Ebola algorithm for the evaluation of the returned traveler: Difference between revisions
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{{Family tree | | | | | | | A01 | | | | A01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Is there a FEVER (subjective or ≥101.5°F or 38.6°C) or compatible EVD symptoms (headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage) in patient who has traveled to an Ebola-affected area in the 21 days before illness onset?''' </div>}} | {{Family tree | | | | | | | A01 | | | | A01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Is there a FEVER (subjective or ≥101.5°F or 38.6°C) or compatible EVD symptoms ([[headache]], [[weakness]], [[muscle pain]], [[vomiting]], [[diarrhea]], [[abdominal pain]] or [[hemorrhage]]) in patient who has traveled to an Ebola-affected area in the 21 days before illness onset?''' </div>}} | ||
{{Family tree | | | | | |,|-|^|-|.| | | }} | {{Family tree | | | | | |,|-|^|-|.| | | }} | ||
{{Family tree | | | | | B01 | | B02 | | B01= Yes| B02= No}} | {{Family tree | | | | | B01 | | B02 | | B01= Yes| B02= No}} | ||
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{{Family tree | E01 | | E02 | | E03 | | E01= '''HIGH-RISK EXPOSURE'''| E02= '''LOW-RISK EXPOSURE'''| E03= '''NO KNOWN EXPOSURE'''}} | {{Family tree | E01 | | E02 | | E03 | | E01= '''HIGH-RISK EXPOSURE'''| E02= '''LOW-RISK EXPOSURE'''| E03= '''NO KNOWN EXPOSURE'''}} | ||
{{Family tree | |!| | | |!| | | |!| | | }} | {{Family tree | |!| | | |!| | | |!| | | }} | ||
{{Family tree | F01 | | F02 | | F03 | | F01=<div style="float: left; text-align: left; width: 20em; padding:1em;">Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient <br> | {{Family tree | F01 | | F02 | | F03 | | F01=<div style="float: left; text-align: left; width: 20em; padding:1em;">Percutaneous (e.g., needle stick) or [[mucous membrane]] contact with [[blood]] or body fluids from an EVD patient <br> | ||
OR<br> | OR<br> | ||
Direct skin contact with, or exposure to blood or body fluids of, an EVD patient<br> | Direct skin contact with, or exposure to [[blood]] or body fluids of, an EVD patient<br> | ||
OR<br> | OR<br> | ||
Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions<br> | Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions<br> | ||
OR<br> | OR<br> | ||
Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE</div>| F02=<div style="float: left; text-align: left; width: 20em; padding:1em;">Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient<br> | Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE</div>| F02=<div style="float: left; text-align: left; width: 20em; padding:1em;">Percutaneous (e.g., needle stick) or [[mucous membrane]] contact with blood or body fluids from an EVD patient<br> | ||
OR<br> | OR<br> | ||
Direct skin contact with, or exposure to blood or body fluids of, an EVD patient <br> | Direct skin contact with, or exposure to [[blood]] or body fluids of, an EVD patient <br> | ||
OR<br> | OR<br> | ||
Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions <br> | Processing blood or body fluids from an EVD patient without appropriate personal protective equipment (PPE) or biosafety precautions <br> | ||
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{{Family tree | | |!| | H01 | | H02 | | H01= Yes| H02= No}} | {{Family tree | | |!| | H01 | | H02 | | H01= Yes| H02= No}} | ||
{{Family tree | | |!| |!| | | | |!| | | }} | {{Family tree | | |!| |!| | | | |!| | | }} | ||
{{Family tree | | | I01 | | | | I02 | | I01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''TESTING IS INDICATED'''<br> | {{Family tree | | | I01 | | | | I02 | | I01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''TESTING IS INDICATED'''<br><br> | ||
• The health department will arrange specimen transport and testing at a Public Health Laboratory and CDC.<br> | • The health department will arrange specimen transport and testing at a Public Health Laboratory and CDC.<br> | ||
• The health department, in consultation with CDC, will provide guidance to the hospital on all aspects of patient care and management</div>| I02=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''TESTING IS NOT INDICATED'''<br> | • The health department, in consultation with [[CDC]], will provide guidance to the hospital on all aspects of patient care and management</div>| I02=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''TESTING IS NOT INDICATED'''<br><br> | ||
''If patient requires in-hospital management:''<br> | ''If patient requires in-hospital management:''<br> | ||
• Decisions regarding infection control precautions should be based on the patient’s clinical situation and in consultation with hospital infection control and the health department<br> | • Decisions regarding infection control precautions should be based on the patient’s clinical situation and in consultation with hospital infection control and the health department<br> | ||
• If patient’s symptoms progress or change, re-assess need for testing with the health department<br> | • If patient’s symptoms progress or change, re-assess need for testing with the health department<br><br> | ||
''If patient does not require in-hospital management''<br> | ''If patient does not require in-hospital management''<br> | ||
• Alert the health department before discharge to arrange appropriate discharge instructions and to determine if the patient should self-monitor for illness<br> | • Alert the health department before discharge to arrange appropriate discharge instructions and to determine if the patient should self-monitor for illness<br> |
Revision as of 20:04, 3 October 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [3]
Overview
The CDC has developed an algorithm for the evaluation of the returned traveler that can be used to stratify patients according to their risk of exposure and triage them urgently to the appropriate level of care.[1]
Algorithm
Is there a FEVER (subjective or ≥101.5°F or 38.6°C) or compatible EVD symptoms (headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage) in patient who has traveled to an Ebola-affected area in the 21 days before illness onset? | |||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||
1. Isolate patient in single room with a private bathroom and with the door to hallway closed 2. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves) | Report asymptomatic patients with high- or low-risk exposures in the past 21 days to the health department | ||||||||||||||||||||||||
Determine the risk of exposure | |||||||||||||||||||||||||
HIGH-RISK EXPOSURE | LOW-RISK EXPOSURE | NO KNOWN EXPOSURE | |||||||||||||||||||||||
Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient OR | Percutaneous (e.g., needle stick) or mucous membrane contact with blood or body fluids from an EVD patient OR | Residence in or travel to affected areas without HIGH- or LOW-risk exposure | |||||||||||||||||||||||
Review case with Health Department including: • Severity of illness | |||||||||||||||||||||||||
Is EVD suspected? | |||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||
TESTING IS INDICATED • The health department will arrange specimen transport and testing at a Public Health Laboratory and CDC. | TESTING IS NOT INDICATED If patient requires in-hospital management: | ||||||||||||||||||||||||