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Ebola Facts October 28, 2014 Identify, Isolate, Inform: ED Evaluation and Management The following diagram provides guidance on evaluation and management of patients who present to the ED with possible Ebola and reflects lessons learned from the recent experiences of U.S. hospitals caring for Ebola patients. • Risk of transmission depends upon likelihood patient will have confirmed Ebola combined with likelihood and degree of exposure to infectious body fluids. That risk also depends on the severity of disease. In addition, close contact with the patient and invasive medical care can increase opportunities for transmission. • In general, majority of febrile patients presenting to the ED do not have Ebola, and the risk posed by patients with early, limited symptoms is lower than from a patient hospitalized with severe Ebola. • But because early symptoms of Ebola are similar to other febrile illnesses, triage and evaluation processes in the ED should consider and systematically assess patients for the possibility of Ebola. • Healthcare facilities must implement administrative and environmental controls and provide onsite management and oversight on the safe use of PPE. Best practice would include continuous safety checks through direct observation of donning and doffing PPE. Source: Centers for Disease Control and Prevention. This guidance is current as of October 28, 2014 from http://www.cdc.gov/vhf/ebola/hcp/ed-management-patients-possible-ebola.html. Please see website for complete details. 10/28/14 Identify, Isolate, Inform: ED Evaluation and Management Triage Recommendations: • Relevant exposure history should be taken including whether patient has resided in or traveled to a country with widespread Ebola transmission or had contact with an individual with confirmed Ebola within the previous 21 days. • Patients who meet exposure criteria should be further questioned regarding symptoms compatible with Ebola including: fever, headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain, or hemorrhage. All patients should be routinely managed using precautions to prevent any contact with blood or body fluids. • If a relevant exposure history is reported and signs or symptoms consistent with Ebola Virus Disease are present, the following should be implemented IMMEDIATELY: • • • • Isolate patient and adhere to procedures designed to prevent transmission as outlined by CDC guidance. Only essential workers should provide patient care. All workers who contact patient should put on appropriate PPE based on the patient’s clinical status. Notify Hospital Infection Control Program and other appropriate staff and report to the local health department. Once appropriate PPE has been put on, continue obtaining additional history and performing physical examination and routine diagnostics. Decision to test patient for Ebola should be made in consultation with local health department. Source: Centers for Disease Control and Prevention. This guidance is current as of October 28, 2014 from http://www.cdc.gov/vhf/ebola/hcp/ed-management-patients-possible-ebola.html. Please see website for complete details. 10/28/14 ED Evaluation and Management Detailed views on next 2 slides. Source: Centers for Disease Control and Prevention. This guidance is current as of October 28, 2014 from http://www.cdc.gov/vhf/ebola/hcp/edmanagement-patients-possible-ebola.html. Please see website for complete details. 10/28/14 Source: Centers for Disease Control and Prevention. This guidance is current as of October 20, 2014 from http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html. Please see website for complete details. 10/28/14 Source: Centers for Disease Control and Prevention. This guidance is current as of October 20, 2014 from Source: Centers for Disease Control and Prevention. This guidance is current as of October 28, 2014 from http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html. Please see website for complete details. http://www.cdc.gov/vhf/ebola/hcp/ed-management-patients-possible-ebola.html. Please see website for complete details. 10/28/14