Download Information Sheet - Ebola Virus Disease

REMOTE HEALTH ATLAS
INFORMATION SHEET – EBOLA VIRUS DISEASE (EVD)
REMOTE HEALTH ATLAS
EBOLA VIRUS DISEASE (EVD)
While the risk of Ebola Virus Disease being diagnosed in Australia is low, this
document provides guidance to Primary Health Care remote staff in the response to
potential Ebola Virus Disease presentations in Primary Health Care remote health
centres.
This document is based on the guidance issued by the Australian Government Department
of Health Ebolavirus disease (EVD) outbreaks in West Africa webpage which is updated
regularly; staff are encouraged to refer to the online information.
In view of the media coverage about this topic, staff are strongly encouraged to seek
accurate evidence-based information through reputable sources such as the World Health
Organisation. See references / supporting documents for links to related information and
resources at the end of this document.
Vigilance
If staff or clients have been in affected countries in the preceding 21 days:
 Consider the possibility of EVD in a client with both of the following:
1. Clinical evidence, which includes fever of greater than 38˚C in the last 24
hours, and additional symptoms such as severe headache, muscle pain,
vomiting, diarrhoea, abdominal pain, or unexplained haemorrhage.
2. History of travel to the affected area or contact with a known case.
 Document a thorough travel history of the patient and any potential contacts who may
have travelled to affected areas in the preceding 21 days.
 When a patient presents with a history of travel to affected countries and reports illness
staff must use the Ebola Virus Disease Flowchart to manage the patient.
 Isolate the patient. All Primary Health Care Managers should discuss a plan for how to
isolate a patient suspected of having Ebola with the District Manager:
 if well, direct the patient to remain in a shady outside area and isolate from other
people. This allows the health centre to continue to function while a management
plan for the patient is being organised.
 if unwell, use an identified room with access to a dedicated toilet at the health centre.
Note: DO NOT use the emergency room as limited treatment will be provided until the Rapid
Response Team arrives on site.
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Once a suspected Ebola patient is placed into an isolation room, the health centre
must be closed for routine health services. Emergency services may be available for
health centres with sufficient staff. The Manager On-Call must be notified.
Staff must utilise Personal Protection Equipment (PPE) to minimise the risk of
contamination when in the room / area with the patient. Remote health centres maintain
a PPE Kit, however for circumstances where there is a greater risk of body fluid
exposure, such as for Ebola, a Department wide standardised Biological High Risk PPE
Kit is provided and must be used. The Biological High Risk PPE Kit is provided to health
centres with two or more staff members as a second person is always required to
ensure PPE is donned (put on) and doffed (taken off) correctly and to monitor potential
cross contamination. Information and training resources on the Biological High Risk PPE
are available via:
 Ebola Virus Disease (EVD) NT Health Services Guideline (intranet) includes
instruction for donning and doffing PPE items (see Appendix 4)
Developed by: Director of Medical Services &
Quality & Safety Team
Endorsed by: Primary Health Care Remote Executive
Release Date: October 2014
Page 1
Reviewed: Dec 14
Next Review: December 2017
REMOTE HEALTH ATLAS

INFORMATION SHEET – EBOLA VIRUS DISEASE (EVD)
 Ebola Management (intranet) – provides training resources and Gown Donning video
 Atlas Personal Protection Equipment
PPE items are also available in the Biological High Risk PPE Kit for training, this allows
staff to become confident in donning and doffing. Clinical staff must practise donning and
doffing PPE while being watched by an observer three (3) separate times to be
considered competent. The ‘training assessment long sleeved gown’ form (intranet) must
be signed by the observer and the completed form maintained by the Primary Health
Care Manager and sent to the District Manager for record keeping.
Waste management: All waste generated in an EVD room is to be classified as clinical
waste:
 double bag ALL waste items and body fluids by in a yellow biohazard waste bag
(Not via sink or toilet). Once used, seal the yellow biohazard waste bags and store in
the same room as the patient until advice is received regarding disposal.
 Advice on waste management will be provided by the Rapid Response Team /
infection control. The Ebola Virus Disease (EVD) NT Health Services Guideline
provides guidance on waste management including cleaning and disinfection (See pp
7-8 and Appendix 9).
 dedicated toilet: if the patient needs to use the toilet ask them not to flush. The
appropriately PPE donned clinician must pour bleach into the toilet prior to flushing
the toilet.
Note: Instruction on how to dilute household bleach for cleaning large spills and the toilet post
use is included on the reverse side of the Biological High Risk PPE Contents List.
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DO NOT insert IV Cannula or take blood / urine until you consult with the rostered Duty
Rural Medical Practitioner (RMP) on-call who will consult with the rostered Infectious
Disease (ID) physician via Alice Springs Hospital (ASH) or Royal Darwin Hospital (RDH)
switchboard for clinical advice. Unless the patient has severe sepsis this may be
delayed until they reach the tertiary facility.
The Duty RMP on-call will also notify the rostered Centre for Disease (CDC) Public
Health Officer to activate the public health response and the National Critical Care and
Trauma Response Centre (NCCTRC) to coordinate a Rapid Response team if required.
With a febrile patient and a history of travel, other infections are the more likely cause
and need to be considered
Retrieval MAY be required for assessment and testing. In the event a Rapid Response
Team is required to attend a patient in a remote community, this will be provided by the
NCCTRC. The decision to initiate a Rapid Response Team will be made by a consultant
panel and execution of the response in consultation with NCCTRC and the Duty RMP
on-call.
Further information will be provided as well as communication to other agencies
BE VIGILANT
If uncertain JUST ASK
Summary
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The largest outbreak of Ebolavirus Disease (EVD) ever reported is continuing in Guinea,
Liberia and Sierra Leone in West Africa.
Regular updates are available from the World Health Organization (WHO) website:
http://www.who.int/csr/don/en/ and http://www.who.int/csr/disease/ebola/en/
The risk of infection is extremely low unless there has been direct exposure to the
bodily fluids of an infected person.
Developed by: Director of Medical Services &
Quality & Safety Team
Endorsed by: Primary Health Care Remote Executive
Release Date: October 2014
Page 2
Reviewed: Dec 14
Next Review: December 2017
REMOTE HEALTH ATLAS
INFORMATION SHEET – EBOLA VIRUS DISEASE (EVD)
The suspected case definition requires clinical and epidemiological evidence:
Clinical Evidence
A compatible clinical illness as determined by an infectious disease physician. Clinical
evidence, which includes fever of greater than 38 degrees celsius, and symptoms such
as severe headache, muscle pain, vomiting, diarrhoea, abdominal pain, or unexplained
haemorrhage;
AND
Epidemiological Evidence
Epidemiologic risk factors within the past 21 days 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, or
 direct handling of bats or primates from disease-endemic areas
Staff Considerations
Staff who have observed the recommended infection control precautions, including the use
of appropriate PPE, while caring for a probable or confirmed EVD case are not considered
to have had low or high risk exposures. However, such staff should be advised to selfmonitor and if they develop symptoms consistent with EVD they should isolate themselves
and notify the Primary Health Care Manager / District Manager. The Duty RMP should be
consulted regarding clinical management.
Primary Health Care remote staff returning from travel to affected West African countries will
require 21 days from the date of return prior to returning to work in a remote community. This
provides an opportunity to monitor health and identify any symptoms should they arise
during the 21 day incubation of the Ebola virus. Clinical staff will not be permitted to return to
a remote community during this period of recovery and alternative work options may be
negotiated.
References and Supporting Documents
Related Atlas items:
Personal Protection Equipment
Personal Protection Equipment Kit Contents
Personal Protection Equipment – Biological High Risk Kit Contents
Northern Territory Department of Health
Ebola Virus Disease (EVD) NT Health Services Guideline(intranet)
Ebola Management (intranet) – provides training resources
Training Assessment Long Sleeved Gown’ form (intranet)
Northern Territory Department of Health Centre for Disease Control (CDC)
NT Contacts webpage
Ebola Virus Disease (EVD) – Important Information NT for Primary Health Care
Providers (Director, CDC and Chief Human Quarantine Officer)
National Critical Care and Trauma Response Centre
Australian Government Department of Health - Fact Sheets
Ebolavirus disease (EVD) outbreaks in West Africa
World Health Organisation website
Ebola virus disease – Fact Sheet
Ebola: Protective measures for medical staff
Developed by: Director of Medical Services &
Quality & Safety Team
Endorsed by: Primary Health Care Remote Executive
Release Date: October 2014
Page 3
Reviewed: Dec 14
Next Review: December 2017
REMOTE HEALTH ATLAS
INFORMATION SHEET – EBOLA VIRUS DISEASE (EVD)
Disease Outbreak News (DONs) – EBV status
Royal Australian College of General Practitioners
Public health and natural disasters
Correct Use of Personal Protection Equipment Poster
United States: Centers for Disease Control and Prevention (CDC), Ebola virus disease
Guidance on Personal Protective Equipment To Be Used by Healthcare Workers
During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including
Procedures for Putting On (Donning) and Removing (Doffing)
Department of Health – Victoria Victorian Ebola Virus Disease Response Plan
Australian Government Department of Health Communicable Diseases Network Australia
(CDNA)
NHMRC (2010) Australian Guidelines for the Prevention and Control of Infection in
Healthcare. Commonwealth of Australia
Developed by: Director of Medical Services &
Quality & Safety Team
Endorsed by: Primary Health Care Remote Executive
Release Date: October 2014
Page 4
Reviewed: Dec 14
Next Review: December 2017