1. 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

2. Community response Module 2

3. 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.

4. 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

5. 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):

6. 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 6

7. 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):
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.

8. 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

9. 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

10. 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

11. 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

12. 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

13. Organisational structure (WHO)
- Figure found in “Ebola and Marburg virus disease epidemics: preparedness, alert, control, and evaluation” (INTERIM version 1.2.; August 2014, WHO):
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.

14. 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

15. 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

16. 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

17. 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

18. 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.

19. 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. Thank you for your attention!