1. Training structure 20.05.2015 Safety and good quality work Module 1: Knowledge about Ebola Virus Disease Support from the community Support from the hospital administration Support from the population Module 3: Standard pre- cautions Module 2: Community response Module 6: Water, disinfection and cleaning Module 5: Personal protective equipment Module 4: Triage & isolation EFFO Ebola

2. Triage & isolation Module 4 20.05.2015

3. Learning objectives module 4 General objective To understand the importance of triage and isolation and to be able to detect and isolate a suspected case of Ebola. Specific objectives 1.To understand the principle of triage 2.To be able to detect suspected cases of Ebola 3.To be able to isolate patients without running a risk 4.To be familiar with the structure of an isolation room 5.To know how to apply national information and case notification directives 20.05.2015

4. How can the transmission of EV be avoided? Sanitary structure Distance Isolation Is there a contagious patient? Triage: When patients arrive at the hospital: identify suspected cases of EV Isolation: Separate (suspected) cases of EVD from other patients 20.05.2015

5. Specific precautions Distinction between -CONTACT isolation -DROPLET isolation -AIR isolation AIR isolation is not necessary for Ebola! 20.05.2015

6. Triage: Entry preparations -Create an area for patient triage -> always maintain a distance of > 2m! -Protection -> protective equipment containing at least a mask, gloves and an overall -Triage equipment: Thermometer Questionnaire, case definition Surgical mask for patients where possible 20.05.2015

7. Triage procedure  Protection: distance, PPE  Always take temperature  Ask patients about their symptoms, people with whom they've been in close contact and recent travel  Alert, prepare isolation if a positive case is identified  Personnel for accompanying patients in isolation  Raising awareness for accompanying persons/family, etc. 20.05.2015

8. Defining pre-epidemic phase cases (OMS) During the pre-epidemic phase: routine monitoring PRESUMED CASES: Any person suffering from HIGH FEVER that does not respond to any conventional fever treatment in the region AT LEAST ONE OF THE FOLLOWING SIGNS bloody diarrhoeia gingival bleeding cutaneous bleeding conjunctivitic irritation haematuria CONFIRMED CASES: Presumed cases confirmed by laboratory AND 20.05.2015

9. Case definition - Pay attention to changes Case definitions may vary from one country to another. Here, the WHO-AFRO recommendation is used. → Always be familiar with national directives! During an epidemic, case definitions must be adapted to fit the situation at a local level. → Use the "case definition during an outbreak" – If the situation in the country enters the epidemic phase (where there is a confirmed case in the country) – If the patient has been in contact with a person suffering from EV (travel to a country where there is an epidemic, visiting a sick person, etc.) 20.05.2015

10. Case definition during an outbreak (WHO) SUSPECTED CASE: Any person DYING SUDDENLY for an UNEXPLAINED reason. Any person suffering from UNEXPLAINED BLEEDING. Any person suffering from a SUDDEN-ONSET HIGH FEVER and AT LEAST THREE OF THE FOLLOWING SYMPTOMS: headaches vomiting anorexia / loss of appetite diarrhoeia intense fatigue abdominal pain muscle or joint pain trouble swallowing trouble breathing hiccups Any person, whether alive or dead, currently or previously suffering from SUDDEN-ONSET HIGH FEVER, and HAVING BEEN IN CONTACT WITH - a suspected, probable or confirmed case of Ebola - a dead or diseased animal OR 20.05.2015

11. If there is a suspected case......what should you do? I have a fever and diarrhoeia I feel very ill I visited my sick aunt in Guinea two weeks ago 20.05.2015

12. What to do in the event of suspected EVD (I) Do not panic, remain professional and take the following actions:  Protect yourself: keep distance!  Explain to the patient and the persons accompanying them that you suspect EVD and that they need to be isolated in order to be treated or even have a sample taken by a specialist team;  Provide effective communication with the patient and the persons accompanying them, as well as with local authorities;  Isolate the patient in the isolation room available for that purpose;  Inform your direct superior immediately if you diagnose a suspected case. 20.05.2015

13. What to do in the event of suspected EVD (II)  Fill out the case notification form.  Before examining the patient or treating for the symptoms: Apply standard precautions and wear PPE.  Disinfect the consulting room where the patient was seen immediately with bleach before seeing other patients.  If the patient cannot move, health personnel must wear PPE and take them to the isolation area. Haemorrhagic patients must be carried and their wounds covered.  Do not take any samples for laboratory testing before the investigative team arrives. 20.05.2015

14. Isolation of patients  Isolate all patients meeting the case definition in a single room/area  If possible, arrange for separate areas for suspected cases and confirmed cases.  If possible, each patient should have their own room. 20.05.2015

15. Isolation: component parts  Preparing the establishment  At-risk areas; prototype for isolation  Responsibilities and communication  Administrative inspection 20.05.2015

16. Preparing the establishment  Isolated from other patients/staff movements  Well-ventilated  Sink and running water  Adequate toilets  Able to handle waste and laundry  Enough rooms for the expected number of patients  Contingency plan for transforming other areas into isolation areas 20.05.2015

17. Isolation principle (MSF) High-risk area RED AREA Low-risk area YELLOW AREA Patients Morgues Medical/care team Surface team Waste Incinerator Interior barrier Exterior barrier Isolation area GREEN AREA 20.05.2015

18. Prototype for an isolation site Entrance Exit Donning GREEN AREA Patient room RED AREA Decontamination YELLOW AREA GREEN AREA Patient entrance DISINFECTION STATION/ EQUIPMENT PATIENT'S BED WASTETOILETS WASTE 0.5 % BLEACH REUSABLE EQUIPMENT 0.5 % BLEACH GLOVED HANDS MIRROR 0.05 % BLEACH HANDS Personnel circuit direction! 20.05.2015

19. Always follow directions! RKI 20.05.2015

20. Responsibilities and communication  Division of responsibilities  Building and training different teams  Effective communication with teams  Specific intervention groups (transport, etc.)  Treatment centre 20.05.2015

21. Administrative inspection Limit and monitor contact points between the entrance and the isolation: -One single entrance -Guard to supervise the entrance -List of authorised persons (personnel and visitors) -Formal prohibition WITHOUT EXCEPTION -Limit moving/transporting patients outside the unit as much as possible -Minimise the number of staff in contact with cases 20.05.2015

22. Thank you for your attention! © leremy – Fotolia.com Copyright images 20.05.2015

23. Exercise: case studies - roleplay Cases 1 to 5 Group work Presentation Suspected case? 20.05.2015