Date post: | 22-Nov-2014 |
Category: |
Health & Medicine |
Upload: | seema-wasnik |
View: | 450 times |
Download: | 2 times |
Preparedness for Ebola Virus Disease
Dr.Diksha Bigamal , Dr. Saurav MitraDr. Seema Wasnik, Dr. M.D. Kaur
Dr. (Prof) Rajesh Sood
Introduction• EVD ( Viral Hemorrhagic Fever ) –a fatal disease in
humans & non human primates – monkeys, gorillas & chimpanzees.
• Family – Filoviridae, Genus – Ebolavirus• 5 species identified- ZAIRE ebola virus
Sudan ebola virus
Tai Forest virus
Bundibugyo virus
Reston ebola virus
EPIDEMIOLOGY• First outbreak – 1976 in Yambuku, Democratic
Republic of CONGO, near Ebola river.
• 1976-2012 – 24 outbreaks reported, Central Africa
• Current outbreak ( 2014) – largest as reported by WHO
• 8 August, the WHO declared the epidemic to be an international public health emergency.
• September , 2014 West Africa Ebola Outbreak - 2,000 deaths.
• Liberia, the most affected country, reported 200 new cases a week for the past three weeks.
CLINICAL FEATURES
• Incubation period: 2-21 days
• Stage I (non-specific): - diarrhea, nausea and vomiting, anorexia abdominal pain - headaches, arthralgia ,myalgia - maculopapular rash.
• Stage II (Specific): - Hemorrhage - anuria - sore throat, tachypnoea, dysphagia & hiccups
- multi organ failure
CLINICAL FEATURES• Differential diagnosis : malaria, dengue, typhoid
fever, shigellosis, rickettsial disease, thrombotic thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Kawasaki disease.
• Prognosis : high mortality rate: 50% -90%.
• Late complications : Arthralgia -ocular diseases - hearing loss - orchitis.
MODE OF TRANSMISSION
• Reservoir : fruit bats are natural hosts.
• Contact : blood , secretions, body fluids & carcasses of infected animals or infected person
• Needle pricks & sexual route
• No airborne transmission
HOW TO DIAGNOSE ??
• Signs & symptoms• H/o of travel to endemic zone• Contact with an infected person.
&
• IgM ELISA & Real time Polymerase chain reaction
Definitions :
Suspected case :
• h/o of travel • close contact with symptomatic person travelling from
EVD area in the past 21 days • fever ≥ 101˚ F , along with ≥ 1 :
- headache, bodyache
- diarrhoea, vomiting , abdominal pain
- unexplained hemorrhage.
Definitions :
• Confirmed case : above features & lab confirmed diagnostic evidence by any one of following :
-- ELISA
- Real time Polymerase Chain Reaction ( RT-PCR)
TREATMENT
• No specific treatment available.
• General supportive measures : adequate hydration, nutritional support & symptomatic treatment.
TREATMENT ( contd..)
• Experimental trials : Z Mapp and an RNA interference drug called TKM-Ebola.
• Two "promising" Ebola vaccines made by GlaxoSmithKline Plc and New Link Genetics
HOSPITAL MANAGEMENT
• Isolate the patient.• Follow universal precautions inc. PPE ( personal
protective equipment)• Restrict visitors• Avoid aerosol generating procedures• Implement environmental infection control measures• Proper disposal of biological wastes
Guidelines for hospital infection
control –
Sources : WHO & CDC
1. Direct patient care :
• Isolate the patient in a single room (door closed) with separate bathroom.
• Restrict entry to the EVD ICU.
• Maintain a log book.
• Use of Personal Protective Equipment is essential
• double gloving, Disposable shoe covers, leg coverings.
SINGLE PATIENT ISOLATION
ISOLATION WARD
LOG OF VISITORS IN ISOLATION AREA :
Date Name Service Time in Time out
12.8.14 Dr. Saurav Intensive care
9:30 am 10:00 am
12.8.14 Lokesh cleaning 10:15 am 10:45 am
12.8.14 Nalini staff Nursing care
11:00 am 11:20 am
Sequence for
Donning the PPE
Sequence for Removing PPE
• Remove the boots.
