Ebola algorithm for the evaluation of the returned traveler: Difference between revisions
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{{Family tree | | | | | | | A01 | | | | A01= '''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?'''}} | {{Family tree | | | | | | | A01 | | | | A01= <div style="float: left; text-align: left; width: 30em; 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}} | ||
{{Family tree | | | | | |!| | | |!| | | }} | {{Family tree | | | | | |!| | | |!| | | }} | ||
{{Family tree | | | | | C01 | | C02 | | C01=1. Isolate patient in single room with a private bathroom and with the door to hallway closed <br> | {{Family tree | | | | | C01 | | C02 | | C01=<div style="float: left; text-align: left; width: 30em; padding:1em;">1. Isolate patient in single room with a private bathroom and with the door to hallway closed <br> | ||
2. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves) <br> | 2. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and gloves) <br> | ||
3.Notify the hospital Infection Control Program and other appropriate staff <br> | 3.Notify the hospital Infection Control Program and other appropriate staff <br> | ||
4. Evaluate for any risk exposures for EVD <br> | 4. Evaluate for any risk exposures for EVD <br> | ||
5. '''IMMEDIATELY''' report to the health department| C02=Report asymptomatic patients with high- or low-risk exposures in the past 21 days to the health department}} | 5. '''IMMEDIATELY''' report to the health department</div>| C02=<div style="float: left; text-align: left; width: 30em; padding:1em;">Report asymptomatic patients with high- or low-risk exposures in the past 21 days to the health department</div>}} | ||
{{Family tree | | | | | |!| | | | | | | }} | {{Family tree | | | | | |!| | | | | | | }} | ||
{{Family tree | | | | | D01 | | | | | | D01= Determine the risk of exposure}} | {{Family tree | | | | | D01 | | | | | | D01= Determine the risk of exposure}} | ||
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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=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: 30em; 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> | ||
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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| F02=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: 30em; 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> | ||
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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| F03=Residence in or travel to affected areas without HIGH- or LOW-risk exposure}} | Direct contact with a dead body (including during funeral rites) in an Ebola affected area without appropriate PPE</div>| F03=<div style="float: left; text-align: left; width: 30em; padding:1em;">Residence in or travel to affected areas without HIGH- or LOW-risk exposure</div>}} | ||
{{Family tree | | |!| | | |!| |!| | | | }} | {{Family tree | | |!| | | |!| |!| | | | }} | ||
{{Family tree | | |!| | | | F01 | | | | F01=Review case with Health Department including: <br> | {{Family tree | | |!| | | | F01 | | | | F01=<div style="float: left; text-align: left; width: 30em; padding:1em;">Review case with Health Department including: <br> | ||
• Severity of illness <br> | • Severity of illness <br> | ||
• Laboratory findings (e.g., platelet counts) <br> | • Laboratory findings (e.g., platelet counts) <br> | ||
• Alternative diagnoses}} | • Alternative diagnoses </div>}} | ||
{{Family tree | | |!| | | | |!| | | | | }} | {{Family tree | | |!| | | | |!| | | | | }} | ||
{{Family tree | | |!| | | | G01 | | | | G01= Is EVD suspected?}} | {{Family tree | | |!| | | | G01 | | | | G01= Is EVD suspected?}} | ||
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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= '''TESTING IS INDICATED'''<br> | {{Family tree | | | I01 | | | | I02 | | I01= <div style="float: left; text-align: left; width: 30em; padding:1em;">'''TESTING IS INDICATED'''<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| I02='''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: 30em; padding:1em;">'''TESTING IS NOT INDICATED'''<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> | ||
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''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> | ||
• Self-monitoring includes taking their temperature twice a day for 21 days after their last exposure to an Ebola patient}} | • Self-monitoring includes taking their temperature twice a day for 21 days after their last exposure to an Ebola patient</div>}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
Revision as of 19:58, 3 October 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
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: | ||||||||||||||||||||||||