Training structure

01.08.2015

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

01.08.2015

Learning objectives module 1 (part 2)

01.08.2015

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

01.08.2015

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

01.08.2015

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

01.08.2015

Rapid test

Testing and validation in progress.

Gold standard: PCR

© RKI Martin Richter

01.08.2015

?

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

01.08.2015

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

01.08.2015

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)

01.08.2015

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

01.08.2015

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

01.08.2015

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)

01.08.2015

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

01.08.2015

The patient’s diet

01.08.2015

• 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

01.08.2015

The stress caused by Ebola

01.08.2015

• 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!

01.08.2015

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

01.08.2015

Thank you for your attention!

Copyright images

01.08.2015

©Adam – Fotolia.com © leremy – Fotolia.com © vladis_studio - Fotolia.com© macrovector - Fotolia.com © andròmina – Fotolia.com