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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. 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. 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 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