management of ebolavirus disease id-1-0009 · id-1-0009. custodian: rhh ipcu service authorised by:...

Tasmanian Department of Health and Human Services

Tasmanian Health Organisation-South

Clinical Protocol

Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current. Please

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MANAGEMENT OF EBOLAVIRUS DISEASE ID-1-0009

Custodian: RHH IPCU service

Authorised by: Medical Advisor, RHH IPCU

Effective Date: October 2014

Review Date: October 2015

Document File Name: ID-1-0009 _EVD_2014v7 final.docx of 26

Background

Objective

Definitions

Initial management of patients

presenting to the RHH ED

Initial management of patients

presenting external to the RHH ED

Laboratory testing

Infection Control Management for

Patients within the Emergency

Department or Inpatient Ward

Clinical assessment and management

Management of exposed persons

References

Stakeholders

Key Words

Related Documents

Appendix 1- Ebolavirus disease

patient risk assessment

Appendix 2- Visitor and Staff

Log

Appendix 3 - Quarantine

Signage

Appendix 4 - Donning PPE

Appendix 5 - Doffing PPE

Appendix 6 - EVD Case Report

Form

Background

EBOLAVIRUS DISEASE

Ebolavirus disease (EVD) is caused by an Ebolavirus. Ebolaviruses are part of the family Filoviridae, which

also includes Marburg virus.

EVD is a quarantinable disease in Australia and is nationally notifiable. As such it can be controlled through

a range of quarantine measures including the enforcement of appropriate quarantine measures if suspected

or confirmed cases are identified.

The largest outbreak of EVD ever reported commenced in West Africa in early 2014 and is continuing in

Guinea, Liberia and Sierra Leone as of the 3rd October 2014.

TRANSMISSION

Ebolavirus spreads person-to-person via contact with the blood, secretions, organs or other bodily fluids of

infected people, and indirect contact with environments contaminated with such fluid, including in

healthcare settings. Airborne transmission, as occurs for measles or smallpox, has never been

documented.



Clinical Protocol

Note: The electronic version of this document is the version currently in use. Any printed version can not be assumed to be current. Please remember to read our disclaimer.

MANAGEMENT OF PATIENTS WITH SUSPECTED

OR CONFIRMED EVD

ID-1-0009.






The risk for infection in healthcare settings can be significantly reduced through the appropriate use of

infection control precautions and adequate barrier procedures and given the high mortality, infection

control precautions are to be rigorously applied.

INCUBATION PERIOD

The incubation period is considered to be from 2 up to 21 days; most commonly 8-10 days.

INFECTIOUS PERIOD

People are not infectious until the onset of symptoms of EVD. People are infectious as long as their blood

and secretions contain the virus.

Objective

The objective of this guideline is to provide guidance for the infection prevention and control management

of any person who has suspected, probable or confirmed EVD, within THO-South, in the context of the

2014 West African outbreak.

The principles of this management guideline could be used for the management of patients with suspected

or confirmed Marburg haemorrhagic fever outside this context..

Definitions

The definitions within this document are aligned to the EVD Communicable Diseases Network of Australia

(CDNA) Set of National Guidelines (SoNG) (v1.2 3 October 2014).

PERSON UNDER INVESTIGATION

This refers to a person who meets broad criteria that requires clinicians to consider the possibility of EVD

and to manage the person in an appropriate manner.

A ‘person under investigation’ with possible EVD is defined to have clinical evidence of EVD

(i.e. fever of 38°C or greater or history of fever within the last 24 hours) AND limited

epidemiological evidence (i.e. travel to an EVD affected area).

*Guinea, Sierra Leone and Liberia as of the 3rd October 2014. Please refer to www.who.int/csr/don/en for

up to date country information.

http://www.who.int/csr/don/en



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SUSPECTED EBOLAVIRUS DISEASE (EVD) CASE

EVD should be suspected in the following circumstances:

Clinical evidence (i.e. fever of 38°C or greater or history of fever within the last 24 hours)

o AND

Epidemiological evidence (lower risk or higher risk exposure as defined below)

o Lower risk exposure includes any of the following:

Household contact with an EVD case

Being within approximately 1 metre of an EVD patient or within the patient’s room or

care area for a prolonged period of time (e.g. healthcare workers, household members)

while not wearing recommended personal protective equipment (PPE)

Having direct brief contact with an EVD patient while not wearing recommended PPE

o High risk exposure criteria include any of the following;

