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Ebola Virus Disease

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Audrey Jennings

on 15 October 2014

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Transcript of Ebola Virus Disease

About Ebola
First discovered in 1976 near the Ebola River
Had 70 cases with 42 deaths
(This is now the Democratic Republic of Congo)
There were other sporadic outbreaks around Africa after that
Researchers believe that bats are the reservoir for the disease
Ebola Virus Disease
In the family

In the genus
5 strains of Ebola
4 are present in humans
other strains in primates and bats
Single stranded RNA virus
Very little is known about this virus and how it works
Ebola Virus
Most recent outbreak in West Africa
Liberia, Sierra Leone, Guinea, and Nigeria
As of October 8th there has been;
8,400 cases
4,033 deaths
4,656 laboratory confirmed cases
CDC and WHO have sent people to help
Recent Ebola Outbreak
Incubation period of 2-21 days
normally 8-10 days
Contracted from infected body fluids including: Blood, saliva, vomit, sweat, breast milk, vaginal secretions, and semen
Direct handling of bats or primates from areas with Ebola
Not as commonly seen in casual social contact
NOT spread airborne
Only contagious when patient is symptomatic
Spread quickly from country to country because of air travel
Early Recognition
Education of the public
Dispatch prearrival information
Limiting potentially infectious procedures
Proper disposal of infected materials
Proper burial techniques
BSI is the most important way to prevent the spread of Ebola
Gloves (may need to double glove)
Face shields
N-95 masks (minimum)
Full eye protection
Full Gown
May need boot covers and leg covers
Watch where/what you are touching with contaminated gloves
Personal Protective Equipment
Limit any activities/procedures that increase the risk of exposure
use of needles
This should only be for diagnostic techniques and medical care purposes
Very careful handling of sharps!
If you must do these, try to stop the ambulance first or wait until you reach the facility
Procedures to try and limit:
Clean your trucks regularly and effectively
If you have a suspected Ebola case:
Disinfecting ALL surfaces with 5% bleach or approved disinfectant
For bulk spills, remove gross material, clean the area, then disinfect the area
Contaminated reusable equipment will be disinfected by trained cleaner per manufacturer recommendations
Contaminated linens must be placed in biohazard and disposed of properly
All crew clothing and PPE will be disposed of in biohazard bags
Cot mattress, straps, and holders will be disposed of in biohazard bag
Wash your hands and self after the incident
Environmental Infection Control
Signs and Symptoms
Sudden onset of symptoms:
Fever greater than 101.5 F (38.6 C)
muscle aches
diarrhea (bloody)
vomiting (bloody)
abdominal pain
May also have:
Chest Pain
Shortness of Breath
Internal and external bleeding
Multi-systems failure
Potential for hemorrhagic fever
This disease is often fatal
If the patient has signs and symptoms of Ebola you should ask:
1. If they recently traveled from or lived in an area with an Ebola outbreak.
2. If they have been in contact with anyone who has been to a region with Ebola.
3. If they present any of the symptoms of Ebola.
You should also...

