Statement on Infection Prevention and Control Measures for Ebola Virus Disease

All healthcare settings where ill individuals may present need to be prepared for Ebola virus disease (EVD).

Decisions on appropriate infection prevention and control measures should be made in conjunction with local, provincial, territorial and federal legislation, regulations and policies. As more is learned about EVD, the measures may need to be modified.

EVD is transmitted by direct contact of non-intact skin or mucous membranes with blood or other body fluids of a person who is sick with EVD. Transmission can occur indirectly through contact with surfaces contaminated with body fluids.

Patients are not infectious before the onset of symptoms, but become increasingly contagious with each stage of the disease and remain infectious while the virus remains in their blood or body fluids.

The following principles are key to appropriate management of EVD:

  • Along with the safety and care of patients, healthcare worker safety must be of paramount importance.
  • Adherence to occupational health and safety principles and application of appropriate engineering controls, administrative controls, and personal protective equipment (PPE) will reduce the risk of transmission of EVD.
  • Prior to interaction with suspect or confirmed EVD patients, healthcare workers must be trained in appropriate use of PPE.
  • Healthcare workers need to have confidence in their PPE and in their ability to use it properly.
  • Comfort and proficiency with PPE are only achieved through repeated practice.

Initial Screening and Evaluation

  1. Identify travel and potential exposure history. Has patient lived in or traveled to a country with widespread EVD or had contact with a confirmed EVD patient in the last 21 days? Visit the WHO Global Alert and Response webpage for frequent updates.
  2. Identify signs and symptoms. Assess for fever or any EVD compatible symptoms (fatigue, loss of appetite, vomiting, diarrhea, headache, abdominal pain, muscle or joint pain, conjunctival injection, pharyngitis or unexplained bleeding).

Suspect EVD if fever or EVD compatible symptoms and a history of potential exposure are present.

Point-of-Care Risk Assessment

A point-of-care risk assessment is performed by healthcare workers to determine the level of risk of exposure and appropriate infection prevention and control measures to protect healthcare workers from exposure.

The following information is based on currently available evidence on EVD and a precautionary approach.

Table - Infection Prevention and Control Measures
Risk Scenario Recommendation Comments
Initial presentation -triage, ambulatory setting Routine practices for all patients

If possible, have a structural barrier located between patients and staff

Initiate contact and droplet precautions if EVD is suspected
Supplies for emesis management and respiratory hygiene should be available (masks, tissues, basins, hand hygiene products, designated hand washing sinks and no touch biohazardous waste receptacles)

If EVD is suspected or confirmed in an ambulatory setting, isolate patient and notify local public health for transfer

In an Emergency Department triage, if there is the possibility of direct contact with patient's body fluids, it is recommended that enhanced PPE as described below for higher transmission risk be available
Lower Transmission Risk

Suspected or confirmed EVD where patient's body fluids are contained (e.g. healthcare worker has no direct contact with body fluids)
Fluid-resistant or impermeable gown

Fluid-resistant mask with eye goggles or fluid-resistant mask with face shield (preferred over goggles)

Procedures that risk generating aerosols should be avoided. If such procedures are necessary, enhanced PPE as described below for higher transmission risk is recommended
Higher Transmission Risk

Suspected or confirmed EVD where there are body fluids contaminating the environment
All exposed skin is covered

Double gloves
Fluid-impermeable gown including foot and leg coverings, head and neck coverings or hazardous material suit including foot and leg coverings, head and neck coverings (if not part of hazardous material suit)
Fluid impermeable apron
Respirator with eye goggles or face shield

Clean anteroom for donning and separate area for doffing
PPE should be donned prior to entry to the patient room

Ensure a trained, tested and drilled monitor watches closely each putting on of PPE (donning) and removing (doffing) procedure

If using a Powered Air Respirator (PAPR), extensive training and experience is required for safe use

Interventions that may result in a higher transmission risk include:

  • Aerosol generating procedures
  • Insertion of intravascular devices (e.g. intravenous catheters, central lines)
  • Direct contact with patient's blood or body fluid and direct or indirect contact with contaminated environment.

For all persons with suspected or confirmed EVD, avoid aerosol generating procedures unless absolutely necessary.

Limit use of needles and other sharps. Where necessary, safety engineered needles and needleless systems should be used and disposed of immediately into designated puncture resistant containers.

Disposable PPE should be used wherever possible.

This information is a summary and is not intended to be comprehensive. Please refer to applicable provincial and territorial guidelines at the following web pages:

Government of Newfoundland and Labrador, Department of Health and Community Services

Government of Prince Edward Island, Department of Health and Wellness

Government of Nova Scotia, Health and Wellness

Government of New Brunswick, Office of the Chief Medical Officer of Health (Public Health)

Gouvernement du Québec, Santé et des Services sociaux (French only)

Government of Ontario, Ministry of Health and Long-Term Care

Government of Manitoba, Manitoba Health, Healthy Living and Seniors

Government of Saskatchewan, Ministry of Health

Government of Alberta, Department of Health

Government of British Columbia, HealthLinkBC

Government of the Northwest Territories, Department of Health and Social Services

Government of the Nunavut, Department of Health

Government of the Yukon, Health and Social Services

Additional reference material including detailed procedures can also be found at the following web pages:

Infection Prevention and Control Expert Working Group: Advice on Infection Prevention and Control Measures for Ebola Virus Disease in Healthcare Settings

Routine Practices and Additional Precautions for Preventing Transmission of Infections in Healthcare Settings

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