1. Training structure EFFO Safety and good quality work
Module 1: Ebola Virus Disease
Module 2:
Epidemic control on different levels
Module 3:
Standard precautions & disinfection
Module 4:
Screening & isolation
Module 5:
Personal protective equipment
Module 6:
Waste management & cleaning
Support from the community
Support from the hospital administration
Support from the population

2. Epidemic control on different levels
Module 2

3. Learning objectives module 2
General objective
To overview risks and strategies of epidemic control on international, national and community level
Specific objectives
To be able to identify critical localities during an epidemic
To realize the complexity of the overall strategy against an epidemic
To know the national strategy against an epidemic
To know the different areas of responsibility and tasks of the health personnel in case of an epidemic
To identify risky behaviors in the population
Note:
We will identify risky behaviour during a group activity after the presentation. 3

4. Risk factors in the event of an outbreak
Airports
Religious institutions
Society
Border crossings
Neighborhood …
Family
Local communities
Bus and train stations
Schools …
Health and social promotion centres …
Hospitals
Additional information
Outbreaks of VHF diseases are a significant public health problem.
Viruses can be found in different localities, therefore an interdisciplinary preparation and coordination is crucial – different critical localities are important (don‘t forget the people working there: e.g. custom officers, drivers, paramedics, funeral parlors,… )
Health workers should be aware of the complexity in order to communicate and educate patients in their own health structures.
Health workers are the local experts and should be aware of their role.
The preparation, warning, response and assessment of an outbreak is very complex and there must be a comprehensive strategy.
Outpatient department
Traditional healers 4

5. Health system and the focus of the EFFO project
Administrative side
Healthcare side
Treatment centres, University hospitals
World Health Organization (WHO)
Ministry of Health (MoH) / National Disease Control Institutions
District hospitals
Regional Health Directorate/ Regional Disease Control Services
Medical centres
Suspected case:
What to do?
Note
The pyramid is a general diagram and not specific to a country.
There is an administrative side and a healthcare side.
The health care side should contact the administrative side to engage the measures provided for in the national plan.
The health structures at the level of medical centres are the focus of the EFFO project.
Each level has a role in the general strategy against Ebola virus disease!
Positions at the interface of the administrative and the healthcare side must be filled.
Local Health Administration/ Rapid Response Team
Health and social promotion
centres 5

6. Four phases of epidemic control (WHO)
Overview of the general strategy
for Ebola virus disease (/ Marburg fever) according to WHO
Preparedness
Alert
Outbreak response and containment operations
Evaluation
before an epidemic
single cases / suspected cases
during an epidemic
after an epidemic
Additional information
According to WHO, the prevention strategy comprises four phases for VHF (esp. Ebola Virus Disease / Marburg Fever); this concept can be transferred to other outbreaks.
The EFFO-training’s focus lies on pre-epidemic preparedness in health structures (phase 1).
The preparedness of the treatment centres, the organisation of the ambulance for transfer, the preparations in laboratories are very important but not the responsibility of the health structure.
Literature
« Flambées épidémiques de maladie à virus Ebola et Marburg: préparation, alerte, lutte et évaluation » (INTERIM version 1.2.; Août 2014, OMS): /130161/1/ WHO_HSE_PED_CED_ _fre.pdf ;
« Ebola strategy. Ebola and Marburg virus disease epidemics: preparedness, alert, control and evaluation », August 014: 6

7. What should be done during the pre-epidemic phase?
Phase 1 (according to WHO):
Establishment of a surveillance system to identify viral hemorrhagic fever (VHF)
Measures against healthcare-associated infections
Health promotion programme
Collaboration with wildlife health services
(…)
Additional information
The establishment of a routine VHF surveillance system also includes the development of clear communication channels in the event of an outbreak, the installation of clear procedures for laboratory sampling, and the provision of a rapid response group
In general, the education and training of medical and paramedical staff plays an essential role in the pre-epidemic phase! 7

8. What should be done during the alert phase?
Phase 2 (according to WHO):
Investigate the suspected VHF case
Obtain laboratory results
Make a decision based on the laboratory results and investigations
(…)
Additional information
A multidisciplinary team (epidemiologist, clinician, laboratory specialist, possibly anthropologist, hygienist, geographer, veterinarian, ...) checks whether the suspected case is justified.
Local authorities should be involved at an early stage.
Initiate first measures to contain a possible outbreak (contact persons, mobilize resources ...)
Laboratory samples are examined in the national reference laboratory. 8

9. Confirmed case: What should be done in the control phase?
Phase 3 (according to WHO):
Immediately inform local, regional and national authorities about a confirmed case (→ Declaration to WHO)
Coordinate and mobilise resources
Clinical management of patients
Epidemiological investigation, surveillance and laboratory
Social and behavioural interventions
Media and communications
Psychological care and social welfare
Logistics and safety/ Environmental management
Research projects and ethical aspects …
Additional information
When there is a confirmed case, a comprehensive and multidisciplinary outbreak fight must take place.
The main participating structures in the hospital will be shown on the next slide. 9