Notify the receiving facility about the possibility of an Ebola case
This allows for the facility to take proper infection control procedures
Any facility should be able to accommodate these precautions as long as they follow the infection control recommendations from the CDC
They will collect specific labs to test for Ebola
These tests would include:
testing for antibody levels
viral isolation
Currently no official treatment
Re-hydration via oral and IV routes
Treatment of specific symptoms
Two US doctors were "treated" with ZMapp
ZMapp is a clinical therapy developed by a private pharmaceutical company
This is still in primary clinical studies
Is a combination of 3 monoclonal antibodies that stick to the virus
Two vaccines currently going through clinical trials
These are still in primary stages
Infectious material in the mucous membranes is the most common mode of transmission!
Is Ebola in the United States?
Patient Assessment
Scene Safety
Pt may have delirium or have erratic behavior, this could increase the risk of infection
Look for signs and symptoms of Ebola
Make sure to check a temperature: Fever of 101.5 F (38.6 C) or greater should increase your index of suspicion
Ask about recent travel and/or contact with other people that have been to an Ebola region.
Deceased patients also require full BSI if you must come in contact with the body
If you are Exposed
Stop what you're doing immediately!
Wash the area with soap and water if any body fluid get on the skin
Irrigate the area with water for at least 20 minutes if mucous membrane are exposed
Report the exposure to the exposure control officer
Fever checks twice a day for the next 21 days
Had cases in 1992 and 1996 due to importation of infected green monkeys
First laboratory case of current outbreak in Dallas, Texas on September 28th
traveler from Liberia
Sought care at Texas Health Presbyterian Hospital of Dallas
Confirmed in 2 healthcare workers in Dallas
Another possible case in Hawaii, DC, and Boston
CDC is confident that the US will be able to contain this outbreak
Boards flight to US
Arrives in Dallas to visit family
Develops Symptoms
Seeks care and is sent home
Placed in isolation at Dallas Hospital
Lab confirms Ebola
Mon Tues Wed Thurs Fri Sat Sun
Social Impacts
People don't believe in the disease
Harming of healthcare workers
People are scared
Destruction of Hospitals
Refusal to help the sick
Sequence for putting on PPE
Gown first
Mask or Regulator
Goggles or face shield
How to Put on a Gown
Select appropriate size
Opening is in the back
Secure at neck and waist
If gown is too small, use two gowns
Gown #1 ties in the front
Gown #2 ties in the back
How to put on a Mask
Place over nose, mouth, and chin
Fit flexible nose piece over nose bridge
Secure on head with ties or elastic
Adjust to fit
How to put on a Particulate Respirator
Select a fit tested respirator
Place over nose, mouth, and chin
Fit flexible nose piece over the bridge of the nose
Secure on head with elastic
Adjust to fit
Perform a fit check-
Inhale- respirator should collapse
Exhale- check for leakage around the face
How to put on Eye and Face Protection
Position the goggles over the eyes and secure to the head using the ear pieces or headband
Position face shield over face and secure on brow with headband
Adjust to fit comfortably
How to put on Gloves
Put gloves on last
Select the correct size and type
Insert hands into gloves
Extend gloves over isolation gown cuffs
How to Safely use PPE
Keep gloved hands away from the face
Avoid touching or adjusting PPE
Remove gloves if they become torn
Wash hands before applying a new pair of gloves
Limit surfaces and items touched
How to Safely Remove PPE
Face Shield or goggles
Mask or Respirator
"Contaminated" and "Clean" areas of PPE
Contaminated- outside and front
Areas of PPE that are likely to have been in contact with infectious organism
Clean- inside, outside, ties on the head and back
Areas of PPE that are not likely to have been in contact with infectious organism
Where to Remove PPE
At doorway, before leaving patient room
Remove respirator outside room, after the door has been closed
How to Remove Gloves:
Grasp outside edge near wrist
Peel away from hand, turning glove inside-out
Hold in opposite gloved hand
Slide ungloved finger under wrist of the remaining glove
Peel off from inside, creating a bag for both gloves
How to Remove Goggles or Face Shield
Grasp ear or head pieces with ungloved hands
Lift away from face
Place in designated receptacle for reprocessing or disposal
Removing Isolation Gowns
Unfasten ties
Peel gown away from neck and shoulders-do not touch front of gown
Turn contaminated outside toward the inside
Fold or roll into a bundle
Removing Mask
Untie the bottom tie, then top tie
Remove from face
Removing a Particulate Respirator
First, lift the bottom elastic over your head
Then lift the top elastic
Hand Hygiene
Perform hand hygiene immediately after removing PPE
If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE
Wash hands with soap and water or use alcohol based hand rub
How it Works
Infects the macrophages and dendritic cells
Spreads through the lymph system
Impairs the adaptive immunity
inactivates dendritic cells
May kill neighboring cells causing
This causes necrosis
Causes systemic inflammatory syndrome which releases cytokines and chemokines
Then spreads to fixed macrophages in liver, spleen, thymus, and other lymph tissues
Causes coagulation defects
On November 8th this patient died
Full transcript