Summary of key measures for prevention and control of filovirus hemorrhagic fever in healthcare facilities
1. Standard precautions should be strictly enforced in the treatment and care of all patients.
2.Suspected and confirmed Ebola hemorrhagic fever patients should be isolated in a single room, or suspected and confirmed patients should be housed in a separate area, and suspected patients should be housed strictly separately from confirmed patients. Access to the isolation area should be restricted, and medical treatment items should be dedicated.
3, Ebola hemorrhagic fever patients in the isolation area of health care workers and other staff should be separated from other areas.
4, all personnel entering the isolation area / ward should strictly regulate the use of personal protective equipment, and strict implementation of hand hygiene. Personnel entering the isolation area should wear at least the following PPE: gloves, isolation gowns, waterproof boots or sealed shoes and shoe covers (masks and eye protection should be worn when splashing may occur).
5.Strictly enforce safe injection and puncture, and standardize the handling of sharp instruments.
6.Strictly enforce the cleanliness of the environment and medical equipment surfaces. Strict management of dirty medical fabrics and high-risk medical waste.
7, the biological sample handling and testing of suspected and confirmed Ebola hemorrhagic fever patients should be carried out in strict laboratory biosafety procedures.
8, the remains of suspected and confirmed patients who died for processing, autopsy or burial, personnel in contact with the body should strictly implement measures to prevent and control infection.
9. Medical personnel in the isolation area and other personnel with a history of exposure to blood or body fluids of suspected or confirmed patients should be promptly assessed and continuously concerned about the risk of infection and, if necessary, promptly isolated.
Preamble
This guideline provides recommendations for infection prevention and control measures for personnel who have been directly or indirectly exposed to patients with suspected or confirmed filovirus hemorrhagic fever, including Ebola hemorrhagic fever and Marburg hemorrhagic fever. Instructions for the implementation of some prevention and control measures are also included. These precautions need to be followed not only by medical personnel, but also apply to infection prevention and control for other personnel who have direct contact with patients (e.g., visitors, accompanying family members, volunteers, etc.), as well as those who do not have direct contact with patients but have potential exposure (e.g., housekeepers, laundry workers, housekeepers, security guards, etc.).
This guideline is an update of the WHO 2008 Interim Guideline for the Prevention and Control of Infection in Healthcare Facilities for Patients with Suspected and Confirmed Filovirus (Ebola, Marburg) Hemorrhagic Fever. The revision of the guidelines is based on international guidance documents and expert consensus on the prevention and control of Ebola hemorrhagic fever outbreaks. Ebola hemorrhagic fever is a very serious disease caused by the Ebola virus and is highly infectious, with rapid disease progression and a high mortality rate of up to 90%. However, the disease can be prevented. Ebola hemorrhagic fever is transmitted mainly through direct contact, such as through contact with the blood, saliva, urine, semen and other body fluids of infected patients, but also through contact with contaminated objects and environmental surfaces, including fabrics contaminated by the body fluids of infected patients.
Ebola virus in the environment is relatively easy to kill, and conventional disinfection methods such as thermal disinfection, use of appropriate concentrations of ethanol-based disinfectants, and chlorine-containing disinfectants can inactivate the virus. The implementation of hospital infection prevention and control measures can effectively reduce or stop the spread of the virus and protect medical staff and other high-risk populations. Therefore, it is recommended that a dedicated management team be established in the infected area to manage clinical cases of the disease; the team should include a coordinator to oversee the implementation of infection control measures in each medical institution and to coordinate and make recommendations on prevention and control activities. The coordinator should be an infection control professional.
The primary purpose of this guideline is not case identification and detection, patient clinical assessment and management, but the process of tracking close contacts and detecting community cases also requires the implementation of infection prevention and control measures in accordance with this guideline, keeping in mind the following principles.
① Avoid shaking hands; ② Maintain a distance of more than 1 meter (3 feet) from the tracing subject as much as possible; ③ Personal protective equipment is not required in the following cases: being able to ensure a distance of more than 1 meter from the tracing subject, tracing asymptomatic individuals (neither fever, diarrhea, bleeding, vomiting), and not touching the environment contaminated by suspected cases; ④ It is recommended that staff responsible for contact tracing and community case detection be equipped with quick-drying hand disinfectant and train them to master the indications and methods of hand hygiene.
1. Prevention and control requirements in daily treatment
Standard precautions should be strictly enforced when treating and caring for all patients, regardless of whether the patient has now developed suspicious signs and symptoms. Since the early symptoms of hemorrhagic fever are not specific, this is the key to prevention and control, of which hand hygiene is the most important measure, and gloves must be worn when touching blood or body fluids. A mask, goggles or protective face screen is required when there is a risk of blood or body fluids being sprayed on the face. Prompt cleaning of contaminated environmental surfaces is also critical.
2. Requirements for prevention and control in the treatment of patients with suspected or confirmed hemorrhagic fever
(1) Patient placement, staffing and visitor management
1.Suspected or confirmed patients should be placed in a single isolation ward, which should be equipped with a special toilet, shower, flowing water hand-washing facilities, soap, disposable hand towels, quick-drying hand disinfectant, personal protective equipment, medication, etc. The isolation ward should also be well ventilated, with windows and doors closed and access restricted.
If there is no isolation ward, suspected and confirmed patients should be placed in a separate isolation area, while suspected and confirmed cases should be placed separately, and ensure that the isolation area can be equipped with the items and facilities required for isolation wards. The distance between the beds in the isolation area is more than 1 meter.
2, Ebola hemorrhagic fever patients isolation area of health care workers and other staff should be separated from other areas. During the disease epidemic, staff cannot move freely between the hemorrhagic fever isolation area and other areas.
3.All unnecessary personnel are prohibited from entering the isolation area of hemorrhagic fever patients.
4. It is best to stop visiting, or if this is not possible, to limit the number of visitors to only those assisting in the care of the patient, such as the child’s parents.
5. Unnecessary visitors should be prohibited from entering the isolation ward/area, and visitors entering the isolation ward/area should be kept at a distance of more than 15 meters from the patient.
6.Visitors of patients with hemorrhagic fever should be screened for signs and symptoms of hemorrhagic fever before entering the healthcare facility.
(2) Hand hygiene, personal protective equipment and other preventive measures
1. Ensure that all visitors are able to use personal protective equipment properly before entering the isolation ward/area and that hand hygiene is strictly enforced.
2.Ensure that all medical personnel (including nursing staff and housekeeping staff) are able to wear appropriate PPE according to the expected risk level before entering the isolation ward/area and coming into contact with the patient or the patient’s surroundings.
3. Work clothes should be worn when working in the patient area and personal clothing is prohibited.
4.When providing treatment and care to patients with hemorrhagic fever (including suspected cases), the following precautions should be carefully implemented to avoid unprotected direct contact with blood and body fluids.
A. Hand hygiene should be strictly implemented in the following cases.
When entering the isolation ward/area, before wearing personal protective equipment and gloves;
Before performing any cleaning/sterile operations on the patient;
After contact with the patient’s blood and body fluids, or after there is a risk of contact with the patient’s blood and body fluids;
After contact with contaminated or potentially contaminated patient bedside surfaces/objects/equipment;
After removal of personal protective equipment when leaving the isolation area.
In the isolation ward/area, hand hygiene should be strictly enforced when the above five indications for hand hygiene occur, and gloves should be changed. When treating and caring for different patients in the same ward, hand hygiene should be performed before touching the next patient after the end of treatment of one patient. In addition, hand hygiene should always be performed after taking off personal protective equipment, otherwise the use of protective equipment will be greatly reduced or even nullified.
Hand hygiene can be performed with a quick-drying hand sanitizer or with soap and running water, and is performed properly according to WHO recommendations. Always wash hands under running water with soap when there are visible contaminants on the hands.
Quick-drying hand sanitizers should be placed at the entrance to the isolation ward/area and inside the isolation ward/area, etc. If a quick-dry hand sanitizer is not available, use running water and soap to wash hands at times when hand hygiene is needed. Quick-drying hand sanitizers can be manufactured by local health care providers according to WHO recommendations and instructions.
B. Put on personal protective equipment in the correct order in a dedicated dressing area before entering the isolation ward/area
Appropriately sized clean gloves should be worn before entering the patient isolation area. If gloves are heavily contaminated with blood or any other bodily fluids during consultation and care operations for the same patient, they should be replaced and hand hygiene should be performed immediately after removing them. When treating or caring for different patients in the same ward, gloves should be removed immediately after touching a patient and hand hygiene should be performed. When the quality of gloves is poor, such as when they are easily torn or ripped during use, it is recommended that double gloves be worn.
Use disposable, impermeable barrier gowns and ensure that clothing and exposed skin are covered.
Use medical masks and eye protection (such as goggles and protective face screens) to prevent splashing into the nose, mouth and eyes.
Use closed, puncture-resistant, impermeable footwear (such as rubber boots) to avoid contamination with blood, other body fluids, or contaminated sharp objects for puncture wounds. If rubber boots are not available, shoe covers should always be used, and gloves must be worn when removing the covers to avoid contamination of the hands.
5, because of handling patients and other operations and inevitably to contact the patient’s blood and body fluids (such as patients with diarrhea, bleeding, vomiting and other symptoms, the environment may be contaminated), in addition to the above-mentioned protective equipment, but also need to wear a double layer of gloves, if the isolation suit can not be impermeable, you also need to wear a waterproof apron outside the isolation suit, if there is no boots, you need to wear shoe covers and socks.
6.Aerosol generation should be avoided as much as possible during operation. When performing operations that may cause coughing or trigger aerosols (e.g. nebulized inhalation therapy, sputum specimen retention, bronchoscopy, tracheal intubation, mask oxygenation), a medical protective mask (e.g. N95 mask) should be worn.
7.Before leaving the isolation ward/area, take off personal protective equipment (including boots) in accordance with the correct procedures and methods, place them in the medical waste bin, and implement hand hygiene.
8. Avoid direct contact with any area of the face (including eyes, nose and mouth) or incomplete skin when taking off PPE and after contact with contaminated items (e.g. gloves, isolation gowns).
9. Reuse of disposable protective equipment is prohibited. When reusing goggles and protective face screens, they should first be cleaned with water (detergent can be added)
Wash, remove the organic material on top, and then completely soak in 1000mg/L chlorine disinfectant for at least 30 minutes (preferably overnight) for disinfection. Rinse thoroughly with water before reuse (to remove hypochlorite residues and salt deposits). Towels used for wiping during cleaning are disposed of in accordance with infectious medical waste; the disinfectant can be safely discharged into a sink or sewer.
10. Strictly clean and disinfect reusable equipment as described below.
11. Strictly enforce the exclusive use of each patient’s treatment items (e.g., stethoscopes). If this is not possible, they should be disinfected between different patients’ use. For example, when the stethoscope is used by different patients, appropriate personal protective equipment must be worn to clean the entire stethoscope (including the medical staff hand contact surface and patient contact surface) first with water and soap solution to remove organic substances, and then wipe with ethanol. The waste generated throughout the process should be disposed of in accordance with infectious waste (refer below).
12. It is prohibited to move items and clinical equipment between isolation wards/areas and other patient areas, except for items that are discarded or destroyed after use. For example, patient medical records and examination records should be kept outside the isolation ward/area to avoid contamination.
(3) Safe injection and sharps management
1.Each patient should have exclusive injection and intravenous treatment items and equipment, which should be disposed of in place after use. Reuse of syringes, needles and other items is prohibited.
2.Minimize the use of needles and other sharp instruments.
3.Minimize patient blood collection and laboratory tests for diagnostic purposes.
4.When sharps must be used, ensure that the following protective measures are implemented.
Prohibit back-set needle caps;
It is forbidden to point the used needle at any part of the body;
It is prohibited to remove the needle of a disposable syringe by hand and to bend, break or otherwise handle used needles by hand;
Place used syringes, needles, surgical blades and other sharps in a sharps container;
5. Place the sharps box as close as possible to the place where the sharps are used and ensure that the opening of the box is placed upwards. If the sharps box is far away, it is forbidden to touch the sharps directly with your hands during the transfer of sharps, and it should be placed in the curved tray;
6.The sharps box should have a lid, and should be replaced with a new sharps box when it is filled to 3/4 of its capacity;
7.The sharps box should be placed in a location that is not easily accessible to visitors, especially children, such as the floor of the children’s activity area and the bottom of the shelf.
3.Management of environmental cleaning and fabrics
(1) Personal protective equipment
1.When cleaning the environment and handling infectious waste, protective/rubber gloves, impermeable barrier clothing and sealed shoes such as boots should be worn.
2.When implementing activities with high risk of splashing such as cleaning or unavoidable need to contact blood or body fluids, such as cleaning the surface of items heavily contaminated by vomit or blood, or cleaning an area within 1 meter/3 feet of a symptomatic patient, facial protective equipment should also be worn, including masks, goggles, protective face screens, and impermeable shoe covers when there are no rubber boots.
(2) Washing and cleaning
1. Environment and object surfaces contaminated by blood, other body fluids, secretions, and excretions should be cleaned and disinfected as soon as possible with qualified medical cleaners/disinfectants such as 1000 mg/L chlorinated disinfectant solution. Cleaning should be done before disinfection to prevent organic matter from affecting the disinfection effect.
2. Cleaners and disinfectants should preferably be prepared daily. Cleaners and cleaning equipment are easily contaminated in use, so they should be replaced frequently.
3.The floors and surfaces of objects in the treatment area should be cleaned with water and detergent at least once a day. Wipes should be moistened to avoid generating dust to contaminate the air and other object surfaces.
4.Dry cleaning of the ground is prohibited. The wipes with dust should not be shaken at will. Prohibit the use of dry wipes to wipe the object table.
5.The order of cleaning should be from the cleaned area to the polluted area to avoid cross contamination.
6. Disinfectant spray disinfection in the patient area is prohibited. The practice is potentially risky and not beneficial for prevention and control.
(3) Fabric management
1.Patients’ used fabrics may be heavily contaminated with body fluids such as blood and vomit, which may produce spraying during the process of handling. Therefore, when recovering contaminated fabrics, gloves, isolation clothing, airtight shoes such as rubber boots and facial protective gear such as masks, goggles or face screens should be worn.
2, contaminated fabric storage place should be clearly marked, and placed in leak-proof plastic bags or buckets. The surface should be disinfected (with an effective disinfectant) before being transferred out of the isolated ward/area.
If any solid excrement, such as feces or vomit, is present on the fabric, it should be carefully scraped off with a sturdy sheet and flushed down the toilet or drain before placing the fabric in a container. If the operation needs to be performed outside the isolation ward/area, the fabric contaminated with solid excrement should be transferred in a special container, and contact with the body should be eliminated.
3, the fabric in the transfer bucket should be transferred directly to the laundry room as soon as possible, and promptly cleaned with water and detergent.
4, low-temperature cleaning process, should first use water and detergent to clean the fabric, and then 500mg / L chlorine reagent soaked for about 30 minutes. Finally dry in accordance with conventional procedures.
5.It is not advocated to wash the contaminated fabric directly by hand. In case of no condition to use washing machine, the contaminated fabric should be removed and put into a large container with hot water and soap solution to ensure that the water submerges the fabric, then pour off the water after stirring with a stick, then re-add 1000mg/L chlorine-containing disinfectant and soak for 10-15 minutes. Remove the fabric again and rinse with clean water. Pour off the water and remove the fabric and dry it. Avoid spraying as much as possible throughout the process.
6. For heavily contaminated fabrics, if absolute safety in cleaning and disinfection cannot be achieved, the fabric can be incinerated to reduce the risk of infection for the personnel handling the fabric.
4.Management of medical waste
(1) personal protective equipment
When handling infectious waste (such as solid dirt, carrying visible blood, excrement and secretions), protective/rubber gloves, impermeable barrier clothing, closed shoes such as rubber boots and facial protective gear (masks, goggles or face screens) should be worn. Goggles can block liquid contaminants from the drum better than a protective face screen. Try to avoid splashing when handling liquid contaminants.
(2) Medical waste management procedures
1.Medical waste should be properly classified when it is generated so that it can be handled correctly and safely.
2.Sharp instruments (such as needles, syringes, glass products) and test tubes that have directly held blood and body fluids should be placed in puncture-resistant medical waste buckets. Medical waste buckets should be placed near where sharps are used, as well as in the laboratory.
3. Place all non-sharp, solid infectious waste in leak-proof waste bags and covered medical waste buckets. Do not use limbs to carry medical waste buckets directly, such as over the shoulder.
4, the depth of the pit for filling medical waste should be appropriate (such as 2 meters), and fill to 1-1.5 meters. And use 10-15cm thick soil to cover medical waste.
5.During a disease outbreak, an incinerator can be used for a short time to dispose of solid waste. However, it should be incinerated thoroughly. When handling combustible materials or wearing combustible gloves should prevent burns.
6, placenta and pathology samples should be buried in a separate pit.
7, medical waste final treatment and disposal area should be closed to animals, untrained personnel or children.
8, feces, urine, vomit and liquid waste from cleaning can be poured into the sewer or commode without special treatment.