Percutaneous (e.g. needle stick) or mucous membrane exposure to blood or body fluids

of an EVD patient (either suspected, probable or confirmed)

Direct skin contact with blood or body fluids of an EVD patient without appropriate PPE

Laboratory processing of blood or body fluids of suspected, probable, or confirmed EVD

cases without appropriate PPE or standard biosafety precautions

Direct contact with a dead body without appropriate PPE in a country where an EVD

outbreak is occurring

Direct handling of sick or dead animals from disease-endemic areas or consumption of

“bushmeat” in a country where EVD is known to occur

PROBABLE EBOLAVIRUS DISEASE (EVD) CASE

EVD should be considered a probability in the following circumstances:

Clinical evidence (i.e. fever of 38°C or greater or history of fever within the last 24 hours)

AND

Epidemiological evidence (see above)

AND

Laboratory suggestive evidence of EVD.

NOTE: No diagnostic tests are to be collected until after discussion with the On-Call

Infectious Disease Physician and others as specified within the “Early Communication”

section of this guideline.



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CONFIRMED EBOLAVIRUS DISEASE (EVD) CASE

Requires laboratory definitive evidence only.

Please refer to the http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm for up to

date information relating to the public health case definitions for EVD.

INITIAL MANAGEMENT OF PATIENTS WITH POSSIBLE EVD

PRESENTING EXTERNAL TO THE RHH ED

EARLY RECOGNITION

Patients who are presenting with ‘clinical evidence and limited epidemiologic evidence’ (see definitions

above) raising the possibility of EVD become a ‘person under investigation’ should be recognized as early as

possible, preferably prior to presentation to the ED. Prior to the transfer of any patient meeting any of the

case definition criteria for EVD, appropriate communication must be undertaken with the RHH Infectious

Diseases Physician on-call (via the RHH switchboard) and if EVD remains a possibility, the patient should be

transferred to the RHH as soon as practicable. The admission destination will be determined by clinical

severity and bed availability. To minimize bed movements, optimally the patient will be transferred directly

to either the Quarantine room on 1BN or a negative pressure room within intensive care, depending on

the clinical severity of the patient’s illness. The RHH Infectious Diseases Physician on-call will liaise directly

with the RHH to inform them of the transfer.

PATIENT ISOLATION

Implementation of transmission-based precautions should occur immediately on recognition of someone

meeting the ‘person under investigation’ criteria for EVD. This will include:

Application of a surgical mask onto the patient

Donning of personal protective equipment (PPE) by staff accompanying patient

o Long sleeved fluid impervious gown o Hat

o P2 (N95) mask

o Approved single use eye protection

o Gloves

o Boots or closed shoes with overshoes (booties)

Transfer patient into physically separate area whilst awaiting transfer

Visitors/family members accompanying the patient on presentation should be accommodated with the

patient whilst further advice is sought. These accompanying persons should also don PPE as per the

staff recommendations above.

Dedicated staff should be assigned to the patient

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola.htm



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Non-essential staff and visitors should be restricted

A visitor log will be maintained for all persons having contact with the patient (refer to Appendix 2).

EARLY COMMUNICATION

Contact the following people directly as soon as practicable:

On-call Infectious Diseases Physician (available via RHH switchboard); this person will contact

the Chief Human Quarantine Officer (0418 123 265) (or the On-call Communicable Diseases

Prevention Unit clinician (0408 532 708)) and the Director of Microbiology. They will also liaise

directly with the RHH if transfer is deemed necessary (Patient Flow Co-ordinator and either 1BN

(NUM) or DCCM (Medical Director and NUM)) regarding their transfer and their admission

destination – i.e. Quarantine room on 1BN (clinically stable patient) or negative pressure room in

DCCM (if clinically unstable or deteriorating patient)

RHH IPCU in normal business hours (0407 175 022 or 62228658) or the Clinical Manager/Patient Flow Manager (CM/PFM) after hours

If the patient is to be transferred to the RHH for further investigation and management, depending on the

mode of transport required, Ambulance Tasmania may need to be contacted.

PATHOLOGY TESTING

No specimens are to be collected from the patient until the patient has been reviewed by the on-call

Infectious Diseases Physician at the RHH. The RHH laboratory is the only state laboratory with the

capacity to manage any specimens from patients with suspected, probable or confirmed EVD.

If the patient is being transferred to the RHH, pathology testing can be deferred until they reach the RHH.

INITIAL MANAGEMENT OF PATIENTS WITH POSSIBLE EVD

PRESENTING TO THE RHH ED

EARLY RECOGNITION

Patients who are presenting with ‘clinical evidence and limited epidemiologic evidence’ (see definitions

above) raising the possibility of EVD become a ‘person under investigation’. These individuals should be

recognized as early as possible, preferably prior to presentation to the ED or at triage. Please refer to

Appendix 1 to assist triage. These patients must be isolated. Once they are isolated, further information

can be obtained and the decision to continue isolation will be determined by the RHH Infectious Diseases

Physician on-call.



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PATIENT ISOLATION

Rigorous application of standard precautions is critical. Implementation of transmission-based precautions

should occur immediately on recognition of suspected EVD. This will include:

Application of surgical mask onto patient

Donning of personal protective equipment (PPE) by staff accompanying patient o Long sleeved fluid impervious gown

o Hat

o P2 (N95) mask


o Gloves


Transfer patient into a negative pressure room; Quarantine room on 1BN as soon as practicable or if

this room is not immediately available, Resuscitation room 4 in ED

Visitors/family members accompanying the patient on presentation should be accommodated with the

patient whilst further advice is sought. These accompanying persons should also don PPE as per the

staff recommendations above

Dedicated staff will be assigned to the patient

Non-essential staff and visitors should be restricted

A visitor log will be maintained for all persons entering the room (refer to Appendix 2)

EARLY COMMUNICATION

The following people should be contacted directly as soon as practicable:

ED Medical Co-ordinator (6166 6101)

ED Nursing Clinical Co-ordinator (6166 6109)

RHH IPCU in normal business hours (0407 175 022 or 62228658) or the Clinical

Manager/Patient Flow Manager (CM/PFM) after hours

On-call Infectious Diseases Physician (available via RHH switchboard); this person will contact the Chief Human Quarantine Officer (0418 123 265) (or the On-call Communicable Diseases

Prevention Unit clinician (0408 532 708)) and the Director of Microbiology

The Executive Director of Medical Services (or the Chief Executive Officer) and the Executive Director of

Nursing should also be contacted.

PATHOLOGY TESTING

No specimens are to be collected from the patient until the patient has been reviewed by the on-call

Infectious Diseases Physician. Management of all laboratory testing will be determined by the Department

of Microbiology.



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CLINICAL REVIEW

The patient will be reviewed by the On-call Infectious Diseases Physician as soon as practicable.

Laboratory Testing: Key principles

Specimens for laboratory testing must not be collected without approval of the Director of Microbiology

(or their delegate), as Ebolavirus has the potential to contaminate laboratory instruments and infect

laboratory staff. Non-microbiological specimens require deactivation by an experienced senior scientist in a

PC2 laboratory prior to processing.

General principles are, Testing should be restricted to minimum essential tests

Wherever possible testing should be performed in “routine” hours

Any testing must be approved by the Director of Microbiology (or their delegate) as above prior to

specimen collection

A Designated Receiving Area (DRA) will be established in microbiology, Samples should be

delivered directly to the DRA by hand

Samples must not be placed in the ferret system or taken to specimen reception

Instructions and containers for transport of the specimen in the hospital will be provided when a

specimen is to be collected

Confirmed Ebolavirus is a Tier 1 Security Sensitive Biological Agent. As a result increased security

requirements are required if infection is confirmed, including maintaining a log of all staff who handle the

specimen.

If the patient is at the RHH, the Director of Microbiology (or their delegate) will be contacted by the

Infectious Diseases Physician on-call to prepare the laboratory for receipt of specimens.

After approval by both the Infectious Diseases Physician on-call and the Director of Microbiology, the

following specimens will be collected for testing:

Green top (haemoglobin, haematocrit, urea, electrolytes, creatinine, liver function tests)

Blue top (coagulation profile and arterial blood gases)

Pink top (Ebolavirus PCR)

Pink top (malaria ICT)

Blood cultures

Serology

The Director of Microbiology will arrange for specific EVD testing to be performed at the Victorian

Infectious Diseases Reference Laboratory (VIDRL).



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Infection Control Management for Patients within the Emergency

Department or Inpatient Ward

STANDARD AND TRANSMISSION-BASED PRECAUTIONS

Rigorous application of standard precautions is critical, particularly hand hygiene. Please refer to the

Transmission Based Precautions Protocol IC1-04 for detailed information about the application of

combined contact, droplet and airborne precautions. Specific Quarantine Disease Signage is to be used

(refer to Appendix 3).

