Since then, outbreaks have appeared sporadically in several African countries.

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2 Ebola Virus Disease (also known as Ebola Hemorrhagic fever) is a severe, often fatal disease caused by infection with a species of Ebola virus. The first Ebola virus species was discovered in 1976 in what is now the Democratic Republic of the Congo near the Ebola River Since then, outbreaks have appeared sporadically in several African countries. Based on evidence and the nature of other similar viruses, researchers believe that Ebola virus is animalborne and that bats are the most likely reservoir.

3 The 2014 Ebola outbreak is the largest Ebola outbreak in history and the first in the western region of Africa. The outbreak in West Africa is worsening, but CDC and other partners are taking steps to respond to this changing situation. In late July, 2014, 2 US healthcare workers who were infected with Ebola virus in Liberia were transported to a hospital in the United States. Both patients were released from the hospital after laboratory testing confirmed that they no longer have Ebola virus in their blood On August 8, 2014, the World Health Organization (WHO) declared that the current Ebola outbreak is a Public Health Emergency of International Concern.

4 The first case of Ebola diagnosed in the United States was reported to CDC by Dallas County Health and Human Services on and laboratory-confirmed by CDC on The patient had traveled to the US from Liberia on He originally fell ill on From to , there have been 6,574 total cases and 3,091 total deaths reported in Africa.

5 Sudden onset of fever greater than 38.6C or 101.5F Severe headache Muscle pain Vomiting Diarrhea Abdominal pain Rash typically occurs around day 5 Unexplained bleeding or bruising (bleeding manifestations occur in >50%) Early symptoms include sudden fever, chills and muscle aches Symptoms become increasingly severe as the disease progresses: mental confusion, bleeding inside and outside the body, shock and multi-organ failure The symptoms of EVD are not specific and are difficult to differentiate from other endemic or epidemic tropical diseases such as malaria, typhoid fever, etc. Laboratory confirmation is key!!

6 Persons are NOT contagious before they are symptomatic. However, the more symptomatic the patient, the more contagious the virus. The incubation period (the time from exposure until onset of symptoms) is typically 8-10 days, but can range from 2-21 days. In the current outbreak, approximately 90% of patients begin to display symptoms in less than 15 days. Case fatality ratio is approx. 55% for the current Ebola outbreak. In cases that proved fatal, the average time between symptom onset and death was 7 days

7 Ebola is spread through direct contact (through broken skin or mucous membranes) with blood or body fluids (including but not limited to urine, saliva, feces, vomit, swear, breast milk, and semen) of a person who is sick with Ebola or contact with objects (such as needles and syringes) that have been contaminated with these fluids. Healthcare providers caring for Ebola patients and the family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with the blood or body fluids of sick patients. The main source of spread is human-tohuman transmission Ebola is NOT spread through the air or water Avoiding contact with infected persons (as well as potentially infected corpses) and their blood and body fluids is of the utmost importance.

8 No specific vaccine or medicine (antiviral drug) has been proven effective against Ebola Previous observation was that serum from an Ebola survivor was therapeutic Symptoms of Ebola are treated as they appear. Basic interventions such as IV fluids, oxygen, etc. can significantly improve the chances of survival Experimental treatments have been tested and proven effective in animals but have not yet been tested in humans Zmapp, is an experimental treatment for use with persons infected with Ebola virus. The product is a combination of three different monoclonal antibodies that bind to the protein of Ebola virus. It has not yet been tested in humans.

9 Recovery from Ebola depends on the patient s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years. In patients that survived the virus, the average time from symptom onset to recovery was 15 days. Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months.

10 Healthcare providers are encouraged to: Ask patients about their travel histories to determine if they have traveled to West Africa within the last month Know the signs and symptoms of Ebola If patient has symptoms, properly isolate the patient Follow infection Control precautions to prevent the spread of Ebola. Avoid contact with blood and body fluids of infected people

11 CDC recommends standard, contact, and droplet precautions for management of hospitalized patients with known or suspected Ebola. Airborne precautions should be used whenever there is a risk of aerosol generating procedures.

12 Prompt screening and early recognition is critical for infection control. Any patient with a suspected case of Ebola needs to be isolated until diagnosis is confirmed or Ebola is ruled out. Patients should be placed in a single patient room (containing a private bathroom) with the door closed A log should be kept of ALL people entering the patient s room

13 CDC recommends a trained monitor actively observe and supervise each worker taking PPE on and off. This is to ensure each worker follows the step by step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any missteps in real-time and immediately address. Personnel should be limited in the isolation room Use only a mattress and pillow with waterproof plastic or other waterproof covering. Do not place patients with suspected or confirmed Ebola virus infection in carpeted rooms and remove all upholstered furniture and decorative curtains from patient rooms before use.

14 Hand hygiene should be performed before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Dedicated medical equipment (preferably disposable) should be used to provide patient care.

