VDH Guidance on Ebola for Health Care Providers

Health care providers across the country are facing concerns about the spread of the Ebola virus into the United States.  Although the Ebola disease outbreak is centered in West Africa, international travelers could bring it to the US. We have already seen Ebola cases in Texas.  

Every health care provider must be prepared to deal with an Ebola-infected individual, whether it is a resident, staff member, or visitor.

The Virginia Health Care Association (VHCA) recently requested guidance/protocols from Virginia’s Health Commissioner for precautions long term care facilities should take in the event they have a staff member returning from a visit to Africa.  On October 14, 2014 we received the following response from Marissa J. Levine, MD, MPN, FAAP, State Health Commissioner, Virginia Department of Health.

This is in response to your recent email seeking guidance regarding long-term care facility staff who may be returning from areas affected by the Ebola outbreak in West Africa.  Thank you for contacting us with your concerns.

In September 2014, the Virginia Department of Health (VDH) published interim guidance on Ebola virus disease (EVD) for non-hospital healthcare facilities (including long-term care facilities) on its website.  This guidance is also attached to this correspondence for your convenience.  This document and other guidance will be updated as the situation changes and more is learned about EVD.  I encourage you to consider distributing this information to your membership and wanted to provide some additional details as well.

At present, the Ebola-affected countries are Guinea, Liberia and Sierra Leone.  Because the West African countries where disease transmission is occurring are subject to change, we encourage everyone to check the Centers for Disease Control and Prevention (CDC) website for a current list of affected countries, when assessing potential risk associated with travel.  

Employees returning from international travel should be asked about their travel history.  If they have not been in an Ebola-affected area in the past 21 days, no further action is needed.  Also, if they have been back in the United States for 21 days or more and remain healthy, they are not at risk for developing EVD.

If travelers have been in an Ebola-affected area in the past 21 days, they should be asked about activities that may have put them at risk of exposure to Ebola virus.  VDH is following CDC guidance for evaluating returning travelers.  The chart below might be a helpful tool to use to assess exposures.

High-Risk Exposure   
Percutaneous (needle stick) or mucous membrane exposure to body fluids of ebola virus disease (EVD) patient                  Yes or No
Direct skin contact with, or exposure to blood or body fluids of an EVD patient without the appropriate personal protective equipment (PPE)  Yes or No
Processing blood or body fluids of confirmed EVD patients without appropriate PPE or standard biosafety precautions Yes or No
Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring Yes or No
Low-Risk Exposure  
Household contact with an EVD patient Yes or No
Other close contact with an EVD patient in healthcare facilities or community settings (within 3 feet of EVD patient or care area for prolonged period of time without appropriate personal protective equipment)  Yes or No

The local health department (LHD) is available to help assess a traveler’s exposures and to work with your facility to answer any of their questions or address specific concerns about illness or about a staff person who has traveled.  The LHD will actively monitor anyone who has had an exposure listed on the chart above in an Ebola-affected country, make further recommendations for disease prevention and control, and take immediate actions if a fever or any other symptoms of EVD develop within 21 days of travel.  Any returning traveler who has not had an exposure, as indicated in the chart above, may continue routine daily activities, including work in health care, and monitor themselves for symptoms of EVD.  

Your member facilities can find their LHD at www.vdh.virginia.gov/LHD/index.htm.  Please encourage them to contact their LHD with further questions about Ebola or to provide consultation on returning travelers’ potential exposures.  Additional information on this evolving situation is available on the CDC Ebola website.

In addition, the Virginia Department of Health (VDH) has created an Ebola page on its website to provide guidance for health care providers and facilities.

This webpage has links to information from the Centers for Disease Control and Prevention (CDC), as well as guidance documents created by VDH.  The webpage has documents addressing:

  • General Information for All Healthcare Professionals
  • Laboratory Testing Considerations
  • Information for Hospitals
  • Information for Emergency Medical Services (EMS)
  • Information for Non-Hospital Settings  (includes long term care facilities)
  • Information for Colleges and Universities
  • Community Feedback

Please consult this webpage frequently to access the latest information and guidance.  VDH is updating the webpage as new information becomes available.