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
Support from the community
Support from the hospital administration
Support from the population

2. Triage & isolation Module 4

3. Learning objectives module 4
General objective
To understand the importance of triage and isolation and to be able to detect and isolate a suspected case of Ebola.
Specific objectives
To understand the principle of triage
To be able to detect suspected cases of Ebola
To be able to isolate patients without running a risk
To be familiar with the structure of an isolation room
To know how to apply national information and case notification directives

4. How can the transmission of EVD be avoided?
Is there a contagious patient?
Sanitary structure
Isolation
Distance
Medical personnel enter the isolation site in full PPE only
Triage:
When patients arrive at the hospital:
identify suspected cases of EVD
Isolation:
Separate (suspected) cases of EVD from other patients

5. AIR isolation is not necessary for Ebola!
Specific precautions
Distinction between
CONTACT isolation
DROPLET isolation
AIR isolation
AIR isolation is not necessary for Ebola!

6. Triage: Entry preparations
Create an area for patient triage
-> always maintain a distance of > 2m!
Protection -> protective equipment containing at least a mask, gloves and an overall
Triage equipment:
Thermometer
Questionnaire, case definition

7. Protection: distance, PPE Always take temperature
Triage procedure
Protection: distance, PPE
Always take temperature
Ask patients about their symptoms, people with whom they've been in close contact and recent travel
Alert, prepare isolation if a positive case is identified
Personnel for accompanying patients in isolation
Raising awareness for accompanying persons/family, etc.
Distance! (> 2 m)
Detecting suspected cases of EVD depends on comprehensive questioning based on the case definition.

8. Case definition in pre-epidemic phase (WHO)
During the pre-epidemic phase: routine monitoring
PRESUMED CASES: Any person suffering from
HIGH FEVER
that does not respond to any conventional fever treatment in the region
AT LEAST ONE OF THE FOLLOWING SIGNS
bloody diarrhoeia
gingival bleeding
cutaneous bleeding
conjunctivitic irritation
haematuria
AND
Definition recommended by WHO-AFRO 9 April 2014
CONFIRMED CASES: Presumed cases confirmed by laboratory

9. Case definition - Pay attention to changes
Case definitions may vary from one country to another. Here, the WHO-AFRO recommendation is used.
→ Always be familiar with national directives!
During an epidemic, case definitions must be adapted to fit the situation at a local level.
→ Use the "case definition during an outbreak"
If the situation in the country enters the epidemic phase (where there is a confirmed case in the country)
If the patient has been in contact with a person suffering from EVD (travel to a country where there is an epidemic, visiting a sick person, etc.)
E.g.: Patient arrived from Guinea five days ago and is showing a symptom of Ebola -> the epidemic phase case definition and not the pre-epidemic definition should be used.

10. Case definition during an outbreak (WHO)
SUSPECTED CASE:
Any person, whether alive or dead, currently or previously suffering from
SUDDEN-ONSET HIGH FEVER, and HAVING BEEN IN CONTACT WITH
- a suspected, probable or confirmed case of Ebola
- a dead or diseased animal OR
Any person suffering from a SUDDEN-ONSET HIGH FEVER and
AT LEAST THREE OF THE FOLLOWING SYMPTOMS:
• headaches • vomiting • anorexia / loss of appetite • diarrhoeia
• intense fatigue • abdominal pain • muscle or joint pain • trouble swallowing • trouble breathing• hiccups OR
Definition recommended by WHO-AFRO 9 April 2014
Discuss with the group: according to this definition, which are the important questions to be asked to patients in order to diagnose suspected cases? For example:
Do they have a fever?
Have they been in contact with a case of Ebola? (Have they travelled to a country where there is an epidemic or been visited by a person from such a country?)
Have they been in contact with a dead or diseased animal?
Do they have several symptoms (diarrhoeia, headaches, vomiting, etc.)?
Are they suffering from bleeding? …?
Any person suffering from UNEXPLAINED BLEEDING. OR
Any person DYING SUDDENLY for an UNEXPLAINED reason.

11. If there is a suspected case...
I have a fever and diarrhoeia
I feel very ill
I visited my sick aunt in Liberia two weeks ago
Discuss with the participants
...what should you do?

12. What to do in the event of suspected EVD (I)
Do not panic, remain professional and take the following actions:
Protect yourself: keep distance!
Explain to the patient and the persons accompanying them that you need to exclude EVD and that they need to be isolated in order to have a sample taken or be treated
Provide effective communication with the patient and the persons accompanying them, as well as with local authorities;
Isolate the patient in the isolation room available for that purpose;
Inform your direct superior immediately if you suspect an EVD- case.

13. What to do in the event of suspected EVD (II)
Fill out the case notification form.
Before examining or treating the patient: Apply standard precautions and wear PPE.
Disinfect the consulting room where the patient was seen immediately with chlorine solution before seeing other patients.
If the patient cannot move, health personnel must wear PPE and take them to the isolation area. Haemorrhagic patients must be carried and their wounds covered.
Do not take any samples for laboratory testing before the investigative team arrives.

14. Isolation of patients
Isolate all patients meeting the case definition in a single room/area
If possible, arrange for separate areas for suspected cases and confirmed cases.
If possible, each patient should have their own room.

15. Isolation: component parts
Preparing the isolation unit
Green, Red and Yellow Zone; prototype for isolation
Define responsibilities and communication
Plan for the topic of isolation

16. Preparing the isolation unit
Isolated from other patients/staff movements
Well-ventilated
Sink and running water
Adequate toilets
Able to handle waste and laundry
Enough rooms for the expected number of patients
Plan for transforming other areas into isolation areas

17. Principle of isolation (MSF)
Low-risk area
YELLOW AREA
GREEN AREA
High-risk area
RED AREA
Isolation area
Patients
Morgues
Medical/care team
Cleaning team
Waste
Incinerator
Interior barrier
Exterior barrier

18. Prototype for an isolation site
Patient entrance
Donning
GREEN AREA
Patient room
RED AREA
Decontamination
YELLOW AREA GREEN AREA
PATIENT'S
BED
DISINFECTION STATION/
EQUIPMENT
0.5 % BLEACH
GLOVED HANDS
0.05 % BLEACH
HANDS
Entrance
Exit
0.5 % BLEACH
REUSABLE EQUIPMENT
WASTE
TOILETS
WASTE
MIRROR
Personnel circuit direction!

19. Always follow directions!
Here, we can see the transition from the red area (patient's room) to the yellow area (decontamination)
Strictly follow one-way staff-flow
RKI

20. Entrance to the isolation unit
Limit and monitor contact points between the entrance and the isolation area:
One single entrance
Guard to supervise the entrance
List of authorised persons (personnel and visitors)
Formal prohibition WITHOUT EXCEPTION
Limit moving/transporting patients outside the unit as much as possible
Minimise the number of staff in contact with cases

21. Thank you for your attention!
Copyright images
© leremy – Fotolia.com

22. Exercise: case studies - roleplay
Cases 1 to 5
Group work
Presentation
Suspected case?