• Remove the inner pair of gloves.
• Remove inner layer of clothes / scrub suit.
• Wash hands with soap and clean water
Use of sharps
2. EQUIPMENT CARE
• Use disposable equipments.
• Non- disposable equipments -disinfected 10% sodium hypochlorite solution.
• Sample collection – properly labelled “ SUSPECT EBOLA “ in non –glass , leak proof containers.
Sample collection :
• ELISA - results within 5 to 6 hours
RT-PCR – results within 48 hours.
• Avoid routine blood samples in EVD suspected patients till report from NCDC is received.
• Wear 3 pair of gloves.
• Discard after sample collection
BLOOD SAMPLES
• Collect 4ml blood in EDTA vial• Wrap in tissue paper • Keep in triple layer sealed packed pouches• Send in leak proof ice boxes.• The HCW, transporting the sample wears PPE kit.
Lab Person
3. ENVIRONMENTAL CARE
• Objects contaminated with blood, other body fluids, disinfected - 1% Sodium Hypochlorite or 5% Lysol.
• Wear PPE while handling contaminated objects & linen
• Soiled linen –
treat with10%bleach,
place in labelled, leak-proof bags
4. Waste Management• Segregate waste for appropriate and safe handling.
• Separate HCW are designated for collection and disposal of infectious waste.
• HCW to wear (PPE) gloves, gown and closed shoes (e.g. boots) when handling solid infectious waste.
• Faeces, urine, vomit & liquid waste - disposed of in the sanitary sewer along with 500ml 1 %bleach.
• Every item which is in contact with patient like mask,I.v sets etc.- packed in double yellow bags, disposed by designated HCW.
• ICU floor ,walls, Ventilators, beds are mopped with 10 % bleaching solution when patients are not occupying the ICU.
Handling of dead body
- should not be sprayed, washed or embalmed
- wear PPE while handling.
- ritual practices should be avoided
- packed in double impermeable leak proof body bag
- burial depth – 1.5 m above ground water level with 1m covering of soil.
BURIAL OF DECEASED
Managing accidental Exposures
Accidental needle stick injury –
1. Immerse the exposed site in 70% alcohol for 20 - 30 seconds.
2. Wash with soap and clean water.
3. Flush the site in running water for 20 to 30 seconds.
4. Incident reporting.
Managing accidental Exposures
Follow up accidental exposures:
1. Regular monitoring - Body temperature twice daily.
2. If temperature ≥ 38.5˚C (101˚F) the health facility staff should be isolated as suspected case of VHF.
Initiatives at rml hospital
• Dr. RML hospital, New Delhi is designated as the nodal hospital, in Northern India for handling EVD patients.
• A control room for EVD outbreak is operating in the DGHS(Room No543-A,A Wing), Nirman Bhawan.
• Integrated disease surviellence Programme(IDSP) network is kept on alert to track passengers from EVD affected areas at airport.
• National Institute of Virology, Pune and National Centre for Disease Control (NCDC) , Delhi are geared to test samples for diagnosis of EVD.
Proforma for EVD suspect patients :
Specific questions
• Detailed h/o travel to the following African countries in the last 21 days : Liberia, Guinea, Sierra Leone and Nigeria.
• Detailed h/o contact with blood or body fluids of an EVD symptomatic patient or through infected objects.
Signs and Symptoms:• Date of onset of fever• Hemorrhages from gums / hematemesis /melena
epistaxsis/purpura/petechiae/eccymosis/any other specify?
• Headache/joint aches/muscle aches/diarrhea/vomiting/stomach pain
Condition of patient :Stable/Critical
Date of Collection of sample
• Total patients – 10.
• All tested negative.
One is never afraid of the unknown; one is afraid of the known coming to an end.
Thank you