Download HISD Health and Medical Services Infectious Disease/EBOLA

Infectious Disease/EBOLA Guidelines for the School Clinic
Background: The procedures in the accompanying algorithm provide guidance on evaluation and management of
individuals who present with possible Ebola Virus Disease. The guidance in this document reflects the most recent
information from the Centers for Disease Control (CDC) adapted from the protocol for Emergency Department
management.
The risk of Ebola in a school is extremely low. Coming into contact with people who do not have fever or other
symptoms poses no risk to the public, even with recent travel to the affected countries. In general, the majority of
febrile individuals presenting to the school nurse do not have Ebola Virus Disease, and the risk posed by individuals with
early, limited symptoms is lower than that from an individual hospitalized with severe Ebola Virus Disease. Nevertheless,
because early symptoms of Ebola Virus Disease are similar to other febrile illnesses, triage and evaluation processes by
the school nurse should include systematic assessment of individuals for the possibility of Ebola Virus Disease.
The risk of transmission of Ebola virus from an individual depends upon the likelihood that the individual will have
confirmed Ebola Virus Disease combined with the likelihood and degree of exposure to infectious blood or body fluids.
That risk depends on the severity of disease; severe illness is strongly associated with high levels of virus production. In
addition, close contact with the individual and invasive medical care can increase opportunities for transmission. As a
result, health care workers working directly with hospitalized patients diagnosed with Ebola are at greatest risk while
those in community/ambulatory settings may be at less risk due lower level of virus production and less severe
symptoms.
Nurses in any setting are an integral part of safe patient care and advocates for patients’ safety. In order to advocate for
patients, nurses must first protect themselves with personal protective gear and follow appropriate guidelines to
prevent exposure to and the potential spread of infectious pathogens and communicable conditions (Texas Board of
Nursing, 2014).
Review the CDC website regularly to remain current on countries with wide spread transmission of Ebola, risk factors
and monitoring.
Student Enrollment
Identify exposure history from the most reliable person enrolling the student:
ASK:
1. Have you or anyone in your family lived in or traveled to a country with widespread Ebola transmission?
2. Have you or anyone in your family had contact with an individual with confirmed Ebola Virus Disease within the
previous 21 days?
Where? __________When? _________ Indicate responses on the Travel History Enrollment Questionnaire and
sign/date.
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If No travel history, enroll with routine assessment of general health using information recorded on health
inventory and other available assessment information.
HISD Health and Medical Services
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If Yes AND travel was within the past 21 days to countries currently designated by CDC including Liberia, Guinea
and Sierra Leone (updated on the CDC website at http://www.cdc.gov/vhf/ebola/):
o CONTACT Health and Medical Services for guidance from local health department. Health and Medical
Services will contact the local health department and put them in contact with the nurse or other
reliable source for more information.
o Be prepared to provide the health department representative with information about exposure history.
SEE LEVEL OF RISK ASSESSMENT AT END OF DOCUMENT
Day to Day systematic triage and evaluation processes by the school nurse for the possibility of Ebola Virus Disease
1. Identify Exposure History: Immediately upon entrance to the nurse’s office, or in advance of entry if possible, a
relevant exposure history should be taken including exposure criteria of whether the individual has resided in or
traveled to a country with widespread Ebola transmission or had contact with an individual with confirmed
Ebola Virus Disease within the previous 21 days.
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Because the signs and symptoms of Ebola Virus Disease may be nonspecific and are present in other
infectious and noninfectious conditions that are more frequently encountered in the United States, relevant
exposure history should be first elicited to determine whether Ebola Virus Disease should be considered
further. If the individual is unable to provide history due to clinical condition or other communication
barrier, history should be elicited from the next most reliable source (e.g. family, friend, classroom teacher).

Notify School Administrator and Health and Medical Services if there is travel history to a country with
widespread Ebola transmission regardless of symptoms. Health and Medical Services will contact the local
health department and put them in contact with the nurse or other reliable source for more information.
2. Identify signs and symptoms: Individuals who meet the exposure criteria should be further questioned
regarding the presence of signs or symptoms compatible with Ebola Virus Disease.

These include: fever (subjective or ≥100°F or headache, weakness, muscle pain, vomiting, diarrhea,
abdominal pain, or hemorrhage (e.g., bleeding gums, blood in urine, nose bleeds, coffee ground emesis or
melena – dark, tarry stools).
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NOTE: To minimize transmission risk, only a healthcare worker should provide individual care if there is
relevant travel history and signs or symptoms consistent with Ebola Virus Disease.

All individuals should be routinely managed using precautions to prevent any contact with blood or body
fluids. If an exposure history is unavailable, clinical judgment should be used to determine whether to
empirically implement isolation protocols.

