9. PATIENTS EVALUATED FOR EBOLA VIRUS DISEASE

  FOR PATIENTS BEING EVALUATED FOR EBOLA VIRUS DISEASE

 

·         Assess the patient for a fever (subjective or ≥ 100.4°F / 38.0°C)

·         Determine if the patient has symptoms compatible EVD such as headache, weakness, muscle pain, vomiting, diarrheic, abdominal pain or hemorrhage

·         Assess if the patient has a potential exposure from traveling to a country with widespread Ebola transmission or having contact with an Ebola patient in the 21 days before illness

 Suspect Ebola if fever or compatible Ebola symptoms and an exposure are present

 ·         Isolate patient in single room with a private bathroom and with the door to hallway closed

·         Implement standard, contact, & droplet precautions

  

 Conduct a risk assessment for: High-risk exposures

 

·                     Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids from an EVD patient

·                     Direct skin contacts with skin, blood or body fluids from an EVD patient

·                     Processing blood or body fluids from an EVD patient without appropriate PPE

·                     Direct contact with a dead body in an Ebola-affected area without appropriate PPE

  Low-risk exposures

 

·                     Household members of an EVD patient or others who had brief direct contact (e.g., shaking hands) with an EVD patient without appropriate PPE

·                     Healthcare personnel in facilities with EVD patients who have been in care areas of EVD patients without recommended PPE

 

 During aerosol-generating procedures

 

·                     Limit number of personnel present

·                     Conduct in an airborne infection isolation room

 

 Patient placement and care considerations

 

·                     Maintain log of all persons entering patient’s room

·                     Use dedicated disposable medical equipment (if possible)

·                     Limit the use of needles and other sharps

·                     Limit phlebotomy and laboratory testing to those procedures essential for diagnostics and medical care

·                     Carefully dispose of all needles and sharps in puncture-proof sealed containers

·                     Avoid aerosol-generating procedures if possible

·                     Wear PPE (detailed in Centre box) during environmental cleaning and use an EPA-registered hospital disinfectant with a label claim for non-enveloped viruses**

  Initial patient management

 

·                     Consult with health department about diagnostic EVD RT-PCR testing

·                     Consider, test for, and treat (when appropriate) other possible infectious causes of symptoms (e.g., malaria, bacterial infections)

·                     Provide aggressive supportive care including aggressive IV fluid resuscitation if warranted

·                     Assess for electrolyte abnormalities and replete

·                     Evaluate for evidence of bleeding and assess hematologic and coagulation parameters

·                     Symptomatic management of fever, nausea, vomiting, diarrheic, and abdominal pain

·                     Consult health department regarding other treatment options