1. Ebola Virus Identification, Isolation, Reporting, Management and
Occupational Safety
Maintenance/Engineering

2. PowerPoint
This module is viewed in PowerPoint. In order for maximum viewing, click on the slide show “indicator” on the toolbar directly below this slide (to the left of the percentages for the Zoom Bar). Once clicked press enter to advance the slides and the backspace bar to go back.

3. Course Details Target Group: Clinical employees
Prepared by: Jonathan M. Schouest, MPH, Infection Preventionist
Education Credit: Inservice credit to also include viewing CDC donning and doffing videos.
Key staff will be invited to engage in additional 1 hour sessions to demonstrate PPE Competency and receive CE credit.
Start Date: November 14, 2014

4. Disclaimer
If indicated by your job description and responsibilities or training, you may have been required (through prior notification) to view in advance a set of CDC produced videos on proper Personal Protective Equipment (PPE) donning and doffing. By completing this module, you are attesting that you have successfully viewed this set of instructional material in its entirety. If you have any questions or concerns about this material. Please address these to this facility’s Infection Control Department. 4

5. Purpose To Introduce Ebola Virus Infection Control, Environmental
Management and Ebola Specific Hospital Incident Command to
employees.

6. Learning Objectives
At the end of this module, employees should be able to:
Identify the basic characteristics of Ebola virus and its case
definition
Identify basic characteristics of the 2014 Outbreak and its
mode of transmission
Identify and demonstrate non-clinical methods of environmental
infection control for Ebola Virus
Identify and demonstrate strategies for personal hygiene and
occupational safety that reduce risk for contracting Ebola Virus
Generally describe protocol for identification, isolation
and notification for patients suspected of or confirmed to have
Ebola Virus
Describe the Hospital Incident Command System structure and
function as it relates to Ebola Virus Response
Describe correct protocol and role of maintenance/engineering in
the management of a confirmed or suspected Ebola patient.

7. Quick Ebola Factsheet Type: RNA virus Disease Type: Hemorrhagic Fever
Origin: 1976, Congo, Central Africa
Reservoir: Non-human primates, bats, other small mammals
Route of Transmission: Blood and body fluids, Droplets
Incubation Period: 2-21 Days
average incubation period: 8-10 Days
Case fatality Rate: 25-90%
average case fatality rate: (currently) 60-70%
Environmental survivability: 48 hours on an inanimate surface
Vulnerable to desiccation and disinfectant with FDA label claim
for non-enveloped viruses

8. Ebola Case Definition Case Definition for Ebola Virus Disease (EVD)
The CDC has defined two levels of definition for Ebola Virus disease, a Person Under Investigation, or a suspected case, AND a confirmed case. See definitions below:
Person Under Investigation (PUI):
A person who has both consistent signs or symptoms and risk factors as follows:
Elevated body temperature or subjective fever or symptoms, including severe
headache, fatigue, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage;
AND
An epidemiological risk factor (like a travel history to an outbreak country or contact
with a confirmed case) within the 21 days before the onset of symptoms.
Confirmed Case:
A PUI with laboratory-confirmed diagnostic evidence of Ebola virus infection
(a positive lab test)

9. Clinical Progression of Ebola
Source: Jonathan B. Perlin, MD, PhD and HCA Clinical Excellence Knowledge Center, 2014

10. Treatment of Ebola
There are no FDA approved treatments available for Ebola virus as of 10/23/2014.
Clinical management focus - supportive care of complications:
Rehydration, management of pain and management of other existing conditions and infections that may develop
Among patients from West Africa, large volumes of intravenous fluids have often been required to correct dehydration due to diarrhea and vomiting.
Several investigational medicines for Ebola virus disease are in development. There are no approved vaccines available for EVD.
Source: Centers for Disease Control and Prevention. Accessed Oct. 14, 2014

11. Geography of Ebola
The Ebola virus is currently devastating several countries in
West Africa including Sierra Leone, Guinea and Liberia
The following slide will illustrate these countries
Several cases have also been recorded in the US and elsewhere from returned travelers from these regions, as well as healthcare workers who treated these persons
It is important for all staff to stay informed about the
basics of Ebola Identification, and prevention
There have been no reported cases of Ebola in California

12. Countries with Widespread Transmission

13. Routes of Transmission
What does Contact with blood and body fluids mean?
Recognized Infectious body fluids for Ebola include
Blood
Sputum and spit
Vomit
Diarrhea
Sweat
Nasal secretions
Semen
You must have direct contact (skin-to-skin or skin-to-
contaminated surface) with these fluids to be considered
exposed

14. Routes of Transmission
What does Droplet transmission mean?
A droplet is a small drop of liquid (like from a sneeze)
that can travel up to three feet (or more if there is a breeze)
Droplets are usually greater than 10 micrometers in size
Droplets can be produced during a sneeze, cough or medical procedure.
Droplet transmission means that if you are close enough to a patient (without a mask) when he/she coughs, sneezes, etc. and you inhale some droplets that contain virus, you could be exposed.