15 The tightened guidelines recommend no skin exposure when PPE is worn. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single use disposable full face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes: Double gloves Boot covers that are waterproof and go to at least mid-calf or leg covers Single use fluid resistant or impermeable gown that extends to at least mid-calf or coverall without intergraded hood. Respirators, including either N95 respirators or powered air purifying respirator(papr) Single-use, full-face shield that is disposable Surgical hoods to ensure complete coverage of the head and neck Apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea

16 Facilities should ensure that space and lay-out allows for clear separation between clean and potentially contaminated areas PPE removal should include: Disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment Disinfection of gloved hands should occur by using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.

17 Staff assigned to EVD patient care should not move freely between the EVD isolation area and other clinical areas All non-essential staff should be restricted from EVD patient care areas Limit the use of needles and other sharps as much as possible Phlebotomy, procedures, and laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and medical care All needles and sharps should be handled with extreme care and disposed in puncture-proof, sealed containers Avoid aerosol-generating procedures such as bronchoscopy, sputum induction, etc.

18 Disposable materials (such as single-use PPE, cleaning cloths, wipes, single-use microfiber cloths, linens, food service, privacy curtains and other textiles after use in the patient room should be placed in leak-proof containment and discarded as regulated medical waste. If re-usable equipment or PPE are used, they should be cleaned and disinfected according to manufacturer instructions and hospital policies. All waste generated during the decontamination process should be treated as infectious waste and placed in red biohazard bags

19 Heavy duty rubber gloves, impermeable gown and closed shoes (e.g. boots) should be worn when cleaning the environment and handling infectious waste. Add facial protection (mask and goggles/face shield) and overshoes is boots are unavailable when undertaking cleaning activities with increased risk of splashes or in which contact with blood and body fluids is anticipated. Environmental surfaces or objects contaminated with blood, other body fluids, secretions or excretions should be cleaned and disinfected as soon as possible using standard hospital detergents/disinfectants (e.g. 0.5% chlorine solution). Cleaning should always be carried out from clean areas to dirty areas, in order to avoid contaminant transfer

20 Linen that has been used on patients can be heavily contaminated with body fluids and splashes may result during handling When handling soiled linen from patients, use gloves, impermeable gown, closed shoes (e.g. boots) and facial protection (goggles or face shield) Place soiled linen in clearly-labeled, leak-proof bags or buckets at the site of use Container surfaces should be disinfected before removal from the isolation room/area If the linen is transported out of the patient room/area, it should be put in a separate container it should never be carried against the body If safe cleaning and disinfection of heavily soiled linen is not possible or reliable, discard the linen.

21 Wear heavy duty rubber gloves, impermeable gown, closed shoes (e.g. boots) and facial protection when handling infectious waste (e.g. solid waste or any secretion or excretion with visible blood even if it originated from a normally sterile body cavity. Goggles provide greater protection than visors from splashes that may come from below when pouring liquid waste from a bucket Avoid splashing when disposing of liquid infectious waste. Waste should be segregated at point of generation to enable appropriate and safe handling. Collect all solid, non-sharp, infectious waste using leak-proof waste bags and covered bins. Bins should never be carried against the body. Waste will be labeled with EBV written on the Biohazard label to identify EBV for the carrier.

22 Visitors who have been in contact with the suspected Ebola patient before and during hospitalization are a possible source of exposure for other patients, visitors and personnel; therefore, visitor access to patient s room should be restricted. Visitors should not enter the patient s room except in cases where it is essential for the patients well-being. All visitors should be logged Visits should be scheduled and controlled to allow for: Screening for EVD symptoms before entering or upon arrival to the hospital. Providing instruction before entry into the patient care area on hand hygiene, limiting surfaces touched, and use of PPE.

23 The duration of precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities

24 Persons with percutaneous or mucocutaneous exposures to blood, body fluids, secretions, or excretions from a patient with suspected EVD should: Stop working and immediately wash the affected skin surfaces with soap and water Mucous membranes should be irrigated with copious amounts of water or eyewash solution Immediately contact employee health and supervisor for assessment and access to postexposure management

25 Healthcare personnel in the United States should immediately contact their state or local health department regarding any person being evaluated for Ebola if the medical evaluation suggests that diagnostic testing may be indicated.

26 Facility leadership has responsibility to provide resources and support for implementation of effective prevention precautions. Management should maintain a culture of worker safety in which appropriate PPE is available and correctly maintained, and workers are provided with appropriate training. Designated on-site Ebola site manager responsible for oversight of implementing precautions for healthcare personnel and patient safety in the healthcare facility. Trained healthcare personnel: facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment. Oversight of practices are critical to ensuring that implementation protocols are done accurately, and any error in putting on or taking off PPE is identified in realtime, corrected and addressed, in case potential exposure occurred.

27 Safe Management of Patient with Ebola Virus Disease (EVD) in U.S. Hospitals Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response phe.gov Ebola Concerns in the Workplace MSDH Interim Ebola Virus Disease Quick Reference Guide