2. OUTLINE
• Objectives of the training
• Update of EVD outbreak in Uganda
• Overview of EVD
• Case management and infant feeding in the context of EVD
• Surveillance for EVD
• Data management
• Risk Community and Community engagement
• Sample management
• Infection prevention and Control: Donning & doffing
• Psychosocial support
• Logistics
• Way forward
4. Objectives
General Objective
• To build capacity for country preparedness to potential Ebola Virus
Disease (EVD) outbreak
Specific Objectives
• To update participants on the ongoing EVD outbreak
• To orient participants on the available knowledge, policies,
guidelines, strategies and tools for prevention and control of EVD
5. Expected Outcomes
At the end of the training participants,
• Will be updated on the ongoing EVD outbreak
• Will appreciate the risk that the country faces
• Be knowledgeable about EVD
• Will be familiar with the current policies, guidelines, strategies and
tools for EVD prevention and control
• Will be able to detect and appropriately manage/respond to Ebola
cases (suspect or confirmed)
• Will be able to identify and resolve gaps in their respective areas
8. Situation update of Uganda EVD
outbreak
• Uganda confirmed the EVD Outbreak on 20th Sept 2022
• First time in decade Sudan Ebola virus reported
• By October 27th October 2022
• Total of 7 districts affected, 9 districts with contacts on follow up
• Total of 121 confirmed cases
• So far 32 deaths, CFR 26%
• Health workers: 15 cases and 6 deaths
• Recoveries 35
• Cumulative contacts listed 1922
• Outbreak more towards DRC than Kenya, risk still exists
10. EVD Risk assessment
•There is risk of EVD spread to Kenya owing to the enormous human traffic between
Kenya and Uganda through:
•The Busia and Malaba ground crossing points
•JKIA, KSM, ELD and MSA international airports
•Heavy population of Ugandan citizens in Kenya (Nairobi, Kajiado and Kakuma)
•Owing to these risks, Kenya needs to implement effective measures to prevent the
EVD outbreak spreading into the country including:
•Stepping up surveillance for detection
•Preparedness for appropriate response
11. High risk counties List of counties
1. Busia 20. Uasin Gishu
2. Nakuru
3. Kiambu
4. Nairobi
5. Machakos
6. Makueni
7. Taita taveta
8. Mombasa
9. Kwale
10. Kericho
11. Bungoma
12. Kakamega
13. Siaya
14. Migori
15. Homa Bay
16. Kisumu
17. Trans Nzoia
18. West Pokot
19. Turkana
12. Despite the above risk map a
case can be reported in any
part of the country!
13. Training plan
• National TOTs trained: 24th to 26th October 2022, 83 pax trained
• CHMT training: 20 high risk counties (8 pax per county 1 per pillar)
• Pillars: co-rdination, case management, surveillance, IPC/WASH,Data management,
RCCE, Community mobilization)
• SCHMT: Scheduled for 3rd to 4th November 2022
• Only 10 counties, financing gaps
• SCHMT training venue: County headquarters
• Eight pax per sub county as per above pillars
• Ten counties : Busia, Kisumu, Migori, Homa bay, Siaya, Kakamega, Tran Nzoia,
Turkana, West pokot, Bungoma and Nairobi
• Same training material and agenda
• Other counties/SCHMT will train as funds are mobilized
16. Presentation Outline
• Etiology and history of EVD
• Mode of transmission of EVD
• Clinical presentation
• Diagnosis of EVD
• Treatment and Prevention of EVD
17. Introduction
• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a
severe acute viral illness
• A disease of humans and non-human primates (Zoonosis)
• It is often fatal with up to 90% fatality
• Outbreaks have appeared sporadically since initial recognition in 1976 in DRC
• Currently Uganda has reported cases
20. History of EVD
• Ebola first appeared in 1976 in
2 simultaneous outbreaks
1. Nzara, Sudan
2. Yambuku, Democratic
Republic of Congo
Yambuku DRC Congo 1976
23. Natural hosts and Mode of transmission
of Ebola Virus
• EVD is believed to be a zoonotic disease
• Certain species of fruit bats are considered possible natural hosts for
Ebola virus
• Not clear how an Ebola outbreak is initially started but it is believed to
occur when humans come in contact with infected animal’s body fluids
or flesh
24. Modes of transmission
• Infection of index case(s) from
bush animals
• Animal found dead in forest or
hunted
• Chimpanzes, gorillas,
monkeys, antelopes, fruit bats,
porcupines
• Thence transmission from
person to person
26. Human to human transmission
• Directly through:
• Contact with blood or body fluids of infected persons
• Contact with bodies of Ebola victims during embalming or
unsafe burials
• Indirectly through:
• Contact with unsterilized medical instruments
• Sharing of contaminated piercing instruments
• Male survivors can transmit the virus for close to One year
through semen after recovery
• Amplification: Where transmission is amplified
• Hospital: health care workers, in-patients, unsafe injections
• Community: household contacts when caring for ill, funeral
27. Ebola transmission risk from body fluids
• Infected people are not contagious until symptomatic
• Viral load and infectiousness of body fluids increases as patient become
more ill
• Women at more risk as they often care for sick
• Dead body highly infectious 🡪 many people infected by traditional burial practices
• Important to educate survivors about transmission risk from other
compartments:
• Can persist in the semen up to 3 months after clinical recovery
• Persists in breast milk in convalescent patients
• Take precautions with contaminated items including bed sheets and
used needles
28. Ebola Pathogenesis
• Enters bloodstream through
skin, membranes, open
wounds
• Viral RNA
• Released into cytoplasm
• Production of new viral
proteins/ genetic material
• Capable of rapid mutation
• Very adaptable to evade
host defenses and
environmental
change/challenges
Copyright: Russell Kightley
Media, Australia
29. Early signs and symptoms
• Incubation period 2 to 21 days
• Initial clinical manifestations are non-specific and mimic many
common infections—makes early diagnosis difficult!
• Fever, chills
• Headache
• Joint pain, muscle pain, backache
• Nausea, vomiting
• Diarrhea
• Fatigue/weakness
• Sore throat, cough
30. Late Symptoms
• Bleeding:
• From eyes, ears, nose, mouth, anus
• Seen in less than half of patients with Ebola
• Eye inflammation (conjunctivitis)
• Depression
• Increased feeling of pain in skin
• Rash over whole body that often contains blood
• Roof of mouth looks red
• Seizures, coma, delirium
• Patients usually die from shock rather than from blood loss
33. Diagnostic tests
• Early diagnosis very difficult as signs & symptoms similar to other
infections
• Laboratory Test
• PCR detection
• ELISA (enzyme-linked immuno-absorbent) assay
• Tests done in biosafety level 3 or 4 labs
• KEMRI or other designated reference labs e.g CDC,NPHLS etc
• Not possible or viable or necessary to have multiple testing centers
in the country for now
34. Treatment
• No curative treatment available
• Only supportive therapy
• Treating complicating infections
• Addressing fluids and electrolyte imbalances
• Maintaining oxygen status
• Maintaining blood pressure and circulation
• Maintaining nutrition needs
• Management of pain
• Treating fever
35. Who is at risk of infection?
• Travelers to affected countries/localities
• Contacts of such travelers
• Family members of EVD cases
• Health workers (HWs) taking care of patients with Ebola
• People handling bodies of Ebola victims
• People handling bush animals
36. Ebola prevention and control in health
settings
• Early identification and prompt referral and isolation of
suspect cases
• Basic universal precautions of hand hygiene and gloving in
health set-ups during routine work
• Wear full personal protective equipment when handling
cases (suspect or confirmed)
• Avoid contact with body fluids of suspect cases
• Handle well specimen taken from Ebola
• Handle appropriately and immediately burry bodies of
Ebola victims
• Vaccines are available
37. Ebola prevention and control in the
community
• Avoid bush meat to reduce wild life to human transmission
• Early identification and prompt release of patients to HFs
• Avoid unnecessary contact with human beings during
outbreaks
• Avoid home care of patients who have any illness
• Surrender bodies of Ebola victims to trained HWs for
appropriate handling and immediately burial
• Avoid risky cultural practices e.g. care for sick, dead and
funeral practices
38. Prevention and Control
Other considerations
Other prevention and control considerations include:
• Early diagnosis and reporting of suspect cases
• Early referral for treatment and laboratory testing
• Increased awareness in the community
• Awareness and high index of suspicion among HWs
• Contact identification, tracing and follow and effective epidemiological
surveillance
39. Intervention Strategies
• Support cases in care unit / isolation
• Reduce the transmission
• Control of the epidemic
• Reduce mortality / suffering of patients
• Monitoring / tracking and tracing contacts
• Identification of transmission chains and followup of possible new cases
• Public awareness campaign
44. Objectives
The primary objectives of patient care are to:
• Maximize the patients’ chances for full recovery from illness.
• Provide care in a manner that minimizes the risk of disease
transmission.
• Reduce suffering and restore patients’ dignity
45. Exposure history
►Provided care to the sick.
►Family members or close friends who are sick or recently died.
►Recently attended a funeral or was exposed to a corpse
►Had specific contact with EVD convalescent patients
►Entered into caves/mines or had other exposure to bats
►Unprotected sexual contact with a male survivor,
breastfeeding from a female survivor who was lactating during
her illness, or attended the delivery of a woman who was
pregnant during her illness.
47. Initial assessment
• The initial physical patient examination detects signs of severe
illness, early signs of shock and determines initial medical therapy
• Vital signs (temperature, blood pressure, respiratory rate (for 30
seconds), heart rate (for 30 seconds), pulse oximetry, pain, weight)
• General condition
• Mental status alterations (Glasgow Coma Scale score < 15 or
AVPU)
• Peripheral pulses and capillary refill
• Evaluation of dehydration
• Hemorrhagic signs.
