1. Infection Prevention Ebola Viral Disease (EVD)
EBOLA PREPAREDNESS PLAN
9/22/2018

2. INTRODUCTION TO EBOLA VIRUS DISEASE (EVD)
An epidemic viral infection effecting multiple countries in West Africa including:
Liberia
Sierra Leone
Guinea

3. 9/22/20189/22/2018

4. How Does Ebola Cause Disease?
Virus enters the body via infected blood/body fluid in contact with a mucosal surface or a break in intact skin
Virus replicates in many different cell types throughout the body
Strong cytokine/inflammatory response

5. How Does Ebola Cause Disease?
Endothelial damage, increased vascular permeability and shock
End organ damage and multi-organ dysfunction
Diffuse intravascular coagulopathy (DIC) with platelet and coagulation factor consumption leads to hemorrhage
IgM antibodies starts forming in 2 day and IgG antibodies form in 5-8 days post infection. Immunologic response correlates with survival
Consider deleting as TMI

6. GENERAL PATIENT CARE AND PRECAUTIONS
Isolation Practices: after positive infection screen
Place a mask on the patient until placed in isolation room
Airborne isolation
Environmental cleaning and disinfection of equipment
Appropriate waste disposal
Injection safety and prevention of sharps injuries T

7. Ebola Virus Disease Incubation 2-21 days
- In the current outbreak, in 90% of patients for whom information is available, <15 days
Case fatality ratio 24-89%
54.9% for current outbreak
Average time between symptom onset and death is 7 days
Average time from symptom onset to recovery is 15 days

8. Transmission of EVD
EVD is transmitted through direct contact with blood or other body fluids of a symptomatic patient
Urine, breast milk, semen, saliva and tears may also carry risk – especially during later stages of illness
Whole virus has never been isolated from sweat of EVD patient
Risk of transmission from contaminated surfaces is exists, but is low and can be further reduced with appropriate cleaning and disinfection
Source: World Health Organization

9. Transmission of EVD
Unlike most viral illnesses, transmission is only possible from symptomatic patient
Increasingly infectious as patient becomes sicker

10. Risk Assessment Criteria No Risk Low Risk High Risk EVD Risk Level
No travel to or residence in affected country/area
No contact with EVD patient caregiver
Low Risk
Household member of EVD patient
Brief direct contact (e.g. hand shake) with an EVD patient without PPE
Healthcare workers who have been in care area of EVD patients without recommended PPE
High Risk
Needle stick or mucous membrane exposure to blood/body fluid from EVD patient
Direct skin contact with skin, blood, or body fluid from EVD patient
Processing blood/body fluids from EVD patient without appropriate PPE
Direct contact with dead body in Ebola-affected area without appropriate PPE
Centers for Disease Control and Prevention,

11. PPE A disposable coverall to cover clothing and exposed skin
N95 mask and eye protection (disposable goggles or face shield) to prevent splashes to the nose, mouth and eyes
Closed, puncture and fluid resistant shoe covers to avoid contamination with blood or other body fluids or accidents with misplaced, contaminated sharp objects.
Impervious shoe covers will be used
Gloves- double
Education will be provided to all caregivers on use of PPE including donning and doffing of PPE

12. Taking off PPE Use the Buddy System
Remove the most contaminated PPE items first.
Hand hygiene must be performed immediately after glove removal
Perform hand hygiene whenever ungloved hands touch contaminated PPE items
Be careful to avoid any contact between the soiled items (e.g. gloves, gowns) and any area of the face (i.e. eyes, nose or mouth) or skin
Discard disposable items in a biohazardous container located inside the room. Nothing is to be removed from the room until treated with bleach and double bagged in a manner to ensure no contamination to outside bag.

13. Hand hygiene How to perform hand hygiene:
Clean your hands by rubbing them with an alcohol based formulation, as the preferred mean for routine hygienic hand antisepsis if hands are not visibly soiled
It is faster, more effective, and better tolerated by your hands than washing with soap and water.
Wash your hands with soap and water when hands are visibly dirty or visibly soiled with blood or other body fluids or after using the toilet

14. Visitors
Visitors will be restricted as determined by Public Health Department or  the CDC.
Only essential staff members will be allowed in the patient care room

15. Laboratory Specimens
Limit testing only to those essential to diagnosis and care
All specimens will be double bagged and will be hand carried. No pneumatic tubes to be used for transport
CDC will guide EVD specific testing including packaging and transportation

16. Laboratory Specimens
Education specific to lab will be provided to ensure safety of lab personnel

17. Safe Injection Practices
Limit the use of needles and other sharp objects as much as possible.
Limit the use of phlebotomy and laboratory testing to the minimum necessary for essential diagnostic evaluation and patient care

18. If the use of sharp objects cannot be avoided:

19. ENVIRONMENTAL CLEANING & MANAGEMENT OF LINEN

20. Cleaning and Disinfecting
Environmental surfaces or objects contaminated with blood, other body fluids, secretions or excretions should be cleaned and disinfected as soon as possible using bleach wipes
Cleaning should always be carried out from “clean” areas to “dirty” areas, in order to avoid contaminant transfer
We need to confirm the use of bleach wipes for this purpose

21. Management of Linen
When handling soiled linen from patients, use gloves, impervious gown, closed shoes (e.g., boots) and facial protection (mask and goggle or face shield)
No exposed skin
Linen used on patients or in patient rooms will be placed in the bio-hazardous waste container located in the patient room

22. POST-MORTEM CARE AND TRANSFER OF BODIES
The processes will be determined by the Local Health Department or CDC
Contact local health department for instructions

23. Sources:
WHO Power Point titled “Key Measures for Prevention and Control of Ebola Virus Disease” by Dr. Sergey Eremin presented on September 16, 2014