Clinical Track – Day 1Located in Murdock

Ebola: Past, Present, Future

Ruth Carrico PhD RN FSHEA CICAssociate Professor

Division of Infectious DiseasesFounding Co-Director

Global Health InitiativeUniversity of Louisville School of Medicine

Objectives

• Update on current issues regarding the Ebola epidemic in West Africa

• Identify specific issues that are relevant for current practice

• Explore implications for the future after learning from past and present experiences

Ebola Hemorrhagic Fever

• Virus of the family Filoviridae, genus Ebolavirus

• Five known strains• No known treatment other than current

experimental vaccines• Care is supportive

Ebola: The Past

• 1976-2014– Outbreaks reported primarily in Uganda, DRC, and

Sudan– Most involving less than 100 individuals with the

outbreak self-limiting– Reports include butchering of bush animals and

contact with bats– Local customs and rituals associated with death

expose families and healthcare personnel

Ebola Outbreaks 1976-2014

Ebola Hemorrhagic Fever: Present

• Current outbreak is the largest in history and first outbreak in West Africa

• Causes disease in humans and nonhuman primates

• Five known Ebola strains with four causing human disease

• First known case 1975 in the DRC near Ebola river

• Reservoir is thought to be the bat

Present Impact

• As of September 25th

– Total case count: 6263– Total deaths: 2917– Laboratory-confirmed cases: 3487

• Primarily involving Liberia, Sierra Leone, Guinea, Nigeria, Senegal

• Cases reported in the Democratic Republic of the Congo are unrelated to the West Africa outbreak

Ebola: The Present

• Close contact with an infected person• Ebola is spread through direct contact with:

blood or body fluids (such as saliva, sweat, semen, stool or urine) of an infected person or animal or through contact with objects that have been contaminated with the blood or other body fluids of an infected person

Symptoms • The incubation period ranges from 2 to 21 days (most

commonly 8-10 days)• Early symptoms include sudden fever, chills, and muscle

aches.• Nausea, vomiting, chest pain, sore throat, abdominal pain,

and diarrhea may follow.• Rash occurs around day 5• Symptoms become increasingly severe mental confusion,

bleeding inside and outside the body, shock, and multi-organ failure.

• Only infectious when symptomatic• Increasingly infectious as the individual gets sicker

Treatment

• Standard treatment for Ebola HF is still limited to supportive therapy

• Experimental drug therapyZmapp, Tekmira

• Vaccines US, Canada

Infection PreventionKey Components of Standard, Contact, and Droplet Precautions Recommended for Prevention of EHF Transmission in U.S. Hospitals

•Patient Placement•Personal Protective Equipment (PPE)•Patient Care Equipment•Patient Care Considerations•Aerosol Generating Procedures (AGPs)•Hand Hygiene•Environmental Infection Control•Safe Injection practices•Duration of Infection Control Precautions•Monitoring and Management of Potentially Exposed Personnel•Monitoring, Management, and Training of Visitors

Environmental

Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus (8/19/14)

Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection.

Case Definition Person Under Investigation (PUI)

1)Clinical criteria, which includes fever and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; 2)AND Epidemiologic risk factors within the incubation period -contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; - residence or travel in an area where EVD transmission is active -direct handling of bats, rodents, or primates from disease - endemic areas.

Current Issues

• Lack of handwashing facilities and access to quality PPE is lacking in African outbreak

• Increasing humanitarian aid will likely result in infected HCP returning to US

• Returning HCP will go to their local communities for care upon their return– Handling of waste – Preventing exposure to other healthcare personnel– Preventing exposure to family members

Key Components for Infection Prevention

• Standard precautions• Prevent unprotected contact with blood/body

fluids of symptomatic individual• Proper use of PPE (selection, use, removal,

disposal)• Prevention of needlestick injury• Handling of blood/body fluids of infected

individuals• Willing healthcare workforce

Current Problems

• What to do with human waste of Ebola patients– Flush?

• What to do with the healthcare waste of Ebola patients– Incinerate? Red bag procedures?

• Laboratory specimen, to draw or not to draw?– Waste specimen disposal?

Ebola: the Future

• Provision of care in the US• Humanitarian aid in Africa• Travelers• Missionaries• International business• Stigma and abuse of international citizens• Economic impact on African nations• Bioterrorism/weaponization

Infection Prevention and Control Core Practices

• Leadership Support• Education and Training of Healthcare Personnel • Patient, Family and Caregiver Education• Performance Monitoring and Feedback• Standard Precautions• Hand hygiene• Personal Protective Equipment• Respiratory Hygiene and Cough Etiquette• Injection and Medication Safety• Transmission-Based Precautions• Preventing Cross-Contamination of supplies and Equipment• Environmental Hygiene and Disinfection/Sterilization of Equipment• Invasive Medical Devices• Occupational HealthHICPAC Document 2014

Alliant Management Services

Clinical Benchmarking Session

Refreshments are available in the hall.This session will begin at 3:20 pm

Remember to check out of your room before the General Sessions Thursday

morning.

Evening Event

Meet outside the Conference Center

at 5:30 pm for ahayride to the venue