48. EVD patients can generally be sorted into 3 clinical
status categories
• Stable and able to eat/drink.
• Stable and unable to eat/drink sufficiently.
• Unstable: danger signs of end organ dysfunction
• ADULTS:
• Systolic blood pressure ≤ 100 mmHg
• Altered mentation: GCS< 15
• Tachypnea (RR ≥ 22 respirations/min)
• Weak rapid pulse (> 100 bpm)
• Oliguria or anuria (urine output <0.5 ml/kg/hour on average, or
assessed qualitatively by asking, “did you pass urine yet today?”)
• Other objective signs of severe dehydration including severe
weakness, sunken eyes, sunken eyes, etc.
49. Patient monitoring
• For any patient with suspected fluid deficit, signs of shock, or
other form of severe EVD monitor hydration status:
• Fluid inputs and outputs to the extent possible. Simple intake
estimation aids can facilitate this (ORS bottles with easily visible
volume gradations, etc.).
• If stool volume cannot be measured, monitor stool frequency.
• In the severely ill patient, monitor urine output using a urinary
catheter.
• Monitor mental status and overall condition:
• EVD patients may exhibit disorientation, confusion, delirium, and,
infrequently, seizures due to direct viral effects or their
complications on the central nervous system (encephalopathy,
biochemical/physiologic disturbances….)
50. Patient management
i. Systematic care: empiric treatment for every patient
upon admission for possible coinfections and/or
preventable illness.
ii. Symptomatic care: relief from suffering linked to EVD
(pain management, gastrointestinal effects and anxiety).
iii. Supportive and critical care: support maintenance of
normal physiology for stable and unstable patients
(respiratory failure, renal failure, bleeding abnormalities,
neurological dysfunction, confusion and delirium).
iv. Specific care: directly targets the virus and viral
replication.
v. End of life care: no longer aimed at curing patient but
focusing on comfort, symptom relief and quality of life.
52. Symptomatic care
• Pain control-
• PCM or opioids. NO NSAIDS
• GI symptoms-
• diarrhoea and vomiting-ondansetron
• Hiccups
• Chlorpromazine, haloperidol
• Anxiety
• diazepam
53. Supportive and critical care
• Haemodynamic support and fliud management
• ORS
• IV fluids
• Vasopressors
• Correction of biochemical abnormalities
• Hypokalaemia
• Hyperkalaemia
• Hypoglycaemia
• Respiratory failure- iatrogenic, acidosis
54. Supportive and renal failure
• Renal failure-pre renal and intrinsic renal causes.
• Bleeding abnormalities- less than half and is not significant.
Coagulopathies not be solved by transfusion.
• Neurological dysfunction- Acidosis and electrolyte disorders
(including hyponatremia), Hypoglycemia, Hypo-perfusion, Viral (or
immune-mediated) encephalitis, Iatrogenic pharmacotherapy
• Confusion and delirium
• Nutritional support
55. End of life care
• Ensure ways of making the patient more comfortable during the process
of dying via pain relief, comfortable mattresses, patient hygiene, patient
positioning, etc.
• Honor requests for cultural, spiritual and religious rituals.
• Provide emotional support and accompany the family (the unit of care is
patient + family).
• Discontinue any unnecessarily monitoring, devices, testing, and
treatments that do not provide comfort.
• Accompany the patient in his/her last moments, if possible.
• Dyspnoea
• Death rattle
56. Children
• Children are less able to engage in their own care.
• Their normal behavior patterns place them at greater risk in a ETU
environment (limits on movement, interaction with other patients,
avoidance of exposure to infectious material, etc.).
• They may not understand or respect these restrictions designed for
their safety.
• They require more staff presence, time, and supervision than adult
patients. EVD survivors may help taking care of children inside the
ETU.
57. Pregnant women
• The focus of pregnant EVD patient management is maternal
survival.
• Every known pregnancy has, however, resulted in either an in-
utero death or a neonatal death shortly following delivery, with
one exception (that received experimental therapeutics)
58. Convalescent patients
• Patients who begin to recover from their disease are likely to
survive.
• Plausible causes of death include arrhythmia and massive
pulmonary embolus. Examination of electrolytes and monitoring
patient lower extremities for signs of deep venous thrombosis is
advisable as patients are recovering.
59. Discharge
• Patients are discharged if they are determined to be non-
cases (EVD laboratory results) or following recovery from
illness.
• Non-cases should be followed daily as contacts for 21 days
post-discharge as their time in the ETU has placed them at
risk of a nosocomial filovirus infection.
60. Viral persistence
• Amniotic fluid- upto 1 month
• Breast milk- upto 10 days
• Intra ocular fluid- upto 2 months
• Semen- upto 1 year
• CSF- traces
61. Management of
Infant and Young Child Feeding
recommendations in the context of Ebola Viral
Disease (EVD)
62. Infant and Young Child Feeding and EVD
❑ Ebola is transmitted via body fluids, including
breast milk.
❑ A breastfeeding mother with symptoms of Ebola,
increases the risk of transmission to the baby.
❑ The safest feeding option for infants less than 6
months of age whose mothers are confirmed
positive for Ebola is Ready-to-Use Infant
Formula (RUIF).
❑ Measure amounts based on the infants' body
weight.
❑ Schedule feeds 2-3 hourly depending on tolerance
and severity of illness
63. Scenario 1:
Asymptomatic Infant less than 6 months of age +
Confirmed Ebola infected mother
❑ Separate the mother and infant
❑ Start replacement feeding with RUIF
❑ In absence of RUIF, start feeding with Powdered
Infant Formula(PIF) prepared in hygienic
conditions
❑ Give psychosocial support to the mother
64. Scenario 2:
Confirmed Ebola infected infant less than six
months of age + Confirmed Ebola infected
mother
❑ Support mother to continue breastfeeding if she can
do so
❑ Provide replacement feeding with RUIF if mother is
too sick to breastfeed
❑ In absence of RUIF, start replacement feeding with
PIF
❑ Give psychosocial support to the mother
65. ❑Separate mother and child
❑Support mother to express breast milk
❑Keep mothers in close proximity to the isolation
centre
❑If mother’s milk is not available, start replacement
feeding with RUIF (or PIF)
❑Give psychosocial support to the mother
Scenario 3:
Negative EVD mother + Confirmed Ebola
infected infant less than six months
66. Scenario 4:
Asymptomatic child 6 –23 months of age + Confirmed Ebola
infected mother, or Confirmed Ebola infected child 6 –23
months of age + Asymptomatic mother
❑Separate the mother and the child
❑Offer Complementary foods, including 2-3 cups of milk (Ultra
heat-treated milk (UHT) animal milk or follow-up formula)
❑Give psychosocial support to child and mother
67. IYCF Recommendations after recovery from Ebola 1/2
❑ Ebola virus remains in other body fluids, including breast milk even if
cleared from blood.
❑ Infants below 6 months of age whose mothers have recovered from
Ebola and not able to resume breastfeeding, should be fed on RUIF (or
PIF) until six months of age.
❑ DO NOT RESUME breastfeeding in infants and young children whose
mothers have recovered from Ebola UNLESS the woman has had two
negative consecutive PCR tests 24 hours apart for presence of Ebola
Virus in her breastmilk.
68. IYCF Recommendations after recovery from Ebola 2/2
❑ For children 6-23 months, introduce complementary foods including 2-3 cups of
milk, (Follow-up formula, Ultra heat-treated milk (UHT) animal milk) at six
completed months of age.
❑ Ensure psychosocial support and follow up at community level.
❑ Monitor compliance to the Breast Milk Substitutes (Regulation and Control) Act,
2012 and its Regulations, 2021
69. Breast Milk Substitutes (Regulation and Control) Act, 2012 and its
Regulations, 2021
This is an Act of Parliament that Provides for appropriate marketing and distribution of breast milk
substitutes and Provides for safe and adequate nutrition for infants;
❑ Section 7 - Cabinet Secretary to permit donations or distribution of Breastmilk Substitutes or
complementary food products.
❑ Regulation 26- Interactions between a manufacturer or distributor with any health worker
shall take place in a public venue approved by the National Committee on Infant and Young Child
Feeding (NCIYCF)
❑ Regulation 36 - no person shall publish or cause or permit to be published or distributed any
informational or educational or communication material that relates to infant and young
children feeding unless approved by the NCIYCF.
❑ Regulation 42 -A person who contravenes the provisions of these Regulations commits an offence
and is liable to a fine not exceeding one million shillings or a term of imprisonment not
exceeding three years, or to both.
70. Nutritional care for malnourished mothers and
children with EVD
❑ Nutrition assessment; weight, height and/or MUAC to be
done on admission with scheduled monitoring
❑ Ebola infected mothers and their children who are
identified as having acute malnutrition, need to be treated
in line with IMAM protocols.
74. OBJECTIVES
• Outline of a Treatment Centre
• Basic requirements of a Treatment Centre
• Basic procedures
• Who does what at at TC
75. Screening at Treatment Center
• Most patients are referred to the treatment center
from community healthcare facilities through the
alert system.
• Some patients will show up at the treatment center
by their own.
• A screening area should be set up at the treatment
center to evaluate suspected cases along the same
lines as in healthcare facilities in communities.