ADDITIONAL RECOMMENDATIONS

To minimize the risk of transmission of EVD, it is recommended that additional strategies to optimize

transmission-based precautions are implemented as outlined below:

1. PATIENT ACCOMMODATION

The patient will be accommodated in a single negative pressure room. If required, security may need to be

employed at the entry of the room.

2. STAFFING

All non-essential staff should be restricted from the patient care area.

Nursing staffing

The patient will be managed by dedicated nursing staff i.e. the patient will be ‘specialed’. 3 suitably

experienced nursing staff who are able to provide all requisite nursing care will be allocated to the patient

for each shift to allow for both direct supervision (or observation) of donning and doffing PPE for each

entry and exit as well as shift breaks. It is recommended that the staff providing care to this patient are

allocated exclusively to the patient and do not provide care to other patients in the unit.

The nursing staff will additionally directly supervise (or observe) other healthcare workers’ practice of donning and doffing PPE for each entry and exit also.

Medical staffing

The patient will be managed by nominated senior medical staff; the staff member will vary according to

where the patient is accommodated but at the commencement of each shift, there should be clear clinical

handover and allocation of which medical staff member will be the most appropriate person to provide

patient care.

http://pssbpr-trim02/pandp/showdoc.aspx?recnum=P2010/1747-001



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The patient will be admitted under the Infectious Diseases Unit. The on-call Infectious Diseases Physician

will review the patient as soon as practicable. Ongoing patient care will be provided by either the Infectious

Diseases Physician or Registrar.

Additional medical care may need to be provided by other senior medical staff depending on the

circumstances and the location of the patient;

If the patient is within the Emergency Department, additional medical care will be provided by

either an Emergency Department Physician or a Senior Emergency Department Registrar.

If the patient has been admitted to ward 1BN, additional medical care, particularly after-hours, may

need to be provided by the Senior Medical Registrar.

If the patient has been admitted to the Department of Critical Care Medicine (DCCM), additional

medical care will be provided by either an Intensive Care Physician or a Senior Intensive Care

Registrar.

Other healthcare worker staffing

If other healthcare workers are required for the care of the patient, they should be made aware of the risk

of the patient having EVD and the appropriate transmission-based precautions required for the care of the

patient.

A visitor log will be maintained for all persons (including staff and visitors) entering the room (refer to

Appendix 2).

3. CLOTHING AND PPE

Careful and vigilant use of PPE is a critical risk mitigation strategy. Personal clothing should not be worn

for working in the patient area. Scrubs should be provided by the hospital for donning each shift. Refer to

‘Linen Management’ in this guideline for further advice on clothing.

Please refer to Appendix 4 and Appendix 5 for signage relating to donning and doffing PPE.

Direct supervision (or observation) of donning and doffing PPE for each entry and exit including

appropriate hand hygiene will be undertaken by a second trained staff member. PPE is donned outside the

anteroom and removed within the patient room, immediately prior to exiting. The P2 (N95) mask may be

retained in place in certain circumstances including: aerosol generating procedures within room, when the

mask would be removed in the anteroom and placed in the clinical waste.



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Recommended PPE for routine care includes:

o Long sleeved fluid impervious gown

o Hat

o P2 (N95) mask


o Gloves


Consideration should be given to enhanced PPE if prolonged patient care, aerosol generating procedures

undertaken (such as caring for an intubated/ventilated patient) or close contact with blood and body fluids

is likely including the following:

o Addition of a plastic apron over the fluid impervious gown

o Double gloving

o Long fluid impervious boots

o Powered air purifying respirator (PAPR) (trained personnel only)

Non-soiled scrubs are to be laundered by the hospital laundry. Soiled scrubs should be removed as soon as

possible and managed as clinical waste (as per soiled linen). If scrubs are visibly contaminated with blood

or body fluids or there is a high risk that this has occurred, then the scrubs should be removed with caution within the ante-room and whilst retaining the P2 (N95) mask in place. Immediately after leaving

the patient care area in the event of an exposure, wash the affected skin surfaces or the percutaneous

injury site with soap and water, a shower should be considered. Accordingly, irrigate mucous membranes

(e.g. conjunctivae) with copious amounts of water or eyewash solution. If a percutaneous or

mucocutaneous exposure to blood or body fluids has occurred refer to Management of Exposed

Person (contacts) in this guideline.

Additional support and training to be provided to the healthcare workers providing direct patient care

including:

Unit-based in-services

Assessment of appropriate donning and doffing technique

Ensuring only those staff that have been successfully fit-tested for a P2 (N95) mask provide care



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4. PATIENT MOVEMENT

Patients should not be transferred from their room to other areas for treatment or investigation without

prior approval from the on-call Infectious Diseases Physician. As EVD is a quarantinable disease in Australia,

additional measures may be considered to support maintaining a patient within a designated area.

When it is required for the patient to be moved from one area to another, prior planning is required to

minimize contact with other people. The patient will be transferred with a surgical mask donned and the

people accompanying the patient should wear PPE as previously described.

5. VISITORS

Visitors should be limited to include only those necessary for the patient’s well-being and care, such as a

child’s parent. As EVD is a quarantinable disease in Australia, advice from the Communicable Diseases

Prevention Unit will be provided in relation to the management of visitors. Ensure all visitors use PPE (as

described above) and perform hand hygiene according to standard precautions and are provided with

related instructions prior to entry into and on leaving the isolation room.

6. EQUIPMENT AND SUPPLIES

Patient-dedicated equipment or single-use non-critical patient-care equipment must be used. Items and

equipment should not be moved between isolation room and other areas of the healthcare facility unless

they are appropriately cleaned and disinfected or discarded and disposed of (refer to ‘Environmental

Cleaning’ in this guideline). Moving medical equipment into the room must be done with regard for the difficulty in removing equipment from the room. It is strongly recommended that all equipment that enters

the room is either discarded to Clinical Waste after use or retained until the patient is discharged. This

includes procedural and emergency trolleys.

Patient charts and records must be kept OUTSIDE the isolation rooms/areas to avoid their contamination.

Any pen or paper taken into the room will ultimately need to be discarded into clinical waste.

Upon patient discharge or transfer, liaison with the RHH IPCU should occur for specific advice regarding

cleaning and disinfection. All medical supplies, patient-dedicated equipment and patient-care equipment that

cannot be cleaned, must be discarded including items packaged in paper or cardboard.

7. LINEN MANAGEMENT

All linen used in the care of the patient must be regarded as having a high infection transmission potential

and should be considered as Clinical Waste and handled accordingly (see below).

The patient should be encouraged to wear hospital clothing and gowns and not their own clothes. This

should be treated as Clinical Waste.



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8. WASTE MANAGEMENT (including urine, faeces and vomit)

Patients may use the toilet in the ensuite and toilet waste may be flushed as usual.

Clinical waste such as faecal material, urine, vomitus and other human blood or body fluids or items that

have been in contact or likely to be contaminated with these substances, must be disposed of in the

macerator in a disposable pan within the anteroom if macerator compatible. If there is concern that

disposal of waste may present a risk for splash, spray or spatter or if there are items associated with the

waste to be macerated which cannot be placed in the macerator, then high absorbency gel (e.g. Vernagel)

may be added to any liquid waste and the item disposed of into the Clinical Waste bag.

All other waste created in the care of a patient with suspected or confirmed EVD must be categorised as

Clinical Waste. All waste must be placed directly into a Clinical Waste bag or rigid sharps container

(depending on nature of waste). The bags must be tied off prior to removal from the patient room. In the

anteroom, it will be placed into a second Clinical Waste bag and tied off. The waste bag will be retained in

the anteroom and only removed following discussion with Infection Prevention and Control. Whilst

properly bagged waste may be handled as per standard Clinical Waste, it is important that all waste is

handled cautiously to minimise the risk of a spill and inadvertent exposure to EVD for staff collecting such

waste.

9. FOOD SERVICES

Disposable cutlery and crockery are required for these patients.

Food Services staff must not enter the patient room but are to give the meal to a ward staff member to deliver to the patient. Reusable meal trays should not be used.

10. ENVIRONMENTAL CLEANING

Diligent environmental cleaning and disinfection is an essential component of safe patient management.

