VHF vigilance: One case brings out all the stops

Faced with a possible case of deadly viral hemorrhagic fever (VHF), infection control professionals at Henderson General Hospital in Toronto recently implemented contingency measures recommended by Health Canada. The hospital infection control precautions implemented are summarized as follows:

r Early-stage VHF: The patient should be admitted to a private room. While a room with negative airflow is not necessary at this stage, it may be necessary if the disease progresses; therefore, admitting the patient to a room with negative airflow at this stage may circumvent transfer later. An anteroom, stocked with supplies, with facilities for hand washing, and an area for donning protective equipment are useful.

Gowns and gloves are recommended for all people who enter the room. Fluid-resistant masks and goggles or other eye protection are recommended if there is any possibility of a blood splash, minor or major (e.g., blood splashes and aerolization of blood can occur when starting an IV, emptying a suction container, taking blood for laboratory analysis, or dropping a container containing blood).

Extreme vigilance is required to prevent needle sticks or other sharps injuries. Parenteral exposure has been associated with a high risk of transmission, a short incubation period, and severe disease. Eliminate sharp instruments wherever possible. If feasible, use a needleless intravenous system.

Patient care equipment (e.g., thermometers, blood pressure cuffs, stethoscopes, commodes, etc.) should be dedicated to the patient. Use disposable supplies whenever possible. Soiled linens, clothing, and protective clothing should be deposited in water-soluble plastic laundry bags that are closed in the room where used. The laundry bags should then be inserted into a designated red laundry bag (or a bag of another recognized color). Heavily soiled laundry should be taken directly to the laundry (not placed in laundry chutes or other storage areas). Soiled linen must go directly to the washing machine, with laundry bags placed directly into the water. Laundry workers should wear gowns, gloves, and masks.

Caregivers and visitors should wash their hands with an antiseptic solution (e.g., chlorhexidine 2%, povidone-iodine 10%, and chlorhexidine 0.5% on alcohol) after any patient contact and after leaving the patient’s room.

r Advanced or end-stage: Hemorrhage may be a prime feature of the clinical course with intense viremia as the disease progresses. The likelihood of staff exposure to blood or other body fluids and the opportunities for virus aerosolization increase with the deterioration of the patient’s condition. Fluid-resistant gowns or coveralls, gloves, fluid-resistant masks that filter to .03 µ and fit securely, and face shields are highly recommended. A private room is necessary; negative airflow is also strongly recommended whenever possible.

Laboratory specimens should be disposed of in the routine manner for Level 4 pathogens. All laboratory specimens must be considered infectious and handled in a consistently safe manner from point of collection to disposal. Specimens should be carried by hand to the laboratory for testing. Limit testing to tests critical to the well-being of the patient. All tests must be collected and performed in a way that prevents aerosol generation.

r Disinfection of environment: VHF viruses are lipid-enveloped RNA viruses and, as such, are inactivated by low-level disinfectants. Products in this category include quaternary ammonium-based products, phenolic chlorine-based products, and iodophor formulations. All body secretions, excretions, and fluids should be disinfected or inactivated prior to disposal (i.e., either by a chemical, autoclaving, or sterilizing prior to flushing in municipal sewer systems).

Personal protective equipment, including gloves, fluid-resistant masks with face shields, and fluid-resistant gowns, should be worn for cleaning up a spill of blood or other body fluid. Remove excess blood or other body fluid with disposable towels. Discard the towels into a plastic-lined receptacle. After cleaning all the organic material from the surface, decontaminate the area with sodium hypochlorite (5% household bleach) or a low-level disinfectant. Leave the disinfectant in place for at least 10 minutes before rinsing.

[Editor’s note: The complete Health Canada guidelines are available on the web at http://www.hc-sc.gc.ca/hpb/lcdc/publicat/ccdr/97vol23/continge/ index.html.]