UHWI Ebola Preparedness & Response Update Feb 4, 2015

Ebola Symptoms

The Ebola outbreak in West Africa was first reported in March 2014 in an outbreak linked to a two-year-old toddler, who died in December 2013 in Meliandou, a small village in south-eastern Guinea. The outbreak rapidly became the deadliest occurrence of the disease since its discovery in 1976 killing more than all other known Ebola outbreaks combined.

Up to 6 January, 8,235 Ebola deaths have been reported in six countries; Liberia, Guinea, Sierra Leone, Nigeria, the US and Mali. The total number of reported cases exceeds 20,000 and the World Health Organization (WHO) has stated that the figures are underestimates, given the difficulty collecting the data. WHO officials this week discovered scores of bodies in a remote diamond-mining area of Sierra Leone, raising fears that the scale of the Ebola outbreak may have been underreported. http://www.bbc.com/news/world-africa-28755033

Ebola Case Count jan 16, 2015

http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html

How the virus spread: Ebola death toll

http://www.bbc.com/news/world-africa-28755033

How Ebola Spread

Countries Ebola Over

UHWI Ebola Preparedness & Response Update

Updated Feb 4, 2015

The University Hospital of the West Indies (UHWI) would like to inform its employees and clients that it has and continues to be actively engaged at all levels in ensuring that all the necessary procedures are implemented for the prevention and control of all infectious diseases. The UHWI follows the guidelines of the Jamaica Ministry of Health, the World Health Organization (WHO), the Pan American Health Organization (PAHO) and the Caribbean Public Health Agency (CARPHA).

The UHWI Ebola Preparedness Committee (UHWI EPC) was established in response to the current outbreak in West Africa.

Below is a summary of key steps which have been implemented by the UHWI EPC to enable the early detection and prevention the spread of Ebola at the UHWI and in Jamaica.

Patient Triage

Patient Triage for VHF will occur in a designated location at the UHWI away from routine patient Triage.
1. All patients will first be screened for fever and diarrhea ( with or without) vomiting*

AND
2.   A history of travel within the 3 weeks of symptom onset.
    a.    Travel to West Africa or other countries where Ebola virus disease transmission has been reported by WHO
            or
    b.   History of travel contact with (a) or patient presenting with (1)
*Additional symptoms screened for will include: headache, joint and muscle aches, weakness, fatigue, stomach pain, lack of appetite, and bleeding.

Suspect or Probable Patients –Interim Isolation

Suspect patients will be transferred to a designated infectious disease isolation holding unit using standard, contact and droplet precautions for further assessment. This isolation unit has been constructed by the UHWI and will serve to contain highly infectious diseases such as Ebola until patients are transferred to the designated MOH Ebola Treatment Centre.

The UHWI would like to thank Mr. L Williams and his team for their hard work in enabling the construction of the UHWI ID isolation unit.

Isolation Unit

UHWI Isolation Unit Construction Team

Education

Professor C Christie-Samuels (Head, Ebola Education Sub-Committee)

Understanding how Ebola is spread, surveillance and the use of recommended infection control guidelines has been proven to interrupt the spread of Ebola. The Education committee is actively involved in increasing the awareness of UHWI employees regarding Ebola through scheduled workshops/meetings. Twenty (28) such workshops/meetings have occurred to date with an estimated attendance of over 3,300 persons. In addition two DM Microbiology Residents had the opportunity to attend the MOH/PAHO Cuban Ebola Preparedness Workshop (December 1 to 3rd, 2014).

Two types of Training Workshops are offered.

A) General Education Training.

And

B) Specialized Training for Front Line Responders with Competency Assessment.

For Information on Education and Training Appointments Contact:

Mrs. Andrea Cross, UHWI EPC Secretary, Telephone: 876-822-0213, Email: andrea.cross@uhwi.gov.jm

24 hour contact number: 1-876-927-1620-9 (UHWI Ebola Preparedness Committee)

The Health Care Worker is defined by WHO as:

“all people engaged in the promotion, protection or improvement of the health of the population”

Reference: WHO. Dal Poz MR, Kinfu Y, Dräger S and Kunjumen T.Counting health workers: definitions, data, methods and global results. Department of Human Resources for Health.

