After the death of the nation's first Ebola patient diagnosed in the US and subsequent infection of two Texas nurses who cared for the patient, the protocol was under great scrutiny. Although many teams have investigated the chain of events leading to the 2 nurses' contracting the virus, the specific problem leading to the exposures may never be known. Nurses Announcements Archive
Published
On Monday evening, October 20, the US Centers for Disease Control (CDC) unveiled new PPE recommendations for healthcare workers who will be dealing with Ebola patients. The new guidelines reflect the protocol practiced in Emory University Hospital, Nebraska Medical Center, and the National Institutes of Health Clinical Center. The new guidelines focus on specific personal protective equipment for health care workers and "offers detailed step by step instructions for how to put the equipment on and take it off safely." While the main change is no exposed skin, there are two options for respiratory protection.
At a media telebriefing, CDC Director Tom Frieden said of the initial Ebola recommendations released on August 1, 2014:
"The bottom line is that the recommendations didn't work for that hospital,"
"[T]he new PPE recommendations are designed to increase the margin of safety for frontline health workers and reflect an expert consensus."
The enhanced guidance is centered on three principles:
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.
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:
[*]Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.
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.
It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including:
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.
Both CDC's and MSF's guidance focuses on:
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: