Telephone call to GP surgery Ask: Clinical: Do the patient have a fever ≥38.6 C (or history of fever in previous 24 hours)? AND Travel history: Has patient travelled from an Ebola affected country in the 21 days before onset of symptoms?
If yes to both… Advise patient to remain at home and to isolate themselves GP contacts designated hospital EVD contact Risk assessment in controlled environment in acute hospital
Presentation at GP Surgery Isolate patient Adopt “talk, no touch” approach Maintain personal protective distance (PPD) of >1 m Perform initial assessment of patient from a distance Refer for further assessment to local designated EVD hospital without undertaking a clinical exam If clinical interaction required prior to transfer, don level 1 personal protective equipment (PPE) Notify Public Health
Receiving Hospitals for Patients Adults only unless otherwise stated Ireland East Hospital Group Mater Misericordiae Hospital Midland Regional Hospital Mullingar St Luke's Hospital Kilkenny St. Michael's Hospital St. Vincent's University Hospital Our Lady’s Hospital Navan Wexford General* Dublin Midlands Hospital Group Midland Regional Hospital Portlaoise Midland Regional Hospital Tullamore Naas General Hospital St. James's Hospital Tallaght Hospital *Adults and children
Receiving Hospitals for Patients Adults only unless otherwise stated RCSI Hospitals Group – Dublin North East Beaumont Hospital Cavan General Hospital Connolly Hospital Our Lady of Lourdes Hospital Drogheda South/South West Hospital Group Cork University Hospital * Kerry General Hospital * Mercy University Hospital Cork Hospital * South Tipperary General Hospital* Waterford Regional Hospital* *Adults and children
Receiving Hospitals for Patients Adults only unless otherwise stated Saolta Health Care Group - (West/ North West) Galway Hospital* Letterkenny General Hospital Mayo General Hospital* Portiuncula Hospital * Sligo Regional Hospital* University of Limerick Hospitals University Hospital, Limerick* Children's Hospital Group Temple Street Children's University Hospital† Our Lady's Children’s Hospital Crumlin† *Adults and children †Paediatric only
Presentation to Emergency Department Raise awareness in waiting areas Triage: Ask re fever and travel history
Presentation to Emergency Department Maintain personal protective distance Isolate patient in a single room Explain the process to the patient; work to avoid patient feeling frightened, alone /abandoned Complete initial risk assessment remotely if feasible e.g. phone, patient’s mobile, intercom Apply standard, droplet and contact precautions Based on outcome of risk assessment, don appropriate level of PPE (level 1 or level 2) to: –Complete physical assessment –Perform diagnostic tests –Give ongoing clinical care
Clinical Risk Assessment Form –To be completed by a senior member of the clinical team Emergency Medicine Consultant Admitting team consultant –Can consult with ID Consultant on call at the National Isolation Unit (NIU), Mater Hospital –Risk assessment to determine: Have there been high risk exposures to EVD or not
High risk exposures IF the person 1.Had close face to face contact (e.g. within 1 metre) without appropriate PPE (including eye protection) with a probable or confirmed case who was coughing/ vomiting/ bleeding/ had diarrhoea? 2.Had direct contact (without appropriate PPE) with any material soiled by body fluids from a probable/confirmed case of EVD 3.Had a percutaneous injury (e.g. with a needle) or mucosal exposure, including mouth-to-mouth kissing, to bodily fluids, tissues or laboratory specimens of a probable or confirmed case? 4.Participated in autopsy, resuscitation or funeral rites with direct contact with human remains, including body fluids in/from an affected area without appropriate PPE? 5.Had unprotected sexual contact with a case up to three months after recovery? 6.Had direct contact with bush meat or fruit bats / rodents / primates, living or dead, in/from affected areast?
Outcome of Risk Assessment No Risk No High Risk Exposure High Risk Exposure
Outcome of Patient Risk Assessment Consider alternative diagnosis Malaria? EVD unlikely No High Risk Exposure Local investigations as normally appropriate No Risk
Outcome of Patient Risk Assessment Contact local ID clinician/ microbiologist & infection control Urgent laboratory investigations Notify Director of Public Health High Risk Exposure
EVD Test Result Positive NIU transfer NegativeRepeat* *Consider repeat EVD test if sample <3 days since onset of symptoms and no alternative diagnosis
High Risk Exposure If patient displays the following symptoms consider early transfer to NIU Fever AND any of the following: Severe headache Vomiting diarrhoea, abdominal pain Unexplained haemorrhagic manifestations in various forms Multi-organ failure