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Gary Evans writes Hospital Infection Control & Prevention (HIC), Hospital Employee Health (HEH) and contributes to IRB Advisor (IRB). As senior writer at AHC, Evans has written numerous articles on infectious disease threats to both patients and health care workers, including pandemic influenza, MERS and Ebola. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.
“So many, I had not thought death had undone so many.” T.S. Eliot, The Wasteland
We are approaching the 10,000 death in the longest and largest Ebola outbreak in history, as the epicenter in West Africa smolders on and new sources of transmission alight and spread.
According to the World Health Organization’s last situation report, the steep decline in case incidence in Sierra Leone from December to the end of January has halted, and transmission remains widespread. Case incidence decreased in Guinea in the week up to February 22 compared with the week before, but cases continue to arise from unknown chains of transmission. In Liberia, transmission continues at very low levels, with only one new case reported in the week up to February 22.
As of March 2, 2015 there were 23,913 suspected and confirmed cases and 9,714 deaths in the Ebola outbreak. The Centers for Disease Control and Prevention seems to have achieved the monumental task of putting a firebreak around the three-nation epicenter, though Ebola could still spread to other nations as long as it has viral life in Africa. Looking at nation’s that previously had cases, there are currently no cases of Ebola in Senegal, Nigeria, Spain, the United States, and Mali, the CDC reports. A country is considered to be free of Ebola transmission when 42 days (double the 21-day incubation period of the virus) has elapsed since the last patient in isolation became laboratory negative for Ebola. Some gave all to try to stop the virus, as 490 health care workers have acquired fatal infections in the West African outbreak. Overall, 837 health workers have been infected, with 347 surviving.
In the U.S., public health and occupational health officials hope to capitalize on the awareness raised by the Ebola outbreak to promote better practices during routine health care encounters and better protect both workers and patients. That effort is bolstered by an infusion of $576 million in federal funds for preparedness, with money for state and local health departments to conduct infection control assessments at hospitals, target gaps and improve health care worker training.
Hospitals also now have new guidance to help them select personal protective equipment. While employee health professionals are aware of the differences between face masks, N95 respirators and powered air-purifying respirators, with Ebola they suddenly had to determine if their protective apparel was protective enough. Full protection meant no exposed skin, no penetration of microbes, no gaps in the seams.
“Protective clothing in health care has been underappreciated,” says Maryann D’Alessandro, PhD, director of the National Personal Protective Technology Laboratory (NPPTL) of the National Institute for Occupational Safety and Health (NIOSH). “Since the Ebola response hit, we have been getting many questions.”
Having the right protective apparel and donning and doffing procedures will help hospitals in the ongoing effort to combat health care associated infections, says Anthony Harris, MD, MPH, president of the Society of Healthcare Epidemiology of America (SHEA) and associate hospital epidemiologist at the University of Maryland Medical Center in Baltimore.
“The advantage of Ebola preparedness is that it allows us to prepare for other potential outbreak situations,” he says.
Michele Marill, editor of Hospital Employee Health, contributed to this story. *
For more on the impact of Ebola on health care in the United States see the April issue of Hospital Employee Health.