For General Healthcare Settings in West Africa: Managing Patients with Ebola Virus Disease (EVD), Their Families, and the Community Safely and Compassionately

Key Points

• Safely isolate and manage patients PUIs for EVD.
• Alert public health authorities about a PUI.
• Educate family and the community about what they can do to stay healthy.

Management of PUIs in General Healthcare Settings (Non-Ebola Treatment Units)

All patients coming to the healthcare facility must be assessed for EVD based on the screening flowchart.

Any PUI should be immediately directed to the isolation area. Proper public health authorities should be immediately notified.

Any PUI needs to be isolated while waiting for the ambulance to pick them up. If more than one patient is isolated in your facility, keep them at least 1 meter apart.

• If the patient is a child, a parent may be present with them in the isolation area. The parent must be dressed in the same personal protective equipment (PPE) as used by healthcare staff inside the isolation area. The healthcare staff will need to assist the parent in putting on and removing the PPE appropriately. A parent wearing PPE should never exit the isolation area without removing their PPE under the supervision of healthcare staff.

The person in charge at the facility should take responsibility for managing the PUI. The person in charge may designate someone else to manage the case, if needed. No other staff should touch or assist the patient in the isolation area after this point. The following guidelines should be followed when isolating a PUI:

1. Calmly inform the patient: Tell the patient calmly that you suspect he or she might have Ebola. Ask the patient to walk into the isolation area. Remind the patient to remain in the isolation area until instructed otherwise.
2. Inform the healthcare staff: Inform the other staff that there is a PUI in the isolation area.
3. Designate one healthcare staff member to manage the patient: Decide who will take responsibility for managing the PUI.
4. Restrict movement: Prohibit visitors (with the potential exception of a parent who is isolated with a young child) from entering the isolation area. Limit where people can walk into and walk out of the isolation area. Use a physical barrier (such as using a separate room, putting up rope, or lining up plastic chairs) and a sign. Allow only designated healthcare staff to access the isolation area. Make sure healthcare staff are wearing appropriate PPE before they access the isolation area. If possible, place a staff member outside the isolation area to restrict access. Keep a list of all individuals who enter the isolation area and record their reason for entering (for example, what procedure did they perform?).
5. Alert public health authorities: Immediately contact the public health authorities after the patient has been safely moved to the isolation area. Try all possible measures to get in touch with the public health authorities so the patient can be picked up as quickly as possible.
6. Contact the family: Ask the patient for his or her family’s contact number. Provide family members with information about the symptoms of Ebola and recommend that they seek care right away if they presently have or if they later develop symptoms. Advise them to use a strong (0.5%) chlorine solution to clean any areas soiled by the patient’s body fluids (blood, feces, vomit, urine, saliva, tears, breast milk, semen, vaginal secretions). Giving family members appropriate support and information may help stop community spread of Ebola.
7. Disinfect the triage area: Clean and disinfect the places where the patient was sitting or was otherwise assessed before entering the isolation area and anything he or she touched. Use a strong 0.5% chlorine solution and a disposable towel or rag. PPE must be worn when cleaning and disinfecting. The recommended PPE includes boots, gowns, two pairs of gloves, an apron, a facemask, and a face shield (goggles can be used if no face shield is available).
8. Provide treatment: Treat the patient’s symptoms. Use only oral medications. Minimize physical contact with the patient.
   DO NOT give any injections or start intravenous fluids.
   DO NOT use a rapid diagnostic test (RDT) for malaria.
   DO NOT conduct any procedure that involves sharp instruments, such as drawing blood.
   DO
   • Keep the patient hydrated.
   • Provide oral rehydration solution.
   • Provide oral antiemetic, if available.
   • Provide malaria treatment for all patients with fever.
   • Ask the patient if he or she is taking treatment for TB or HIV. Ensure this information is relayed to the isolation center so that the patient can continue taking their treatment without interruption.

• It is important for healthcare workers to protect themselves while providing care to a PUI.
  • Minimize the number of staff allowed to enter the isolation area.
  • Ensure all staff entering the isolation area are wearing appropriate PPE.
  • Ensure staff put on and remove PPE properly.

9. Feed the patient: Try to contact family members of the patient. Ask the family to bring food for the patient. Family members may not enter the isolation room. Pass the food to the patient, such as by placing it on the floor and pushing it toward the patient.
10. Alert local authorities if the patient attempts to leave or run away: Try to convince the patient to stay. Find out why the patient wants to leave (such as food, water, fear). Do not physically restrain any patient. You have a responsibility to the community to inform security if a patient in isolation attempts to leave the premises.
11. Continue to reassure the patient: Provide psychosocial support to the patient. Prepare the patient for the possibility of a positive Ebola test.
    • Remind the patient that many people survive EVD.
    • Acknowledge the patient’s anxiety and be aware that during EVD treatment anxiety can be magnified by the required infection control measures, such as
      • Isolation.
      • PPE, which can sometimes feel dehumanizing.
      • Reduced or absent communication with family and healthcare workers.
    • Explain what you are doing and why, both to your patient and to the patient’s family.
    • Always provide care with dignity and compassion.
    • Use everyday words and concepts rather than medical and public health jargon. Check for understanding by asking patients and family members to restate and explain information in their own words.