77. Features of Treatment Centre
• Suitable site/location
• Patient flow arrangement within the isolation unit
• Orientation of staff working at isolation unit
• Changing rooms for medical staff
• Availability of supplies for changing rooms e.g. PPEs
• Availability of supplies for patient care
• Ensure proper storage of supplies
• Plan and orient staff on management of waste
• Plan for safe burial practices
78. IPC measures for Screening Suspected
Cases at Treatment Center
• Define an area for screening
– With direct access from outside for suspected
cases
– And easy access from inside for health workers
– Open area with low fence to ensure a minimum of
privacy
79. Precautions during Screening
• Use masks and gloves
• Respect 1- 2 m distance with patient at all time
• Position patient properly during interview
• Insert thermometer from the patient back
• Use the local case definition
• Do not perform physical exam
• If the patient fulfills the case definition:
– Educate the patient on what is happening and reason for isolation
– Transfer patient to the suspect case area where he will be seen by
the clinical team (physical exam, EVD testing, malaria RDT)
– Encourage ORS
• Clean surface and chair between patients
80. Patient Placement
• Put suspected or confirmed cases in single isolation
rooms with an adjoining dedicated toilet or latrine,
showers, sink equipped with running water, soap
and single-use towels, alcohol-based hand rub
dispensers, stocks of personal protective
equipment (PPE), stocks of medicines, good
ventilation, screened windows, doors closed and
restricted access.
81. Patient Placement-2
• If isolation rooms are unavailable:
– cohort these patients in specific confined areas while
rigorously keeping suspected and confirmed cases
separate and ensure the items listed here for isolation
rooms are readily available; and
– make sure that there is at least 1 meter (3 feet) distance
between patient beds.
82. Screening
Area
Hand
Washing
Station
Entrance
Staff
Water Reserves
Screening Area at Treatment Center
Cleaning Area
Medical Staff
Mobile LAB
Changing
Area (Scrubs)
PPE
Changing
Room
Suspect Cases
Confirmed Cases
Hazardous Waste Mgnt
Corpse preparation
ZONE PPE
Entrance ambulance,
visiting family members
IPC Staff
Pharmacy storage
of material
ZONE
WITHOUT
PPE
Removal
of PPE
Toilet
Zone without PPE
(Scrubs with
BOOTS)
83. Staff Allocation-1
• Ensure that clinical and non-clinical personnel are
assigned exclusively to HF patient care areas and
that members of staff do not move freely between
the HF isolation areas and other clinical areas
during the outbreak.
• Restrict all non-essential staff from HF patient care
areas.
84. Visitors
• Stopping visitor access to the patient is preferred, but if this
is not possible, limit their number to include only those
necessary for the patient’s well-being and care, such as a
child’s parent.
• Do not allow other visitors to enter the isolation
rooms/areas and ensure that any visitors wishing to
observe the patient do so from an adequate distance
(approximately 15 m or 50 feet).
• Before allowing visitors to HF patients to enter the HCF,
screen them for signs and symptoms of HF.
85. Isolation processes
• Plan how to arrange the isolation unit
• Ensure that there is a pre-designated isolation unit(s)
• Ensure there is referral system of patients to isolation unit(s)
through established coordination process
• Limiting number of staff and ensure coordination of HR
• Discourage relatives visiting and provide information to relatives
• Ensure barrier nursing practices at isolation unit(s)
86. Isolation Unit should have:
• An isolated toilet: should also be used to receive patient’s
disinfected waste and other liquid waste
• Adequate ventilation:
– Disinfectants were used
– To prevent any airborne or droplet transmission
• Screened Windows: To prevent mosquito and insect-borne
diseases
87. Plan How to Arrange the Isolation Area:
Sample Layout
• Changing room: Should have hooks; storage shelf and
disinfection station
• Patient(s) room: Bed(s); Disinfection station; screens
between beds; space for medical supplies and equipment
• Toilet: Disinfection station
90. Isolating suspected or confirmed VHF patients
• Isolating patients will:
– Restrict patient access to health facility staff trained to use VHF isolation
precautions
• Identify area for the isolation site:
– Should already be available to admit patients requiring isolation
– If isolation unit NOT available: Ensure locating one
• A separate building
• Uncrowded area
91. Plan Disinfection for VHF-Contaminated Items:
• Disinfectants: ensure availability of disinfectants/bleach solution
• Soap and clean water: Disinfect before washing and sterilisation for
reusable equipment or linen.
• Sterilization: Heat sterilisation requires special equipment, such as
autoclave or steam sterilizer. Where not available boiling for 20
minutes will kill VHF viruses.
92. Gather supplies for the patient area:
• Beds and mattresses
• Plastic sheetings to cover mattresses – to prevent contamination and also for ease
disinfection.
• Bedding
• One thermometer, One stethoscope, One BP machine per patient
• Disinfectants
• Puncture-resistant container for sharps waste (Sharp Box)
• Bedpan
• Screens or other barriers
• Wall clock
• Disinfection station: buckets, sprayer, bleach solutions, soap, water, mop.
• Extra supplies of gowns and gloves
93. Gather supplies for the Changing Room
• Hooks, nails or hangers
• Roll of plastic tape: for taping cuffs and trousers of protective clothing
• Disinfection station with bleaching solution
• Hand washing station with bucket, soap dish, clean water, and supply of
one-use towels
• Containers with soap water for collecting
– Used instruments to be sterilised
– Reusable protective clothing to be laundered
• Containers for collecting:
– Infection waste to be burned
94. Arrange for storing of supplies Outside the Changing Room
• Shelf or box for storing clean protective clothing
• Supply of clean protective clothing
• Container for collecting non-infectious waste
• Covered shelf
95. Set Up Changing Rooms
• For patient-care staff
• For laboratory, cleaning, laundry, and
waste disposal staff
96. Security Barrier Around Isolation Area
• Restrict general public access to the isolation
area
• Place signs around the isolation area stating that
access is restricted.
102. Introduction to EVD surveillance
• Defn of surveillance: Surveillance is the ongoing systematic
collection, analysis, and interpretation of health data. It includes
the timely dissemination of the resulting information to those who
need them for action
• Surveillance plays a key role in understanding the epidemic
dynamics guiding response and monitoring of response activities
• Systematic contact tracing is critical in breaking the chains of
transmission
103. Purpose of Ebola surveillance
• Confirm an outbreak
• Identify all cases and contacts
• Detect patterns of epidemic spread
• Estimate the potential for further spread of the disease
• Determine whether control measures are working
104. Surveillance strategies
• Response to rumours/alerts: Log and verify them
• Active case search
• Contact tracing and follow-up for all contacts
• Documentation
• Prompt notification
• Data management
105. Surveillance before EVD outbreak
• Implement surveillance under IDSR
• Train health personnel at all levels so as
to be able to detect outbreak
• Share surveillance data regularly
• Involve animal health: Ebola outbreaks
are often preceded by outbreak in
wildlife, so surveillance of wildlife die-offs
should alert public health system
• Involve other key players/partners
• Prepare contingency plan
107. General considerations
• Activate contingency plan
• Activate a multi-sector national Task Force
• Train health personnel at all levels
• Establish Rapid Response Teams (RRTs) at all levels
• Establish EVD alert management system at all levels
• Communicate: to media, to stakeholders and to public
• Share surveillance data regularly
108. Rapid Response Teams (RRTs)
• At all health levels and HFs. Do you have one here?
• Respond to alerts 24/7 of Ebola
• Composition: Epidemiologists, clinician, IPC expert, data manager, lab
personnel, environmental health, health educator...
• Train them in:
• In-depth knowledge of EVD
• Case identification based on case definition
• Personal protection
• Use of surveillance tools
• Contact tracing, follow up and referral
• Communication skills
• Line listing, documentation & report
109. Identifying cases using Ebola case
definition
Any person with One or more of the following:
Acute onset of fever, Vomiting, Diarrhoea, Abdominal pain, Headache, Sore throat,
Measles-like rash, Red eyes, Bleeding from body openings
AND
History of travel to Uganda or DRC or contact with somebody who has been with a
person with the above symptoms within the last 3 weeks or in contact with a
confirmed case
110. Case Detection: Three scenarios
• Scenario 1: Case detected at POE screening
• moved to holding area,
• then to ambulance moved to designated holding area in isolation facility
• Samples collected if positive moved to isolation
• Contacts kept in quarantine
• Followed up for 21 days
• Scenario 2: Case detected in health facility
• Moved to isolation
• Sample collected in full PPE
• Sample referred to KEMRI
111. Case Detection: Three scenarios
• Scenario 3: Case detected in community CHV notified who notifies CHA
• Explain to the patient/family the need for hospital care
• Arrange for hospital transfer in ambulance
• Samples collected and referred to KEMRI
• If the subject has died, explain to the family the need for safe burial
• After obtaining consent, coordinate funeral arrangements with the burial
team
• Immediately notify the Sub-County health office and also DDSR
through hotlines 0732-353535/ 0729-471414 in all scenarios
• If samples turned negative the suspected case is released
112. Intensify case identification using case
defn
• All HWs and POE staff MUST know the case definition and use it to
detect possible cases then follow available protocols
• Monitor rumours and other alerts
• H. Facilities, media, politicians, community
• Respond to each alert/rumour
• Investigate to see if case definition is met
• Investigate by lab
• Identify and record contacts
• Use appropriate surveillance tools
113. When an Ebola suspect case has been
identified
(Case meets working case definition)
114. Identifying cases using Ebola case
definition
Any person with one or more of the following:
Acute onset of fever, Vomiting, Diarrhoea, Abdominal pain, Headache,
Sore throat, Measles-like rash, Red eyes, Bleeding from body openings
AND
History of travel to Uganda or DRC or contact with somebody who has
been with a person with the above symptoms within the last 3 weeks or
in contact with a confirmed case
115. Handling a suspect case 1/4
Refer to the steps on the Ebola case definition chart
• Immediately notify the Sub-County health office and also DDSR through
hotlines 0732-353535/ 0729-471414
• Immediately don full PPE
• Isolate the patient and give supportive care
• Withdraw 5 to 10mls of blood in a plain sterile tube or vacutainers
• Fill the Ebola case investigation form
• Triple package the specimen as whole blood and put in a cooler box.
