For General Healthcare Settings in West Africa: Initial Screening of Patients Within the Healthcare System

Key Points

• Screening patients is one of the most important infection control measures.
• All patients should be screened before entering the main clinic.
• Screening attendants should follow established plans or protocols for screening.

One of the most important components of infection control is to immediately screen all patients and separate those patients who may have EVD from patients who do not. Screening is the process that happens as soon as a patient arrives at a healthcare facility. It is very important that all patients are screened before proceeding into the main clinic.

The purpose of screening is to identify patients who may have EVD so that they can be separated from other patients and healthcare workers will know when to use appropriate PPE while caring for these patients.

A screening attendant should be available at the screening site at all times. There should be a barrier that keeps unscreened patients and community members from entering the clinic until they are screened. While waiting to be screened, patients should be instructed to maintain a distance of 1 to 2 meters (3 to 6.5 feet) from each other. This minimizes the potential of spreading infection. If the prescreening area has seating, chairs should be spaced a minimum of 1 meter (3 feet) apart. It is not recommended to use benches in the pre-screening area, because it puts people too close to one another.

Before starting to screen a patient, the screening attendant must wash his/her hands and put on gloves and a face shield (if not available, a face mask and goggles can be worn). Additional precautionary measures may be considered (for example, an impermeable gown) but avoiding physical contact and maintaining a minimum 1 meter (3 feet) should be the priority.

The attendant should explain to the patient that all patients need to be screened because of the presence of Ebola in-country. The screening attendant should then go through a set of screening questions. These questions should be available, printed and laminated, at the screening station.

The screening attendant should DO the following screening procedures:

1. Ask the patient about
   • Any unexplained bleeding.
   • Ebola-related signs and symptoms. Symptoms of Ebola include fever (38.0°C/100.4°F or greater core temperature, or 37.5°C/99.5°F axillary [underarm] temperature) and additional symptoms, such as severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal (stomach) pain, or unexplained hemorrhage (bruising or bleeding).
   • Contact in the past 21 days with either people who have or may have Ebola.
2. Take the patient’s temperature.

   Screeners must be wearing basic PPE – boots, gloves, face shield (or goggles and face mask, if a face shield is unavailable) to take a temperature.

   • Taking a temperature using a mercury or digital thermometer:
     When using a mercury or digital thermometer, temperature should be measured in the axilla (underarm), and the patient should be approached from behind. Digital thermometers will measure accurate temperatures in less than 1 minute, while mercury thermometers require at least 5 minutes to measure the body temperature. The screener should leave a mercury thermometer in the axilla for at least 5 minutes. Once the patient’s temperature has been taken, the thermometer needs to be cleaned with a disposable paper towel soaked in mild (0.05%) chlorine solution and then allowed to dry before the next use. Chlorine residue should be wiped off the thermometer before it is used on the next patient.
   • Taking a temperature using noncontact infrared thermometers:
     The screening attendant should stand at least 1 meter (3 feet) away from the patient and extend their arm to hold the thermometer at a distance of 5-6 centimeters (or 2 inches) away from the patient’s temple. If any part of the infrared thermometer touches the patient, the entire thermometer must be disinfected with 0.05% chlorine on a disposable towel.
     After the temperature is taken, the screener should remove his/her gloves carefully and dispose of them, and then immediately clean his/her hands with soap and water, alcohol-based hand rub, or mild (0.05%) chlorine solution. Detailed information on hand hygiene procedures can be found here.
3. Determine whether the patient meets criteria for a PUI. Once the screening questions have been asked, and the temperature has been taken, the screener should identify the patient as either a PUI or not.