Health Alert
GUIDANCE REGARDING TRIAGING PATIENTS AT NON-HOSPITAL HEALTH CARE SETTINGS
FOR POSSIBLE EBOLA INFECTIONS

Summary

The epidemic of Ebola virus disease in West Africa continues to unfold. Particularly affected are Liberia, Guinea, Senegal, Nigeria, and Sierra Leone. Several cases have also been reported from the Democratic Republic of Congo in a simultaneous, but unrelated outbreak.

Background

Recently, the Ebola virus was transmitted to two health care providers from an ill patient in Dallas, Texas. The patient subsequently passed away and the two nurses are still hospitalized. While it is unlikely there will be Ebola cases in Delaware, the Delaware Division of Public Health (DPH) is still urging providers to be ready.

Based on currently available information, Ebola virus is only transmitted by patients who have symptoms. Transmission occurs when a susceptible individual comes in contact with blood or other bodily fluids of an infected individual.

Symptoms of Ebola Virus Disease occur after an incubation period of two to 21 days and include:

• Fever (Temperature greater than 38⁰C or 100.4⁰F)
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhage (bleeding or bruising)

Recommendations/Reporting

DPH is providing the guidance below to outpatient facilities including, but not limited to urgent care centers and outpatient clinics, in order to help with triaging and handling patients who may have had potential exposures to Ebola virus.

1. Ensure that staff are familiar with the signs and symptoms of Ebola virus disease listed aove.
2. Have on hand several sets of personal protective equipment (PPE) and ensure that staff are familiar with their use. DPH is now recommending an approach based on World Health Organization (WHO) guidelines, and including use of impermeable gowns, double gloving for all patient contact, use of eye protection, as well as appropriate attention to the safe removal of PPE. See links to the WHO website under “additional information” for details.
3. Develop a quick screening tool that can be used by front desk staff to assess patients coming into your facility, including screening for recent travel to West Africa. An example of such a tool is included here and is also available on the DPH website.
4. Be sure that this screening is administered to all patients coming into your facility, rather than to a select few based on language, name, perceived accent, race, or other demographic.
5. For patients for whom the screening tool suggests no exposure to Ebola, continue to manage as you normally would.
6. For patients for whom the screening tool suggests the possibility of Ebola exposure but who have no symptoms consistent with Ebola, continue to treat as you would any patient but also contact the DPH Office of Epidemiology at 888-295-5156 (Monday-Friday: 8:30 a.m.- 4:30 p.m.) or 302-744-4700 (after 4:30 p.m., weekends, and holidays).
7. For those whose responses suggest the possibility of Ebola exposure AND who have ANY of the symptoms listed above, take the steps listed below:
   1. First, remain calm. Bear in mind that there are several travel related illness including malaria, typhoid fever and dengue much more common than Ebola, and whose symptoms overlap with Ebola. You may very well be seeing any of these other illnesses.
   2. Separate the patient from staff and other patients in a room that has a door, and private bathroom if available.
   3. Call 9-1-1 to arrange for the patient to be transported to the hospital and tell the operator that Ebola is suspected.
   4. While awaiting the transport, contact DPH Office of Epidemiology at 888-295-5156 (Monday-Friday: 8:30 a.m. - 4:30 p.m.) or 302-744-4700 (after 4:30 p.m., weekends, and holidays).
   5. Any staff person attending to the patient should be appropriately attired in PPE - including impermeable gown, double gloving, face protection, and shoe covers if patient has vomiting or diarrhea. See additional information below for guidance.
   6. After the patient has left, clean the room where he/she was kept following CDC guidelines at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html

Additional Information

WHO guidance for donning and removing Personal Protective Equipment (PPE):

• http://www.who.int/csr/disease/ebola/put_on_ppequipment.pdf?ua=1
• http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf?ua=1

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