Ebola Treatment Centres - Preventing Infection

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1 Ebola Treatment Centres (ETC or CMC) Patient and staff flow Francis Chatelain And Michalis Papageorgiou Ebola introduction 2014

2 Control of infection and epidemic through isolation of Ebola Patients Patients: contagious via its fluids!! Risk of infecting their relatives and medical staff. Prevent contamination by placing a physical and chemical barrier (chlorine and protocols) around the patient. It is necessary to isolate every Ebola suspect case as even if it is not yet confirmed he might be contagious from the 1 st onset of symptoms. 1 patient or 10 in the treatment centre: same principles apply, just not at the same scale. Explanation and communication to the population are essential: coming to the ETC = better care for the patients and protection of the relatives

3 Infection control for Ebola: Infection control is essential : limitation of transmission risks. Virus: - Fragile - Does not survive long outside of a body - Survives a few day in fluids outside of a body (blood, urine, sweat, breast milk, excreta, ) Chlorine, UV and soap kill the virus

4 Considerations when Setting up a treatment centre Location: - Centralise the ETC (training, HR, logistics) - Close to the outbreak epicentre (limiting movements of patients) - Easy access by car (ambulance, log) - Access to water, management of waste water - Spacious (other activities, extension,?) Buildings: - Existing Health Structures - Other existing buildings - Tents, semi-temporary

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7 Risk Areas Different areas corresponding to different level of risks Barrier between the different areas (physical-see through and chemical) I. High Risk Area: area with direct contact with patients fluids (inside or outside ETC) - Patients care - Preparation of dead bodies for burial - Contaminated Waste - full Personal Protective Equipment (PPE): compulsory, maximum protection - Administrative control: patients and only authorised staff or visitors

8 Risk areas (continuation) II. Low Risk Area: No direct contact with patients fluids. - Area with supporting activities for High risk Area: changing rooms, laundry, storage, lab - Personal Protective Equipment (working clothes) => Scrubs, boots, exam gloves - Administrative control: logistics, cleaning and medical staff etc. III. Outside of treatment centres - Universal precautions + risk assessment - common sense (importance to understand the disease)

9 Patient Segregation High/ low likelihood suspects and confirmed cases Aims at preventing that a patients presenting Ebola-like symptoms (eg malaria) gets infected within the treatment center while expecting ebola tests results. Areas separated with physical and chemical barriers Systematic disinfection between patients of boots and gloves with 0.5% chlorine solution Latrines and showers separated between Low and High Risk area but also between suspect, probable and confirmed patients.

10 Patient Flow Two distinctive sectors: Suspect cases (see case definition) Confirmed cases Prevent contamination of suspect cases that are in fact negative for Ebola Suspect (high and low likelihood) and confirmed: no contact between them As soon as a suspect case becomes confirmed or presents signs that categorise him as high likelihood cases: transfer to the appropriate sector

11 Staff flow From low risk area to high risk area Never the other way round! Disinfection of staff after each contact with a patient, FOR EVERY PATIENT (regardless if suspect or confirmed) In low risk area: 2 sectors, the staff flow goes from the «low likelihood suspect cases» sector to the «high likelihood» one, Never the other way round

12 Specific precautions (additional to Universal Precautions) Hand/glove washing: always disinfect using 0.5% chlorine solution- High Risk Zone, 0.05% Low Risk Zone Wear, full PPE to protect all skin sections: scrubs, boots, gloves (2 pairs) overalls, apron, mask, hood, goggles. Always follow dressing and undressing protocols. Wash (see guideline) With chlorine solution 0.5%: beds, tables, floor, latrines, showers With Solution 0,05%, laundry, dishes. Patients cloth soiled by fluids (blood, vomit, faeces ) Disinfected 0,5% then burned. Beds, floor soiled with blood, urine, vomit, faeces : pour 0.5% chlorine solution on the spill, leave for 10 min, remove with absorbant pad, discard and burn. Needles and wastes: waste area in High Risk Area and incineration All material that enters the High Risk Area is considered as contaminated and must be burned if not possible to disinfect

13 Risk areas (continuation)

14 Low risk area High Risk Areas High Risk Zone Preparation of chlorine solutions Laundry Changing rooms stock/pharmacy. Confirmed cases Suspect cases Waste area Morgue

15 Exemple of an Ebola Treatment Center structure LEGEND : LOW RISK ZONE HIGH RISK ZONE Latrine + bathroom Chlorine hand washing Chlorine footbath Chlorine preparation Laundry lines Laundry area Store room Guard +spray Probable/confirmed cases ward or rooms Probable/confirmed cases ward or rooms Expansion probable/confirmed cases ward or rooms HIGH RISK ZONE Waste window Morgue Outer fence Inner fence LOW RISK ZONE STAFF Changing room 2 Spray or dip Expansion suspected cases ward or rooms waste Sharps pit Organic waste pit Corpses Doctor s Suspected cases ward or rooms room Suspected cases ward or rooms Burner and pit HIGH RISK ZONE OUTSIDE Changing room 1 STAFF Guard +spray PATIENTS Screening room Slope down

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19 Try to: Plan for a visitors zone Visitors in Low Risk areavisual contact with High Risk area Visit in High risk area possible but with protective clothing E.T.C. Visitors

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21 Protection of staff, do not forget... All Ebola patients fluids are contagious The full Personal Protection Equipment protect you from infection, but only if: YOU RESPECT THE PROTOCOL FOR DRESSING AND UNDRESSING It does not protect you if it is perforated: beware of needles, broken glass, metal. It is essential to check at all time our own PPE, our colleagues PPE and the authorised visitors PPE. If you are not feeling good, get out!! But you must always respect the undressing protocol!

22 Protective equipments only protects you from spills and splashes but they are not completely waterproof nor very resistant. Any handling of infectious waste must be done with extreme precautions.

23 Ensure that all skin and mucous membrane is covered Waterproof material Clothing: Scrubs. Gloves (2 pairs) Overall Apron Boots Hood Mask Goggles Dressing

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25 NOT LIKE THIS

26 E.T.C. High Risk entry Always get dressed with someone else supervising!!!

27 Undressing Strict procedures Risk of contamination: eyes, mouth, nose, skin (mucous membranes) Remove first the most contaminated clothing Chlorine solutions 0.5% and 0.05%

28 E.T.C. High Risk area exit