Guidance for the Evaluation of Employees with Suspected Infection with

Ebola Virus Disease

Early recognition is critical for infection control. Health care providers should be alert for and evaluate any patients suspected of having Ebola Virus Disease (EVD).

Person Under Investigation (PUI)

A person who has both consistent symptoms and risk factors as follows:

  • Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
  • Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

Ebola Testing

Ebola virus is detected in bloodonly after the onset of symptoms, usually fever. It may take up to 3 days after symptoms appear for the virus to reach detectable levels. Virus is generally detectable by real-time RT-PCR from 3-10 days after symptoms appear.

Ideally, specimens should be taken when a symptomatic patient reports to a healthcare facility and is suspected of having an Ebola exposure. However, if the onset of symptoms is <3 days, a later specimen may be needed to completely rule-out Ebola virus, if the first specimen tests negative.

Evaluation

Employees presenting to Employee Health will be evaluated for signs and symptoms of EVD.

Upon arrival to Employee Health
Does employee have fever (subjective or ≥101.5°F)? / Oral temp:
Does patient have compatible EVD symptoms such as headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage? /  Yes  No
Has the patient traveled to an Ebola-affected area in the 21 days before illness onset? /  Yes  No
If fever greater than ≥ 101.5°or EE responds “Yes” :
  • Immediately close Employee Health office
  • Don PPE (surgical mask and shield or goggles, gloves, and gown)
  • Place a surgical mask on the employee
  • Call ED to transfer employee.
  • Notify Employee Health Manager, Infection Preventionist and Medical Director of Infection Control

Conduct a risk assessment for exposure (asymptomatic):
  • Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids from an EVD patient
  • Direct skin contact with skin, blood or body fluids from an EVD patient
  • Processing blood or body fluids from an EVD patient without appropriate PPE
  • Direct contact with a dead body in an Ebola-affected area without appropriate PPE
/  Yes  No
  • Household members of an EVD patient or others who had brief direct contact (e.g., shaking hands) with an EVD patient without appropriate PPE
  • Healthcare personnel in facilities with EVD patients who have been in care areas of EVD patients without recommended PPE
/  Yes  No
If “Yes” :
  • Provide support and offer EAP
  • Notify Employee Health Manager, Infection Preventionist and Medical Director of Infection Control
  • Work in concert with CDC 1 (770) 488-7100 and Office of Public Health 1(800) 256-2748​
  • Follow Blood and Body Fluid Policy/Protocol

Upon employee exiting Employee Health
  • PPE should be carefully removed without contaminating one’s eyes, mucous membranes, or clothing with potentially infectious materials
  • Discard disposable PPE
  • Re-useable PPE should be cleaned and disinfected per the manufacturer’s reprocessing instructions
  • Hand hygiene should be performed immediately after removal of PPE
  • Wear PPE (detailed in center box) during environmental cleaning and use an EPA-registered hospital disinfectant with a label claim for non-enveloped viruses

Ebola EH Eval KB/mgb 10/04/14