Checklist for Patients Being Evaluated for Ebola Virus Disease (EVD)

Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers. It is not spread through the air or water. The main source for spread is human-to-human transmission. Avoiding contact with infected persons (as well as potentially infected corpses) and their blood and body fluids is of paramount importance.It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees). The Checklist aims to assist countries assess and test their level of readiness, and be used as a tool for identifying concrete actions to be taken by countries and identifying potential gaps.

Title Page

Site
Conducted on
Prepared by
Location

Upon arrival to clinical setting/triage

Assess the patient for a fever (subjective or ≥100.4°F / 38.0°C)
Determine if the patient has symptoms compatible EVD such as headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage
Assess if the patient has a potential exposure from traveling to a country with widespread Ebola transmission* or having contact with an Ebola patient in the 21 days before illness onset Suspect Ebola if fever or compatible Ebola symptoms and an exposure are present

Upon initial assessment

Isolate patient in single room with a private bathroom and with the door to hallway closed
Implement standard, contact, & droplet precautions
Notify the hospital Infection Control Program at ________________________________________
Report to the health department at ____________

Conduct a risk assessment for: High-risk exposures

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

Low-risk exposures

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

During aerosol-generating procedures

Limit number of personnel present
Conduct in an airborne infection isolation room
Don PPE as described in the Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing)

Patient placement and care considerations

Maintain log of all persons entering patient’s room
Use dedicated disposable medical equipment (if possible)
Limit the use of needles and other sharps
Limit phlebotomy and laboratory testing to those procedures essential for diagnostics and medical care
Carefully dispose of all needles and sharps in punctureproof sealed containers
Avoid aerosol-generating procedures if possible
Wear PPE (detailed in center box) during environmental cleaning and use an EPA-registered hospital disinfectant with a label claim for non-enveloped viruses**

Initial patient management

Consult with health department about diagnostic EVD RT-PCR testing***
Consider, test for, and treat (when appropriate) other possible infectious causes of symptoms (e.g., malaria, bacterial infections)
Provide aggressive supportive care including aggressive IV fluid resuscitation if warranted
Assess for electrolyte abnormalities and replete
Evaluate for evidence of bleeding and assess hematologic and coagulation parameters
Symptomatic management of fever, nausea, vomiting, diarrhea, and abdominal pain
Consult health department regarding other treatment options