This communication provides an update to the November 5, 2014 Delaware Health Alert regarding the ongoing Ebola virus disease outbreak.
The epidemic of Ebola virus disease (EVD) in West Africa continues to evolve. Mali was recently added to the list of Ebola-affected countries that includes Liberia, Guinea, and Sierra Leone. On November 17, WHO declared the Ebola outbreak in the Democratic Republic of the Congo (DRC) to be over. This outbreak in DRC was unrelated to the ongoing Ebola outbreak in West Africa.
For an up-to-date list of countries with ongoing high level transmission, visit the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html
The CDC is conducting enhanced entry screening at five U.S. airports (New York’s JFK International, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta) for all U.S.-bound air travelers who have been in Guinea, Liberia, Sierra Leone, or Mali. Contact information of travelers with a final destination, or home address, in Delaware are referred to the Delaware Division of Public Health for 21-day monitoring of temperature and monitoring for Ebola symptoms.
A total of 42 travelers from these countries have been referred to the DPH and currently, DPH is monitoring the health of 15 ‘low risk’ travelers and one traveler with ‘some risk’ for Ebola. All travelers remain healthy with no symptoms, including the ‘some risk’ traveler whose monitoring ends on December 7. Due to this enhanced monitoring system, it is unlikely that patients responding “yes” to travel and/or exposure relevant to Ebola and complaining of symptoms will present to your non-hospital facility.
There has been no community (non-hospital) associated transmission of Ebola in the United States. There has been evidence of healthcare associated transmission of EVD in the United States, with two nurses who cared for a man with travel-related EVD in Dallas, TX contracting the disease. Both nurses received immediate treatment and have since recovered.
Based on currently available information, the 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 EVD occur after an incubation period of two to 21 days and include:
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 the Ebola virus.
Focus is on safety and efficiency, not on speed
With Ebola virus disease, the emphasis must be on safety (of the patient and of healthcare providers) rather than on speed. Consequently, the response when you call will be a deliberate but efficient one rather than a speedy one (unlike what happens with medical emergencies). When you call the DPH to arrange transport, a chain of responses will be set up including alerting a specialized EMS unit to deploy to your facility, notifying the receiving hospital and other important parties and ensuring that the receiving hospital is ready to take the patient. The response will be safe and deliberate but will take longer than your facility typically expects with routine calls to emergency medical services. Expect to wait on average 60-90 minutes from the time you make the call to the time the patient is picked up.
For non-hospital settings in which invasive procedures and aerosol-producing procedures are NOT performed, DPH is recommending the following for attending to persons suspected of having been exposed to Ebola (Person Under Investigation), while awaiting the patient’s transport from your facility.
Refer to the CDC guidance on personal protective equipment to be used by healthcare workers during management of patients with ebola virus disease: http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html
Video training on PPE is available from CDC at: http://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html
A poster on safe donning and removal of PPE: http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf
An easy-to-understand graphic for PPE removal: http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf?ua=1
DPH recommends that outpatient/non-hospital facilities consider deferring non-emergency invasive or aerosol-generating procedures on individuals with history of travel to affected areas or history of exposure to known Ebola cases until at least 21 days have passed since their last potential exposure.
If aerosol generating procedures (such as nebulizer treatments) or invasive procedures must be done in an outpatient setting, DPH recommends that such facilities follow CDC guidelines for PPE use in hospital settings available at link below and that the number of staff involved in the procedure be limited to the minimum number that can safely be involved. For further information: http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html.
When cleaning up after a suspected Ebola patient has been removed from your facility, you should follow CDC guidelines for cleaning is available at: http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html
Cleanup should be done by individuals adequately attired in appropriate PPE, with proper attention to careful removal of PPE, as is done for those who have cared for the patient.
Call the DPH Office of Infectious Disease Epidemiology 24/7 at 888-295-5156, including weekends and holidays.
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