General IPC principles and patient management

General IPC principles and patient management requirements include that:

• preventing the transmission of infection in health care settings requires the application of three main types of controls:
  • administrative support for the implementation of an evidence-based IPC program
  • adequate environmental and engineering infrastructure
  • PPE
• direct or indirect exposure of mucous membranes and non-intact skin to blood and other body fluids is the primary route of infection for VHF. There is no evidence that Ebola (or other VHF viruses) can penetrate intact skin¹
• although airborne transmission of VHF has not been demonstrated, the possibility of transmission via aerosol-generating events or procedures should not be excluded²
• transmission-based precautions must be implemented for all patients with suspected or confirmed VHF. Implement standard, contact and airborne precautions
• in some VHF cases, asymptomatic people in the incubation period are not contagious. VHF is not spread from asymptomatic people through routine clinical or household contact
• a person with VHF is not contagious until the appearance of symptoms. The illness typically progresses from ‘dry’ symptoms (fever, aches and fatigue) to ‘wet’ symptoms (diarrhoea, vomiting and sometimes, bleeding)
• patients are most infectious during the secretory or ‘wet’ phase of the illness
• procedures that increase environmental contamination with blood or body fluids should, wherever possible, be avoided. In particular, these include aerosol-generating procedures (AGPs). Clean and disinfect environmental surfaces as soon as possible after any such contamination occurs
• avoid unnecessary pathology testing. See Appendix 4: Specimen collection and transport for suspected VHF for further details about specimen collection procedures, including decontamination of samples
• PPE must be used when caring for anyone suspected or confirmed of having a VHF or when potentially coming into contact with their blood or body fluids. Choice of PPE should be based on the symptoms exhibited (that is, ‘dry’ or ‘wet’). See Personal protective equipment for more information
• limit the number of health care workers (HCWs) who provide care for a patient with suspected VHF
• limit the use of sharps, such as needles, as much as possible. Sharps should be handled with extreme care and disposed of into a disposable puncture-proof sharps container dedicated for the use of the patient. Consider the use of retractable safety devices, if available, noting staff should be trained in their use
• for non-designated hospitals and other health care settings, even when an early transfer is planned, arrangements for appropriate care while waiting for transfer will be required.

Patient placement

Management of patient placement includes that:

• patients with suspected VHF must be placed in a single room (with the door closed) with their own toilet and bathroom facilities. If ensuite facilities are not available, use a commode in the patient’s room
• a negative pressure ventilation room is not required for the management of patients with suspected VHF, unless AGPs will be performed.

Zoning

To ensure staff can safely don and doff PPE, careful consideration should be given to the location of the patient’s room and surrounding environment (for example, common corridors). Use of separate zones, based on the risk of environmental contamination, may be useful.

More information about zoning, including information about PPE for clinical care of patients with suspected or confirmed EVD in the Australian health care setting, can be found at Infection prevention and control principles and recommendations for Ebola virus disease.