1. business and industrial
2. hospitality industry
3. event planning

Buncombe County Health & Human Services
Aging and Veteran’s Services ~ Social Work Services
Public Assistance & Work Support Strategies ~ Public Health
Amanda Stone, MSW
Health and Human Services Director
To:
Buncombe County Medical Providers
From: Dr. Jennifer Mullendore, Medical Director
Date:
Thursday, October 16, 2014
RE:
Health alert from the Buncombe County Department of Health
Updated Ebola guidance for NC Providers and Labs
Please see the updated provider and laboratory guidance regarding Ebola (attached with key changes
highlighted below). This version has been updated to include clinical observations shared through the
Infectious Disease Society of America by physicians who provided care to Ebola cases at Emory
University; updated infection control guidance; and updated testing guidance.
I am also attaching an updated algorithm for evaluation of the returned traveler. This has been revised
to reflect two changes made by CDC:
A change in the fever criterion used (≥100.4 rather than 101.5), and
A focus on persons who resided in or traveled to “a country with wide-spread Ebola
transmission”, rather than “an Ebola-affected area”.
**If you encounter a patient with fever or compatible Ebola symptoms (headache, weakness, muscle
pain, vomiting, diarrhea, abdominal pain, or hemorrhage) AND they have resided in or traveled to a
country with wide-spread Ebola transmission (currently Guinea, Liberia, & Sierra Leone) in the 21 days
before illness onset, you need to:
1.
2.
1. Isolate patient in single room (with a private bathroom if inpatient setting) and with the door
to hallway closed.
2. Minimize the number of staff interacting with the patient.
3. Implement standard, contact, and droplet precautions (gown, facemask, eye protection, and
gloves).
4. If inpatient setting, notify the hospital Infection Control Program and other appropriate staff.
-MORE-
HHS
Administration
p. 828.250.5700
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Aging & Veteran’s
Services
p. 828.250.5726
PO Box 7408
Asheville, NC
28802
Social Work
Services
p. 828.250.5500
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Public Assistance
p. 828.250.5500
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Public Health
p. 828.250.5000
f. 828.250.6235
PO Box 7407
Asheville, NC
28802
Page 2 – BC Health & Human Services, Provider Health Alert – NC Ebola Guidance
10/16/14
5. Immediately contact your local health department (250-5109 for Buncombe County Disease
Control) or the NC Communicable Disease Branch (919-733-3419) to discuss next steps.
Infection Control
• Detailed guidance on putting on and removing PPE is available
at www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf
•
The NC Division of Public Health recommends having a dedicated monitor observe putting on
and removing of PPE by all healthcare personnel caring for patients with suspected or confirmed
Ebola Virus Disease.
•
If a patient with suspected EVD is going to be transported to another facility, the transport
staff and the receiving facility should be notified before transport so that appropriate
precautions can be taken.
Ebola Virus Testing at the NC State Lab
• Since all specimens tested at the State Lab will be forwarded to the CDC for further testing, you
must send 2 purple top tubes.
•
It may take up to 3 days after symptoms appear for the virus to reach detectable levels.
o
Therefore, if specimens are collected < 3 days after onset, a later specimen may be
needed to completely rule-out Ebola.
See the attachments for further details.
For your understanding, the role of the local health department related to Ebola is:
• providing updates and guidance to the local medical community;
• identification, interviewing and active monitoring of contacts (not testing and treatment
of sick individuals); and
• keeping the public informed and educated on this issue.
Buncombe County Health and Human Services staff have been and will continue to be in
communication with state and federal public health officials, Mission Hospital infection control
staff and leadership, local emergency management organizations, local universities, faith-based
organizations, and the local media to ensure our community is prepared to respond if needed.
-MORE-
HHS
Administration
p. 828.250.5700
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Aging & Veteran’s
Services
p. 828.250.5726
PO Box 7408
Asheville, NC
28802
Social Work
Services
p. 828.250.5500
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Public Assistance
p. 828.250.5500
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Public Health
p. 828.250.5000
f. 828.250.6235
PO Box 7407
Asheville, NC
28802
Page 3 – BC Health & Human Services, Provider Health Alert – NC Ebola Guidance
10/16/14
This is an evolving situation and recommendations are likely to change as new information
becomes available.
• Updated information and guidance are available from the CDC
at http://www.cdc.gov/vhf/ebola and from North Carolina Public Health
at http://epi.publichealth.nc.gov/cd/diseases/hemorrhagic.html.
As always, if you have any questions or concerns related to this or any other communicable
disease, please contact your local health department (250-5109 for Buncombe County Disease
Control; available 24/7).
Thanks,
Jenni
Jennifer Mullendore, MD, MSPH
Medical Director
Buncombe County Health and Human Services
Office: (828) 250-6308
Jennifer.Mullendore@buncombecounty.org
"Health care is vital to all of us some of the time, but public health is vital to all of us all of the time." -Dr. C. Everett Koop, former US Surgeon General
-END-
HHS
Administration
p. 828.250.5700
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Aging & Veteran’s
Services
p. 828.250.5726
PO Box 7408
Asheville, NC
28802
Social Work
Services
p. 828.250.5500
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Public Assistance
p. 828.250.5500
f. 828.250.6235
PO Box 7408
Asheville, NC
28802
Public Health
p. 828.250.5000
f. 828.250.6235
PO Box 7407
Asheville, NC
28802