Routine environmental cleaning of the patient room and associated environs, including ensuite and

anteroom, will be undertaken by the IPCU Environmental Services Staff. Divercleanse (1000 ppm available

free chlorine) will be used for cleaning and disinfecting all environmental surfaces and items. Any items to

be removed from the room must be carefully considered for its ability to be cleaned and disinfected. If an

item cannot be cleaned then it must be considered as Clinical Waste and handled as per waste

management requirements. Staff caring for the patient may undertake additional cleaning of items in the

room as required to minimise the burden of Ebolavirus on items and surfaces.



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Recommended PPE for environmental cleaning includes:

o Long sleeved fluid impervious gown o Addition of a plastic apron to the fluid impervious gown

o Hat o P2 (N95) mask o Approved single use eye protection or full face shield (preferred) o Heavy duty rubber gloves o Long fluid impervious boots

For cleaning up a spill of blood or body fluid, soak the spill with a sodium hypochlorite solution made up to

5000 ppm and cover with absorbent paper towel; leave to soak for 30 minutes before wiping up. Discard

the towels into the Clinical Waste bags. Following the removal of the initial material, the area of

contamination should be liberally covered with sodium hypochlorite solution made up to 5000 ppm and left

for a further 30 minutes before rinsing.

Terminal cleaning should occur once the patient has left the room. The entire room should be cleaned

with Divercleanse made up to 1000 ppm, this includes cleaning the walls. Items that cannot be cleaned and disinfected should be classified as Clinical Waste and discarded accordingly. Items used to support cleaning

should be discarded into Clinical Waste; this includes rags, mops heads and buckets.

11. CADAVERIC MANAGEMENT

After the death of a patient with EVD, the body remains highly infectious and close contact by family and

other visitors must be limited and PPE must continue to be utilised after death of the patient.

Staff wearing PPE (as specified above) must place the body of a confirmed or suspected EVD patient in a

leak-proof double body bag. Absorbent material must be placed between each bag, and the bag sealed and

disinfected with a 1,000 ppm sodium hypochlorite solution. Normal measures must be undertaken to

ensure that the identification of the deceased person is possible. Special arrangements are to be made prior

to transfer to the Mortuary. The body bag should not be opened except by a designated person after

consultation with the on-call Communicable Diseases Prevention Unit clinician.

CLINICAL ASSESSMENT AND MANAGEMENT

Clinical assessment of a patient with suspected EVD will be undertaken by the on-call Infectious Diseases

Physician and may be assisted by the use of the EVD Case Report Form (refer to Appendix 5.)

There are no specific therapeutic options available to treat human infections and care is largely supportive.



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Exclusion of treatable conditions is important but management will be guided by the on-call Infectious

Diseases Physician. Empirical therapy for conditions such as malaria and bacterial sepsis may be considered,

particularly if there are delays in the availability of laboratory tests.

MANAGEMENT OF EXPOSED PERSONS (CONTACTS)

Persons, including healthcare workers, with percutaneous or mucocutaneous exposure to blood or body

fluids, secretions or excretions from a patient with suspected or confirmed EVD should immediately and

safely stop any current tasks, leave the patient area and safely remove PPE. If scrubs are contaminated with

blood or body fluids, these should be removed with caution within the ante-room and whilst retaining the

P2 (N95) mask in place. Immediately after leaving the patient care area, wash the affected skin surfaces or

the percutaneous injury site with soap and water, a shower should be considered. Accordingly, irrigate

mucous membranes (e.g. conjunctivae) with copious amounts of water or eyewash solution.

Immediately report the incident to the Occupational Exposure coordinator. Exposed persons should be

evaluated according to the Occupational Exposure Protocol. In addition, the on-call Infectious Diseases

Physician should be contacted and they should receive follow-up care including fever monitoring, twice

daily for 21 days after the incident. Exclusion from work may need to be considered. Immediate isolation and consultation with the on-call Infectious Diseases Physician is recommended for any exposed person

who develops fever within 21 days of exposure.

References

WHO Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or

Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola. September 2014

Management and Control of Viral Haemorrhagic Fevers. ENIVD Scientific Advisory Committee. May 2001

CDNA. EVD outbreaks in West Africa. Important information for clinicians in secondary or tertiary care.

