the following instructions: • There are 25 multiple choice questions. • Time limit: 30 minutes. • Learners should write their names on the questionnaire. No one but

the facilitators will know an individual’s score. • The facilitator will review answers after the next session. • Collect the questionnaires as learners complete them.

• Copies of post-workshop questionnaire

• Flip chart with instructions for learners to complete the post-workshop questionnaire



Topic: Skills Practice and Evaluation

Session objective: By the end of the session, learners will be able to: • Demonstrate the skills of hand hygiene, putting on and removing PPE without contamination, safe

injection practices, and sharps disposal


Introduction (10 minutes) Tell the learners that the focus of this workshop is to achieve competencies in essential IPC practices so that everyone is able to protect themselves as well as patients from EVD. For the next 120 minutes, learners will practice the following skills in pairs with one member practicing the skills and the second member playing the role of a trained assistant. They will practice: • Hand hygiene skills • Putting on and removing PPE • Safe injections and sharps disposal Facilitators move from team to team and evaluate each learner for competencies in putting on and removing PPE. Provide feedback to the whole group on their performance and encourage them to continue to practice and support each other as they provide services to EVD patients. (15 minutes)



Topic: Identifying Gaps and Developing a Plan of Action

Session objectives: By the end of the session, learners will be able to: • Identify gaps in current practices of managing EVD patients at health care facilities • Develop a plan of action to address gaps


Introduction Tell learners that it is very challenging to meet the needs of patients and communities during an outbreak situation, given the available human resources and supplies. The purpose of this session is to identify the gaps and make efforts to close some of the gaps that can be addressed at the health facility level. Ask learners to list the gaps in the health care facility with regard to preventing health care-associated infections when managing EVD patients. Let the learners list as many gaps as they may want to list. From the list, identify the gaps that can be easily addressed by the health care facility itself with very little external assistance. For example, “health care providers not following hand hygiene and PPE guidelines even though supplies are available”; “there is no system to ensure compliance to hand hygiene and PPE guidelines”; “Providers experience severe burnout.” Identify critical gaps and develop actions items to complete the action plan. Encourage learners to ask any questions they may still have. Let them know that they may receive follow-up SMS text messages after they register for them; the objective is to remind them continually about key points covered during the workshop. Summarize the session, making an appropriate statement about developing an action plan.


INITIAL KNOWLEDGE ASSESSMENT USING THE INDIVIDUAL AND GROUP ASSESSMENT MATRIX The initial knowledge assessment is not intended to be a test but rather an assessment of what the learners, individually and as a group, know about the workshop topic. Learners, however, are often unaware of this and may become anxious and uncomfortable at the thought of being “tested” in front of their colleagues at the beginning of a workshop. The facilitator should be sensitive to this attitude and administer the assessment in a neutral and non-threatening way as the following guide illustrates:

Learners draw numbers to assure anonymity (e.g., from 1 to 12 if there are 12 learners in the workshop).

Learners complete the assessment.

The facilitator gives the answers to each question.

The facilitator passes around the individual and group assessment matrix for each learner to complete according to her/his number.

The facilitator posts the completed matrix.

The facilitator and learners discuss the results of the assessment as charted on the matrix and jointly decide how to allocate workshop time.


INITIAL KNOWLEDGE ASSESSMENT QUESTIONS Instructions: In the space provided, print a capital T if the statement is true or a capital F if the statement is false.

EBOLA VIRUS DISEASE



3. Bodies of patients who have died from EVD are highly infectious.

4. Ebola virus is secreted in breast milk and can potentially infect breastfed babies.







10. It is not necessary to wear double gloves during the care of EVD patients.

11. Each disease has only one route of transmission.













21. Liquid contaminated waste could safely be disposed of in a pit latrine.




24. Patients dying of EVD should be handed over to relatives for immediate funerals.




INITIAL KNOWLEDGE ASSESSMENT QUESTIONS: ANSWER KEY Instructions: In the space provided, print a capital T if the statement is true or a capital F if the statement is false.

EBOLA VIRUS DISEASE


F


T

3. Bodies of patients who have died from EVD are highly infectious. T

4. Ebola virus is secreted in breast milk and can potentially infect breastfed babies. T


T


F



F


T


F

10. It is not necessary to wear double gloves during the care of EVD patients. F

11. Each disease has only one route of transmission. F


T


T



T


F




T


F


T


F


T

21. Liquid contaminated waste could safely be disposed of in a pit latrine. T



T


T

24. Patients dying of EVD should be handed over to relatives for immediate funerals. F



T

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WORKSHOP FINAL KNOWLEDGE QUESTIONNAIRE Instructions: Circle the best answer for each question.

