HEALTH ADVISORY #319
August 8, 2014
EBOLA GUIDANCE ~ Evaluation of patients presenting to primary care, urgent care, or other outpatient settings with signs, symptoms, and travel history concerning Ebola Virus Disease (EVD)
Please distribute to Healthcare Providers, Infection Control Department, Emergency Department, Employee Health Service, Director of Nursing, Medical Director, Directors of Pharmacy, Laboratory Service, and all patient care areas.
SUMMARY
This advisory provides guidance for the evaluation and management of patients suspected to have EVD who present to outpatient facilities.
BACKGROUND
Several outbreaks of Ebola virus disease (EVD) are occurring in parts of West Africa (Guinea, Sierra Leone, Liberia, and Nigeria). On August 1, 2014, Centers for Disease Control and Prevention (CDC) released a health advisory with guidelines for the evaluation of patients presenting to a health care setting and suspected of having Ebola virus disease (EVD) (http://emergency.cdc.gov/han/han00364.asp) which NYSDOH retransmitted on August 2, 2014.
EVD Symptoms and Risk Factors
1) Clinical criteria, including
- Fever > 38.6°C or 101.5° F, AND
- additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage, AND
2) Epidemiologic risk factors within the past 3 weeks before the onset of symptoms, such as
- contact with blood or other body fluids of a patient known to have or suspected to have EVD
- residence in—or travel to—an area where EVD transmission is active
- direct handling of bats, rodents, or primates from disease-endemic areas
Currently involved countries are Guinea, Sierra Leone, Liberia, and Nigeria. Check the CDC travel notification website for the most up-to-date information: http://wwwnc.cdc.gov/travel/notices.
WHAT TO DO IF YOU HAVE A PATIENT WITH SUSPECTED EVD
1) For any ill patient who presents with fever and additional symptoms and who reports recent travel (3 weeks prior to onset of symptoms) to an area with ongoing EVD transmission as mentioned above:
- Screen upon presentation and immediately place patient in a private room with a closed door
- Provide the patient with a surgical mask and demonstrate its proper use
- Minimize the number of staff who interact with the patient and keep a list of these staff
- Staff who interact with the patient should follow standard, droplet, and contact infection control precautions. EVD is NOT transmitted through the airborne route.
- Appropriate personal protective equipment (PPE) should be worn upon entry to the patient’s room to include gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask.
- Additional protective equipment might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.
- More detailed information on these and other infection control issues including environmental cleaning and disinfection, applicable to both the inpatient and outpatient settings, is available at http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.
- Call the Local Health Department in which your facility is located for consultation. Contact the Erie County Department of Health at (716) 858-7697 during normal business hours and (716) 961-7898 after hours.
2) When you call the LHD, be prepared to:
- Describe the patient’s risk factors and travel history, including dates and locations of travel and any contact with sick patients, healthcare facilities, or animals in areas with ongoing EVD transmission
- Describe the patient’s presenting symptoms, signs, and duration of illness
3) When you call the LHD, you can expect to:
- Discuss the case and possible recommendations for testing
4) Do NOT refer the patient to an Emergency Department, hospital, or other facility without consulting with the LHD.
- This includes situations in which you speak to the patient on the phone, but do not see him/her in person.
- If the patient must be immediately referred to an Emergency Department, at a minimum please alert the 911 center, transport agency, ED and the LHD.
REPORTING
All suspect EVD cases should be reported promptly by telephone to the Erie County Department of Health (ECDOH) Epidemiology and Surveillance Office at (716) 858-7697 during normal business hours and (716) 961-7898 after hours.
CONTACT PHONE NUMBER
ECDOH Epidemiology and Surveillance Office: (716)858-7697 during normal business hours and (716)961-7898 after hours.
ADDITIONAL INFORMATION
The CDC’s Ebola Website contains the most up-to-date information about the outbreak and has specific materials for healthcare workers, airline personnel, travelers, and the general public. It can be accessed at http://www.cdc.gov/vhf/ebola/.
Health Category Definitions:
Health Alert FLASH: conveys the highest level of importance due to a large-scale, catastrophic public health emergency; warrants immediate action or attention
Health Alert Priority: conveys the highest level of importance; warrants immediate action or attention to a health problem or situation
Health Advisory: provides important information for a specific incident or situation; may not require immediate action
Health Update: provides updated information regarding an incident or situation; no immediate action necessary
The ECDOH Health Alert & Advisory System is an e-mail notification system designed to alert community partners about important health related information. You can sign up to receive alerts & advisories at http://www2.erie.gov/health/index.php?q=node/59.
The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis, or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice or delay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.