11 August 2014

EVD. CDNA National Guidelines for Public Health Units. SoNG endorsed by CDNA. 3 October 2014



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Stakeholders

Director, Infectious Diseases and Microbiology

Medical Advisor, Infection Prevention and Control, RHH

NUM, Infection Prevention and Control Unit, RHH

Senior Medical Advisor, Public and Environmental Health Services

Medical Director, Emergency Department

NUM, Emergency Department Medical Director, Department of Critical Care Medicine

NUM, Department of Critical Care Medicine

NUM, 1BN Medical

ADON, Medical Services

Key Words - Intranet Search Function

1. Ebola 2. EVD

3. Viral haemorrhagic fever

4. VHF

5. Quarantine 6. Infection

Related Documents

Transmission Based Precautions Protocol IC1-04

http://pssbpr-trim02/pandp/showdoc.aspx?recnum=P2010/1747-001



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APPENDIX 1

EBOLAVIRUS DISEASE (EVD) PATIENT RISK ASSESSMENT

Does the patient:

Have a fever (≥ 38°C) or history of fever in the past 24 hours AND

Report returning from an EVD affected *country in the 21 days prior to the illness

onset

NO

EVD highly unlikely

YES

Don a surgical mask onto the patient

Place the patient into a negative pressure room

(resuscitation room 4 in ED or quarantine room on 1BN)

Quarantine transmission based precautions

Contact key personnel:

o ED Medical Co-ordinator and Nursing Clinical Co-ordinator

(6166 6101 and 6166 6109)

o RHH IPCU (0407 175 022 or 62228658) or the Clinical

Manager/Patient Flow Manager (CM/PFM)

o ID physician on-call (available via RHH switchboard); this

person will contact the Chief Human Quarantine Officer

(0418 123 265) ( or the CDPU clinician on-call (0408 532

708) and the Director of Microbiology

EVD possible

*Affected countries (3/10/2014): Sierra Leone, Liberia, Guinea.

Refer to www.who.int/csr/don/en/ for up to date information.

http://www.who.int/csr/don/en/



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APPENDIX 2

VISITOR AND STAFF LOG

Name Staff Y/N

Date Time in e.g. 08:10

Time out e.g. 08:20

Contact number

(mobile

preferable)



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APPENDIX 3

QUARANTINE SIGNAGE



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APPENDIX 4

DONNING PPE



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APPENDIX 5

DOFFING PPE



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APPENDIX 6

EVD CASE REPORT FORM

1 NOTIFICATION Date notified __/__/____ dd/mm/yyyy

Notifier name

Notifier organisation Telephone

Email

Treating Doctor

Telephone Fax

Email

2 INTERVIEW Was the case interviewed

Yes No N/A

If case not interviewed, state who was interviewed and their relationship to the case

Date of first interview __ /__ /____ dd/mm/yyyy

Name of interviewer

Telephone number of interviewer

3 CASE DETAILS Name (first name, surname)

Date of birth __ /__ /____ dd/mm/yyyy

Age (yrs / months) __ Yrs __ Mths

Sex Male Female

Occupation - specify

English preferred language

Yes If no specify language….

Address (permanent)

Telephone (home)

Telephone (mobile)

Email

Temporary address (if different from permanent address

Telephone (temporary home)

Telephone (mobile)

Email



Clinical Protocol



OR CONFIRMED EVD

ID-1-0009.






CASE DETAILS Indigenous Status Aboriginal

origin

Torres Strait

Islander origin

Both

Aboriginal and Torres Strait Islander

origin Not

Aboriginal or Torres Strait Islander

Unknown

Ethnicity – specify

Country of birth – specify

4 CLINICAL DETAILS

Date of symptom onset __ /__ /____ dd/mm/yyyy

Febrile phase fever malaise myalgia

headache pharyngitis conjunctival injection

vomiting diarrhoea bloody

diarrhoea abdominal

pain

rash petechiae

Other symptoms –specify

Complications Hypotension

Spontaneous

bleeding

Oedema

Shock Neurologic

involvement

Multi-

organ failure Other complications – specify

5 HOSPITAL and TREATMENT DETAILS

Hospitalised Yes No Unknown

Date admitted __ /__ /____ Date discharged __ /__ /____

Name of hospital – specify

Isolated in single room Yes No Unknown

Admitted to ICU or HDU ICU HDU Unknown

Date admitted to ICU/HDU __ /__ /____ Date discharged __ /__ /____

6 OUTCOME Patient outcome Alive Dead Unknown

Date outcome information

sought

__ /__ /____



Clinical Protocol



OR CONFIRMED EVD

ID-1-0009.