1. A person exposed to Ebola virus is contagious a. Immediately after exposure to the virus b. After the signs and symptoms appear c. After the signs and symptoms have resolved

2. Human-to-human transmission of EVD occurs a. By contact with a patient’s blood and body fluids b. By contact with contaminated items used for patient care c. Both a and b

3. Which of the following is true about deceased Ebola patients? a. They are not infectious b. They are highly infectious c. Neither a nor b

4. What advice will you give to a woman with EVD about breastfeeding? a. Ebola virus is secreted in the milk and she should not breastfeed b. Ebola virus is secreted in the milk but she can breastfeed c. Ebola virus is not secreted in the milk and she can breastfeed

5. The natural hosts of Ebola virus are thought to be a. Bats b. Pigs c. Monkeys

6. The incubation period for Ebola Virus Disease is a. 2–12 days b. 2–18 days c. 2–21 days

7. A probable case of EVD in a health care facility during an outbreak is defined as a. Any case that has tested positive during laboratory investigation b. Any suspected case evaluated by a clinician as EVD c. Both a and b


8. A well-designed screening form for EVD should capture the following to effectively identify all suspected cases a. History of exposure to Ebola virus b. Signs and symptoms of EVD c. Both a and b

9. Which of the following is a correct recommendation about screening staff wearing PPE? a. Screening staff do not need to wear PPE during screening b. Screening staff should wear double gloves, impermeable gown, face mask, and goggles or face

shield during screening c. Screening staff should wear rubber boots, head cover, double gloves, and goggles or face

shield

10. Standard Precautions are designed for use with a. All patients at all times b. Admitted patients c. Women and children

11. Particulate respirators (N-95 masks) are recommended PPE during a. All patient care activities in the isolation room b. Aerosol-generating procedures like airway suctioning c. Preparing human remains for safe burial

12. Which of the following is the correct order of putting on PPE for the EVD isolation room? a. Scrub suit, rubber boots, two pairs of gloves, gown or coverall, mask, head cover, face shield

or goggles, gloves, and plastic apron b. Scrub suit, rubber boots, first pair of gloves, gown or coverall, mask, head cover, face shield

or goggles, second pair of gloves, and plastic apron c. Scrub suit, rubber boots, gown or coverall, mask, head cover, face shield or goggles, two pairs

of gloves, and plastic apron

13. During Ebola outbreaks, double gloving is recommended a. While preparing human remains for the funeral b. During all patient care activities in the isolation room c. Both a and b

14. Which of the following is true about the routes of transmission of diseases? a. A disease has only one route of transmission b. A disease may have multiple routes of transmission c. Both a and b


15. The single most important IPC practice for reducing transmission of infections within a health care facility is a. Wearing gloves b. Handwashing c. Wearing goggles

16. Which of the following is the recommended disinfectant for environmental cleaning in health care facilities during an Ebola outbreak? a. Gluteraldehyde 2% b. Chlorine bleach 0.5% c. Hydrogen peroxide 3%

17. In order to prepare 0.5% chlorine solution from 3.5% chlorine solution, mix 1 part of 3.5% chlorine solution with a. 8 parts of water b. 7 parts of water c. 6 parts of water

18. Which of the following should not be used for environmental cleaning? a. Wet mopping b. Wet dusting c. Dry dusting

19. Which of the following is true about linen that is heavily soiled with blood and body fluids from an Ebola patient? a. Wash with hot water and soak in 0.5% chlorine solution for 15 minutes b. Do not handle or wash heavily soiled linen but destroy by burning c. Wash with cold water and soak in 0.5% chlorine solution for 15 minutes

20. Which of the following is true about waste generated during the care of a patient with EVD? a. Consider all waste as contaminated waste but segregate sharps from other waste b. Consider segregating contaminated and non-contaminated waste in the isolation room c. Consider segregating the waste before final disposal

21. Contaminated liquid waste could be disposed of a. In a pit latrine b. In a sanitary latrine connected to a sewage line c. Both a and b


22. Before entering the EVD isolation room for collecting blood samples, the laboratory personnel should perform the following tasks. a. Collect all supplies needed for collecting blood b. Wear recommended personal protective equipment c. Both a and b

23. Which of the following is correct about safe and dignified burial of patients dying of EVD? A team trained in safe burial should a. Prepare the dead body and carry out safe burial as soon as possible b. Carry out burial of the deceased patient, respecting culture and religious beliefs of the family

members c. Let family members prepare the deceased patient for safe burial and transport the body to the

graveyard

24. A safe burial team for field situation comprises the following members a. A supervisor, community member, communicator, and those who handle the dead body b. A supervisor, sprayer, communicator, religious representative, and those who handle the

dead body c. A supervisor, local teacher, community member, and those who handle the dead body

25. Planning and preparedness activities at the health facility to manage an Ebola outbreak include a. Establishment of a multidisciplinary coordination committee b. Development of communication plans c. Both a and b


WORKSHOP FINAL KNOWLEDGE QUESTIONNAIRE: ANSWER KEY Instructions: Circle the best answer for each question. 1. A person exposed to Ebola virus is contagious

a. Immediately after exposure to the virus b. After the signs and symptoms appear c. After the signs and symptoms have resolved

