Dealing with Ebola virus disease

Ebola virus disease (EVD) is a rare but severe infection caused by Ebola virus. Since March 2014, there has been a large outbreak of Ebola virus in West Africa, with widespread and intense transmission in Guinea, Liberia and Sierra Leone. This is the largest ever known outbreak of this disease prompting the World Health Organization (WHO) to declare a Public Health Emergency of International Concern in August 2014. Cases have also occurred in Senegal, Nigeria, the U.S. and Spain.
    
One repatriated healthcare worker has been treated in London, but to date there have been no other cases of Ebola linked to the West Africa outbreak in the UK.

Ebola transmission
Unlike infections like flu or measles, which can be spread by virus particles that remain in the air after an infected person coughs or sneezes, transmission of Ebola from person to person is by direct contact with the blood or body fluids (e.g. saliva, vomitus, urine, stool and semen) of a symptomatic infected person. This means that the body fluids from an infected person (alive or dead) have touched someone’s eyes, nose or mouth, or an open cut, wound or abrasion. There is no evidence of transmission of Ebola virus through intact skin or through small droplet spread, such as coughing or sneezing.
    
Infection can also occur if broken skin or mucous membranes of a healthy person come into contact with environments that have become contaminated with an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles. The likelihood of contracting Ebola is considered low unless there has been this type of specific exposure. Ebola virus is not spread through routine, social contact (such as shaking hands or sitting next to someone) with asymptomatic individuals. People who have had social contact with symptomatic individuals with confirmed Ebola infection should be followed up as a contact through the local Health Protection Team.
    
The Ebola virus is not a robust virus, and is readily inactivated, for example, by soap and water or by alcohol.

Identifying patients at risk
Ebola is spread through direct contact with blood and body fluids from infected people. The incubation period ranges from two to 21 days. It remains unlikely but not impossible that travellers infected in one of the affected countries could arrive in the UK while incubating the disease and develop symptoms after their return. Although the likelihood of imported cases is low, healthcare staff in the UK need to remain vigilant.
    
Individuals may present in several different ways to hospitals: referral by NHS 111, referral by primary care, self-presentation directly to A&E, or transfer by ambulance. Triage mechanisms need to be able to quickly identify patients at risk so that they can be isolated and a risk assessment completed.
    
Patients with a history of travel to an affected area within the last 21 days who have a fever (>380C), or a history of fever in the past 24 hours, should be isolated and any further assessment carried out by staff wearing appropriate personal protective equipment (PPE). Apart from fever, other symptoms of Ebola may include headache, sore throat, general malaise, diarrhoea, vomiting, bleeding and bruising.
    
Additional information that may assist with the subsequent risk assessment includes whether the individual has come into contact with a person known/suspected to have Ebola, cared for anyone with a severe illness or who has died of an unknown cause, attended any funerals, had any contact with dead bodies, visited any traditional or spiritual healers, or been admitted to hospital in the affected areas.
    
Guidance on the risk assessment and management of viral haemorrhagic fevers (including Ebola) by the Advisory Committee on Dangerous Pathogens (ACDP) is the principal source of guidance for clinicians risk assessing and managing suspected cases.

Cleaning requirements
The following cleaning requirements have been written based on the ACDP guidance for the management of individuals with suspected or confirmed viral haemorrhagic fever, such as Ebola virus. This guidance applies for individuals who have been categorised as high possibility or confirmed Ebola. Specialist advice should be sought from the Health Protection Team, where required.
    
All cleaning must be conducted wearing appropriate personal protective equipment (PPE) according to the standards described in the ACDP guidance.
    
Where there has been no obvious contamination with blood or bodily fluids, affected areas should be disinfected with hypochlorite containing 10,000ppm available chlorine. Affected clothing or linen should be contained within an impermeable bag and treated and disposed of as category A waste.
    
For areas where there has been contamination with blood or bodily fluids, the above guidance should be followed as well as addition measures. Bodily fluids should be mopped up with absorbent material, such as disposable paper towels. The area should then be disinfected with freshly prepared hypochlorite solution containing 10,000ppm available chlorine ensuring a contact time of two minutes before wiping up with disposable paper towels, but do not mix hypochlorites with any other cleaning agents as this may create dangerous fumes. The surface should then be washed with warm water and detergent. For larger spills, where possible, allow any potential aerosols to settle out. Adequate ventilation must be ensured when disinfecting areas with chlorine based products
    
Specialist contractors may consider fumigation necessary following assessment. All waste, including linen and potentially contaminated cleaning equipment, should be treated and disposed of as category A waste.

Source: Public Health England

FURTHER INFORMATION
Guidance from Public Health England can be downloaded from tinyurl.com/lce8ovc

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