7 LABORATORY CRITERIA

Testing must be organised according to the SoNG Laboratory Testing Guidelines in discussion with jurisdictional public health laboratory

Specimens collected Blood /

serum

Throat swab Urine

Date collected __ /__ /____ __ /__ /____ __ /__ /____

Laboratory that received specimens

Specimens transferred to Jurisdictional PH lab (if relevant e.g. NSW, QLD)

Yes No Unknown

Detection of virus by PCR in Jurisdictional PH lab (if relevant e.g. NSW, QLD)

PCR

Specimens transferred to NHSQL Yes No Unknown

Isolation of virus Yes No Unknown

Detection of virus by PCR Antigen

detection

Electron

microscopy IgG Titre Single

high titre

Titre ___ Date __ /__ /____

Four fold

rise

1st titre --- Date __ /__ /____

2nd titre --- Date __ /__ /____

IgM positive Yes No

Unknown/ Not done

Confirmation by Special pathogens

lab Atlanta CDC

National Institute of

Virology, Johannesburg Lymphopaenia Yes No Unknown

Thrombocytopaenia Yes No Unknown

8 EXPOSURE

PERIOD

Between dates:

__ /__ /____ (onset of symptoms minus 21 days)

TO __ /__ /____ (onset of symptoms minus 1 day)

During this time was there contact with a confirmed/probable case/s?

Yes No Unknown

Case Contact 1 name

Case Contact 1 type Living patient Deceased patient

Specify type of contact Visit sick

patient

Care for sick

patient – specify type of care

Bury

deceased patient



Clinical Protocol



OR CONFIRMED EVD

ID-1-0009.






EXPOSURE PERIOD

Exposed to blood,

saliva, urine, vomit or faeces of sick

patient

Exposed to

blood, saliva, urine, vomit or faeces of

deceased patient Case Contact 2 name

Case Contact 2 type Living patient Deceased patient

Specify type of contact Visit sick

patient

Care for sick

patient – specify type of care

Bury

deceased patient

Exposed to

blood, saliva, urine, vomit or faeces of sick patient

Exposed to blood,

saliva, urine, vomit or faeces of deceased patient

Recent residence or travel in an area with active Ebola disease/outbreak

Yes No Unknown

If yes, specify country, region

Specify dates of travel __ /__ /____ To __ /__ /____

Animal exposures

Contact with bats primates or other animals from disease-endemic area?

Yes Details:

No Unknown

Contact with people who are in close contact with bats or

primates from disease-endemic areas b/c of their work?

Yes Details:

No Unknown

Laboratory exposure Yes Details:

No Unknown

Did the case visit a healthcare facility or hospital during their exposure period?

Yes Specify including date last attended:

No Unknown



Clinical Protocol



OR CONFIRMED EVD

ID-1-0009.






EXPOSURE

PERIOD

Other high risk settings (e.g. funeral / burial of suspected/confirmed EVD patient) -Specify

For any exposure

Location of possible exposure

Nature of possible exposure- specify

Dates of possible exposure __ /__ /____ To __ /__ /____

7 PLACE INFECTION ACQUIRED

Australian state or territory Specify

Country - specify

8 INFECTIOUS PERIOD

Between dates __ /__ /____ (onset of symptoms)

To __ /__ /____ (10

weeks after onset or as long as blood/

secretions contain virus) Isolation commenced Yes No Unknown

If yes, date isolation commenced __ /__ /____

Details of isolation

Did case travel during their infectious period?

Yes No Unknown

PLACE VISITED Arrival date Departure Date

Flight no. or mode of transport

1

2

3

4

Did the case attend any of the following places during their infectious period?

Name Telephone Date attended

Childcare

Preschool / School

Educational/residential facility

Hospital/healthcare facility

9 CASE

CLASSIFICATION Confirmed Probable Suspected Rejected



Clinical Protocol



OR CONFIRMED EVD

ID-1-0009.






10 CONTACT

MANAGEMENT Contact setting No. of

casual contacts*

No. of low risk close contacts*

No. of high risk close contacts*

Household

Ambulance staff

Medical/healthcare staff

Laboratory staff

Work

Other - specify

Contact surveillance No. of casual contacts

No. of low risk contacts

No. of high risk contacts

No temperature monitoring but advice to seek information and health care if symptoms develop

Twice daily self-monitoring of temperature for 21 days and reporting to PHU if fever > 38 C temp or other symptoms develop

Details of contacts hospitalized with temperature >38 degrees

Name DOB UR no. Telephone

APPENDIX 4

DOFFING PPE APPENDIX 4

DOFFING PPE