116. Handling a suspect case 2/4
• Transport the packaged specimen using the fastest means available to
KEMRI Centre for Viral Research or other designated reference lab
• If the sample cannot be transported immediately, refrigerate but do not
freeze
• Inform anyone handling the specimen that they are handling potentially
infected samples. If possible stick a bio-hazard label sticker on it
• Restrict/limit the number of medical and support personnel visiting or seeing
the patient
117. Handling a suspect case 3/4
• Stop cleaners going to the isolation room
• Stop relatives from visiting the patient. Only one relative may be
allowed to stay with the patient However, the relative must be well
trained and given personal protective clothing too as if she is a HW
• Manage waste appropriately
• Avoid contact with your body parts e.g. through scratching
• Create an adjacent room where staff will change their clothes. As
soon as anyone leaves the isolation room they must change all
clothes in the changing room
118. Handling a suspect case 4/4
• If the case is not in a HF ……
• Explain to the patient/family the need for hospital care
• Arrange for hospital transfer
• If the subject has died, explain to the family the need for safe burial
• After obtaining consent, coordinate funeral arrangements with the burial
team
• Start identifying, listing and following contacts
• Ebola contact listing form
• Ebola contact tracing and follow-up form
119. Fill case investigation form
• A record of all cases MUST be kept as a line-list (MOH 503)
• A case investigation form (similar to MOH 502) should be
completed for every case meeting the standard case definition
• Case investigation form should also be completed for all suspect
deaths either in the community or in the health facility
• Case investigation form should accompany all laboratory
specimens collected from suspect cases
120. Maintain a line list of all cases
• The designated treatment centre or the admitting HF should
maintain a line list of all the suspect/ probable/ confirmed cases
• The case investigation form and the line list should be submitted to
the next higher level daily
• The surveillance team at the County and MOH level will regularly
analyze data to describe/ characterize the epidemic and monitor its
evolution
121. Contact tracing
Who is a contact?
• A person without any symptoms having had physical contact with a case or
the body fluids of a case within the last three weeks
• The notion of physical contact: we may say there is contact:
• If we can prove or we know that there was contact or
• Even when we only highly suspect that there was contact
• Contact situations: having shared the same room/bed, cared for a patient,
touched body fluids, or closely participated in a burial
122. Contact listing, tracing and follow up
• When a suspected case is identified, all individuals that had direct
contact with the case (since onset of the symptoms) should be listed
using the contact listing form
• Identify a competent officer to follow up all the contacts on a daily basis
for the next 21 days from the day of last exposure using the contact
follow form
• The team should comprise of CHVs supervised by HWs
123. Contacts
• They MUST be observed daily, usually at home
• We only quarantine contacts at particularly high risk of infection, e.g, a
mortician who did postmortem on confirmed case
• Monitor body temp at least once and, where possible twice daily
for 21 days after the exposure
• They MUST report to the local HF if they develop fever
• Febrile contacts should be evaluated immediately by the clinician
responsible for contact-tracing
• Any contact having temp of 38.5 and above, MUST be considered
a new case and isolated
124. Community education
• Residents in the affected areas must be taught to avoid high-risk
behaviors during the outbreak, including:
• Bathing or touching corpses
• Touching blood or body fluids of sick individuals
• Re-using injection equipment or needles
• Hunting, preparing or eating bush meat
• Communities should also be urged to report any suspect case
immediately to the nearest HF or to the EOC
125. Establish an Alert Desk
• An alert desk (EOC) should be established at the National and County
levels equipped with toll free telephone lines and manned by a trained
team
• Widely disseminate the toll free numbers
• Members of the public should be encouraged to call in when they have
suspect/ alert cases or when they have any query
• All in-coming alert calls should be registered and the information passed
on to the relevant team for appropriate verification/ investigation
• All health facilities should also have an alert desk
126. Daily Reporting by HFs
• During an outbreak, all HFs in the affected county/ Sub-county should
provide daily updates including zero reporting (passive surveillance)
• The County/ Sub-county team may also call the HFs (active surveillance)
• This is to ensure that the county/ sub county team monitors the
epidemic situation
127. Verbal autopsy
• During an outbreak, community deaths could be a signal of an
undetected transmission
• All community deaths should therefore be verified and the likely cause
of death established
• If the verification indicates that the likely cause of death is EVD, a Case
Investigation Form (CIF) should be completed and the case line listed
• Contacts to the case should be identified and followed up
129. Objective
• To assure proper isolation of suspected VHF patients, barrier
nursing care and management of the patients
• To assure proper implementation of the universal precautions,
preparation and utilization of disinfectants
130. Organization
• Med Sups are responsible for the hospital based surveillance in their
respective hospitals
• Designate one staff in each ward/sections to carry out day-to-day
surveillance activities
• This surveillance person will make a daily follow up from the
designated staff of each ward/sections
131. The surveillance focal person
Duties and responsibility
• Each morning ask the night nurse/physician whether a patient(s)
suspected of EVD has been admitted to the hospital
• If yes, see the patient immediately
• Each day walk through all wards and isolation unit in the health
establishment and visit the outpatient department
• Detect and identify patient‘(s) having signs and symptoms
suspected of EVD
132. If an EVD suspect case is present..
• Take history or assist in questioning of suspect case(s) about the possible
source of infection and the presence of similar disease in the patient's
community
• Ensure immediate clinical examination
• Take or assist in taking proper specimen
• Assist in filling out prescribed forms
• Assist in storage, proper packing and dispatch of specimen
• Urgently notify or assist in notification of each case or death by the quickest
means to the SDSC/CDSC
133. Deployment of Community Event Based Surveillance
(CEBS)
Signal objective Signal
code
Signal description
Routine signal to detect community
clusters of EVD symptoms
1 Two or more people presenting with similar symptoms in a
community within a week
Routine signal to detect single
community EVD symptoms
6 Any event that causes public health anxiety/concern
Additional EVD signal to detect
possible importation or close contact
with EVD
7 Any person presenting with either hotness of the body,
vomiting, diarrhoea, headache, rash, red eyes, or bleeding
AND recently (within three weeks) travelled or had contact
with a person from Uganda or DRC
134. CEBS Activities
• Revision of the data capture and reporting mechanisms to include
the new EVD signal (Signal No. 7)
• Rapidly conduct a CEBS sensitization of Point Of Entry (POE)
counties and those already implementing CEBS with the EVD
outbreak scenario of no case reported
• Escalation of the CEBS sensitization to all the counties if the EVD
outbreak scenario changes with the reporting of an in-country case
136. Presentation outline
• Goal and objectives
• Introduction to Risk Communication and Community Engagement (RCCE)
• Communicating Risk Pre-, During and Post Outbreak
• Community Engagement
• EVD RCCE Preparedness & Response for current threat from Outbreaks in
neighbouring countries
• RCCE Preparednes/Readiness Checklist for EVD
• Coordination of EVD RCCE activities
• RCCE strategic approaches
• Key EVD messages per EP&R thematic interventions
• Dynamic listening and rumour management
• Planning sample
137. Communication Goal & Objectives
Goal:
• To create awareness about EVD and its impact
Objectives
• To increase the knowledge among the general public about EVD
• To increase knowledge and information on EVD among HWs
• To engage policy makers, stakeholders and opinion leaders for
support of EVD awareness
• To mobilize communities to take necessary actions against EVD in
case of a reported outbreak
138. Introduction to RCCE
• Risk communication: aims at availing key information / messages
on the imminent risk of EVD in Kenya to the general public for
action:
• The key messages should target specific audiences for action
• The channels for communication should be appropriate for the targeted
audience to ensure reach.
• Community engagement: involving the community in risk
communication so that we establish the facilitators and barriers to
adoption of the desired actions / behaviors and act on them so as to
provide an ENABLING ENVIRONMENT
Summary: RCCE seeks to increase access to EVD messages
through a variety of communication channels to the community
for increased uptake of EVD prevention & control measures
139. What is risk communication?
• A two-way real time exchange of information, perceptions and advice
among risk assessors, risk managers, and various groups including those
who are at risk of a threat to their survival, health, economic or social well-
being such as disease outbreak.
• A multi-disciplinary approach using a mix of communication and
engagement tactics.
• Risk communication is a very important component and is a core public
health intervention in any response to disease outbreaks/epidemics,
pandemics and other health emergencies
140. Why risk communication?
• Risk communication is a very important component and is a core
public health intervention in any response to disease
outbreaks/epidemics, pandemics and other health emergencies
• Its ultimate purpose is that everyone at risk can make informed
decisions to mitigate the effects of the threat (hazard) such as a
disease outbreak and take protective and preventive action
Information Decision Action
141. 5 Principles of Risk Communication
1. Timely announcements and
transparency;
2.Create/build and Maintain
Trust;
3. Listen to, understand and
respect public concerns;
4.Plan; and
5. Ensure Equity
143. Hazard
Precaution
Advocacy
Outrage them to your levels of
concern so that they take action
Arouse emotions required to
prevent secondary crisis
WATCH OUT!
LOW Outrage/Fear and HIGH Hazzard
Title of the Presentation
143
Outrage
&
Fear
144. HIGH Outrage/Fear and LOW Hazzard
Title of the Presentation
144
Hazard
•Listen and acknowledge
the truth
•Give facts about why there
is no danger
"CALM
DOWN…..respectfully"
Outrage
management
Outrage
&
Fear
145. Hazard
Crises
Communication
• Explain what is happening
• Deal with emotions
WE ARE ALL IN THIS TOGETHER
When Outrage/Fear and Hazzard are HIGH
Title of the Presentation
145
Outrage
&
Fear
146. Hazard
• Communications surveillance
• Identify and address outrage early
on
When Outrage/Fear and Hazzard are LOW
Title of the Presentation
146
Outrage
&
Fear
Health
Education;
Stakeholder
relations
148. Pre-outbreak or Routine Risk Communication - 1
• Public Health Emergency Management Subcommittee for Risk
Communication should meet at least once monthly or quarterly
to:
• Review the risk communication plan
• Review required risk communication materials/logistics
• Develop, pre-test, print and disseminate IE&C materials
based on the common public health risk
• Organize training for risk communication resource teams
• Identify/train spokesperson to be ready when an outbreak
occurs.
