Ebola guidelines to protect workers, patients
Use N95s if aerosols may be generated
Ebola does not spread by the airborne route, but recently issued infection control recommendations recommend that health care workers don at the least N95 respirators if performing a procedure that may generate aerosols with the patient’s blood or body fluids. (http://1.usa.gov/1pvUSQz)
The Centers for Disease Control and Prevention has posted Ebola recommendations to protect health care workers caring for a suspected or confirmed case of Ebola, a highly fatal, hemorrhagic fever virus that is spread via contact with the blood or body substances of an infected, symptomatic patient. The virus does not spread during the incubation phase, which can last up to 21 days. The CDC also recently added Ebola guidelines for cleaning and disinfecting patient rooms while ensuring housekeeping staff can safey perform their jobs. (http://1.usa.gov/1ljxMOM)
The CDC recommends an Ebola patient should be placed in a single patient room containing a private bathroom with the door kept closed. Facilities should maintain a log of all persons entering the patient’s room. Consider posting personnel at the patient’s door to ensure appropriate and consistent use of PPE by all persons entering the patient room. All persons entering the patient room should wear at least, gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask.
Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment). These would include but are not limited to: double gloving, disposable shoe covers, leg coverings.
Workers should wear respiratory protection at least to the level of an N95 respirator if they are doing procedures on an Ebola patient or body fluids that could generate aerosols. The CDC recommends avoiding aerosol generating procedures (AGPs) on Ebola patients if possible. If performing AGPs, use a combination of measures to reduce exposures from aerosol-generating procedures when performed on Ebola HF patients.
Conduct the procedures in a private room, ideally in an Airborne Infection Isolation Room (AIIR) when feasible. Room doors should be kept closed during the procedure except when entering or leaving the room, and entry and exit should be minimized during and shortly after the procedure. In addition to a respirator, health care workers performing an AGP on an Ebola patient should wear gloves, a gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles. Dedicated medical equipment (preferably disposable) is recommended, with the use of sharps and needles limited as much as possible. All needles and sharps should be handled with extreme care and disposed in puncture-proof, sealed containers, the CDC recommends.
Dearth of data on role of environment
"The role of the environment in transmission has not been established," the CDC conceded. "Limited laboratory studies under favorable conditions indicate that Ebola virus can remain viable on solid surfaces, with concentrations falling slowly over several days.1,2
"In the only study to assess contamination of the patient care environment during an outbreak, virus was not detected in any of 33 samples collected from sites that were not visibly bloody. However, virus was detected on a blood-stained glove and bloody intravenous insertion site."3
Still, there is no epidemiologic evidence of Ebola virus transmission through the environment, the CDC stated.
Simarly, no transmission has been documented from fomites that could become contaminated during patient care (e.g., bed rails, door knobs, laundry), the CDC added.
"However, given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity, higher levels of precaution are warranted to reduce the potential risk posed by contaminated surfaces in the patient care environment," the CDC advised.
CDC recommendations for environmental infection control include:
- Be sure environmental services staff wear recommended personal protective equipment including, at a minimum, disposable gloves, gown (fluid resistant/ impermeable), eye protection (goggles or face shield), and facemask to protect against direct skin and mucous membrane exposure of cleaning chemicals, contamination, and splashes or spatters during environmental cleaning and disinfection activities.
- Additional barriers (e.g., leg covers, shoe covers) should be used as needed. If reusable heavy-duty gloves are used for cleaning and disinfecting, they should be disinfected and kept in the room or anteroom.
- Be sure staff are instructed in the proper use of personal protective equipment including safe removal to prevent contaminating themselves or others in the process, and that contaminated equipment is disposed of as regulated medical waste.
- Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection.
- To reduce exposure among staff to potentially contaminated textiles and cloth products while laundering, discard all linens, non-fluid-impermeable pillows or mattresses, and textile privacy curtains as a regulated medical waste.
- Sagripanti JL, Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces. Arch Virol 2010; 155:2035-2039
- Sagripanti JL, Lytle DC. Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Arch Virol 2011; 156:489494
- Bausch DG et al. Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites J of Infect Dis 2007; 196:S142S147