The World Health Organization (WHO) has released updated guidelines due to the Ebola Virus Disease (EVD) outbreak in West Africa:
Recommendations for ships
In case of a passenger presenting with symptoms compatible with EVD (fever, weakness, muscle pain, headache, sore throat, vomiting, diarrhoea, bleeding) on board of a ship, the following precautions must be applied:
- Keep his/her cabin doors closed, if not placed in an medical isolation room on board.
- Provide information about the risk of Ebola transmission to persons who will take care of the patient or enter the isolation area.
- A log listing all people entering the cabin should be maintained.
- Anyone who enters the cabin toprovide care to the person in isolation or to clean the cabin must wear PPE with :
- A surgical protection mask; and eye protection or a face shield
- Non-sterile examination gloves or surgical gloves;
- Disposable impermeable gown to cover clothing and exposed skin. A waterproof apron should be worn over a non-impermeable gown or when coming in close contact with the person in isolation.
- Before exiting the isolation the PPE should be removed in such a way as to avoid contact with the soiled items and any area of the face.
- Limit the movement and transport of the patient from the cabin for essential purposes only. If transport is necessary, the patient should wear a surgical mask.
- Clean and disinfect spills without spraying or creating aerosol. Used linen, cloths, eating utensils laundry and any other item in contact with a patient’s body fluids should be collected separately and disinfected in such a way as to avoid any creation of aerosol or any contact with persons or contamination of the environment. Effective disinfectant is a dilution of sodium hypochlorite at 0.05 or 500 ppm available chlorine, with a recommended contact time of 30 minutes.
- All waste produced in the isolation cabin must be handled according to the protocol of the ship for clinical waste. If incinerator is available on board, then waste must be incinerated. If waste must be delivered ashore, then special precautions are needed and the port authority should be informed before waste delivery.
- Start case investigation immediately. Protective equipment is not required when interviewing asymptomatic individuals, when a distance of one metre is maintained.
- Close contacts should be identified and asked to do passive self-monitoring of temperature (e.g. monitoring temperature only if feeling feverish) and symptoms or active self-monitoring (e.g. by regular temperature measurement twice a day and for 21 days.
In the event of a suspected diagnosis of EVD on a ship, immediate expert medical opinion should be sought and the event must be reported as soon as possible to the next port of call by the Captain.
The patient should disembark in such a way as to avoid any contact with healthy travellers and wearing a surgical mask. Personnel in contact with the patient during the medical evacuation should wear a surgical protection mask and PPE.
The competent authority at port may need to arrange depending on the situation: medical evacuation or special arrangements for disembarkation and hospitalization of the patient and laboratory diagnosis.
Passengers, crew members and cleaning staff who have been identified through contact tracing should be assessed for their specific level of exposure. Passive self-monitoring of temperature (e.g. monitoring temperature only if feeling feverish) and symptoms or active self-monitoring (e.g. by regular temperature measurement twice a day) for those at higher risk level should be continued for 21 days.
At the request of a governmental port health authority, ship operators shall also facilitate obtaining, from some or all passengers, to provide information on their itinerary and their contact details (should they need to be contacted) when there is a particular reason to believe they may have been exposed to infection on board of the ship. Additionally, countries may consider requiring arriving ships to complete and deliver the Maritime Declaration of Health (IHR Annex 8). Measures taken on board should also be noted on the IHR Ship sanitation control certificate (IHR Annex 3)
Source: World Health Organization (WHO)