1. Screening and overall organization at the Ebola Treatment Unit

2. Screening at Ebola Treatment Unit Most patients are referred to the treatment center from community healthcare facilities through the alert system. Some patients will show up at the treatment center by their own. A screening area should be set up at the treatment center to evaluate suspect cases

3. IPC measures for Screening Suspect Cases at Treatment Center Define an area for screening –With direct access from outside for suspect cases –And easy access from inside for health workers –Open area with low fence to ensure a minimum of privacy –Safe separation between patient and health worker For example, screen which allows visibility but no contact

4. Precautions during Screening Use masks and gloves Respect 1.5-2 m distance with patient at all time Off set positioning patient during interview Pass patient digital thermometer (without touching), ask to take temperature (they keep thermometer) Do not perform physical exam Clean surface and chair between patients

5. Use the local case definition. A few consideration about the case definition: History of exposure/contact is key and assistance from the accompanying members is often needed Clinical signs and symptoms –Make sure that terms have been adapted to local context (e.g. fever = hot body) to be well understood by patient –For fever, it is important to also ask about a history of fever during the past 24h as fever might fluctuate during the day and absence of fever or low fever at time of screening does not exclude Ebola, especially if other symptoms are present. Important to reinforce this with national staff. Negative history of exposure and /or absence symptoms does not exclude Ebola. –As the outbreak evolves and stigma and fear of being put in isolation increase, patients might hide important information. Keep you suspicion high. –May not remember sequence of symptoms. –Patient may say ‘no’ but family gives history of symptoms/contacts –If not admitted, refer to follow up

6. If the patient fulfills the case definition: –Educate and counsel the patient on what is happening and reason for isolation Best care possible at treatment unit To protect their family from infection –Fill out admission and contact tracing forms –Transfer patient to the suspect case area – by clinical team in full PPE- where he will be seen (physical exam, Ebola testing, malaria RDT, start ORS and other treatment) –Some patients will resist being admitted Counsel Do not force admission

7. Screening Area Hand Washing Station Entrance Staff Water Reserve s Screening Area at Treatment Center Cleaning Area Medical Staff Mobile LAB Changing Area (Scrubs) PPE Changing Room Suspect Cases Confirmed Cases Hazardous Waste Mgnt Corpse preparation ZONE PPE Entrance ambulance, visiting family members IPC Staff Pharmacy storage of material ZONE WITHOUT PPE Removal of PPE Toilet Zone without PPE (Scrubs with BOOTS)

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11. Kenema Treatment Centre Screening Area Entrance for Ambulance Cleaning area and water storage View from Outside

12. Gueckedou Treatment Center Entrance for staff View of the tents with confirmed cases and area for safe removal of PPE Medical Team

13. Gueckedou Treatment Center Ambulance carrying a suspect case Patient entering the Suspect case Area