• Develop and update all required training modules, guidelines
and monitoring checklists.
149. Pre-outbreak or Routine Risk Communication - 2
• Develop and share SOPs for social mobilization and community
engagement.
• Integration of risk communication in the overall emergency response
plan.
• Ensure communication coordination mechanism is in place with clear
terms, clear defined roles and responsibilities of each entity.
• Conduct sensitization and public awareness through mass media.
• Conduct community sensitization using:
• Community drama groups.
• Public Address.
• Meetings and barazas
• Local community radios.
• Create a system for dynamic listening and rumour management.
151. Why Communicate risk during outbreak?
• Early and regular communication of advice and guidance reduce
risk.
• Encourages the public to adopt protective behaviors that will
reduce confusion and fear and allows better use of resources.
152. Communicating risk during outbreak response-1
1.PHEMC through PHEOC at national and PHEMC at county and subcounty
should:
• Ensure communications are consistent.
• Reflect the data that has been analysed.
• Prepare and disseminate targeted messages to:
• health workers, media, civil society, general population and affected
community and stakeholders.
1.Communicate with partners and stakeholders
• Coordinate Partners and other stakeholders.
• Risk Communication and Social Mobilization Subcommittee ensures
that:
• there is an internal communication system among national
stakeholders to ensure information flows to different government
sectors on time.
153. Communicating risk during outbreak response-2
3.Communicate with the affected community and their respective
stakeholders.
• Subcounty, county and national must nominate a spokesperson who
should be trained& shall be providing information on the outbreak
situation.
• Use varied methods as per existing communication structures e.g.:
• Press releases
• Press conferences
• Television and radio messages
• Organize regular meetings with community members, community
Leaders, religious, opinion and political leaders
• NB: Only authorized and credible persons should communicate during crisis
period
154. Communicating risk during outbreak response-3
4.Communicate with media
• Meet regularly with the media
• Brief and educate the media on priority hazards and on response systems
• Provide them with appropriate information to cultivate a respectful and
trusted relationship with them
• Regular press releases and media briefings
4.Communicate with health workers
• Communicate regularly with the health workers at all levels by providing
correct information.
• About the data (including any gaps).
• Results of the analysis of the data.
155. Communicating risk during outbreak response-4
6.Communicate with media
• Meet regularly with the media
• Brief and educate the media on priority hazards and on response
systems
• Provide them with appropriate information to cultivate a
respectful and trusted relationship with them
• Regular press releases and media briefings
157. Communicating risk after/post outbreak
• Develop and share SOPs for social mobilization and community
engagement.
• Integration of risk communication in the overall emergency response
plan.
• Ensure communication coordination mechanism is in place with clear
terms, clear defined roles and responsibilities of each entity.
• Conduct sensitization and public awareness through mass media.
• Conduct community sensitization using:
• Community drama groups.
• Public Address.
• Meetings and barazas
• Local community radios.
• Create a system for dynamic listening and rumour management.
159. Session Objectives
• Describe why community engagement is essential for effective
emergency risk communication
• List actions for community engagement
• Describe ways of communicating effectively with large audiences
during a health emergency
• Rumour tracking and Management
160. What is Community Engagement?
• Community engagement is the process by which organizations and individuals
build a long-term relationship with collective vision for the benefit of the
community
• It is primarily about the practice of moving communities towards a better
change through empowerment and involvement
• This presentation will focus on community engagement for risk communication
• Communities MUST BE at the heart of any public health intervention,
especially in emergencies
161. Why Community Engagement?
• Community engagement is central to any public health intervention.
• Community engagement involves those affected in understanding the risks
they face and involves them in response actions that are acceptable.
• Its importance is even more significant during public health emergencies
because:
• Everyone has a right to know about risks to their health and well-being
• Most diseases have a cultural aspect and therefore communities must be engaged for a
desirable change
• Culturally appropriate information can help in making informed decisions to reduce the
health risks
• Action taken by individuals, families and communities affected are key to controlling the
public health threat/problem
162. Social Mobilization
• Is a process that engages and motivates a wide range of partners and
allies at national and local levels to raise awareness of and demand for
a particular development objective through dialogue.
• Members of institutions, community networks, civic and religious
groups and others work in a coordinated way to reach specific groups of
people for dialogue with planned messages.
• Social mobilization seeks to facilitate change through a range of players
engaged in interrelated and complementary efforts.
163. Actions for Community Engagement
• Community engagement covers a broad range of activities. Some activities undertaken
by government practitioners & partners include:
• Reaching out to/informing the community of policy directions of the government
• Consulting the community as part of a process to develop government policy, or
build community awareness and understanding
• Involving the community through a range of mechanisms to ensure that issues and
concerns are understood and considered as part of the decision-making process
• Collaborating with the community by developing partnerships to formulate options
and provide recommendations.
• Shared leadership/empowering the community to make decisions and to implement
and manage change.
• In Kenya’s constitution stakeholder engagement is a legal requirement for any policy
process
164. Challenges in Community Engagement
• Maintaining community involvement over time.
• Overcoming differences between responders, community and different influencers.
• Working with unique, especially vulnerable, or hard to reach communities.
• Communities and responders may not perceive risk in the same ways.
• Communities have complex social dynamics and changing power relationships
which influence how we engage them.
• Conflicts – imbalances in level of engagement when dealing with several villages
165. EVD RCCE Preparedness & Response for
current threat from Outbreaks in neighboring
countries
166. RCCE Preparedness/Readiness Checklist for
EVD-1
• Do you have a communication plan,guidelines for EVD RCCE
• Have you established coordination structures for RCCE
• Have you mapped stakeholders for RCCE
• Have you strengthened RCCE capacities for risk communication
teams such as leaders, key influencers, media
• Have you developed/adopted the key messages for EVD such as
IEC materials, and electronic messages
• Disseminated of EVD key messages using multi channel
approach
167. RCCE Preparedness/Readiness Checklist for
EVD-2
• Strengthened community engagement strategies targeting the
community members especially at-risk populations
• Have you established mechanism for tracking rumors including
timely management
• Have you established process for monitoring positive behaviors
change resulting from RCCE activities
• Is there a toll-free number installed at the EOC?
• Have the gaps regarding resource availability been identified
and resource mobilization began?
• Have you mapped the available resources(funds, kits, supplies
etc.) and identified gaps?
168. Coordination of EVD RCCE activities in Kenya
• There is a National RCCE
Sub-Committee
• Membership:
• MoH,
• Development partners -
UNICEF, WHO, A-CDC
• INGOs - KRCS,
AMREF,IRCK
• Others?
169. RCCE Coordination:
National Level Terms of Reference (TOR)
Purpose
The role of the national, county, sub-county Ebola risk communication, social mobilization and community
engagement, Technical Working Group/committee is to plan, coordinate and ensure timely, efficient and effective
Ebola risk communication and successful implementation and management of social mobilization and community
engagement to prevent and control Ebola outbreaks.
Membership
The national Advocacy, Communication and Social Mobilization (ACSM) team will transform into the Ebola risk
communication, social mobilization and community engagement, Technical Working Group/committee. It should
be multidisciplinary in nature, with broad membership co-opted, to enable mobilization/engagement of
stakeholders (Government agencies, partners, civil society, media etc.), pooling resources and community
participation and involvement from a wide base. The committee should be constituted at national, county and
sub-county level, with a multi-disciplinary representation as indicated above:
The national level TWG will provide leadership for capacity building, research and coordinated planning,
supervision, monitoring and evaluation. The county and sub-county groups will be responsible for constituting
their specific technical working groups, adopting any guidelines and standard operating procedures as appropriate
to local situation, developing communication plans relevant to their immediate catchment areas. Some functions
will mirror national level committee, with the difference being the level of operation
170. National TOR cont’d
Specific Tasks
• Developing national, county, and sub-county Ebola risk communication, social mobilization, and community engagement plans.
• Participating in identifying issues and challenges relating to Ebola risk communication, social mobilization, and community engagement.
• Planning and management of Ebola risk communication, social mobilization, and community engagement communication research.
• Developing strategies and plans for Ebola risk communication, social mobilization, and community engagement informed by research findings.
• Overseeing/coordinating/supervising implementation of Ebola risk communication, social mobilization, and community engagement activities.
• Mobilizing resources for Ebola risk communication, social mobilization, and community engagement activities.
• Delivering Ebola outbreak information to the mass media and manage media relations during the outbreak
• Facilitating formation, supporting, and ensuring functionality of county and sub-county committees.
• Developing and implementing required capacity-building activities to enhance Ebola risk communication, social mobilization, and community engagement activities.
• Facilitate monitoring, evaluation and utilization of data collected to inform planning for Ebola prevention and control.
• Advising the preparedness and response teams on matters pertaining to Ebola Risk communication, social mobilization, and community engagement.
171. County/Sub-county EVD RCCE TWG
Expectations:
• Domesticate the National RCCE TWG TOR
• Convene regular RCCE TWG Meetings
• Adopt & Localize RCCE Messages
• Continuous Engagement on Messaging with Local Networks
• Continuous monitoring of Rumors & manage appropriately
• Context-specific evidence KAP, HCD & Anthropological assessment in ETUs,
Communities & Institution
172. National RCCE IEC Assets in
Development and Approval Process
• Print Materials
• Posters
• Leaflets
• Brochures
• Banners
• Visibility Materials (Caps, T-
Shirts etc)
• Community Guide for CHVs
• Flip Chart
• Electronic Materials
• Radio Spots
• TVC Spots
• Social Media Frames
(Facebook, Twitter etc)
• Website E-Print Materials
• SMS Short Messages (719)
173. RCCE strategic approaches
• Rumor monitoring & management:
actively picking up any mis-information and
dis-information on EVD and responding to
them in real time
• Advocacy: engaging the community
leaderships [administrative, social and
political] so that they can influence the
community to prevent & control EVD
including resources mobilization.
