by Brianna Crandall — November 3, 2014—The Centers for Disease Control and Prevention (CDC) announced last week that it 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) healthcare workers should use and offers detailed step-by-step instructions for how to put the equipment on and take it off safely, but it also includes isolation guidelines and cleaning procedures that facilities/janitorial staff may be involved in planning or carrying out.
The enhanced guidance is centered on three principles:
- All healthcare workers undergo rigorous training and are practiced and competent with PPE, including putting it on and taking it off in a systemic manner.
- There is no skin exposure when PPE is worn.
- All workers are supervised by a trained monitor who watches each worker putting PPE on and taking it off.
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 handling of all patients treated so far at the facilities has reportedly followed the three principles, and none of the workers at these facilities have contracted the illness, says CDC.
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.
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:
- Two specific, recommended PPE options for facilities to choose from. Both options provide equivalent protection if worn, put on and removed correctly.
- Designated areas for putting on and taking off PPE. Facilities should ensure that space and layout allows for clear separation between clean and potentially contaminated areas
- Trained observer to monitor PPE use and safe removal
- Step-by-step PPE removal instructions that include:
- Disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment
- Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.
PPE is only one aspect of infection control
CDC emphasizes that it is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including:
- Prompt screening and triage of potential patients
- Designated site managers to ensure proper implementation of precautions
- Limiting personnel in the isolation room
- Effective environmental cleaning
“Think Ebola” and “Care Carefully”
The CDC reminds healthcare workers to “Think Ebola and to “Care Carefully. Healthcare 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, healthcare workers should activate the hospital preparedness plan for Ebola, isolate the patient in a separate room with a private bathroom, and ensure standardized protocols are in place for PPE use and disposal. Healthcare workers should not have physical contact with the patient without putting on appropriate PPE.
The new PPE guidance is available on CDC’s Web site. A fact sheet summarizing the agency’s updated guidance is also available. The National Institute for Occupational Safety and Health’s (NIOSH) Workplace Safety and Health Topic Web page on Ebola lists resources for workers who may be exposed to the virus.