If a relevant exposure history is reported and signs or symptoms consistent with Ebola Virus Disease are
present, the following measures should be implemented IMMEDIATELY:
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3. Isolate the individual in a private room or separate enclosed area with private bathroom and adhere to
procedures and precautions designed to prevent transmission by direct or indirect contact (e.g. dedicated
equipment, hand hygiene, and restricted individual movement) until further notice. Avoid any unnecessary direct
contact.
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Activate campus emergency plan with Administrator including contacting EMS. Administrator may
consider using lock down procedures in anticipation of EMS arrival.
The individual should remain in view while also avoiding any unnecessary contact.
The nurse must put on appropriate PPE based on the individual’s clinical status before further contact.
Minimum PPE for individuals who are considered clinically stable (no obvious bleeding, vomiting or
diarrhea) includes 1) face shield, 2) surgical face mask, 3) impermeable gown and 4) two pairs of gloves.
Only trained EMS personnel should provide care if the individual is exhibiting obvious bleeding,
vomiting, copious diarrhea or a clinical condition that warrants invasive or aerosol-generating
procedures (e.g., suctioning, active resuscitation),
Only equipment dedicated to the individual should be used to provide care and should be discarded in a
designated receptacle.
A log should be maintained of all individuals who enter the school clinic or area.
Ensure that any students in the clinic are transferred to another designated area.
Ensure that medication and treatment supplies are moved to a designated area.
Notify School Administrator and Health and Medical Services and other appropriate staff. Health and
Medical Services will activate nursing support and report to the relevant local health department
immediately.
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Call 911 for transport to the nearest emergency center.
Provide information to EMS regarding signs and symptoms as suspected case of Ebola.
Provide contact information for individual
Administrator will designate trained individual to provide medications and remain with students moved
to the designated area.
5. Further evaluation and management:
 Decontamination will be handled by the appropriate department to be contacted by campus
Administrator. The Plant Operator must receive guidance from CFS before cleaning the area or
removing contaminated articles.
 All disposable designated equipment should be placed in double bag container or biohazard “red” bag.
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INTENTIONALLY LEFT BLANK
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DETERMINING LEVEL OF RISK
(Updated CDC guidance November 28, 2014)
LEVEL OF RISK EXPOSURE
High risk includes
Some risk includes:
FACTORS
 Percutaneous (e.g., needle stick) or mucous membrane
exposure to blood or body fluids of a person with Ebola while
the person was symptomatic
 Exposure to the blood or body fluids (including but not limited
to feces, saliva, sweat, urine, vomit, and semen) of a person
with Ebola while the person was symptomatic without
appropriate personal protective equipment (PPE)
 Processing blood or body fluids of a person with Ebola while the
person was symptomatic without appropriate PPE or standard
biosafety precautions
 Direct contact with a dead body without appropriate PPE in a
country with widespread Ebola virus transmission
 Having lived in the immediate household and provided direct
care to a person with Ebola while the person was symptomatic
ACTIONS
Cannot attend school , work
regardless of presence or absence of
symptoms.
 Close contact in households, healthcare facilities, or community
settings with a person with Ebola while the person was
symptomatic
 Close contact is defined as being for a prolonged period of time
while not wearing appropriate PPE within approximately 3 feet
(1 meter) of a person with Ebola while the person was
symptomatic
Cannot attend school, work
regardless of presence or absence of
symptoms.
Medical evaluation is required prior
to attendance.
Medical evaluation is required prior
to attendance.
Notify School/Dept. Administrator,
Health and Medical Services by
phone at 713 556 7280 or by
afterhours contact for Emergency
Preparedness Plan
Complete communicable disease
report
Notify School/Dept. Administrator,
Health and Medical Services by
phone at 713 556 7280 or by
afterhours contact for Emergency
Preparedness Plan
Complete communicable disease
report
Update December 16, 2014
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HISD Health and Medical Services
LEVEL OF RISK EXPOSURE
Low (but not zero) risk
includes :
With symptoms:
Fever (subjective fever or
measured temperature
≥100 F) OR any of the
following: vomiting,
diarrhea, unexplained
bruising or bleeding
FACTORS
 Having been in a country with widespread Ebola virus
transmission within the past 21 days and having had no known
exposures
 Having brief direct contact (e.g., shaking hands), while not
wearing appropriate PPE, with a person with Ebola while the
person was in the early stage of disease
 Brief proximity, such as being in the same room for a brief
period of time, with a person with Ebola while the person was
symptomatic
 direct contact while using appropriate PPE with a person with
Ebola while the person was symptomatic
 Traveled on an aircraft with a person with Ebola while the
person was symptomatic
With symptoms
ACTIONS
Depends on the individual is with or
without symptoms as described
below:
Cannot attend school, work. Medical
evaluation is required prior to
attendance.
Activate
 Emergency Notification
 Isolation precautions
 EMS – inform that there is a
suspected case
 Decontamination procedures
Notify School/Dept. Administrator,
Health and Medical Services by
phone at 713 556 7280 or by
afterhours contact in Emergency
Preparedness Plan
Complete communicable disease
report when feasible
Asymptomatic (no fever,
vomiting, diarrhea, or
unexplained bruising, or
bleeding)
Without Symptoms
May attend school, work. No
restrictions on travel, work.
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LEVEL OF RISK EXPOSURE
No identifiable risk
includes:
FACTORS
 Contact with an asymptomatic person who had contact with
person with Ebola
 Contact with a person with Ebola before the person developed
symptoms
 Having been more than 21 days previously in a country with
widespread Ebola virus transmission
 Having been in a country without widespread Ebola virus
transmission and not having any other exposures as defined
above
 Having remained on or in the immediate vicinity of an aircraft
or ship during the entire time that the conveyance was present
in a country with widespread transmission or cases in urban
areas with uncertain control measures, and having had no
direct contact with anyone from the community.
ACTIONS
May attend school unless ill for other
reasons.
No restrictions on travel, work.
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