EBOLA

EBOLA VIRUS DISEASE

EVD, formerly called as Ebola hemorrhagic fever is a severe fatal illness that affects humans and animals.

The disease was first discovered in 1976, in a village near to a river known as Ebola River, located in democratic republic of Congo. Hence it got the name Ebola virus disease.

VIRUS

The disease is caused by the infection with Ebola virus, which has 5 subtypes, out of which 4 affects humans n animals and 5^th one affect only animals.

Ebola is a zoonotic virus and fruit bats are the likely host of Ebola virus.

OUTBREAK

 The largest and most complex Ebola outbreak occurred in 2014 in W.Africa and WHO has informed that nearly all of the cases were due to human to human transmission.

First travel associated Ebola was reported in US.

The recent positive cases of Ebola were reported in Texas who were 2 HCWs who provided care for Ebola +ve patient.

No positive cases are reported till now in GCC countries.

WHY IS EBOLA SO DANGEROUS?

It is because the disease can lead to impaired kidney and liver function.

It lowers the WBC and plt count which leads to decreased immunity n internal and external bleeding.

The fatality rate reaches up to 90%.

HOW EVD SPREADS?

Through contact with infected animals humans get the infection and later it spreads from one person to another.

The virus is transmitted through broken skin or mucus membrane by direct contact with the blood, or other body fluids or secretions.

It can also be transmitted by touching contaminated environment, cloths, linen, needles and through sexual contact.

Direct contact with deceased body also leads to disease transmission.

INCUBATION PERIOD

2 to 21 days

SIGNS AND SYMPTOMS

Fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, rash, impaired kidney function, internal and external bleeding.

DIAGNOSIS

ELISA, PCR, virus isolation, IgG n Ig M. in Kuwait it is done in Shaab.

History of travel.

TREATMENT

No definitive treatment.

Supportive care for dehydration – IVF, oral fluids, maintaining BP, O2 saturation.

No vaccine till now.

PREVENTION

Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola HF.

INFECTION PREVENTION AND CONTROL RECOMMENDATIONS by infection control directorate

1. Notification of suspected n confirmed cases
2. Triage

In casualty there should be separate triaging area.

At least 1 meter distance between patients with Ebola H.F. and other individuals

Waiting areas are adequately ventilated.

Patients should wear surgical mask.

Droplet precautions : for any patient known or suspected to have Ebola H.F

3. Hand hygiene

Hand hygiene is the single most efficient method to prevent ebola virus disease.

Follow the techniques of hand hygiene n 5 moments of hand hygiene.

Before touching patient, after touching patient, before clean or aseptic procedure, after body fluid exposure risk, after touching patient surroundings.

4.  Personal protective equipments (PPE)

HCWs, cleaners n porters, lab workers handling specimen, visitors

All persons upon entering the room of the patient and when handling blood, body substances, excretions and secretions should wear at least:

a.            Gloves

b.            Gown

c.             goggles

d.            Facemask

If exposure is more wear double gloves, leg cover. Wear before entering the patients room n discard in pts room.

For aerosol generating procedures wear N95 mask.

Order of wearing- gown, mask, goggles, gloves

Removing – gloves, goggles, gown n mask

While removing ensure that you are not touching the contaminated areas.

5.  Isolation of patients

Single room with doors should be always closed

Maintain log book of visitors

PPE

Doors should have contact n droplet isolation precaution sign

Male – psy female tb hosp

6. Duration of Infection Control Precautions
7.  Transport

      Avoid the movement and transport of patients out of the isolation room.

       Where possible, all procedures and investigations should be carried out in the isolation room.

       Minimal number of staff present during any procedures.

      Notify in advance the ambulance staff and staff of destination hospital.

      Transfer of only one patient in the ambulance at a time.

      The patient should wear a 'surgical ' mask if can be tolerated.

8. Patient Care Equipment- use disposable ones, if not sterilize properly.
9. Safe Injection practices

Follow policies for safe injection and Prevention and Management of Needle stick Injuries.

Phlebotomy should be minimized

All needles and sharps should be handled with extreme care and disposed in puncture-proof, sealed container, changed when 2/3^rd full, kept at eye level.

10.  Aerosol Generating Procedures

Avoid aerosol generating procedures for Ebola HF patients. Bronchoscopy, intubation, extubation. Use N 95 mask.

11. Monitoring and Management of Potentially Exposed Personnel
1. Stop working and immediately wash the affected skin surfaces with soap and water.
2.  Mucous membranes (e.g., conjunctiva) should be irrigated with copious amounts of water or eyewash solution
3. Immediately contact preventive medicine for assessment and access to post exposure management
4. Stop working for 21 days if symptomatic.
12. Visits- log books, check health status
13. Handling  Laboratory specimens – handle with care, PPE, leak proof containers
14. Environmental control and waste management

All waste disposed in clinical waste, use double bag, n sent for incineration.

All used items should be disposed- cloths, linen, mattress. If not disposable clean with precept.

Dispose mops n brush used for cleaning.

15.  Human Remains

No death care, only packing the orifices. Wear all PPEs.

No post mortem examination ideally. Buried immediately.

Use double sealed, leak proof cadaver bags.

Black sticker.