Keep Safe Keep Serving

Keep Safe Keep Serving

Description of the Infection Prevention and Control (IPC) Package

Community

Health Care Facilities

Health Care Facilities

Health Care Facilities

Standard Operating Procedures for Healthcare Facilities Keep Safe - Keep Serving

Rationale for S.O.P.s Provide facilities with written guidance on safety, health, environmental, and operational information to perform job safely and minimize risk of infection To provide basis for estimates of supplies needed and ensure that healthcare processes can continue uninterrupted

Rationale for S.O.P.s To serve as a training document for teaching care providers in healthcare facilities To serve as a checklist for auditors to assess job performance and availability of supplies

S.O.P.: Word of Caution S.O.P.s are intended to provide advice on infection prevention and control practices. As the Ebola outbreak evolves, the S.O.P.s and training materials will need to be adapted accordingly.

Content of S.O.P.s Written guidance for different levels of care: Health clinics Health centers/ Hospitals Ebola Care Centers (ECCs) Topics General considerations for facility set-up and policies Triage Facility staffing and use of PPE Environmental cleaning and disinfection

Content of S.O.P.s: General Considerations Facility set-up of isolation areas General staff/ work policies Establishing Infection Prevention & Control (IPC) infrastructure

Content of S.O.P.s: Triage Designated triage area Designated staff Protocol to isolate suspected EVD patient Screening for EVD on general medical ward

Content of S.O.P.s: Personal Protective Equipment (PPE) Two levels of PPE: Basic PPE: Indications when to use Enhanced PPE: Indications when to use Safe removal of PPE and hand hygiene

Content of S.O.P.s: Patient Care Minimizing direct patient contact Oral rehydration and medications Standard precautions Safe handling of needles

Content of S.O.P.s: Environmental Considerations Cleaning and disinfection Body fluid/ spills Contaminated equipment Laundry, utensils Waste management

Estimates of Supplies Needed Based on the guidance of S.O.P.s, supply needs (including PPE) can be estimated Estimates can be scaled according to facility size and type of service anticipated

Example of assumptions to guide estimates: Excel file

Summary Content of Training for Healthcare Providers Keep Safe Keep Serving

Objectives of Training Background on Ebola virus disease (EVD) Establish triage at healthcare facilities Provide guidance for clinical care/ case management Educate healthcare workers about proper use of personal protective equipment (PPE)

Clinical Features of Ebola Incubation period, viral course, and shedding Signs and symptoms Human-Human transmission Direct contact with bodily fluids Nosocomial transmission Funeral exposures

Designate Infection Prevention and Control (IPC) Officer Develop infection control committee Ensure staff follow recommended practices Ensure adequate supplies of PPE Consult experts and county officials

Triage Only one access point to the facility. All patients/ staff must go through triage. Triage staff should be dressed in face shield, gown, and gloves. Stay at least 3 feet away from patient when possible. Interview the patient using the Ebola triage flow chart

Ebola OUTBREAK Triage Decisionmaking Flowchart Contact Yes No Fever Fever Unexplained death Yes No Yes No Yes No 3 of the symptoms OR * Unexplaine d Bleeding OR Unexplain ed Death 3 of the symptoms* Yes No Yes No Probable Suspect Alert case Not a case *Symptoms include: headache, vomiting, nausea, loss of appetite, diarrhoea, intense fatigue, abdominal pain, general muscular or articular pain, difficulty in swallowing, difficulty in breathing, hiccoughs Note: Confirmed cases requires positive laboratory test Liberia, 2014

Triage Process Patient is a probable or suspect case? No Yes Transfer to general ward Do not admit; keep patient separate Monitor daily for Ebola Transfer immediately to Ebola care center (ECC) or ETU

Triage Process Suspected or probable cases should be kept in isolation room until transfer to an ETU or ECC Isolation area should be a designated, separate room away from non-ebola patients. A separate latrine should be provided if possible.

Care of Patients in the General Ward No-touch/ Minimal touch policy Minimize needles/ invasive procedures Screen all patients on the ward for Ebola Check temperature 3 x daily Interview using triage form daily

Deaths Dead bodies are highly infectious Call burial team right away to remove body If burial team does not come soon: Always wear advanced PPE when handling body Cover body with sheet Move to separate area if can be done safely

How to Prevent Infections in Healthcare Workers Do not go to work if you are sick Call your supervisor and tell him/her that you are sick Tell your co-workers not to go to work if they are sick Do not wear your work clothes (or scrubs) home Wear and remove PPE properly with a buddy watching Wash your hands according to protocol

Personal Protective Equipment Basic PPE: Staff in most patient care areas Enhanced PPE: Staff for Ebola pts or maternity ward Closed toe shoes with covers or boots Face shield Gown Gloves (1 set) Rain boots or closed-toed shoes with covers Face shield Gown 2 pairs of gloves Hood Face mask Apron

Basic PPE Enhanced PPE With acknowledgments to Kumblytee Johnson

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