10. Organisational structure of the response
Opinion leaders, Women, traditional healers, anthropological evaluation, formal and informal modes of communication, social / cultural practices
Frauengruppen, Kulturelle Praktiken, Anthropologische Studien, formelle und informelle Kommunikation
Infection control, Triage (in/out), Barrier nursing, organize funerals, clinical trials, Ethic committees
Behavioural and social interventions
Psychosocial support
Clinical case Management
Medias
Ethics
Coordination
Communication,
Press,
Journalists
Presse, Journalisten,
Duty of care, Research
Logistics
Control of vectors and reservoirs in nature
Epidemiological investigation, surveillance and laboratory
Security, Police, Lodging, Food, Social and Epidemiological mobile teams, Finances and Salaries, Transport and Vehicles
Transport, Finanzierung und Löhne, mobile Teams, Sicherheit, Unterbringung und Versorgung
Active case-finding, Follow-up of contacts, Specimens Laboratory testing, Database analysis, Search the source
Additional information
The figure illustrates the multidisciplinary approach of the various subcommittees used in activities against the Ebola virus disease epidemics.
This organizational structure can be used for the preparation of the health facilities.
Highlighted in red are the most important points for the healthcare facilities.
Literature
Graphic adapted from WHO: (page 42)
WHO

11. Responsibilities at the hospital (I)
Clinical case Management
Information on the suspected case
Isolation of the patient
Treatment
Transferal of patient in a treatment centre
Ethics
Ensure a symptomatic treatment
Ensure communication of patient with family
Epidemiology, Surveillance:
Documentation of contacts
Information for epidemiological teams
Clinical case Management
Ethics
Epidemiological investigation, surveillance and laboratory
Group discussion
Collect further important points with participants

12. Responsibilities at the hospital (II)
Psychosocial Support
Provide psychosocial support for the patient and his / her family
Receive psychosocial support from colleagues, family, community
Behavioural intervention
General hygiene measures in health institutions
Hygiene measures in community / in homes
Medias
Clear agreement who communicates with the press
Psychosocial support
Behavioural and social interventions
Medias
Group discussion
Collect further important points with participants 12

13. Responsibilities at the hospital (III)
Logistics
Choice of an appropriate place for a temporary isolation unit
Consideration of safety measures for the isolation unit
Storage of material for general hygiene measures
Storage of personal protective equipment
Waste-management
Organisation and training of a team who takes care of suspected cases
Set up of a list for communication and responsibilities (e.g. transferal of patients)
Form for investigation: case definition, list of contacts
Group discussion
Collect further important points with participants

14. Organisational structure of the response
Opinion leaders, Women, traditional healers, anthropological evaluation, formal and informal modes of communication, social / cultural practices
Frauengruppen, Kulturelle Praktiken, Anthropologische Studien, formelle und informelle Kommunikation
Infection control, Triage (in/out), Barrier nursing, organize funerals, clinical trials, Ethic committees
Behavioural and social interventions
Psychosocial support
Clinical case Management
Coordination
Medias
Ethics
Presse, Journalisten,
Communication,
Press,
Journalists
Duty of care, Research
Logistics
Control of vectors and reservoirs in nature
Epidemiological investigation, surveillance and laboratory
Security, Police, Lodging, Food, Social and Epidemiological mobile teams, Finances and Salaries, Transport and Vehicles
Transport, Finanzierung und Löhne, mobile Teams, Sicherheit, Unterbringung und Versorgung
Active case-finding, Follow-up of contacts, Specimens Laboratory testing, Database analysis, Search the source
Additional information
- All activities and responsibilities require structured and transparent coordination.
WHO

15. Contacts
The epidemiological investigation, monitoring and laboratory is very important for stopping the transmission chains.
Use of the current case definition
Draw up a comprehensive list of contacts for each suspected / confirmed case
Surveillance of all contacts for 21 days after the last exposure
Additional information
If you think a suspected case is possible in a patient, a list of contacts should be drawn up.
If necessary, the listed contacts should be monitored for 21 days.
Normally, it cannot be immediately known if any suspicious case will be a confirmed case (laboratory is needed).
The investigation team can produce the details because there are several classifications of contacts.
Source: RKI 15

16. Simultaneous processes during an outbreak
Contact tracing
Dealing with official forms …
Identification of suspected case
Isolation of patient
Patient care
Transferal of patient
External communication
With medias, family, social environment, community, …
Internal communication
Group discussion
Discuss key issues for the preparation of a health structure with participants, e.g.:
Can a patient be detected? (Knowledge and vigilance of personnel with emergencies, ...)
Can contact be avoided? (Patients are not close to others in the waiting area)
Has an isolation area been identified? (There is a prepared site and staff are aware of it)
Is there a team with PPE and who knows how to handle a suspected case? (They have undergone several training courses and know who to ask if in doubt)
Is the equipment ready (storage)? (PPE, mirror, bleach, access key, etc.)
Is internal and external communication well regulated?
Have responsibilities been clarified?
Is the use of the official form known? …

17. What should be done after the epidemic ?
Phase 4: Post-epidemic period (according to WHO):
Declare the end of the epidemic
Resume the activities of the pre-epidemic phase (phase 1)
Monitor recovering patients and social problems
Produce the end-of-epidemic report
Keep records on the epidemic
Evaluate the management of the epidemic … 17

18. Tasks during this training
Which case definition is being used in your health structure?
Is there a plan for communication?
Do you have a contingency plan in case of a suspected case?
The responses will be discussed during the next days. 18

19. Thank you for your attention!
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