• Communication: ensure
availability of information
through a variety of
communication channels to
reach targeted audiences
• Social mobilization: engaging
various community groups,
organization and structure so
that they collective practice EVD
prevention & control measures
as a social norm.
174. Summary of EVD prevention & control
measures
1. Epidemiological surveillance & contact tracing
2. Rapid Response Team [RRT]
3. Laboratory
4. Case Management
5. Infection Prevention & Control [IPC]
6. Psychosocial Support [PSS]
7. Safe and Dignified Burials
175. Key EVD messages per EPR thematic area
Identification of the RCCE touch points, audience
segmentation & key messages
176. Epidemiological Surveillance & Contact tracing
• An index EVD case may first be detected at Port of Entry [POE], in the
community or at a health facility
• This calls for enhanced & active surveillance at this potential areas for
proper procedures to be instituted in identification, handling the case
and reporting to the RRT.
• At POEs: screening undertaken, EVD suspect case identified, kept in a holding
room then moved to an isolation facility using an ambulance and sample taken.
• At a health facility: screened, suspected EVD case identified, moved to
isolation facility and sample taken.
• At the community: Community Health Volunteer [CHV] informs Community
Health Assistant [CHA] then RRT for evacuation to an isolation facility and
sample taken.
177. Implication for RCCE at POE
• Persons arriving at POEs need to
know
• That they will be screened
• How the screening will be done
• why they are being screened?
• In the unlikely event an EVD
suspected case is detected they
also need to know what action will
be taken and why?
• Primary audience:
Travelers/persons entering into
Kenya from EVD affected
country(ies) - DRC & Uganda.
• Secondary audience: POE staff
should have the information and
educate the arriving persons
• Tertiary audience: Management
of the means of conveyance -
Airline, Truck Drivers Associations
178. Implication for RCCE at health facilities
& messages
• Suspected EVD case needs
to know what action will
follow including:
• Moved to an isolation room
• Sample taken & how
• Interim management as
results are awaited
• Primary audience: suspected
EVD case
• Secondary audience: Health
care workers to inform the
suspected EVD case
• Tertiary audience: care givers
and contacts of the suspected
EVD case.
179. Implication for RCCE at community
level
• Suspected EVD case needs to
know what action will follow
including:
• Reporting to the RRT for
evacuation
• Appreciating why it is important
to evacuate and isolate.
• The general public needs to
know the importance of early
care-seeking
• Primary audience: suspected
EVD case
• Secondary audience: Health
care workers to inform the
suspected EVD case
• Tertiary audience: care givers
and contacts of the suspected
EVD case.
180. RRT
[RCCE touch point & key messages]
• A multi-disciplinary team that
ensure there is a coordinated
detection, investigation and
rapid response to a suspected
EVD case.
• Need to educate the suspected
EVD case on subsequent
action:
• Evacuation to an isolation centre
for care.
• Contacts will also be evacuated
• Why?
• Primary audience: Suspected
EVD case
• Secondary audience: Contacts
of the suspected EVD case
• Tertiary audience: general
community
181. Laboratory
[RCCE touch point & key messages]
• This is the safe collection, packaging,
shipment and delivery of the specimen to
a designated laboratory for analysis and
reporting.
• The suspected EVD case needs to be
informed
• How and Why the specimen is being
taken?
• Where it is being transported to?
• Why the Lab staff is wearing PPE
• Turn Around Time [TAT] for the results
• What will be the interim care while waiting
for the results
• What will be the implication of the results
[+ve or -ve]
• Primary audience: Suspected EVD
case
• Secondary audience: Laboratory
staff to inform the EVD suspect
• Tertiary audience: Care givers &
contacts of the suspected EVD
case
182. Case Management
[RCCE touch point & key messages]
• There is no curative treatment for EVD
• Early supportive treatment is important
in increasing the survival rate of EVD
cases.
• EVD cases need to know that:
• Management of EVD is undertaken within
isolation facilities.
• There is a high restriction of movement
and contacts with caregivers and loved
ones.
• Primary audience: EVD case
within the ETU.
• Secondary audience: Care givers
and relatives of the EVD case
• Tertiary audience: general
community so that they do not
visit ETU, Clergy that offer
prayers...
183. Infection Prevention & Control
[RCCE touch point & key messages]
• EVD is a highly contagious
disease hence deliberate
measures observed to prevent
possible transmission at:
• Points of entry (POE)
• Community level
• Health facility level through
deliberate measures.
• Primary audience: Contacts of
EVD suspected & confirmed
cases
• Secondary audience: general
public - need to know and
observes EVD prevention &
control measures
• Tertiary audience: MoH &
partners to avail PPEs,
184. Psychosocial Support
[RCCE touch point & key messages]
• PSS is vital to ensure the well-
being of the affected population,
and to counteract the threats to
public health and safety that fear,
stigmatization and misconception
poses.
• Primary audience: EVD suspected
and confirmed cases, Health care
workers, family
• Secondary audience: PSS service
providers both formal [trained] &
informal [Community Own
Resources Persons like Religious
leaders]
• Tertiary audience: Community
leaders - social, political &
administrative to assure the
community
185. Safe & Dignified Burials
[RCCE touch point & key messages]
• An EVD infected body is highly
infectious, and care should be
taken during the handling for
final internment to prevent
possible spread of EVD infection
to the handlers.
• The final rites should however be
done in a dignified manner while
observing safety measures.
• Primary audience: Family
members of the departed EVD
infected body
• Secondary audience: General
community
• Tertiary audience: Community
leadership - social, religious,
administrative and political
187. Know what your
audiences think and do
(perceptions)
Know what your audiences
are concerned about
(Information needs)
Know what to say
(my message)
Know what to do
(my feedback)
Why listen? Challenges in Community
Engagement
Why listen?
188. RUMOUR
S
Challenges in Community Engagement
Identifying Rumours of concern
• Which rumours do our key stakeholders care about?
• Which rumours do we care about?
• How do we find rumours before it’s too late?
• Rumour found – to react or ignore?
• How do we address a rumour?
189. RUMOUR
S
Challenges in Community Engagement
Which Rumours do we care about?
• Misinformation
• Myths and harmful practices
• Information that harm
reputation and diminish trust
in your department
• Information that pose a public
health risk
190. Challenges in Community Engagement
Rumor Spread
• Person to person - word of mouth
• Media
• Internet, blogs, social media
• SMS text messages
• Where else? ------------
191. Challenges in Community Engagement
Monitoring for Rumors
❑ Mainstream media
❑ Hotlines
❑ Social media
❑ Websites
❑ Blogospheres
❑ SMS messages
❑ Focus groups
❑ Intercept interviews
❑ Feedback from community influencers and community volunteers
❑ What else? Being a participant in ----------
192. Addressing Rumours: react or ignore?
• The two factors that influence a rumour are its importance to the listener
and its ambiguity.
• Rumours travel when events are important for individuals, and when
the news received about the rumours is either lacking information or is
ambiguous.
• The ambiguity may arise from the fact that
• the news is not clearly reported, or
• conflicting versions of the news have reached the individual, or
• from the person's lack of understanding.
193. Addressing Rumours: the need for speed
• Meeting the demand/needs of the audiences
• Silence increases ambiguity and confusion
• Simply denying a rumour does not eliminate ambiguity; it may
even increase it
• Address the rumour directly where needed
• Use credible spokespersons and speakers to address rumours
194. Show empathy
Let the community
know that they are
part of the solution
Communicate and
engage early
Be transparent
Addressing rumours: engagement strategy
• Rumours fly in the absence of credible and frequent information.
• Therefore, we must give people the most accurate possible information,
promptly and completely
Provide information on
what is being done
Listen to their
concerns
195. Addressing rumours: engagement strategy
Addressing Rumours: target the source
• Put out the forest fire
• Target the sources
• Prevent the spread beyond
the original source
• Stay consistent with
strategies and messages
196. Rumour monitoring & management
• Ebola rumour will be tracked using
the Online Rumour Tracking Tool –
MOH Health Promotion Unit
• Link:
https://ee.humanitarianresponse.info/x/Iv
Kq2mzB
• Infodemic Dashboard UNICEF
• Link: Infodemic tracking dashboard
198. Create an enabling environment for effective
communication to the population at risk-1
• Establish risk communication systems and structures at subcounty, county
and national level.
• Conduct mapping to gather information to develop communication
strategies and plans.
• Identify and train personnel for risk communication.
• Develop coordination platform and mechanisms for internal and partner
communication.
• Develop a coordination platform and mechanisms for engaging key
stakeholders including:
• media outlets, community radio networks.
199. Create an enabling environment for effective
communication to the population at risk-2
• Develop Risk Communication Plan for Public Health Emergencies at
the subcounty, county and national level.
• Orient key stakeholders on procedures for Risk Communication.
• Prepare detailed budgets and advocate for resources mobilization.
• Multisectoral collaboration to implement public health emergency
and risk communication activities at all levels.
• Create a system for dynamic listening and rumour management.
201. Demonstration: Sample Communication Plan
• In preparing risk communication plan, state:
• Behaviour objectives
• specific objective per strategic interventions
• Develop the strategies and activities
• Identify the target groups to effect the behaviour change.
