THE RAVAGING EBOLA VIRUS: SAFETY MEASURES FOR HEALTH WORKERS

1. Dr OBA Owoeye
Clinical Grand Round, Department of
Physiotherapy, CMUL/LUTH, Lagos
27th August , 2014

2. Outline

 Introduction
 Transmission
 Signs and Symptoms
 #ebolascares and #ebolafacts
 Diagnosis
 Prevention
 The Ebola Rules…
 Hand Hygiene
 Proper Hand Washing
 Hand washing Facts
 Conclusion
Dr OBA Owoeye - Aug '14 2

3. Introduction

 Ebola virus disease (EVD) or Ebola, formerly known as
Ebola haemorrhagic fever, is a severe and highly
contagious illness in humans
 EVD outbreaks have a case fatality rate of up to 90%
 EVD outbreaks occur primarily in remote villages in
Central and West Africa, near tropical rainforests
Dr OBA Owoeye - Aug '14 3

4.  Ebola first appeared in 1976 in 2 simultaneous
outbreaks, in Nzara, Sudan, and in Yambuku,
Democratic Republic of Congo. 
The latter was in a
village situated near the Ebola River after which the
disease is named
 The virus is transmitted to people from wild animals and
spreads in the human population through human-to-human
transmission
 Fruit bats of the Pteropodidae family are considered to
be the natural host of the Ebola virus
Dr OBA Owoeye - Aug '14 4

5. 
 Severely ill patients require intensive supportive care.
No licensed specific treatment or vaccine is available for
use in people or animals
 The virus has 5 species; the Zaire Ebolavirus species
being the most virulent and presently endemic in SW
Africa
 EVD is so far only endemic in SW Africa
Dr OBA Owoeye - Aug '14 5

6. 
 Ebola virus has receptors in virtually all the systems
in the human body….
 Samples from patients are an extreme biohazard
risk; testing is conducted under maximum biological
containment conditions
Dr OBA Owoeye - Aug '14 6

7. Transmission

Ebola is introduced into the human population
through close contact with the blood, secretions,
organs or other bodily fluids of infected animals
or humans
Burial ceremonies in which mourners have
direct contact with the body of deceased
persons can also play a role in the transmission
of Ebola
……….viral load is highest in infected dead bodies
Dr OBA Owoeye - Aug '14 7

8. 
 Men who have recovered from the disease can still
transmit the virus through their semen for up to 7
weeks after recovery from illness
 Health-care workers have frequently been infected
while treating patients with suspected or confirmed
EVD. This has occurred through close contact with
patients when infection control precautions are not
strictly practiced
(WHO, 2014)
Dr OBA Owoeye - Aug '14 8

9. Signs and Symptoms

 sudden onset of fever
 intense weakness
muscle pain
 headache
 sore throat
 dizziness
 vomiting
 diarrhoea
 rash
 coughing
 internal and external
bleeding
DEATH
Dr OBA Owoeye - Aug '14 9

10. #ebolascares and #ebolafacts

 The incubation period (ie time interval from infection
with the virus to onset of symptoms) is 2 to 21 days
 Present evidence confirms that the Ebola virus is
only infectious when infected persons begin to
exhibit symptoms
 Suspected cases in other parts of the world have
tested –ve to diagnosis
Dr OBA Owoeye - Aug '14 10

11.  No licensed vaccine for EVD is available

 No specific treatment is available. New drug therapies
are being evaluated
 Severely ill patients require intensive supportive care as
patients are frequently dehydrated and require oral
rehydration with solutions containing electrolytes or
intravenous fluids
 It is not a death sentence if detected early
Dr OBA Owoeye - Aug '14 11

12. 
 …it is not known for now how long the virus can
survive out of its host….
 Ebola virus is not airborne but can be aerosolised
 Survivors are no longer infectious and of no threat to
the community… also said to develop immunity
against index spp
Dr OBA Owoeye - Aug '14 12

13. Diagnosis

R/O malaria, typhoid fever, cholera, plague, rickettsiosis, relapsing
fever, meningitis, hepatitis and other viral haemorrhagic fevers.
Ebola virus infections can be diagnosed definitively in a laboratory
through several types of tests:
 antibody-capture enzyme-linked immunosorbent assay (ELISA)
 antigen detection tests
 serum neutralization test
 reverse transcriptase polymerase chain reaction (RT-PCR)
assay
 electron microscopy
 virus isolation by cell culture
Dr OBA Owoeye - Aug '14 13

14. Prevention

 It is not always possible to identify patients with EBV
early because initial symptoms may be non-specific
 For this reason, it is important that health-care
workers apply standard precautions consistently with
all patients – regardless of their diagnosis
Dr OBA Owoeye - Aug '14 14

15. Prevention/Protection

 Personal hygiene
 Environmental hygiene
 Hand hygiene I
 a pair of gloves per patient
 regular washing/sanitization of hands
 Respiratory hygiene
 use of face masks…. II
 PPEs III
Dr OBA Owoeye - Aug '14 15

16. 
 LI
…… for asymptomatic patients/individuals
 LI + LII
….undiagnosed but suspected patient but with non specific
symptoms
 LIII
….for suspected pts with hx of contacts with index cases &
confirmed Ebola pts
Dr OBA Owoeye - Aug '14 16

17. The Ebola Rules…

SIN Rule
- Screen, isolate, notify -
Hands Arrest Rule
…avoid touching your face and any body openings
at work until hands are washed or sanitised -
Metre Rule
…maintain a distance of 1m whenever you are
with a suspected patient
Dr OBA Owoeye - Aug '14 17

18. Hand Hygiene

Invisible vs Visible Dirt…. Sanitise vs Wash
Suspected Hand Contamination … wash with
hypochloride
………………………………………….
How to Use Sanitizers
Proper Hand Washing Technique
Dr OBA Owoeye - Aug '14 18

19. How well do u wash or sanitize your
hands?

Dr OBA Owoeye - Aug '14 19

20. Sanitizers

Make sure the product contains at least 60%
alcohol
Apply enough of the product to the palm of
your hand to wet your hands completely
Rub your hands together, covering all
surfaces, until your hands are dry
Antimicrobial wipes are also effective option
Dr OBA Owoeye - Aug '14 20

21. Proper Hand Washing
Tecniques

Dr OBA Owoeye - Aug '14 21

22. #washyourhands

Hand-washing doesn't take much time or effort, but
it offers great rewards in terms of preventing
illness. Adopting this simple habit can play a major
role in protecting your health
Dr OBA Owoeye - Aug '14 22

23. Hand Washing Facts – from
cdc.gov

 diarrheal dx-associated deaths by up to 50%
 …up to a million deaths a year could be prevented
 a large % of foodborne disease outbreaks are spread by
contaminated hands….with routine HW…
 risk of respiratory infections by 16%
 The use of an alcohol gel hand sanitizer in the
classroom provided an overall reduction in absenteeism
due to infection by 19.8% among 16 elementary schools
and 6,000 students
Dr OBA Owoeye - Aug '14 23

24. Conclusion

 The Ebola sage is not a war against socialisation but
avoiding unnecessary contacts (with suspected humans
and surfaces) is wise
 Ebola is only transmissible when the host is symptomatic
 Ebola virus is not airborne but can be aerosolized
 Always remember to apply the Ebola Rules
 Regular washing of hands is healthy
 Trust God for absolute protection
Dr OBA Owoeye - Aug '14 24