(FSM Department of Health & Social Affairs) - Teams of health care workers recently gathered in Pohnpei for a workshop on Infection Control and Prevention for Ebola Virus Disease.
The workshop was run by the World Health Organization’s Dr Angela Merinos a Public Health Clinician from WHO’s Suva Office, and Nurse Danielle Ballantyne, who had been a Head Nurse at Medicins Sans Frontieres (Doctors Without Borders) Ebola treatment Centre in Liberia.
The training covered a number of topics. Ebola virus disease is a severe often fatal illness. On average, in West Africa, about half the people with this disease die. The initial symptoms can include sudden illness, intense weakness, muscle pain and a sore throat. Similar symptoms occur in a number of other diseases such as malaria, typhoid fever, shigellosis, cholera, leptospirosis and hepatitis.
Ebola is highly infectious. The virus is spread by direct contact with blood or bodily fluids of infected persons. The incubation period: the time from when a patient has been exposed to the virus until the time symptoms and disease appears ranges from 2-21 days. Patients however, only become infectious when they are sick.
The risk of Ebola reaching the FSM is very low. There are very few travellers from Ebola affected areas of West Africa to the FSM. People who have been in contact with patients with Ebola virus disease are restricted from travel until 21 days after their last contact. Any person entering the FSM must first travel through Guam or Honolulu, and may have gone through several customs and immigration screenings, where it is hoped that any potential cases may have already been picked up.
The training ended with a functional exercise. Staff exercised accepting a patient, placing him into the isolation ward and drawing a blood specimen for Ebola Virus confirmatory testing.
The exercise highlighted the importance of following strict protocols for donning and removing the safety suits and decontaminating between each step with dilute bleach, which fortunately kills the virus. Any breach in protocol increased the risk of spread of the virus.
Teams of isolation room staff were required to design how the isolation rooms in their state hospital could be divided into green, yellow and red zones to minimize the spread of the virus. Fortunately most hospital isolation rooms could be modified without too much expense.
The training did not focus on treatment for Ebola patients. What was stressed however was that any treatment or procedure must be carefully assessed to determine if it could be safely carried without undue risk of spread of the virus to health care workers or the community.
Some time was devoted to the safe handling of human remains. This has been a big concern in Africa, and would probably be very upsetting for Micronesians as well. It was recommended that human remains must be removed by rapid response teams and placed in heavy duty leak-proof body bags. The outside of the bag must be decontaminated before placing inside a coffin. To prevent the spread of infection a strict rule of no handling of or washing the body must be enforced.
What about those people suspected of having Ebola but who don’t actually have it? Patients must have two separate blood specimens confirmed negative for Ebola before they can leave isolation. The infrequent and long flights to Atlanta, where the Ebola reference laboratory is located, means the patient may have to be in isolation for a week or two. FSM cannot perform this testing as the FSM laboratories do not comply with the mandated biosafety level for performing such testing.
FSM has a small stock of containment suits, a core team of trained isolation unit staff and there are isolation units in each FSM hospital.