15. Environmental Infection Control
What are some things that can be done to reduce Ebola transmission risk in the environment?
Wipe down surfaces with disinfectant wipes
If you are a member of housekeeping or handle food, wiping down all touched surfaces with appropriate disinfectant wipes as often as indicated
Not re-using disposable items (gowns, forks or plates, patient care equipment or cleaning equipment or supplies)
Respect Isolation Precautions and visitor restrictions
If a patient is in isolation, don appropriate Personal Protective Equipment (PPE) before entering the room and follow guidelines according to hospital policy
Store clean items separate from dirty items (this applies to both medical waste and food service activities)

16. Personal Infection Control
What can I do to protect myself and others from Ebola?
Hand Hygiene!
This is the single most effective prevention measure you can take in a work setting to protect yourself from not only Ebola, but almost all other infectious diseases
Even if you are unknowingly exposed to an Ebola patient, Hand Hygiene Is the easiest, fastest way to reduce the risk that you will develop the Disease.
Don’t come to work if you are sick
Promptly inform your supervisors of your symptoms and stay home to protect yourself and your co-workers
Respiratory Protection
Don’t hesitate to put a surgical mask on yourself or offer one to a patient or visitor if you or they are coughing or appear ill
Communicate with you Infection Prevention Department!
Fast communication with Infection Prevention and Control can limit the exposure of additional individuals in the case a suspected Ebola patient comes to Tulare.

17. Protocol
For non-clinical care staff, protocol has defined the steps of Identify, Isolate and Notify as important for employees to recognize in the process of management of a potential Ebola case, so lets explore each step

18. Protocol: Identify
Tulare is currently using CDC recommended, as well as specific algorithms to question patients seeking care at any of our facilities about their symptoms and travel history
These questions determine if the patient will qualify as a Person Under Investigation (PUI)
In your regular responsibilities, if you happen to encounter a person who has traveled within the past 21 days to Liberia, Sierra Leone, or Guinea and is showing symptoms consistent with Ebola, inform your supervisor as soon as possible
This guideline applies whether or not this person is a employee or is currently seeking care at Tulare.

19. Protocol: Isolate
By contrast, if a person suspected of having Ebola is encountered outside of a clinical area (like in the waiting room) staff should take the following steps to limit exposure and isolate, keeping in mind the necessary factors (travel history and symptoms) that must be present to qualify a person for evaluation for Ebola.
Isolate the patient in place (like in the nearest unoccupied room), and reassure them that clinical staff will be there shortly to evaluate them
Immediately inform nearest clinical staff and your supervisor, they will activate the emergency response which will transport the patient to the designated treatment area for evaluation
Inform security to secure any areas where the person was or may have been and gather names and contact numbers of as many people who were in that area as possible, the emergency response will collect this information from you and continue the process for the local Health Department.

20. Protocol: Isolate
Tulare is currently using CDC recommended isolation procedures and has Designated an Ebola Evaluation and Treatment Zone (DEETZ) in which to isolate and treat suspected or confirmed cases, while the rest of the facility can function as normal.
This Zone is located in ER 2 and encompasses the ER entrance and adjacent hallway and offices to ER2
If a suspected Ebola patient is identified, this zone will be secured and only designated staff will be allowed access.
Tulare has also designated a Hospital Ebola Response Team who will be the clinical staff responsible for rapid response and clinical care of a suspected case.

21. The Red circled area is designated as the DEETZ. As you can see,
while this area is isolated, the rest of the hospital, including Ambulance
entrance may function as normal. Maintenance/engineering will be responsible
for ensuring the continuing function and maintenance of this area during a
lockdown for patient evaluation

22. Protocol: Notify
Once you have been notified (or notify a supervisor in the case you encounter a symptomatic person) of a potential or confirmed Ebola case, the Hospital Incident Command System (HICS) will be activated and assume coordinating activities for Tulare’s response
So what is the HICS?
HICS is a systematic plan for assigning job roles and coordinating a response to a hospital disaster that is used by all hospitals in the US
HICS has been tested at Tulare using drills on an annual basis
In the case of a suspected Ebola patient, HICS will be activated and will coordinate all major functions of the hospital (including isolating and treating the patient), and whether or not the hospital can continue to function as normal.
It is important that if the HICS is activated for an Ebola patient, you follow all instructions given by HICS personnel and your supervisors to ensure an effective response to the situation.

23. Protocol for Services
Engineering/maintenance plays a very important role in the Ebola response. Specifically, maintenance will be called upon to:
Ensure the functioning of all equipment within the DEETZ before a patient is brought there for evaluation. (time allowing)
Ensure the DEETZ is capable of being secured and all entrances locked by security if the zone must be locked down
Collaborate with IT personnel to set up reliable communications between the Ebola care team and the rest of the hospital, local public health authorities, and the patients themselves.
Alter environmental controls for the Ebola treatment zone as required medically and by the clinical care team
Any other task within the scope of maintenance/engineering as ordered by the Hospital Incident Command personnel
Continue normal maintenance and engineering activities while the rest of the hospital continues to function
The altering of environmental controls for medical or Ebola care team reasons deserves special attention so lets explore this in detail

24. Why Alter Environmental Controls
An Ebola Patients’ condition can change very quickly
Such clinical change can require a quick response from the clinical staff, including the use of extensive personal protective equipment (PPE)
This personal protective equipment can become very hot after working for some time
lowering the temperature of the DEETZ treatment area can increase the comfort of the staff working there and allow them to work with the patient for longer
Potentially, this lower temperature can also benefit the patient through increased vasoconstriction!