Ebola algorithm for the evaluation of the returned traveler: Difference between revisions
Rim Halaby (talk | contribs) No edit summary |
Rim Halaby (talk | contribs) No edit summary |
||
Line 4: | Line 4: | ||
==Overview== | ==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. | 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.<ref name=CDC>CDC.gov [http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf]</ref> | ||
==Algorithm== | ==Algorithm== | ||
{{Family tree/start}} | {{Family tree/start}} | ||
{{Family tree | | | | | | | A01 | | | | A01= <div style="float: left; text-align: left; width: | {{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}} | ||
{{Family tree | | | | | |!| | | |!| | | }} | {{Family tree | | | | | |!| | | |!| | | }} | ||
{{Family tree | | | | | C01 | | C02 | | C01=<div style="float: left; text-align: left; width: | {{Family tree | | | | | C01 | | C02 | | C01=<div style="float: left; text-align: left; width: 20em; 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</div>| C02=<div style="float: left; text-align: left; width: | 5. '''IMMEDIATELY''' report to the health department</div>| C02=<div style="float: left; text-align: left; width: 20em; 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}} | ||
Line 23: | Line 23: | ||
{{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: | {{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> | ||
Line 29: | Line 29: | ||
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: | 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> | ||
Line 35: | Line 35: | ||
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>| F03=<div style="float: left; text-align: left; width: | 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: 20em; padding:1em;">Residence in or travel to affected areas without HIGH- or LOW-risk exposure</div>}} | ||
{{Family tree | | |!| | | |!| |!| | | | }} | {{Family tree | | |!| | | |!| |!| | | | }} | ||
{{Family tree | | |!| | | | F01 | | | | F01=<div style="float: left; text-align: left; width: | {{Family tree | | |!| | | | F01 | | | | F01=<div style="float: left; text-align: left; width: 20em; 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> | ||
Line 46: | Line 46: | ||
{{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: | {{Family tree | | | I01 | | | | I02 | | I01= <div style="float: left; text-align: left; width: 20em; 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</div>| I02=<div style="float: left; text-align: left; width: | • 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> | ||
''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> |
Revision as of 20:01, 3 October 2014
Ebola Microchapters |
Diagnosis |
---|
Treatment |
Postmortem Care |
Case Studies |
Ebola algorithm for the evaluation of the returned traveler On the Web |
American Roentgen Ray Society Images of Ebola algorithm for the evaluation of the returned traveler |
FDA on Ebola algorithm for the evaluation of the returned traveler |
CDC on Ebola algorithm for the evaluation of the returned traveler |
Ebola algorithm for the evaluation of the returned traveler in the news |
Blogs on Ebola algorithm for the evaluation of the returned traveler |
Risk calculators and risk factors for Ebola algorithm for the evaluation of the returned traveler |
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: | ||||||||||||||||||||||||