Training structure
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Safety and good quality work
Module 1: Knowledge about Ebola Virus Disease
Support from the communitySupport from the hospital administrationSupport from the population
Module 3:
Standard pre-cautions
Module 2:
Community response
Module 6:
Water, disinfection and cleaning
Module 5:
Personal protective equipment
Module 4:
Triage & isolation
EFFO Ebola
Ebola virus disease (EVD)Module 1 - Part II
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Learning objectives module 1 (part 2)
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General objectivesTo know general information on EVD and be motivated to practice to gain more confidence and skills when dealing with suspected Ebola patients.
Specific objectives1. To know the principle of diagnosis2. To know the basics of pathophysiology3. To recognise the bases on the treatment of EVD4. To know the special challenges when working in an
isolation unit
Presentation outline Module 1: EVD
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Part 1INTRODUCTIONI. Epidemiological situationII. Information about the
Ebola virusIII. Modes of transmission
and incubation periodIV. SymptomatologyV. Differential diagnosis
Part 2
I. Positive diagnosis: PCR, rapid tests
II. Pathophysiology of EVD
III. Care of casesIV. Work in the
isolation area and the stress caused
The diagnosis
The definitive diagnosis is carried out in a specialised laboratory
In the hospitals, a suspected case must be detected:
• by the symptoms and
• by the case definition
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Diagnosing Ebola
The diagnosis can also be carried out in a mobile laboratory.
The laboratory takes about 3 hours to screen for the Ebola virus. This is done by polymerase chain reaction (PCR).
Transport can be time consuming.
Avoid accidents when taking samples or during packaging and transportation.
© RKI Martin Richter
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Rapid test
Testing and validation in progress.
Gold standard: PCR
© RKI Martin Richter
01.08.2015
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Pathophysiology
•Infection through damaged skin, mucous membranes or parenterally
•The Ebola virus enters the immune cell (monocytes, macrophages, dendritic cells)
• Bloodstream carries the infection to the liver• to the spleen• to the lymph nodes• The infection of many tissues
The response is individual, the symptoms and complications can be very different
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Pathophysiology
• Secondary infection (low levels of lymphocytes)• Septic shock• Blood clots• Haemorrhage• Fluid build-up in the brain (cerebral oedema)• Renal failure• Hepatic failure• Pancreatitis (severe abdominal pain)• Intestinal damage leading to diarrhoea and dehydration
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Care of patient at MSF - history
Médecins sans Frontières (MSF) has a great deal of experience with EVD.
Treatment has changed over the years:
1. until 1995: symptomatic treatment
2. from 1995: antibiotic treatment, anti-malarial treatment, palliative care
3. from 2007: invasive treatment, biochemical diagnosis
4. from 2014: experimental drugs (Favipiravir, Brincidofovir, VSV, convalescent plasma)
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Care of suspected cases
• Treatment primarily consists of supportive treatment and symptomatic treatment At the medical level At the psychosocial level
• Always protect yourself by using PPE in psychosocial and physical terms (note: working in PPE is hard)
Any invasive procedure represents a risk to the health worker who performs it
Only perform invasive procedures when absolutely necessary
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Patient care (non invasive)
Fever and/or pain -> paracetamol (avoid diclofenac, aspirin, ibuprofen -> effect on platelets)
Diarrhoea, vomiting -> food on demand
Signs of hypoglycaemia: -> sugary drink
Treatment of other problems -> broad spectrum antibiotic, anti-malarial treatment
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Patient care (invasive procedures)
Diarrhoea, vomiting, signs of dehydration -> intravenous rehydration
Signs of hypoglycaemia: sugary drink if possible or i.v. D50
Seizures: intravenous or intrarectal diazepam
… (Transfusion of whole blood, platelets, dialysis, experimental treatments)
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Experimental treatments of EVD
Examples of drugs: - Monoclonal antibodies (ZMapp)- Convalescent plasma- Antivirals (Favipiravir, Brincidofovir)- RNA-based antivirals (siRNA)- Immunostimulants- Anti-haemorrhagic (FX06)- Anti-coagulant (rNAPc2)- Several candidate vaccines are under development and being tested (VSV)
The main problems: • evidence of benefit for patients• availability
Symptomatic and non-specific treatment is still the mainstay of treatment of EVD
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The patient’s diet
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• Meals are served in appropriate and individualised containers
• Plates are washed and decontaminated• Always include vitamins in the treatment• Families can also deliver food to their relatives,
but the food needs to be handed over to the patient by a health worker in PPE
Treating EVD
The best practices for patients are evolving!- Medication- Diet- Experimental treatments- Vaccine candidates are being tested
-> Discuss the case with colleagues and the authorities responsible to determine the treatment plan
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The stress caused by Ebola
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• Physical fatigue• Physical isolation (not allowed to touch others)• Constant awareness and vigilance required• May be contaminated or may contaminate others• Fear of dying• Tension between public health priorities and the needs of the patient• Stigmatisation• Consequences in communities and families
These are some of the challenges for health workers and patients Explain every procedure and gesture to the patient to reassure them
(permanent dialogue)
Procedure in case of a suspected case
- Triage -> suspected case identified- Patient is isolated immediately (distance of > 2 metres!)- The suspected case is communicated to the persons
responsible- Contacts are documented (epidemiology)- The isolation unit is enabled- The team in PPE can take care of the patient
A patient with typical symptoms of EVD and with a very suspicious story comes to your health facility
The patient doesn´t scare me!
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Working in the isolation unit
- Always in pairs (1 “clean” and 1 “dirty” person)- Know/discuss what to do before putting on PPE (communication
is more difficult and you cannot stay in the PPE for more than 1 hour)
- Prepare medicines, food, waste bag, etc. If you forget something, you can’t turn around easily (one way flow in the isolation unit!)
- Don’t forget documentation (warning, the document stays in the red zone)
- Person responsible in the green zone to give instructions for decontamination needs to be ready
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Thank you for your attention!
Copyright images
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