This communication provides an update to the October 17, 2014 Delaware Health Alert regarding the ongoing Ebola virus disease outbreak.
The epidemic of Ebola virus disease (EVD) continues to unfold. Particularly affected are the West African countries of Sierra Leone, Liberia, and Guinea; but travel related cases have also shown up in other areas including Dallas, TX, and New York City.
Because of increased monitoring of travelers instituted by DPH in conjunction with CDC’s Division of Global Migration and Quarantine, it is unlikely that patients responding “yes” to travel and/or exposure relevant to Ebola and complaining of symptoms will present to your non-hospital facility. Virtually all such patients would already be under monitoring by DPH.
There has been evidence of healthcare associated transmission of EVD in the United States, with two nurses who cared for a man with travel related EVD in Dallas, TX contracting the disease. Both nurses received immediate treatment and have recovered.
There has been no community (non-healthcare) associated transmission in the United States.
The epidemic continues to evolve. For an updated list of countries with ongoing high level transmission, visit the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html
Based on currently available information, Ebola virus is only transmitted by patients who have symptoms. Transmission occurs when a susceptible individual comes in contact with blood or other bodily fluids of an infected individual.
Symptoms of EVD occur after an incubation period of two to 21 days and include:
The Division of Public Health (DPH) is providing the guidance below to outpatient facilities including, but not limited to, urgent care centers and outpatient clinics, in order to help with triaging and handling patients who may have had potential exposures to Ebola virus.
For non-hospital settings in which invasive procedures and aerosol producing procedures are NOT performed, DPH is recommending the following for the care of persons suspected of having been exposed to Ebola: **
An easy to understand graphic for PPE removal is available at http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf?ua=1
The CDC also provides detailed guidance on PPE removal available at http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html AND http://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html
**For facilities performing invasive procedures or aerosol generating procedures, see next section
DPH recommends that outpatient/non-hospital facilities consider deferring non-emergency invasive or aerosol-generating procedures on individuals with history of travel to affected areas or history of exposure to known Ebola cases until at least 21 days have passed since their last potential exposure.
If aerosol generating procedures (such as nebulizer treatments) or invasive procedures must be done in an outpatient setting, DPH recommends that such facilities follow CDC guidelines for PPE use in hospital settings available at link below and that the number of staff involved in the procedure be limited to the minimum number that can safely be involved http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html.
When cleaning up after a suspected Ebola patient has been removed from your facility, you should follow CDC guidelines for cleaning available at http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html
Cleanup should be done by individuals adequately attired in appropriate PPE, with proper attention to careful removal of PPE, as is done for those who have cared for the patient.
Call the DPH Office of Infectious Disease Epidemiology 24/7 at 888-295-5156, including weekends and holidays.
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