Ebola Guidance for Nursing Personnel Staff

Guidance for staff intending to travel to, or returning from, Ebola affected countries (last updated 22nd October 2014)

The escalating humanitarian crisis caused by the Ebola outbreak in West Africa and the transmission to healthcare workers in Spain and the USA have received extensive media coverage. The on-going outbreak of Ebola in West Africa, primarily affecting Guinea, Liberia and Sierra Leone has been declared a Public Health Emergency of International Concern by the World Health Organization.

This is the largest outbreak of this disease. There have been no cases of Ebola in the UK to date (one healthcare worker working in Sierra Leone was repatriated to the UK for treatment in August 2014 and has since made a full recovery).

Ebola is a severe and life threatening viral disease caused by the Ebola virus. The onset of illness is sudden, with fever, headache, joint and muscle pain, sore throat and intense weakness. This is then followed by diarrhoea, vomiting, rash, impaired kidney and liver function and stomach pain. Some patients may develop a rash, red eyes, hiccups, internal and external bleeding. Ebola haemorrhagic fever is fatal in between 50 to 90% of all clinically ill cases.

Ebola is spread through direct contact with blood and body fluids from infected people. The incubation period ranges from 2 to 21 days. Anyone who has close contact with a person infected with the virus, or someone who handles samples from patients is at risk. This includes hospital staff, family members and laboratory workers, all of whom are at risk if they do not use appropriate protective equipment/barrier nursing techniques. These precautions include wearing protective gowns, gloves, and masks, in addition to wearing eye protection (e.g. eye goggles) or a face shield.

It remains unlikely but not impossible that travellers infected in one of the affected countries could arrive in the UK while incubating the disease and develop symptoms after their return. The realistic possibility that cases could be seen in the UK has generated understandable anxiety, particularly amongst those of us required to care for potential cases and as a result there is a comprehensive Trust plan in place to ensure GSTT is in a state of preparedness. Although the likelihood of imported cases is very low, travellers returning to the UK from the affected areas, particularly those who have been involved in health care overseas, need to remain vigilant.

Nursing Personnel has reviewed its return to work advice for staff returning from affected countries. This advice applies to ALL staff, clinical and non-clinical.

• Current FCO advice is that there should be no non-essential travel to the affected countries.
• British Airways have suspended flights to Sierra Leone and Liberia until 31 December due to the public health situation and some other airlines have also suspended flights to these countries.
• Further detail is available on the gov.uk website

Existing Nursing Personnel staff who are planning to visit Ebola affected countries.

The Agency requests that staff follow FCO advice and do not place themselves at risk of infection.

The Agency recognises that some staff may have family in one of the affected countries but it does not consider essential travel to include, for example, visiting family at Christmas. If staff choose not to follow the FCO/Agency advice and travel to one of the affected countries which may then result in work restrictions and / or exclusion on return, this period of absence from the Agency will be unpaid.

All staff who travel to one of the Ebola affected countries (Guinea, Liberia and Sierra Leone) irrespective of the reason for travel (personal or work related) must contact Occupational Health prior to making any travel arrangements and on return to the UK, prior to their return to work.
Existing Trust staff who have visited Ebola affected countries- this will mainly apply to those who have visited affected countries for the purpose of charity and/or healthcare work:

If no healthcare work was undertaken whilst in one of the Ebola affected countries, and staff had no direct contact with a known or suspected Ebola patient, including attending a funeral, staff should:

• • Inform Nursing Personnel prior to departure
  • Monitor their health / temperature for 21 days from leaving the affected country.
  • If the staff member becomes unwell with symptoms such as fever, chills, muscle aches, headache, nausea, vomiting, diarrhoea, sore throat or rash within 21 days of coming back from Guinea, Liberia or Sierra Leone, they should stay at home and immediately telephone 111 or 999 and explain that they have recently visited West Africa. These services will initiate the appropriate care pathway
  • They must keep in touch with Nursing Personnel and inform Occupational health prior to return to work

• No work restrictions required

 
If healthcare work was undertaken abroad, or the staff member had direct contact with an Ebola case
e.g. routine medical / nursing care but wore appropriate protective clothing with no known breaches in the personal protective equipment (PPE), the staff member should:

• Inform Nursing Personnel prior to departure by contacting 0844 522 0414
• Check temperature twice daily for 21 days after return and report any raised temperature

or other suspicious symptoms to the monitoring team at Public Health England (PHE)

• Must provide Occupational Health/Nursing Personnel with documentary evidence from their Voluntary Aid agency / affiliated health care institution who organised the overseas placement outlining the extent of their exposure and specific detail regarding the PPE used
• Contact Nursing personnel prior to return to work
• Be able to return to work but not to Exposure Prone Procedures (EPPs) until monitoring completed, the Occupational Health team will provide specific advice

If healthcare work was undertaken abroad or the staff member had direct contact with an Ebola case and may have had unprotected exposure of skin or mucous membranes to potentially infectious blood or body fluids, including on clothing or bedding, for example:

• unprotected handling of clinical/lab specimens
• mucosal exposure to splashes
• needlestick injury
• kissing and/or sexual contact

The staff member should:

• Inform Nursing Personnel prior to departure by contacting 0844 522 0414
• Check temperature twice daily for 21 days after return
• Provide Occupational Health with documentary evidence from their Voluntary Aid agency / affiliated health care institution who organised the overseas placement outlining the extent of their exposure
  and specific detail regarding the PPE used
• Contact Nursing Personnel via 0844 522 0414 prior to return to work

They will NOT be placed in patient care areas until monitoring is completed; the Occupational Health team will provide specific advice on an individual basis

Agency / Locum / temporary staff – if they have visited Ebola affected countries, any work activity in any Trusts will be deferred for 21 days from leaving the affected country

Additional Information
For more information about health recommendations for travel to Africa, see: National Travel Health Network and Centre (NaTHNaC)
For more information about Ebola virus disease, see: Ebola virus disease: information for humanitarian aid workers

Ebola virus disease: an overview (NHS)