March 2020 Edition ABOUT NCDC Nigeria Centre for Disease Control (NCDC) is Nigeria’s national public health institute with the mandate to provide a healthier and safer Nigeria through the prevention and control of diseases of public health importance. It is focused on protecting the health of Nigerians through evidence-based prevention, integrated disease surveillance and response activities, using a one health approach, guided by research and led by a skilled workforce. NCDC operations and activities are guided by five key goals: . Accurately measure the burden of infectious diseases in Nigeria . Ensure Nigeria is able to meet its international obligations as a member of the World Health Assembly . Develop a Public Health laboratory service network to support the detection, prevention and response to critical infectious diseases . Reduce the adverse impact of predictable and unpredicted public health emergencies . Create an efficiently managed and evidence-based organization with a clear focus of health promotion and disease prevention. NCDC operates through five directorates: Surveillance and Epidemiology, Public Health Laboratory Services, Emergency Preparedness and Response, Prevention and Programmes Coordination and Administration. NCDC is the host for the ECOWAS Regional Centre for Disease Control (RCDC) and the regional hub for the Africa Centres for Disease Control (ACDC). FOREWORD The first edition of the National Guideline on Infection Prevention and Control of Viral Hemorrhagic Fevers was published in 2017. This was in recognition of the threat of emerging and reemerging infectious diseases such as Lassa fever and Ebola virus disease to the country. This version was utilized in major treatment centres across the country especially in response to Lassa fever outbreaks. The implementation highlighted important lessons that have now been reviewed to develop an improved version of the guideline. Over the years, the understanding of Viral Haemorrhagic Fevers (VHFs) in Nigeria particularly Lassa fever has improved, following our experience in the management of Lassa fever cases. The Nigeria Centre for Disease Control (NCDC) has taken increased responsibility to improve the availability of evidence-based guidelines for infectious diseases. During the 2018 Lassa fever outbreak, we recorded infections among health workers- one of the areas that spurred the need to improve the development and implementation of these guidelines. To ensure alignment with global best practice, we have worked with stakeholders across the country and internationally to harmonize various experiences, discuss these, understand the research available and develop revised guidelines. The development of this guideline was a collaborative effort involving the participation of infection prevention and control experts in Nigeria, the clinical managers in the VHF treatment centres in Nigeria, Occupational Health Physicians and NGOs that work in the area of infection prevention and control. This reviewed guideline describes the infection prevention and control practices that need to be in place in the management of VHFs. It starts with a section on how every hospital can screen for VHFs using the Screen, Isolate and Notify (S-I-N) approach. It also includes a practical resource in the form of Standard Operating Procedures and Checklists, and it is designed to serve as a major reference for anybody involved in the care and management of VHFs and all health facilities in VHF endemic areas as they all run the risk of encountering VHF cases. I am grateful for the leadership and support of the Federal Ministry of Health led by Honorable Minister Dr. Osagie Ehanire. I would also like to recognize and thank the excellent committee who worked on this important document.We hope that this guideline will advance improvement in infection prevention and control in management of VHFs. As more information becomes available, we will continue to update our recommendations in order to ensure better outcome for the patients and communities. Dr. Chikwe Ihekweazu Director General, Nigeria Centre for Disease Control ACKNOWLEDGEMENT The Nigeria Centre for Disease Control (NCDC) wishes to acknowledge the technical contribution of experts from the following institutions - Irrua Specialist Teaching Hospital (ISTH), Federal Medical Centre, Owo and Federal Teaching Hospital Abakaliki (FETHA). We would also wish to express our gratitude to our partners, (RESOLVE, World Health Organization, AFENET, the United States Centers for Disease Control and Prevention, Medecines San Frontiers, ALIMA, Nigeria Infection Control Society and Dr. Ameyo Stella Adadevoh Health Trust) for their financial and technical supports. Finally, we wish to appreciate our dynamic leader, Dr Chikwe Ihekweazu, the Director General NCDC for giving us the opportunity to produce this guideline for infection prevention and control in Viral Haemorrhagic Fevers. Mrs. Elsie Ilori Team Lead, National Lassa fever Technical Working Group Contents ABOUT NCDC ..................................................................................................................... 1 FOREWORD ....................................................................................................................... 2 ACKNOWLEDGEMENT ...................................................................................................... 3 ACRONYMS AND ABBREVIATIONS .................................................................................. 7 LIST OF FIGURES .............................................................................................................. 8 CHAPTER ONE: Introduction ............................................................................................. 9 Case Definition: ................................................................................................................. 12 Lassa fever ........................................................................................................................ 12 Ebola Virus Disease .......................................................................................................... 13 CHAPTER TWO: Basic principles of infection prevention and control .............................. 14 CHAPTER THREE:............................................................................................................ 17 CHAPTER FOUR: Hand hygiene in management of VHF patients .................................. 25 Why is hand hygiene important in VHF management? ...................................................... 25 Hand hygiene with Alcohol-based Hand-rub ...................................................................... 26 Handwashing with Soap and Water ................................................................................... 28 CHAPTER FIVE: Facility considerations including Water, Sanitation and Hygiene (WaSH) in a VHF treatment centre .................................................................................................. 29 Patient placement in the VHF treatment centre ................................................................. 32 CHAPTER SIX: Personal Protective Equipment (PPE) in the Care of Viral Haemorrhagic Fever Patients .................................................................................................................... 41 CHAPTER SEVEN: Injection safety and management of sharps ...................................... 50 CHAPTER EIGHT Environmental cleaning, linen processing and waste management practices to prevent transmission of VHF .......................................................................... 52 Environmental cleaning...................................................................................................... 52 Cleaning and disinfection in the VHF treatment centres .................................................... 53 IPC considerations ............................................................................................................. 53 Procedure for cleaning patient care areas ......................................................................... 53 Linen Management ............................................................................................................ 55 Waste management in VHF treatment center .................................................................... 59 Transportation of waste ..................................................................................................... 62 CHAPTER NINE: Infection prevention and control measures in the dialysis of Lassa fever patients .............................................................................................................................. 66 CHAPTER TEN: Discharge of patients from the VHF treatment centre ............................ 74 CHAPTER ELEVEN: Diagnostic laboratory activities: sample management .................... 75 General Recommendations for Laboratory Safety ............................................................. 75 CHAPTER TWELVE: Administrative Controls, Safe Work Practices and Employee’s Health in the VHF Treatment Centre ................................................................................. 82 IPC Governance Structure ................................................................................................. 83 Role of the Infection Prevention and Control Committee (IPCC) ....................................... 84 Role of Infection Prevention and Control Team (IPCT) .....................................................