WHO. 2007

Training of Marksman UHWI Security

The hospital security department plays an important role in emergency and control access to the UHWI, and controlling visitors’ movements. They are positioned at key locations throughout the UHWI and if necessary can direct patients to specific areas.

Training in the use of Personal Protective Equipment for Front Line Responders

Training of Accident and Emergency Doctors and Nurses

FMS - Annual Research Conference Ebola Awareness Booth

Infection Control Practices

The UHWI Infection Control Sub-Committee has the responsibility of working with the UHWI Infection Control Committee in the monitoring of infection control procedures for Ebola at the UHWI. This includes:

1. Standard Precautions

2. Contact Precautions

3. Droplet Precautions

Good Hand Hygiene is the foundation of infection control and is important in the prevention and control of Ebola.

Hand Hygiene

http://thelovingmum.sg/wp-content/uploads/2012/10/8_steps_hands.jpg

Communications

The UHWI Communications Sub-Committee has the responsibility for the implementation and vetting of communications within the UHWI. All external, media and internal communications are under the jurisdiction of the office of the CEO and the Medical Chief of Staff. All patient matters will be handled with strict confidentiality.

Staffing

The UHWI will limit the number of health care Triage workers for Ebola surveillance and management. These workers must be medically cleared and display competence in the use of appropriate Viral Hemorrhagic Fever (Ebola) infection control procedures. All health care workers will be provided with the appropriate category WHO Personal Protective Equipment (PPE) and infection control supplies. Employees engaged in care will be volunteer employees and will not be coerced to care for high risk infectious patients with illness such as Ebola which has a fatality rate of 70% in the current outbreak.

Security

Designated security checkpoints will be manned by trained security personnel.

Transfer of Patient to designated Ministry of Health Facility

The patient will be transferred to the designated MOH facility at the National Chest Hospital under the supervision of the MOH for long term care. Patients will be transported for using WHO guidelines under approval of the Medical Chief of Staff or designate.

Reporting of Suspect or Probable Cases

All suspect or probable cases will be reported immediately to the MOH under confidentiality using the designated UHWI Ebola Preparedness and Response Communication Algorithm. This Algorithm will be made available to relevant persons.

Interim Patient Management

Only one blood sample will be taken by a MOH trained health care worker and transported by the MOH to the Public Health Agency of Canada for confirmatory investigation. Health care will concentrate on nutrition, fluid balance, oxygen, antibiotics and blood and blood products from universal donors with restricted movement of patients.

Implementation of an Infectious Disease Ward

The UHWI is in the process or renovating a permanent infectious disease ward for all infectious diseases. This will have the capacity to manage four patients (Biosafety Level 3 and 4 pathogens).

Patient Contact Tracing

The initial list of contacts will be identified by the UHWI Public Health Team (Surveillance) Team using the national guidelines. Follow up contact tracing will be by the MOH.

Management of waste disposal

Waste disposal will be managed by trained UHWI Environmental and Maintenance using WHO guidelines in collaboration with the MOH.

Management of Deceased

All deceased will be managed on location using WHO guidelines and transported to the MOH designated morgue by the MOH.

Patient and Staff Counselling

Designated counseling services will be available by trained counselors.

Monitoring and Evaluation

The UHWI EPC Monitoring and Evaluation sub-committee will audit and monitor all activities of the Preparedness and Response Plan. Scheduled feedback to the committee will allow for adjustments and improvements to staff and patients. These guidelines are being updated, as new information becomes available.

UPDATES/PERIODICALS

World Health Organization-Ebola Response Roadmap- situation report- 31 October, 2014

1) UHWI SITUATION UPDATES: