Ebola Information for Healthcare Professionals and Other Partners
This is a Wisconsin Disease Surveillance Category I disease:
Report IMMEDIATELY by TELEPHONE to the Wisconsin Department of Health Services (DHS), Division of Public Health (DPH), Bureau of Communicable Diseases (608-267-9003), upon identification of a confirmed or suspected case.
Since the Ebola virus outbreak began in Africa, DHS has been assisting health care partners by providing guidelines for monitoring individuals returning from affected West African countries, and ensuring that all providers are ready with the appropriate infection control protocols and required precautions for managing an Ebola patient. DHS will continue to provide the latest information on this page.
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Local public health agencies (LPHAs) serve key roles in preparing to coordinate an Ebola response for their communities. Not only do LPHAs do the initial screening and monitoring of returning travelers, they also work with their community partners to plan and drill how a response could unfold locally. Clear communication regarding expectations and roles, determined in advance, is necessary for the successful execution of a response in an actual event.
DHS expects all hospitals and providers to prepare to identify, isolate, report, and safely manage patients suspected of having Ebola until after consultation with DPH and EMS transport is arranged or an Ebola diagnosis is confirmed by laboratory testing. The CDC has provided an algorithm and checklists to help providers prepare for these tasks.
- CDC Algorithm for Emergency Departments - Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients who Present with Possible Ebola Virus Disease
- CDC Patient care checklist for patients under investigation for Ebola Virus Disease
- CDC EMS Ebola Preparedness Checklist (PDF)
As of December 9, 2014, all travelers from Ebola-affected West African countries enter the United States at one of five international airports (New York John F. Kennedy; New Jersey Newark Liberty; Washington Dulles; Hartsfield-Jackson Atlanta; and Chicago O’Hare) where enhanced health screening is being conducted by the CDC’s Division of Global Migration and Quarantine. Travelers are asked their final destination(s) during the screening. The CDC then sends the passenger’s name, address and phone number to the state health department of residence or destination, along with the statement that the passenger passed the screening (i.e., is not currently ill), has been instructed to self-monitor and has been provided a CDC Ebola Care Kit. When DHS receives such a notification from CDC, staff will notify the LPHA serving the area where the traveler resides or will be staying and ask them to contact the traveler and follow-up as per the Wisconsin protocol.
By conducting their own screening using the Questionnaire for People with Recent Travel to West Africa (Word), the LPHA will confirm that the asymptomatic individual traveled within one of the affected countries. If so, he/she should be monitored for fever and other Ebola symptoms for 21 days after his/her last day in the affected country. The traveler should also notify the LPHA if they plan to travel out of the jurisdiction during this observation period or if they have pre-scheduled medical/dental appointments. If the traveler reveals any potential exposures to Ebola, the LPHA should notify DPH immediately. (If travel did not occur in one of the Ebola-affected countries or if travel occurred more than 21 days ago, no monitoring is needed.)
Based on the answers to the screening questions, LPHAs will determine the risk level for the traveler. This risk level will determine how the traveler will be monitored. Individuals who are determined to be at high risk or some risk in consultation with DHS will receive direct active monitoring. Direct active monitoring requires daily, personal observation of the traveler by LPHA staff while the traveler takes his/her temperature and reports on any symptoms. More information regarding this process is contained in the DHS Guidance Regarding Direct Active Post-Arrival Monitoring (PDF). Movement restrictions may be recommended for persons at high or some risk.
Most travelers will be classified into the low risk category and will need only active monitoring. Active monitoring requires the LPHA to check in with the traveler by phone daily to get the results of his/her self-monitoring. Detailed information on active monitoring can be found in CDC’s Interim Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure.
Monitored individuals must be instructed that if they become symptomatic, they should contact their LPHA immediately for assistance (including arrangement of EMS transport, if necessary). They should be instructed not to present to a hospital or clinic without first contacting their LPHA.
Transport of Patients
If an LPHA suspects a person to have Ebola, the agency should immediately call the DPH emergency on-call number at 608-258-0099 (this number is for emergency calls from health professionals only). DPH will then assist in risk assessment, approval of Ebola testing based on patient evaluation, and coordination of patient transfer to appropriate care facility.
For the purposes of Ebola response, DHS has outlined three categories of Emergency Medical Services (EMS). In brief:
- Category One services are pre-identified services, known to DHS, that will coordinate with the DPH to transport laboratory-confirmed Ebola patients.
- Category Two services are those services able and equipped to transport patients suspected of having Ebola.
- Category Three services are those services that will screen for potential Ebola patients. If they identify a suspect case or cases, they will notify a Category Two service to respond. More information on the responsibilities of EMS during the Ebola response can be found in the DHS Emergency Medical Services guidance.
More information on the responsibilities of EMS during the Ebola response can be found in the DHS Emergency Medical Services guidance.
Hospitals have also been divided into three categories for the purposes of Ebola Response. In brief:
- Category One hospitals or “designated hospitals” are pre-identified facilities that are prepared to care for a laboratory-confirmed Ebola patient. There are three healthcare systems in Wisconsin serving in this capacity: UW Health (University of Wisconsin Hospital and the American Family Children’s Hospital, Madison); Froedtert & the Medical College of Wisconsin (Froedtert Hospital, Milwaukee); and Children's Hospital of Wisconsin, Milwaukee.
- Category Two hospitals are those facilities that can care for a potential Ebola patient for the first 72-96 hours while confirmatory testing occurs or transportation is arranged. Key healthcare protocols that must be addressed by Category Two hospitals while preparing for these activities include:
- Safe transportation
- Laboratory testing
- Properly packaging a possible Category A agent for transport
- Infection control
- Healthcare worker protection
- Environmental services
- Waste disposal
- Category Three hospitals must be able screen, identify, isolate, and report a patient with risk factors and symptoms of Ebola, but are unable to care for suspect or confirmed Ebola patients. These facilities (usually smaller hospitals and clinics) should have a transfer plan in place with a Category Two facility and EMS in the event that they identify a suspect patient. This plan should be drilled.
More information on the hospital categories can be found on the Hospital Categorization one-page brief (PDF).
Personal Protective Equipment
The CDC Ebola infection control guidelines apply to all healthcare settings. These include the use of personal protective equipment (PPE), environmental cleaning and disinfection and ability to isolate a patient (until transported). Patients should be evaluated to determine whether transportation by private means (patient’s vehicle) is safe or whether transport by EMS should be arranged. All healthcare partners involved in transporting and receiving a potential Ebola patient should be notified prior to transport so responders may prepare and use the appropriate PPE.
DHS is aware of nationwide PPE shortages. CDC is working on this with manufacturers, and DHS is also working on solutions through our Strategic National Stockpile. In the event of a confirmed Ebola case, DHS has limited stockpiles of PPE that could be used until larger quantities can be secured.
For additional information, please see the links below:
Collection and Testing of Specimens
Inquiries about a suspect case should be directed to DPH. After consultation and approval from DPH, specimens from suspect patients will be sent directly to the Wisconsin State Laboratory of Hygiene (WSLH). Healthcare facilities will collect 2 whole blood specimens in 4 mL PLASTIC EDTA tubes (specimens in glass tubes will not be tested). DPH will arrange transport of properly packaged specimens to the WSLH in Madison. The WSLH will test one specimen and send the other to CDC for further testing, if necessary. The WSLH has shared detailed information with hospital and other clinical laboratories regarding specimen collection and shipment. Please remember DPH and CDC must approve all Ebola testing. WSLH will report test results to DPH, the submitting laboratory, and CDC.
Each Category Two hospital should have staff trained in packaging suspected Category A infectious substances along with the packaging materials required for such specimens.Refer to the November 24, 2014 DHS memo (WSLH is Now Approved to Test for Ebola Virus) regarding details on submission of specimens, including the required forms, and transport of specimens to WSLH.
For additional information, please see the links below:
In healthcare settings, household bleach (0.5% sodium hypochlorite) should be used at a concentration of 1:10 (1 part bleach to 9 parts water). An EPA-registered hospital disinfectant that is effective against non-enveloped viruses (e.g., norovirus, poliovirus) can also be used. Disinfectant wipes that meet the above criteria are also acceptable.
In the event that a confirmed Ebola patient is identified in Wisconsin, decontamination of residences, offices, schools, jail cells or similar non-healthcare locations where the patient had been present may be required. DHS can assist assessing the need for decontamination and in identifying contractors who can properly conduct this type of decontamination. Consult the DHS guidance on the Handling, Decontamination, Transport, and Disposal of Non-Health Care Setting Ebola-Contaminated Waste (PDF).
CDC and DHS agree that it is safe to dispose of Ebola patient waste in the sanitary sewer system. As an added precaution, DHS is also recommending pre-treatment of waste in the toilet bowl for at least five minutes with one cup of undiluted bleach prior to flushing. Hospitals and their wastewater treatment facilities should discuss the issue of Ebola patient waste disposal and decide whether pre-treatment of waste with bleach will be required locally. Wastewater treatment facilities in Wisconsin are regulated by the Department of Natural Resources (DNR). If a hospital in your county is having difficulty discussing the issue of Ebola patient waste disposal with their waste treatment facility, they should engage their DNR Regional Wastewater Specialist/Engineer to assist in facilitating this discussion.
DNR regulates medical waste disposal in Wisconsin and has identified an incinerator in Illinois that will accept Ebola patient waste. Stericycle© is currently the only U.S. Department of Transportation (DOT) approved service to pick up Ebola solid waste.
Information relevant to managing waste from a non-healthcare setting can be found in the DHS guidance on the Handling, Decontamination, Transport, and Disposal of Non-Health Care Setting Ebola-Contaminated Waste (PDF, 3.1 MB).
For additional information, please see the links below:
- DHS Ebola Patient Waste Guidance (PDF)
- DNR Infectious Waste
- DNR Regional Wastewater Specialists
- Interim Guidance for Managers and Workers Handling Untreated Sewage from Individuals with Ebola in the United States
- DHS guidance on the Handling, Decontamination, Transport, and Disposal of Non-Health Care Setting Ebola-Contaminated Waste (PDF)
Wisconsin does not have state-specific guidance. Please refer to CDC guidance.
Ebola Traveler Notification
How does Wisconsin find out about travelers that might be at risk for Ebola?
- Screening is conducted at five designated international airports (New York John F. Kennedy; New Jersey Newark Liberty; Washington Dulles; Hartsfield-Jackson Atlanta; and Chicago O’Hare) by CDC’s Division of Global Migration and Quarantine (DGMQ). As part of the Ebola Response, DGMQ is tasked with tracking passengers who have some level of Ebola risk. To do this, DGMQ has developed a document that contains screening information from each traveler.
How does the relevant information get to Wisconsin?
- Passengers on board flights originating from West African counties are questioned by the DGMQ for Ebola risk factors at the five major airports receiving these travelers. The information collected is promptly and securely sent to WDHS via Epi-X email. All WDHS on-call epidemiologists receive and watch for these DGMQ notices. An example of the format of the information can be found in Appendix B.
How will local public health be notified?
- If a traveler’s final destination is within your local public health jurisdiction, a WDHS epidemiologist will call your agency (likely the LPHA Health Officer) and provide the information contained within the notification from DGMQ. DGMQ notifications received during evening hours during the work week will generally be called to the LPHA the next morning unless the traveler reports high risk exposure. Notifications received during weekends will be forwarded to the LPHA using the Emergency Call Rank list on the PCA Portal.
What actions do I take when I receive a notification?
- As a Local Public Health Agency receiving this information, you will be asked: If you have the latest CDC and WI guidance for "traveler monitoring" To establish initial contact with the traveler via phone To re-screen the traveler to assess risk (errors have been found in the initial DGMQ screening) Describe active monitoring requirements and develop a daily monitoring plan with the traveler Enter traveler into WEDSS (contact investigation for ‘Hemorrhagic Fever, Ebola’) Update traveler information in WEDSS contact investigation
Should I share DGMQ information with my local partners?
- Because asymptomatic travelers do not pose a public health threat, DHS recommends protecting their privacy by not sharing information, including traveler counts, locally. (DHS provides a statewide count of travelers to all partners weekly, but does not include information on location.) Unless a traveler returning to your area has had high-risk exposures, DHS believes it is not necessary to share the notification information with EMS, 911, or local hospitals. If a traveler has had a high-risk exposure, the LPHA may decide that EMS, 911, and the Category Two hospital to which that traveler would likely be referred should all be notified that a (unnamed) high risk individual is within their jurisdiction. Again, every effort should be taken to protect the privacy of the traveler.
What does the CDC provide to these travelers?
- These travelers will also receive an Ebola Care Kit at the initial screening that will prepare them for active monitoring. Included in this kit is information on Ebola and monitoring, a digital thermometer with instructions, and a 30-day cell phone. The number to this phone will be included in the traveler notification information sent by CDC DGMQ to DHS. Other telephone information is also provided in the notification, but you may determine the preferred means of contact with the traveler.
DHS Contact Information
- General public information Ebola help line - 1-844-684-1064
- Office hours line for health professionals with suspect patient - 1-608-267-9003
- DHS Media Number - 1-608-266-1683
Wisconsin's Ebola Preparedness Updates
- Situation Report, March 11, 2015 (PDF)
- Situation Report, February 12, 2015 (PDF)
- Situation Report, January 15, 2015 (PDF)
- Situation Report, December 18, 2014 (PDF)
- Situation Report, December 11, 2014 (PDF)
- Situation Report, November 25, 2014 (PDF)
- Situation Report, November 20, 2014(PDF)
- Situation Report, November 13, 2014 (PDF)
- Situation Report, November 6, 2014 (PDF)
- Situation Report, October 30, 2014 (PDF)
- Situation Report, October 23, 2014 (PDF)
- Situation Report, October 17, 2014 (PDF)