Stopping the spread of infection starts with three simple steps to proactive patient management – Identify, Isolate, and Inform. When implemented quickly, these three activities reduce risk, and they are crucial steps for healthcare workers caring for patients.
Learning best practices and assessing and managing placement of individuals suspected to have Ebola virus disease and Other Special Pathogens, commonly referred to as Persons Under Investigation (PUI), is the most critical step in identifying and correctly diagnosing the illness. With the help of the tiered system developed by the Centers for Disease Control and Prevention (CDC), there is a national framework used to coordinate a networked approach to mitigate disease transmission and activate resources within your state and Health and Human Services (HHS) region.
The tiered system has been implemented in varying ways in state and territory health departments to identify healthcare facilities that function in one of three capacities — Frontline Healthcare Facility, Ebola Assessment Hospital, or Ebola Treatment Center. Each facility is tasked with having the ability to identify patients who present with Ebola virus disease and Other Special Pathogens, isolate them to prevent disease transmission, and inform appropriate internal staff and public health authorities.
Per the CDC case definition on patient evaluation, a person who has both consistent signs or symptoms as follows should be considered a Person Under Investigation (PUI). A person who has both consistent signs or symptoms and risk factors as follows should be considered a PUI:
- Elevated body temperature
- Subjective fever
- Severe headache
- Muscle pain
- Abdominal pain
- Unexplained hemorrhage
- An epidemiologic risk factor within the 21 days before the onset of symptoms
- International travel to a hot spot location of confirmed EVD
- Contact with someone with Ebola virus disease within the last 21 days
Early recognition leads to early isolation and is another key to preventing the spread of infection. Screening should be done immediately upon patient arrival or in advance if possible.
If the assessment meets the EVD case definition, take action. When a patient becomes a PUI, it is essential to think of isolation considerations. Questions to ask include:
- What is your defined path to move the patient to the isolation area?
- What PPE should the health care worker wear?
- What would your facility do if there was more than one patient? Or family members?
- What other tools or resources (e.g. checklists, resource documents) could be created in advance to assist the team?
It’s time to alert others, including public health authorities. Notifications to facility personnel should be made immediately. It is key to have a list of these individuals ahead of time. Meet with key stakeholders and establish relationships in advance. This will make the inform process much more manageable.
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