Training structure EFFO Ebola Safety and good quality work Module 1: Knowledge about Ebola Virus Disease Module 2: Community response Module 3: Standard pre-cautions Module 4: Triage & isolation Module 5: Personal protective equipment Module 6: Water, disinfection and cleaning The structure of the training shows the logo of the project with the content. Module 1 to Module 6 are part of the training. The parameters in the base of the structure are essential for the success of the training, but these cannot be monitored by the project. The “roof” of the structure is the objective of the training. Support from the community Support from the hospital administration Support from the population 20.05.2015

Community response Module 2 20.05.2015

Learning objectives module 2 General objectives To know how to respond to Ebola on national, hospital and community level. Specific objectives To know the general strategy against Ebola virus disease To know where Ebola is found To realise the complexity of the preparedness and response to the Ebola virus disease To know the role and tasks of health workers To identify risky behaviours We will identify risky behaviour during a group activity after the presentation. 20.05.2015

Risk factors in the event of an outbreak Airports Society Religious institutions Local communities Customs Border crossings Family Bus and train stations Schools Neighborhood Funeral parlour Drivers Paramedics Health and social promotion centres Outbreaks of Ebola virus disease are a significant public health problem. Work towards the preparation of measures must be carried out in an interdisciplinary team because the virus can be found in different places. Health workers should be aware of the complexity in order to communicate and educate patients in their own health structures. Health workers are the local experts. The preparation, warning, response and assessment of an outbreak is very complex and there must be a comprehensive strategy. Medical centres Regional and national hospitals Traditional practitioners Carers 20.05.2015

General strategy - four phases (WHO) Pre-epidemic preparedness Alert (detection, investigation, risk assessment) Outbreak response and containment operations Post-epidemic evaluation -> Focus here: pre-epidemic preparedness in health structure According to WHO, the prevention strategy comprises four phases. Training and focus on pre-epidemic preparedness in health structures The preparedness of the treatment centres, the organisation of the ambulance for transfer, the preparations in laboratories are very important but not the responsibility of the health structure. Source: “Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation” (INTERIM version 1.2.; August 2014, WHO): http://www.who.int/csr/disease/ebola/PACE_outbreaks_ebola_marburg_en.pdf 20.05.2015

health system and EFFO project focus Administrative side Healthcare side World Health Organization (WHO) University hospitals Ministry of Health (MoH) / National Disease Control Institutions District hospitals Regional Health Directorate/ Regional Disease Control Services Medical centres OUR FOCUS Suspected case: What to do? The pyramid is a general diagram and not specific to a country. There is an administrative side and a healthcare side. The health care side should contact the administrative side to engage the measures provided for in the national plan. The health structures at the level of MC/MCU are the focus of the EFFO project. Each level has a role in the general strategy against Ebola virus disease. Local Health Administration/ Rapid Response Team Health promotion centres 20.05.2015 6

Organisational structure of the response (WHO) - Figure found in “Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation” (INTERIM version 1.2.; August 2014, WHO): http://www.who.int/csr/disease/ebola/PACE_outbreaks_ebola_marburg_en.pdf The figure illustrates the multidisciplinary approach of the various subcommittees used in activities against the Ebola virus disease epidemics. Subcommittees must be prepared before the fight against the disease. 20.05.2015

What should be done during the pre-epidemic phase? Establishment of a surveillance system to identify viral haemorrhagic fever Measures against healthcare-associated infections Health promotion programme Collaboration with wildlife health services 20.05.2015

What should be done during the alert phase? Investigate the suspected Ebola case Obtain laboratory results Make a decision based on the laboratory results and investigations 20.05.2015

Confirmed case: What should be done in the control phase? Immediately inform local, regional and national authorities about a confirmed case Declare the Ebola outbreak at WHO Coordinate and mobilise resources Epidemiological investigation, surveillance and laboratory 20.05.2015

Confirmed case: What should be done in the control phase? Social and behavioural interventions Media and communications Clinical management of patients Psychological care and social welfare Research projects and ethical aspects Logistics and safety Environmental management 20.05.2015

What should be done afterwards? Post-epidemic period Declare the end of the epidemic Resume the activities of the pre-epidemic phase Monitor recovering patients and social problems Produce the end-of-epidemic report Keep records on the epidemic Evaluate the management of the epidemic 20.05.2015

Organisational structure (WHO) - Figure found in “Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation” (INTERIM version 1.2.; August 2014, WHO): http://apps.who.int/iris/bitstream/10665/130161/1/WHO_HSE_PED_CED_2014.05_fre.pdf The figure illustrates the multidisciplinary strategy of the various subcommittees used in Ebola virus outbreak control activities. This organisational structure can also be used for the preparation of the health structure. The red arrows show the important points for health structures. 20.05.2015

Responsibilities at the hospital Psychosocial support: - provide psychosocial support to the patient and their relatives - receive psychosocial support from colleagues, family, society Behavioural intervention: standard precautions in health structures precautions in the community/home Media: - It must be clarified in advance who communicates with journalists 20.05.2015

Responsibilities at the hospital Care of a suspected case: Communication of a suspected case Isolation of the patient Care Transfer of the patient to the treatment centre Ethics: Ensure communication of the patient with family Provide symptomatic treatment Epidemiology and surveillance: Documentation of the contacts of suspected cases Communication to the epidemiology team 20.05.2015

Responsibilities at the hospital Identification of the interim isolation area and safety Storage of materials for standard precautions Storage of personal protective equipment Waste management Organisation and training of a team to care for suspected cases List of communication and allocation of responsibility (-> e.g. patient transfer) Investigation forms: case definition, contact list 20.05.2015

The tasks in a hospital Detection of an Ebola case Isolate the patient Care for the patient Isolation area Personal protective equipment Triage Knowledge about the disease Symptomatic treatment Epidemiology; official forms Internal communication Responsible team For the preparation of a health structure, the key issues are: Can a patient be detected? (Knowledge and vigilance of personnel with emergencies, etc.) Can contact be avoided? (Patients are not close to others in the waiting area) Has an isolation area been identified? (There is a prepared site and staff are aware of it) Is there a team with PPE and who knows how to handle a suspected case? (They have undergone several training courses and know who to ask if in doubt) Is the equipment ready (storage)? (PPE, mirror, bleach, access key, etc.) Is internal and external communication well regulated? Is the use of the official form known? etc. Investigative team External communication Family, local population Media Patient transfer 20.05.2015

Epidemiological investigation The epidemiological investigation, monitoring and laboratory is very important for stopping the transmission chains. -> Ask for the current case definition -> Draw up a comprehensive list of contacts for each detected/suspected case -> This is essential for the surveillance of all contacts for 21 days after the last exposure If you think a suspected case is possible in a patient, a list of contacts should be drawn up. If necessary, the listed contacts should be monitored for 21 days. Normally, it cannot be immediately known if any suspicious case will be a confirmed case (laboratory is needed). The investigation team can produce the details because there are several classifications of contacts. 20.05.2015

Which case definition is being used in your health structure? Practical exercise Which case definition is being used in your health structure? Is there a communication list? Do you have a contingency plan in case of a suspected case? -> Please bring the answers for the exercises tomorrow and the day after tomorrow 20.05.2015

Thank you for your attention! 20.05.2015