Vol. XXXII No. 4

JOURNAL OF VASCULAR NURSING www.jvascnurs.net

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Clinical Column Ebola virus disease Lily Thomson, RN, BN, RNFA

Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, has a high fatality rate of approximately 90%. Currently, there are no licensed, specific treatments or vaccines available for use in people or animals. The incubation period for EVD is 2-21 days. Affected individuals are not infectious during the incubation period or before the onset of symptoms. Personto-person transmission can occur, primarily through direct contact with blood, body fluids, secretions, and excretions of someone who is infected or through indirect contact with contaminated materials. The Ebola virus is not an airborne pathogen. EVD symptoms are similar to viral hemorrhagic fevers, such as Marburg. Infectious diseases such as malaria or typhoid also have similar symptoms. The most common symptoms of an individual infected with the Ebola virus include sudden onset of fever, headache, malaise, and myalgia. Other symptoms may include sore throat, cough, conjunctivitis, and rash. This is followed by nausea, vomiting, diarrhea, abdominal and chest pain, and impaired kidney and liver function. Both internal and external bleeding occur in the advanced stage of the disease. Laboratory profiles show elevated liver enzymes, and low white blood cell and platelet counts. Although EVD is not indigenous to North America, international travel and the location of the National Microbiology Laboratory may provide opportunity for the introduction of the Ebola virus or infected individuals into North America. EVD should be suspected in all patients with fever and a travel history to any country where EVD outbreaks are occurring, or exposure within 21 days of illness onset. Geographic areas currently affected by EVD include Guinea, Liberia, Nigeria, Democratic Republic of Congo, and Sierra Leone. The initial manifestations of hemorrhagic fever may be nonspecific; therefore, the practice of standard precautions is imperative when providing care to all patients, regardless of their presentation of signs and symptoms in the clinical setting. The most important From the Department of Vascular Surgery, Health Sciences Centre, Winnipeg, Manitoba, Canada. Corresponding author: Lily Thomson RN, BN, RNFA, Vascular Clinical Research Coordinator, Health Sciences Centre Winnipeg, Manitoba, Canada Peri-Operative Nurse, St. Boniface General Hospital, Winnipeg, Manitoba, Canada (E-mail: lthomson@ sbgh.mb.ca). 1062-0303/$36.00 Copyright Ó 2014 by the Society for Vascular Nursing, Inc. http://dx.doi.org/10.1016/j.jvn.2014.09.002

measure is hand hygiene and gloves to be worn for contact with blood or body fluids. A medical mask and goggles or face shield should be used if one is at risk for splash of blood or body fluids to the face. Cleaning of contaminated surfaces is paramount. Direct patient care for suspected or confirmed patients with hemorrhagic fever should be provided in a single isolation room. Practice hand hygiene and use personal protective equipment (PPE) when providing patient care. PPE includes the following items: Gloves (disposable), impermeable gown, medical mask, eye protection, and closed, puncture- and fluid-resistant shoes. Use double gloving and wear a waterproof apron over the gown if the gown is nonimpermeable, and disposable overshoes and leg coverings if boots are not available. Avoid aerosolgenerating procedures if possible. Wear a respirator (FFP2 or EN-certified equivalent or US NIOSH-certified N95), if any procedures risk stimulating coughing or promote the generation of aerosols. Carefully remove and dispose of PPE. Do not recycle any single-use disposable PPE. Clean and decontaminate reusable equipment. Dedicated equipment for each patient, such as stethoscope and dedicated injection/parenteral medication equipment, is to be used for patient care. The virus is thought to survive for days in fluids, such as blood and vomit, and in corpses. However, chlorine disinfection, heat, direct sunlight (UV light), soaps, and detergents can destroy the lipid envelop of the virus, thereby eliminating the virus. Health care workers and individuals can be protected with careful implementation of infection prevention and control measures to reduce or stop the spread of the Ebola virus.

REFERENCES World Health Organization. Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever on health-care setting, with focus on Ebola, http://apps.who.int/iris/bitstream/10665/ 130596/1/WHO_HIS_SDS_2014.4_eng.pdf?ua=1; 2014. Pan American Health Organization, World Health Organization. Ebola virus disease (EVD): implications of introduction in the Americas, http://www.paho.org/hq/index.php?option=com_ docman&task=doc_view&gid=26416&Itemid; 2014. Public Health Ontario. Infection prevention and control guidance for patients with suspected or confirmed Ebola virus disease (EVD) in Ontario health care settings, http://www. publichealthontario.ca/en/eRepository/EVD_IPAC_Guidance. pdf; 2014. IDSA. IDSA Ebola guidance, http://www.idsociety.org/2014_ Ebola/#; 2014.

Ebola virus disease.

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