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Community health workers prepare for Ebola

Community health workers prepare for Ebola


More than 400 primary healthcare workers from throughout the Auckland region have upskilled on preparations and protocols for Ebola cases.

The healthcare staff attended a seminar organised by the Goodfellow Unit at the University of Auckland’s Faculty of Medical and Health Sciences. While the majority were general practice staff (GPs, nurses, practice managers and receptionists), there were also a large number of community pharmacists and a range of other primary care professionals from services such as school clinics, travel medicine and urgent care centres.

Seminar organiser, Goodfellow Chair, Professor Felicity Goodyear-Smith, was pleased with the large turnout. “The aim was to dispel undue fears about Ebola and to provide the primary care sector with helpful information on how to respond in the unlikely event they have to deal with a suspected case,” she said.

At the recent meeting, Auckland Medical Officer of Health, Dr Shanika Perera outlined regional planning and preparations to protect Aucklanders from the Ebola virus disease (EVD).

“The three key take-home messages for primary care are; keep up-to-date with information available on the Ministry of Health website, remain vigilant with all your patients, and call Auckland Regional Public Health Service if you have any EVD concerns about a patient,” she told the meeting.

Auckland was unlikely to get a case of Ebola due to New Zealand’s geographical isolation, low traveller numbers and a lack of direct flights from West Africa, said Dr Perera.

“Symptoms are often non-specific and can mimic other diseases from that part of the world, so a suspected Ebola case is more likely to have another illness such as typhoid, malaria or meningococcal disease,” she said. “But we still need to respond to the possibility that a case may be EVD because of the serious public health implications.”

Border planning included identifying in-bound travellers with suspected EVD, which required a response involving multiple agencies led by the on-call Medical Officer of Health for the Auckland region.

“We are screening all in-bound passengers with six key questions to find anyone that has travelled from that part of the world,” she says. “To date (since August) we have identified 73 people arriving from infected countries, but that is expected to halve now that Nigeria is no longer affected.”

Only three of those cases needed further assessment by public health officials.
She urged health workers to read the Ministry of Health guidelines for public health workers on the Ministry of Health’s website.

Final assessment of a patient with suspected EVD would be a joint decision by a team of hospital clinicians, and officials from the Auckland Region Public Health Service and the Ministry of Health.

Clinical microbiologist and infectious diseases expert Dr Sally Roberts, is involved in infection prevention and control at Auckland District Health Board.

Dr Roberts outlined risk assessment and clinical pathways for primary care of suspected cases of Ebola in healthcare settings, including risk assessment, triage, transportation, clinical care, and diagnostic testing of patients, as well as aspects of staff health and welfare, and environment and waste management.

“Suspected cases will come via Auckland, Wellington or Christchurch airports and might include flights from Australia, as in the case of New Zealanders working in the mining industry in Australia who may be travelling back and forth from Africa,” said Dr Roberts. “A person’s travel history is very important for any feverish traveller, and we need a detailed account of their movements, including places, dates and times and who in their social network they were in contact with.”

Healthcare workers need to keep up to date with case definitions via the Ministry of Health’s website, she said.

Dr Roberts said the Ebola virus was susceptible to ultraviolet light, desiccation and high temperatures, and disinfectants (such as those used against norovirus or rotavirus). It is not an airborne virus like measles, chicken pox or tuberculosis.

She urged health care workers to take seriously the checklist for personal protective equipment (PPE) that includes long-cuffed gloves, a semi-pervious, splash resistant, disposable gown, a surgical mask and face shield or visor.

“Removing this PPE poses the greatest risk to staff looking after Ebola patients and this needs to be practised under supervision,” she said. “I also can’t stress enough the importance of good hand hygiene.”

She recommended the A4 instructions on the World Health Organisation website that could be printed out and laminated for use in health care.

“The incubation period for EVD is from two to 21 days after exposure, but it is most common for people to start showing symptoms around eight to nine days after exposure,” says University of Auckland microbiologist, Dr Siouxsie Wiles.

She told the audience in her introduction on separating fact from fiction on Ebola that EVD only spreads once someone is symptomatic.

Dr Wiles explained that Ebola originates from contact with bats that are thought to be the primary host of the disease. It may be spread from fruit that bats have fed on, or from butchering and eating infected wild animals that have come into contact with bats. After that, Ebola was spread via human to human contact.

Ebola was not an airborne disease and could only be spread from contact with the blood, vomit, pee, poop, sweat, semen, spit or other body fluids from someone who has contracted EVD, said Dr Wiles.

Another guest speaker, the Government’s Chief Medical Officer of Health, Dr Don Mackie, said nationally, there were two expert groups to inform planning around Ebola readiness, and also to translate Ebola protection protocols into the New Zealand setting to make sure they were a good fit.

The two groups are the National Ebola Readiness Incident Management Team and the Ebola Technical Advisory Group.

“Their expertise is available via the Ministry of Health, to support hospitals looking after Ebola patients,” he said. “We have concentrated expertise in the four district health boards that could be dealing with these cases.”

Any questions or queries about Ebola readiness could be sent to ebolareadiness@moh.govt.nz

ENDS

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