Table 1.
Summary of best protective measures implemented in direct patient care and care and related activities
Protective measures
Method of implementation
Personnel involved
Establish isolation wards/areas
– Mark out single rooms and give priority to people with known or suspected Ebola infection.
–Refer to guidelines to establish an isolation area.
–Coordinator or sensory control staff decides on patient placement in isolation wards/areas.
–When a patient is not placed in an isolation ward/area, the medical staff should promptly report to the coordinator.
Restrict access to the isolation ward/area for patients with hemorrhagic fever
– Ensure that medical and other staff in the isolation area for hemorrhagic fever patients are separated from other areas and that staff cannot move freely between the isolation area for hemorrhagic fever and other clinical areas during an outbreak.
–Specialized staff guarding between areas where suspected and confirmed hemorrhagic fever patients are housed.
–Hang signs to restrict access to personnel.
–Registration of people entering and leaving should be done.
–Coordinator and/or sensory control staff
Reduce the number of visitors
–Restrict access to visitors with signs and other warnings. Signs should be simple and easy to understand to avoid ambiguity.
–Person access should be properly registered.
–Coordinator and/or probation staff
–Preferably with the involvement of the patient’s relatives and community leaders.
–The medical staff has the obligation to remind when someone violates and report to the coordinator.
Ensure that hand hygiene is practiced by all staff and visitors. Hand hygiene should be strictly enforced even when wearing personal protective equipment.
– Inform staff and visitors of the importance of hand hygiene through training or awareness posters.
–Ensure easy access to quick-drying hand sanitizer, soap solution, water and disposable hand towels at the entrance to the isolation ward/area and at the point of consultation.
–Coordinator and/or sensory control staff
–preferably with the involvement of the patient’s relatives and community leaders
–Medical staff are obliged to remind when there is a violation and to report it to the coordinator.
Try to limit the use of needles and other sharp instruments. If this cannot be avoided please refer to the requirements of this guideline.
–Inform staff and caregivers of basic instructions on the use of needles and sharps through training or posters.
–Ensure that relevant equipment is adequate.
Medical staff should follow the guideline requirements.
Safe handling of needles and other sharps
–Inform staff, visitors, and caregivers of the basics of safe sharps handling through training or posters.
–Ensure that relevant equipment is adequate.
–Medical staff should follow the guidelines. Report to the coordinator when there is a violation.
Establish a process for the safe management of medical waste and medical fabrics
–Provide staff, visitors and caregivers with basic knowledge of safe management of medical waste and medical textiles through training or posters.
–Ensure adequate availability of relevant equipment.
–Medical staff should follow the guidelines. Report to the coordinator when there is a violation.
Minimize diagnostic blood collection and laboratory tests for patients
–Train staff and provide actionable instructions on when blood collection and laboratory tests are needed.
–Medical staff should comply with guideline requirements.
Transfer patients out of isolation wards/areas only when ruling out viral infection or performing critical tests
–Train staff and provide actionable instructions on the correct time to transfer patients from the isolation area and provide precautions to be taken.
–Medical staff should follow the guidelines. Report to the coordinator when there is a violation.
Clean the environment and patient care equipment safely according to these guidelines
–Provide instructions on cleaning to staff, visitors and caregivers through training or informational posters.
–Ensure that supplies and equipment needed for cleaning are adequate.
–Medical staff should follow the guidelines. Report to the coordinator when there is a violation.
5. Preventive and control requirements during medical activities other than treatment of patients with suspected or confirmed hemorrhagic fever
(1) Laboratory tests
1. Blood or other samples from patients with suspected or confirmed hemorrhagic fever should be collected safely in accordance with the relevant guidelines.
2. All laboratory sample handling should be performed in a biosafety cabinet, or at least in a fume hood with an exhaust device. Any manipulation on an open laboratory bench is prohibited.
3.Operations such as pipetting and centrifugal separation produce aerosols, and the risk of infection through inhalation of these aerosols is equal to the risk of transmission by direct contact.
4.Laboratory personnel handling clinical specimens from patients with suspected hemorrhagic fever should wear closed shoes or rubber boots, gloves, disposable impermeable barrier gowns, eye protection devices, face screens and medical protective masks, and may use power-assisted breathing apparatus (PAPR) when performing operations such as dispensing and centrifugation that may produce aerosols.
5.When taking off personal protective equipment, avoid contact with contaminated items (such as gloves, isolation clothing) and face (including eyes, nose and mouth).
6.Reusable isolation gowns and waterproof aprons should be replaced immediately after use and strictly cleaned and disinfected before reuse.
7.Take off personal protective equipment after specimen processing and implement hand hygiene immediately; hand hygiene should be implemented immediately after contact with potentially contaminated material, even if personal protective equipment is worn at the time.
8.Place specimens in clearly marked, leak-proof containers and transport them directly to the designated specimen processing area.
9.The outer surface of the container should be thoroughly disinfected (using an effective disinfectant) prior to specimen transport.
(2) Transfer and burial of patient’s body
1.Consult the coordinator and/or sensory control personnel before transporting and burying the body.
2. Refer to the “Ebola and Marburg virus disease epidemic: preparedness, early warning, control and assessment – interim manual” published by WHO.
3. Minimize the handling of patients’ bodies. The following principles and recommendations should be adhered to in the handling process, and the specific implementation can be appropriately adjusted according to local cultural and religious practices.
Wear personal protective equipment including impermeable isolation clothing, masks, goggle gear, double-layer gloves and closed shoes or rubber boots to handle the bodies of suspected or confirmed hemorrhagic fever patients. After plugging natural orifices, place the body in a double bag, wipe the outer surface of each body bag with an appropriate concentration of disinfectant (e.g., 1000 mg/L chlorinated disinfectant), seal for storage and label as high risk of infection. Immediately transport the body to the mortuary.
Equip the temporary storage area of the body with personal protective equipment (PPE), which needs to be worn during the receiving and encapsulation of the body, and removed immediately after handling and hand hygiene implemented.
Bodies should not be sprayed, washed or embalmed. Any washing of the body for the purpose of a “clean funeral” is discouraged.
In the event of a disease outbreak, only specially trained personnel should handle the body.
During transport, motorists may not wear personal protective equipment if they can ensure that they do not come into contact with the body of a suspected or confirmed hemorrhagic fever patient.
After sealing and packing the body with leak-proof material, it is best to place the body in a coffin and bury it immediately.
(3) Autopsy
1. The coordinator and/or sensory control personnel should be consulted before each autopsy.
2. Autopsies should be performed only when necessary and by trained personnel on the bodies of patients with hemorrhagic fever.
3. Personnel examining the body need to wear goggle devices, masks, double gloves, disposable impermeable isolation clothing, and closed shoes such as rubber boots.
4.Personnel who perform autopsy on patients with confirmed or suspected hemorrhagic fever need to wear medical protective masks or power-fed respirators.
5.When taking off PPE, avoid direct contact with contaminated gloves, PPE and any area of the face (including eyes, nose and mouth).
6.Hand hygiene should always be implemented immediately after taking off PPE.
7.Place specimens in clearly marked, non-breakable, leak-proof containers and transport them directly to the designated specimen handling area.
8.The external surfaces of all containers holding specimens should be thoroughly disinfected prior to transfer.
9.Tissue or body fluids to be disposed of should be placed in clearly marked, sealed, incinerable containers.
(4) Handling of patient body fluids and blood after exposure
1. Any personnel, including medical personnel, whose skin or mucous membranes have been exposed to blood, body fluids, secretions, or excretions of a suspected or confirmed hemorrhagic fever patient, need to immediately stop their current work, leave the patient isolation area, and properly remove their personal protective equipment while ensuring safety. Immediately after leaving the patient isolation area, wash exposed skin surfaces and wound sites with water and soap solution. If mucosal exposure occurs, rinse mucosal surfaces (e.g., conjunctiva) with plenty of water or eye wash rather than chlorinated solvents or other disinfectants.
2. Report the exposure immediately to the local coordinator. This is a race to the bottom task and must be reported as soon as possible after the medical staff leaves the patient’s care unit.
3. Medical evaluation of the exposed person, including other potential exposure risks (e.g., HIV, HCV), and follow-up visits are required, which include taking temperature twice daily for 21 days after the last exposure occurred. Any exposed person who develops febrile symptoms within 21 days is advised to consult an infectious disease specialist immediately.
4. Medical personnel suspected of being infected should be cared for separately and the preventive and control measures recommended in the above document should be strictly implemented until the infection is ruled out.
Close contacts of infected medical personnel should be followed up, including family members, friends, and colleagues who may have been exposed to Ebola through contact with the medical personnel.