202. Demonstration: Sample Communication Plan
Strategy Broad Activities Materials Needed Implementers Indicators Budget Timelines
Advocacy Activity 1 Indicate materials
needed to support
implementation
Indicate level and
implementation
partners
Indicate the
bench mark
used to measure
the activity
Indicate total
cost of activity
Indicate
date/period of
activity
Activity 2 etc.
Social Mobilization Activity 1 Indicate materials
needed to support
implementation
Indicate level and
implementation
partners
Indicate the
bench mark
used to measure
the activity
Indicate total
cost of activity
Indicate
date/period of
activity
Activity 2 etc.
Communication
activities
Activity 1 Indicate materials
needed to support
implementation
Indicate level and
implementation
partners
Indicate the
bench mark
used to measure
the activity
Indicate total
cost of activity
Indicate
date/period of
activity
Activity 2 etc.
203. Conclusion
• Human behavior is complex and influenced by multiple factors over long
period. It can not be changed overnight
• Proactively communicate key EVD messages
• Access to information alone does not translate to action;
• Participation of intended beneficiaries and other players is a pre-
requisite for achieving desired outcomes;
• Communicate actions that are within the laws, policies, and regulations
of the Country/County;
• Strengthen the leadership (stewardship) role of MOH at national and
county levels
207. Disease Surveillance and Outbreak Response Unit
SESSION OBJECTIVES AND OUTCOMES
Objectives
• Ensure safe collection of sample from Ebola
Suspected Case
• Ensure safe and appropriate transportation of
sample(s) to Reference Lab
208. Disease Surveillance and Outbreak Response Unit
OUTLINE
• Before specimen collection
• During specimen collection
• After specimen collection
209. Disease Surveillance and Outbreak Response Unit
BEFORE SPECIMEN COLLECTION
Before entering patient isolation room
• Assemble all materials
• Fill out patient documentation
• Perform hand hygiene
• Put on all personal protective equipment
• Carry all key material for sample collection
210. Disease Surveillance and Outbreak Response Unit
ASSEMBLE ALL MATERIALS
• Equipment for collecting blood sample: 5 - 10 mls
in tube containing EDTA, serum separator tube
(SST)
• Equipment for preventing infection
OR +
213. Disease Surveillance and Outbreak Response Unit
COLLECTION OF EVD BLOOD SAMPLE
• Only specimens essential for diagnosis or monitoring should be obtained
• Specimen to be collected: BLOOD IS THE SAMPLE OF CHOICE IN KENYA
• 5 ml of blood for BS for malaria in tube containing EDTA ; for serology and PCR in
serum (red top) separator tube (SST)
• Specimens should be obtained by staff experienced in the required techniques
• Need for good coordination with the other teams (epidemiologist, IPC colleagues,
clinicians etc…
214. Disease Surveillance and Outbreak Response Unit
DURING SPECIMEN COLLECTION
• Collection of blood sample from a patient
• Prepare room
• Identify and prepare the patient
• Collect blood sample
• Remove blood collector tube from holder and put in the rack
• Put needle, other items that drip blood or have body fluids on them
into the infectious waste bag
• Prepare blood sample for transportation
• Remove PPE
• Perform hand hygiene
215. Disease Surveillance and Outbreak Response Unit
COLLECTION OF BLOOD SAMPLE (1ST PART)
Prepare room Identity & Prepare
the Patient
Select the site
Apply a tourniquet
Ask the patient to form a
fist so that the veins are
more prominent
Disinfect the area where
you will put the needle
Anchor the vein Perform the blood draw
219. Disease Surveillance and Outbreak Response Unit
COLLECTING SPECIMENS FOR EBOLA TESTING
• Specimens should be obtained when a patient meets the criteria for person under investigation (PUI)
including patients with clinical signs, symptoms, and epidemiologic risk factors for Ebola virus
disease.
• If the first specimen is obtained 1-3 days after the onset of symptoms and tests negative and the
patient remains symptomatic without another diagnosis, a later specimen is needed to rule-out Ebola
virus infection.
• Staff who collect specimens from PUIs should wear appropriate PPE
• For adults, a minimum volume of 4 mL whole blood is preferable.
• For pediatric samples, a minimum of 1 mL whole blood should be collected in pediatric-sized
collection tubes.
• Blood must be collected in plastic collection tubes.
• Do not transport or ship specimens in glass containers or in heparinized tubes.
• Do not separate and remove serum or plasma from the primary collection container. 219
220. Disease Surveillance and Outbreak Response Unit
TRANSPORTING SPECIMENS WITHIN THE FACILITY
• PPE to be worn during transport within the facility should be determined by a site-specific risk
assessment, and may vary among facilities.
• Recommendations for PPE include disposable fluid-resistant closed lab coat, disposable gloves,
covered legs and closed-toed shoes.
• Before removing patient specimens from the site of care, it is advisable to plan the route of the sample
from the patient area to the location where it will be packed for shipping to avoid high traffic areas.
• Before removing patient specimens from the site of care, the outside of the specimen containers should
be decontaminated with an approved disinfectant
• In compliance with Biosafety standards, specimens should be placed in a durable, leak-proof
secondary container.
• After placing in a secondary container, specimens should be hand-carried to the laboratory or packing
area. 220
222. Disease Surveillance and Outbreak Response Unit
AFTER SPECIMEN COLLECTION
• Prepare all shipment materials before handling the sample(s)
• Prepare the sample
• Package the sample
• Mark and label the box
• Finalize the shipment
223. Disease Surveillance and Outbreak Response Unit
PREPARE ALL SHIPMENT MATERIALS BEFORE
HANDLING THE SAMPLE(S)
224. Disease Surveillance and Outbreak Response Unit
SHIPPING OF AN EVD BLOOD SPECIMEN
• Store samples in refrigerator if it is not possible to ship within 24
hours
• Refrigerated samples should be shipped with ice packs
• Ship specimens in separate sealable leak-proof container
• Packing, shipping and transport of all samples related to a suspected
case of EVD must comply with set requirements
228. Disease Surveillance and Outbreak Response Unit
TESTS DONE
• Molecular diagnosis-rRT-PCR (5-10hrs)
• Serology (10 hrs)
• Ag capture ELISA
• IgM ELISA
• Sequencing of positive PCR samples
• Results are relayed to Director General & Incident Manager who will communicate with the
CHMT/EOC
Need to repeat test????
• From graph on previous slide, both antigens and IgM rise to measurable levels after the 2nd day
of illness
• So if the initial sample is taken before 72hrs since onset of illness, there will be need to repeat
the test after 72 hours from onset of illness
229. CONTACT PERSONS
Nairobi
KEMRI VHF Laboratory
Dr. Samson Konongoi-
0722560850
Victor Ofula-0722899066
CDC-Nairobi
Dr. Bonventure Juma-
0711833222
Kisumu
CDC-Kisumu
Dr. Clayton Onyango-
0732233966
Kilifi
WT/KEMRI
Dr. Isabella ochola-
0735090938
Dr. Charles Nyaigoti-
0720538778
229
232. Disease Surveillance and Outbreak Response Unit
❑ Infection prevention and control refers to the policies and procedures utilized
to minimize the risk of transmission of infections
❑ Effective IPC is central in preventing spread of EVD in healthcare settings and the
community.
❑ Any person working in or entering a healthcare facility is at risk of transmitting
infection or being infected
❑ So IPC is everybody’s business
❑ Patients and Health care workers are at risk of acquiring infections in the
healthcare setting (Healthcare-associated infections)
❑ Effective IPC can significantly reduce the rate of Healthcare Acquired Infections
INTRODUCTION
233. Disease Surveillance and Outbreak Response Unit
Standard precautions
+
Additional transmission based precautions
[Contact precautions & Droplet precautions]
IPC PRECAUTIONS
234. Disease Surveillance and Outbreak Response Unit
● Practices applied to ALL cases, regardless of their perceived or confirmed
infectious status.
● First-line approach to IPC to minimize risk of transmission of infectious agents
even in high-risk situations
● Include:
1. Hand hygiene
2. Respiratory hygiene
3. Personal protective equipment, according to the risk assessment
4. Safe injection practices and sharps management
5. Safe handling, cleaning and disinfection/sterilization of patient care
equipment
6. Environmental cleaning
7. Safe linen management
8. Waste management
Standard precautions:
IPC PRECAUTIONS…
235. Disease Surveillance and Outbreak Response Unit
● Hand hygiene is the best way to
prevent the spread of germs in
health care settings and the
community
● 80% of HAIs are transmitted
through hands of HCW
● It prevents many health care-
associated infections
● Hand hygiene protects you, your
coworkers, your patients and the
environment
1. Hand Hygiene
Standard precautions
The five moments of hand hygiene
236. Main types of hand hygiene
Cleaning: physically removing germs and dirt, use
for visibly soiled hands
Disinfection: chemically killing germs, for visibly
un-soiled hands
1. Hand Hygiene…
Washing hands with soap and water Rubbing hands with alcohol-based handrub
(ABHR)
237. Disease Surveillance and Outbreak Response Unit
1. Hand Hygiene….. Steps of handwashing
• Be sure to wash both
wrists
• Wash hands for 40–60
seconds
238. Disease Surveillance and Outbreak Response Unit
1. Hand Hygiene….. Steps of handrubbing
• Be sure to rub both wrists
• Rub for 20 – 30 seconds
243. Disease Surveillance and Outbreak Response Unit
▪ Have a person to observe you when you don or doff PPE (BUDDY SYSTEM)
▪ Ensure you have all and the right sized PPE before starting a task
▪ Ensure that no mucosal surface is exposed
▪ Check PPE is correctly put on (mirror / observer)
▪ Avoid self contamination while using the PPE
• Do not touch face, mask, eye wear etc
▪ Avoid self contamination on removal of the PPE
▪ Avoid contamination of others
▪ Avoid contamination of the environment
• Dispose of PPE immediately and safely
▪ Do not reuse PPE if it is disposable
▪ Always perform hand hygiene after removing PPE
Key POINTS
2. PPE….
245. Disease Surveillance and Outbreak Response Unit
Definitions
Cleaning
• The first step required to remove contamination by foreign material, such as dust or soil. It will also
remove organic material, such as blood, secretions, excretions and microorganisms, to prepare a
medical device for disinfection or sterilization.
