All healthcare settings where ill individuals may present need to be prepared for Ebola virus disease (EVD).
Decisions on appropriate infection prevention and control measures should be made in conjunction with local, provincial, territorial and federal legislation, regulations and policies. As more is learned about EVD, the measures may need to be modified.
EVD is transmitted by direct contact of non-intact skin or mucous membranes with blood or other body fluids of a person who is sick with EVD. Transmission can occur indirectly through contact with surfaces contaminated with body fluids.
Patients are not infectious before the onset of symptoms, but become increasingly contagious with each stage of the disease and remain infectious while the virus remains in their blood or body fluids.
The following principles are key to appropriate management of EVD:
Suspect EVD if fever or EVD compatible symptoms and a history of potential exposure are present.
A point-of-care risk assessment is performed by healthcare workers to determine the level of risk of exposure and appropriate infection prevention and control measures to protect healthcare workers from exposure.
The following information is based on currently available evidence on EVD and a precautionary approach.
|Initial presentation -triage, ambulatory setting||Routine practices for all patients
If possible, have a structural barrier located between patients and staff
Initiate contact and droplet precautions if EVD is suspected
|Supplies for emesis management and respiratory hygiene should be available (masks, tissues, basins, hand hygiene products, designated hand washing sinks and no touch biohazardous waste receptacles)
If EVD is suspected or confirmed in an ambulatory setting, isolate patient and notify local public health for transfer
In an Emergency Department triage, if there is the possibility of direct contact with patient's body fluids, it is recommended that enhanced PPE as described below for higher transmission risk be available
|Lower Transmission Risk
Suspected or confirmed EVD where patient's body fluids are contained (e.g. healthcare worker has no direct contact with body fluids)
|Fluid-resistant or impermeable gown
Fluid-resistant mask with eye goggles or fluid-resistant mask with face shield (preferred over goggles)
|Procedures that risk generating aerosols should be avoided. If such procedures are necessary, enhanced PPE as described below for higher transmission risk is recommended|
|Higher Transmission Risk
Suspected or confirmed EVD where there are body fluids contaminating the environment
|All exposed skin is covered
Fluid-impermeable gown including foot and leg coverings, head and neck coverings or hazardous material suit including foot and leg coverings, head and neck coverings (if not part of hazardous material suit)
Fluid impermeable apron
Respirator with eye goggles or face shield
Clean anteroom for donning and separate area for doffing
|PPE should be donned prior to entry to the patient room
Ensure a trained, tested and drilled monitor watches closely each putting on of PPE (donning) and removing (doffing) procedure
If using a Powered Air Respirator (PAPR), extensive training and experience is required for safe use
Interventions that may result in a higher transmission risk include:
For all persons with suspected or confirmed EVD, avoid aerosol generating procedures unless absolutely necessary.
Limit use of needles and other sharps. Where necessary, safety engineered needles and needleless systems should be used and disposed of immediately into designated puncture resistant containers.
Disposable PPE should be used wherever possible.
This information is a summary and is not intended to be comprehensive. Please refer to applicable provincial and territorial guidelines at the following web pages:
Gouvernement du Québec, Santé et des Services sociaux (French only)
Additional reference material including detailed procedures can also be found at the following web pages: