Managing Ebola

[Glenys Harrington]

Dear All,

Last week I posted 2 responses in relation to managing Ebola on
another/similar list server.

I’m posting a summary of my responses and comments here by way of sharing
information/tips from my previous experience with a WHO Outbreak Team during
the SARS outbreak and locally with my Infection Control Team during the H1N1
outbreak.

Response 1

Managing Ebola – TRAINING is key!

Some points to consider:

. Team/s should be dedicated and voluntary – the voluntary aspect is
important!

. A voluntary team should include: nurses, medical, laboratory,
nursing supervisors/coordinators, environmental services staff, patient
services and hospital courier staff.

. Training needs to be simulated/scenario based (use florescent
markers) and needs to occur well before you receive your first
suspected/confirmed case.

. Stick with the basics – mandatory contact and droplet
precautions with ramped up PPE for aerosol generating procedures.

. Credential team members in donning and removing PPE.

. Have a buddy system in place for removing PPE.

. Have a mirror mounted outside the isolation room/s so staff can
see what they are doing when they are removing PPE.

. Train roving nursing supervisors/coordinators to monitor and
ensure compliance on all shifts (AM, PM , ND) in areas when
suspected/confirmed cases are being managed.

. Have a register in place (outside the room) to document/record all
staff who will be entering the room of a suspected/confirmed case – provide
team staff with a name stamp (so their name is legible in the register),
include date and time in the register.

. Monitor all staff entering the room (i.e. twice daily
self-reported temperature checks) from the first day of contact with a
suspected/confirmed case until 21 days after the last day of contact.

For non-designated receiving hospitals

. Consider training a voluntary dedicated team (i.e. nurses,
medical, laboratory, nursing supervisors/coordinators environmental
services, patient services and hospital courier staff) to cover a minimum
72hr rotation period in an ED Department(likely receiving area). Cover all
shifts – AM, PM, ND.

For designated receiving hospitals

. Train a voluntary dedicated team (as above) to cover a 4-5 week
rotation period for 4-6 suspected/confirmed cases or possible contacts.

. In this setting consider 2 – 3 site specific teams – one for the
containment unit/infectious disease ward, one for ED/receiving area and one
for ICU.

Response 2

Strategies to screen persons who may present to a GP practices

Here is a process to manage possible suspected or confirmed cases in the GP
setting:

a) Reception staff should ask every presenting person if they have travelled
recently (within the last 4 weeks)?

b) For those who have travelled ask them to complete a checklist which lists
Ebola affected countries.

c) Ask them to tick “yes” or “no”.

d) If “yes” triage” to any of the listed countries triage directly into a GP
consulting office/examination room of the practice

e) If “no” to all countries listed on the checklist triage into the waiting
room of the practice

Simple, easy, cost effective strategy. We used a similar strategy to screen
visitors to hospitals during the SARS outbreak.

In the GP setting travel history, triage and hand hygiene is what is the
most important in terms of screening.

regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

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