2. Human-to-human transmission of EVD occurs a. By contact with a patient’s blood and body fluids b. By contact with contaminated items used for patient care c. Both a and b

3. Which of the following is true about deceased Ebola patients? a. They are not infectious b. They are highly infectious c. Neither a nor b

4. What advice will you give to a woman with EVD about breastfeeding? a. Ebola virus is secreted in the milk and she should not breastfeed b. Ebola virus is secreted in the milk but she can breastfeed c. Ebola virus is not secreted in the milk and she can breastfeed

5. The natural hosts of Ebola virus are thought to be a. Bats b. Pigs c. Monkeys

6. The incubation period for Ebola Virus Disease is a. 2–12 days b. 2–18 days c. 2–21 days

7. A probable case of EVD in a health care facility during an outbreak is defined as a. Any case that has tested positive during laboratory investigation b. Any suspected case evaluated by a clinician as EVD c. Both a and b

8. A well-designed screening form for EVD should capture the following to effectively identify all suspected cases a. History of exposure to Ebola virus b. Signs and symptoms of EVD c. Both a and b


9. Which of the following is a correct recommendation about screening staff wearing PPE? a. Screening staff do not need to wear PPE during screening b. Screening staff should wear double gloves, impermeable gown, face mask, and goggles

or face shield during screening c. Screening staff should wear rubber boots, head cover, double gloves, and goggles or face shield

10. Standard Precautions are designed for use with a. All patients at all times b. Admitted patients c. Women and children

11. Particulate respirators (N-95 masks) are recommended PPE during a. All patient care activities in the isolation room b. Aerosol-generating procedures like airway suctioning c. Preparing human remains for safe burial

12. Which of the following is the correct order of putting on PPE for the EVD isolation room? a. Scrub suit, rubber boots, two pairs of gloves, gown or coverall, mask, head cover, face shield

or goggles, gloves, and plastic apron b. Scrub suit, rubber boots, first pair of gloves, gown or coverall, mask, head cover, face

shield or goggles, second pair of gloves, and plastic apron c. Scrub suit, rubber boots, gown or coverall, mask, head cover, face shield or goggles, two pairs

of gloves, and plastic apron

13. During Ebola outbreaks, double gloving is recommended a. While preparing human remains for the funeral b. During all patient care activities in the isolation room c. Both a and b

14. Which of the following is true about the routes of transmission of diseases? a. A disease has only one route of transmission b. A disease may have multiple routes of transmission c. Both a and b

15. The single most important IPC practice for reducing transmission of infections within a health care facility is a. Wearing gloves b. Handwashing c. Wearing goggles

16. Which of the following is the recommended disinfectant for environmental cleaning in health care facilities during an Ebola outbreak? a. Gluteraldehyde 2% b. Chlorine bleach 0.5% c. Hydrogen peroxide 3%


17. In order to prepare 0.5% chlorine solution from 3.5% chlorine solution, mix 1 part of 3.5% chlorine solution with a. 8 parts of water b. 7 parts of water c. 6 parts of water

18. Which of the following should not be used for environmental cleaning? a. Wet mopping b. Wet dusting c. Dry dusting

19. Which of the following is true about linen that is heavily soiled with blood and body fluids from an Ebola patient? a. Wash with hot water and soak in 0.5% chlorine solution for 15 minutes b. Do not handle or wash heavily soiled linen but destroy by burning c. Wash with cold water and soak in 0.5% chlorine solution for 15 minutes

20. Which of the following is true about waste generated during the care of a patient with EVD? a. Consider all waste as contaminated waste but segregate sharps from other waste b. Consider segregating contaminated and non-contaminated waste in the isolation room c. Consider segregating the waste before final disposal

21. Contaminated liquid waste could be disposed of a. In a pit latrine b. In a sanitary latrine connected to sewage line c. Both a and b

22. Before entering the EVD isolation room for collecting blood samples, the laboratory personnel should perform the following tasks. a. Collect all supplies needed for collecting blood b. Wear recommended personal protective equipment c. Both a and b

23. Which of the following is correct about safe and dignified burial of patients dying of EVD? A team trained in safe burial should a. Prepare the dead body and carry out safe burial as soon as possible. b. Carry out burial of the deceased patient, respecting culture and religious beliefs of the

family members c. Let family members prepare the deceased patient for safe burial and transport the body to the

graveyard


24. The safe burial team for field situation comprises of the following members a. A supervisor, community member, communicator, and those who handle the dead body b. A supervisor, sprayer, communicator, religious representative, and those who handle

the dead body c. A supervisor, local teacher, community member, and those who handle the dead body

25. Planning and preparedness activities at the health facility to manage an Ebola outbreak include a. Establishment of a multidisciplinary coordination committee b. Development of communication plans c. Both a and b

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