Disinfection
• A process to reduce the number of viable microorganisms to a less harmful level. This process may not
inactivate bacterial spores, prions and some viruses.
Sterilization
• A validated process used to render an object free from viable microorganisms, including viruses and
bacterial spores, but not prions
Decontamination
• Whole process from cleaning and disinfection
4. Environmental cleaning
Standard precautions
246. Disease Surveillance and Outbreak Response Unit
Definitions
Cleaning
• The first step required to remove contamination by foreign material, such as dust or soil. It will also
remove organic material, such as blood, secretions, excretions and microorganisms, to prepare a
medical device for disinfection or sterilization.
Disinfection
• A process to reduce the number of viable microorganisms to a less harmful level. This process may not
inactivate bacterial spores, prions and some viruses.
Sterilization
• A validated process used to render an object free from viable microorganisms, including viruses and
bacterial spores, but not prions
Decontamination
• Whole process from cleaning and disinfection
4. Environmental cleaning
Standard precautions
248. Disease Surveillance and Outbreak Response Unit
Key points
• Clean & disinfect surfaces or objects contaminated with body fluids, secretions or excretions ASAP
• Application of disinfectants should be preceded by cleaning to prevent inactivation of disinfectants by
organic matter
• If locally prepared, prepare cleaning and disinfectant solutions daily
• Clean floors & work surfaces at least once a day with clean water and detergent.
• Moistened cloth helps to avoid contaminating the air and other surfaces with air-borne particles
• Allow surfaces to dry naturally before using them again
• Dry sweeping with a broom should NEVER BE DONE
• Rags holding dust should not be shaken out and surfaces should not be cleaned with dry rags
• Clean from “clean” areas to “dirty” areas, in order to avoid contaminant transfer
• DO NOT spray (i.e. fog) occupied or unoccupied clinical areas with disinfectant. This is potentially
dangerous & has no proven disease control benefit
4. Environmental cleaning
Standard precautions
249. Disease Surveillance and Outbreak Response Unit
5. Decontamination of medical devices
Standard precautions
Cleaning
(Non-Critical Equipment)
Disinfection/HLD
(Semi-Critical Equipment)
Sterilization
(Critical Equipment)
STORAGE
Soap and water or enzymatic detergents
Chemical,
Autoclaving
Chlorine, Quaternary
ammonium
compounds
250. Disease Surveillance and Outbreak Response Unit
6. Linen Management
Standard precautions
Steps
1. Washing contaminated linen by hand is discouraged
2. If there is solid bodily fluids/excrement (soil, feces, or vomit) on the linen: Remove/scrape it off with a
solid, flat object, dispose of this waste in the patient latrine, and disinfect the container used.
3. Place soiled linen in a container (leak-proof bag or bucket) before transporting it out of the isolation
area, and disinfect the outer surface of the container.
4. Transport the container directly to the laundry room.
5. If a washing machine is unavailable soak the linen hot soapy water and stir with a stick.
6. Rinse with clean water.
7. Soak in 0.05% chlorinated water for 30 minutes.
8. Rinse with clean water.
9. Spread out to dry.
NB:If safe cleaning and disinfection of heavily soiled linen is not possible then burn to avoid
unnecessary risks to the handlers
251. Disease Surveillance and Outbreak Response Unit
Chlorine preparations
Chlorine
strength
Used for Contact time
Routine 0.05% Linen 30 minutes
0.5% Surfaces 10 minutes
PPE 10 minutes
1.0% Blood/body fluid
spills
10 minutes
Context of Ebola 0.05% Linen, PPE 30 minutes
0.5% Environmental
surfaces, PPE, blood
and body fluid spills
Minimum 10
minutes
252. Disease Surveillance and Outbreak Response Unit
How to make chlorine solutions for cleaning and disinfection
253. Disease Surveillance and Outbreak Response Unit
6. Waste Management
Standard precautions
Waste management process
254. Disease Surveillance and Outbreak Response Unit
6. Waste Management
Standard precautions
Waste Segregation
NB: In an isolation set up all waste should be considered infectious!!!!!!!
255. Disease Surveillance and Outbreak Response Unit
6. Waste Management
Standard precautions
Key Points
• Waste should be segregated at point of generation
• Collect all solid, non-sharp, infectious waste using leak-proof waste bags & covered bins.
• Bins should never be carried against the body (e.g. on the shoulder).
• Waste should be placed in a designated pit of appropriate depth: 2 meters and filled to a depth of 1–
1.5 m.
• After each waste load, the waste should be covered with a layer of soil 10 –15 cm deep
• An incinerator may be used for short periods to destroy solid waste
• It is essential to ensure total incineration has taken place
• Placenta and anatomical samples should be buried in separate pit
• Control area for final treatment & disposal to prevent entry by animals, untrained personnel or
children
• Waste: faeces, urine, vomit and liquid waste from washing, can be disposed of in sanitary sewer or pit
latrine. No further treatment is necessary
256. Disease Surveillance and Outbreak Response Unit
● Additional practices (transmission-based precautions) for specific
situations where standard precautions are not sufficient to interrupt
transmission
● These are tailored to:
○ Infectious agent
○ Mode of transmission
● The there types of transmission based precautions
○ Contact precautions
○ Droplet precautions
○ Airborne precautions
Additional precautions:
IPC PRECAUTIONS…
257. Disease Surveillance and Outbreak Response Unit
▪ Applied when a patient is suspected or known to have
an infection that are spread by touch or contact with
other patient, patient’s environment, surfaces, and
equipment
▪ It is the main mode of transmission of EVD and can
occur even through intact skin
1. Contact Precautions
Additional precautions…
258. Disease Surveillance and Outbreak Response Unit
Elements of Contact precautions:
• Put a sign on the door
• Put a note in the chart
• Single room (preferred)
• Dedicated care equipment
• Before coming into contact with the patient or patient environment:
○ Perform hand hygiene
○ Put on recommended EBV PPE
• Immediately after contact with the patient and/or his environment:
○ Follow the PPE removal sequence
○ Perform hand hygiene
Elements of Contact precautions
1. Contact Precautions…
259. Disease Surveillance and Outbreak Response Unit
Droplet precautions:
● Applies when patients are known or suspected to have infections transmitted by
respiratory droplets
● Respiratory droplets are particle > 5 microns from the lungs, mouth or nose that are
expelled into the air when people cough, talk or sneeze.
● Ebola virus is transmitted among humans through close and direct physical contact with
infected bodily fluids
● Droplets can also spread via the hands when people sneeze or cough into their hands and
then touch mucous membranes of another person
● When in close contact (within 1 metre) of patients with EVD, health-care workers should
wear face protection (a face shield or a medical mask and goggles)(WHO)
2. Droplet Precautions
Additional precautions…
260. Disease Surveillance and Outbreak Response Unit
Elements of Droplet precautions:
• Put a sign on the door/bed
• Put a note in the chart
• Single room (preferred)
• Ensure patients are physically separated (more than 1 meter/3 feet apart) from
each other
• Before entering the patient-care area:
• Perform hand hygiene
• Put on a surgical mask (NOT a respirator)
• Wear additional PPE IF required, depending on the risk assessment
• Before leaving the room:
• Remove and properly discard PPE
• Perform hand hygiene immediately after removing PPE
Elements of Droplet precautions
2. Droplet Precautions….
261. Disease Surveillance and Outbreak Response Unit
Airborne precautions:
● Applies when patients known or suspected infections transmitted over long
distances through the air (Aerosols)
● Respiratory aerosols are particle < 5 microns from the lungs, mouth or nose that
are expelled and can remain suspended in air when people cough, talk or sneeze.
● Also applicable when performing aerosol generating procedures (AGPs) like
intubation, nebulization e.t.c
● When attending to EVD and due to the possibility of patient condition
deteriorating and requiring performance of AGP, all HCW should apply airborne
precautions (Respirator)(CDC)
3. Airborne Precautions
Additional precautions…
262. Disease Surveillance and Outbreak Response Unit
Elements of Airborne precautions:
• Put a sign on the door/bed
• Put a note on the file
• Single room (mandatory), an airborne infection isolation room (AIIR), with;
• Ensure good ventilation of the room
• Negative pressure or natural ventilation with doors kept closed
• Before entering the room
• Performing hand hygiene
• Wear a recommended Ebola PPE including a respirator (FFP2 or N95)
• After leaving the room:
• Remove PPE following recommended guidelines
• Performing hand hygiene
Elements of Airborne
Precautions
3. Airborne Precautions…
263. Disease Surveillance and Outbreak Response Unit
WHO SHOULD WEAR PPE
• Healthworkers
• Doctors, nurses, and other providing direct patient care
• Support staff handling patients or patient materilals
• All laboratory staff
• Laboratory support staff
• Burial teams
• Family members who care for EVD patients
2. PPE
Standard precautions
266. Disease Surveillance and Response Unit
Introduction
❑There is need for clarity in referring EVD cases
❑Every health level must evaluate
❑Decide which facility will offer what service
❑Preferably each level should have one facility that
will be the referral/secondary facility for that level
❑Network the facilities
267. Disease Surveillance and Response Unit
Reaching decision on transfer
of patients (1)
❑Set up in each hospital a clinical team for initial clinical evaluation
of suspect cases
❑Composition of such a committee
▪ Medical Director
▪ Infection control/infectious disease medical officer
▪ Relevant consultants in medicine and other disciplines
