Ebola: Healthcare resources for preparedness and response

CDC Emergency Operations Center (EOC) for hospitals and health departments: 770-488-7100 or via email at eocreport@cdc.gov
CDC Ebola Hotline – for medical personnel to be connected to public health experts, call
800-CDC-INFO (800-232-4636)

2014 West Africa outbreak

The 2014 Ebola outbreak is one of the largest Ebola outbreaks in history and it is affecting countries in West Africa, including Guinea, Liberia, Nigeria, Sierra Leone, and Mali. As of January 23, 2015, there have been 21,797 cases and 8675 deaths. There have been two imported cases, including one death, and two locally acquired cases in healthcare workers have been reported in the United States (details on cases).

Transmission

A person infected with Ebola virus is not contagious until symptoms appear. The virus is spread through direct contact (through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth) with the blood or body fluids such as, but not limited to, feces, saliva, urine, vomit, and semen of a person who is sick with Ebola, or with objects like needles that have been contaminated with the virus, or infected animals. Ebola is not spread through the air or by water or, in general, by food.

Healthcare worker risks

In healthcare settings, Ebola is spread through direct contact (e.g., through broken skin or through mucous membranes of the eyes, nose, or mouth) with blood or body fluids of a person who is sick with Ebola or with objects (e.g., needles, syringes) that have been contaminated with the virus.

For all healthcare workers caring for Ebola patients, personal protective equipment (PPE) with full body coverage is recommended to further reduce the risk of self-contamination. To protect healthcare workers during care of an Ebola patient, healthcare facilities must provide onsite management and oversight on the safe use of PPE and implement administrative and environmental controls with continuous safety checks through direct observation of healthcare workers during the PPE donning and doffing processes.

PPE guidance

CDC has provided updated guidance on PPEs , including the type of PPE to be used and on the processes for donning and doffing (i.e., putting on and removing) PPE for all healthcare workers entering the room of a patient hospitalized with Ebola virus disease (Ebola). The guidance in this document reflects lessons learned from the recent experiences of U.S. hospitals caring for Ebola patients and emphasizes the importance of training, practice, competence, and observation of healthcare workers in correct donning and doffing of PPE selected by the facility.

Early recognition

Early recognition is critical to controlling the spread of the Ebola virus and all healthcare personnel must be alert in evaluating patients for possible Ebola virus disease.

Inquire about travel to West Africa 21 days before illness
Early recognition includes vigilance in inquiring about a history of travel to West Africa 21 days before illness onset for any patient presenting with fever or other symptoms consistent with Ebola.
Evaluate for Ebola symptoms
The symptoms of possible include fever, myalgia, severe headache, abdominal pain, vomiting, diarrhea, or unexplained bleeding or bruising. If the patient reports a history of recent travel to one of the affected West African countries (Liberia, Sierra Leone, and Guinea) and exhibit such symptoms, immediate action should be taken to isolate the patient and notify the local-state health department.
CDC Ebola traveler evaluation algorithm and checklist
CDC has provided an Ebola algorithm for evaluation of returned traveler and Ebola checklist to evaluate a patient for Ebola .
Isolate if positive travel history and Ebola symptoms
Isolate patients who report a travel history to an Ebola-affected country (currently Liberia, Sierra Leone, and Guinea) and who are exhibiting Ebola symptoms in a private room with a private bathroom and implement standard, contact, and droplet precautions. Review and implement the CDC’s updated (Oct 20, 2014) Guidance on PPD to be used by healthcare workers during management of patients with Ebola virus disease in U.S. hospitals, including procedures for putting on (donning) and removing (doffing)

Assess your hospitals readiness for accepting Ebola patients

CDC has provided a Detailed hospital checklist for Ebola preparedness to review your organization’s overall readiness for accepting Ebola patients

Role of environment

The precise role of the environment in transmission has not been established. However, Ebola virus can remain viable on solid surfaces, with concentrations falling slowly over several days. Given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity, higher levels of precaution are warranted to reduce the potential risk posed by contaminated surfaces in the patient care environment. As such, CDC has provided guidance for environmental control in hospitals that includes the use of personal protective equipment and appropriate US EPA-registered hospital disinfectant Hospitals also should have the capability to request diagnostic tests or prepare samples for shipping and testing elsewhere.

Supply and chain and PPE procurement

Supplies from Premier contracted suppliers: A list of personal protective equipment (PPE) and other supplies, as well as information about ordering and availability from Premier’s contracted suppliers is provided for members on PremierConnect® (password required).
CDC: Best practices for procuring personal protective equipment for Ebola response (Oct 20, 2014) CDC’s guidance for Personal Protective Equipment (PPE). HHS has been working closely with PPE manufacturers and distributors in order to maintain visibility on availability of PPE.