Other Infections

CDC Issues Stricter Ebola Virus Protection Guidance for Healthcare Workers

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The U.S. Centers for Disease Control and Prevention (CDC) this week issued new, expanded guidelines to help healthcare workers protect themselves against Ebola virus infection. The guidance details procedures for use of personal protective equipment (PPE), including how to take it off without contamination.

The CDC has recently come under fire after 2 nurses at Texas Presbyterian Hospital were infected with Ebola virus after caring for an ill patient recently arrived from Liberia. Healthcare providers at the hospital contend that they did not have adequate equipment or training in how to use it, and the CDC has acknowledged that tighter procedure are warranted.

The full CDC PPE guidance is available online. Below is an edited excerpt from a new CDC fact sheet summarizing the guidelines.

Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola

The Centers for Disease Control and Prevention is tightening previous infection control guidance for healthcare workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely. 

Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.

The enhanced guidance is centered on three principles:

All patients treated at Emory University Hospital, Nebraska Medical Center and the NIH Clinical Center have followed the three principles. None of the workers at these facilities have contracted the illness.

Principle #1: Rigorous and Repeated Training

Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step donning and doffing of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.

Principle #2: No Skin Exposure When PPE is Worn

Given the intensive and invasive care that US hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.

CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single use disposable full face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:

The guidance describes different options for combining PPE to allow a facility to select PPE for their protocols based on availability, healthcare personnel familiarity, comfort and preference while continuing to provide a standardized, high level of protection for healthcare personnel. The guidance includes having:

o   Disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment;

Principle #3: Trained Monitor

CDC is recommending a trained monitor actively observe and supervise each worker taking PPE on and off. This is to ensure each worker follows the step by step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any missteps in real-time and immediately address.

PPE is Only One Aspect of Infection Control

It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including:

Think Ebola and Care Carefully

The CDC reminds health care workers to "Think Ebola" and to "Care Carefully." Health care workers should take a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, unexplained hemorrhage. If the patient is under investigation for Ebola, health care workers should activate the hospital preparedness plan for Ebola, isolate the patient in a separate room with a private bathroom, and to ensure standardized protocols are in place for PPE use and disposal. Health care workers should not have physical contact with the patient without putting on appropriate PPE.     

CDC’s Guidance for U.S. Healthcare Settings is Similar to MSF’s (Doctors Without Borders) Guidance

Both CDC’s and MSF’s guidance focuses on:

Five Pillars of Safety

CDC reminds all employers and healthcare workers that PPE is only one aspect of infection control and providing safe care to patients with Ebola. Other aspects include five pillars of safety:

10/22/14

References

U.S. Centers for Disease Control and Prevention. Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing). October 20, 2014.

U.S. Centers for Disease Control and Prevention. Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola. Fact sheet. October 20, 2014.