Ebola

Ebola- Uganda  has had repeated outbreaks of Ebola and Marburg. The adaptation of the IMAI DCM in 2013 coincided with a 3 district outbreak of Ebola, leading to a request from the MOH that the Alliance also develop a pocket size guide for Ebola and Marburg case management which could be distributed to all front-line health workers.  This was completed in December 2013 then updated in February 2014 to include CCHF, after a case was documented in Uganda (internal link to Uganda VHF pocket guide).

Ebola- West Africa and DRC  In response to the West African outbreak of Ebola, the Ugandan VHF pocket guide was rapidly revised and expanded to produce Clinical Management of Patients with Viral Haemorrhagic Fever: A Pocket Guide for the Front-line Health Worker- Interim emergency guidance- generic draft for West African adaptation – published in English in 30 March 2014 then released in French in April 2014; the most current version was updated in 2016. 

Based on this pocket guide, the WHO Ebola Clinical Team Training was rapidly developed with initial implementation in Liberia then Sierra Leone in 2014 to prepare  health workers (both clinicians and cleaners/hygienists, and  staff) to work in an Ebola Treatment Unit/Center (ETU/ETC. In 2018, WHO updated the powerpoints from this training course  and posted them in OpenWHO for use in response to the 2018 Ebola outbreak in the DRC. For the latest updates on Ebola virus disease, refer to the WHO website. 

With the urgent need to prepare more clinical teams to manage the rising number of Ebola patients, the Alliance was contracted by WHO Pandemic and Epidemic Diseases to develop and implement the WHO  Ebola Clinical Team Training, based on the WHO VHF pocket guide and drawing from the WHO IMAI Quick Check+ training and the expertise of clinicians deployed through WHO GOARN and MSF. This training was used extensively in Sierra Leone and Liberia; some in Guinea and in inter-country trainings in English and French (in Uganda and Senegal) to prepare clinical teams in other countries during the 2014-2016 Ebola outbreak. In total, more than 8000 health workers trained (link to Epi Record article).    

The WHO Ebola Clinical Team Training curriculum addresses both case management and infection prevention and control and is designed for the full ETU team, both clinicians and cleaners/hygienists, including dead body managers within the facility. 

The training/mentoring is delivered in 3 phases:

  • Phase 1: didactic training with skill stations for handwashing, PPE donning and doffing, solving clinical cases (3 days)

  • Phase 2: simulated patient in a mock ETU (2 days)

  • Phase 3: mentored introduction to work in an ETU. 

The didactic training included the following sections:

  • Ebola overview:  biology, this outbreak, new treatments

  • Strategies to stop Ebola transmission

  • Infection prevention and control for the clinical team

  • PPE for Ebola 

  • Screening and overall organization of the Ebola Treatment Unit (ETU)

  • Clinical care in the ETU

  • Collecting blood samples from a suspect or confirmed Ebola patient

  • Health worker preparation for work in an Ebola outbreak 

  • Cleaning and disinfection protocol for Ebola 

  • Environmental cleaning, linen management, waste management

  • Dead body management in the facility

This participatory course was taught using the wallcharts, limited PowerPoints; group discussion; case studies (within a participant training manual); skill stations and practical exercises including putting on and removing personal protection equipment with competency assessment. Patients recovered from Ebola contributed as “expert patients” both to simulate patients in the mock ETU and on a panel during the didactic sessions, sharing real experience and patient’s views with the participants.

Two additional modules support outpatient safe surveillance and isolation of Ebola suspects were developed and added additionally in inter-country trainings in Uganda then Ebola to prepare :  

  • Preparing health centre, health post, or hospital outpatient for Ebola screening/surveillance- in at-risk countries

    • This entails encouraging all front-line health workers to ask about travel and to expand their differential diagnosis of common presenting symptoms (fever, diarrhoea) to include Ebola and respond by isolating the patient if Ebola is suspected and calling for help/transfer. 

  • Preparing health centre, health post, or hospital outpatient for Ebola screening/surveillance- in Ebola affected countries. 

This latter was expanded in early 2015 from a powerpoint module to a mobile training course, delivered by trainers on-site throughout Port Loko and Mekeni districts in Sierra Leone experiencing sporadic Ebola cases presenting to hospitals and health centres (link internal to NonEbola health facility clinical decisions making training – participant manual and facilitator guide). The course emphasized the importance not only of screening patients on arrival for Ebola but also rescreening patients admitted to hospital.