The Centers for Disease Control and Prevention released new guidelines Oct. 20, tightening its previous infection control guidance for healthcare workers caring for patients with Ebola. The guidelines also address concerns about what constitutes proper personal protective equipment for healthcare workers and the correct way to don and doff PPE, among other protocols.
The guidance is centered on the following three principles.
All healthcare workers should undergo rigorous training and be practiced and competent with donning and doffing PPE.
No skin should be exposed when PPE is worn.
A trained monitor should watch each worker put on and remove PPE.
Those three principles were followed at Emory University Hospital in Atlanta, Nebraska Medical Center in Omaha and the NIH Clinical Center in Bethesda, Md., facilities that have cared for patients with Ebola, according to the CDC. No workers at these facilities have contracted the illness.
Focusing only on PPE gives a false sense of security of safe care and worker safety, the CDC stated in the news release. 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.
The CDCs equipment recommendations for PPE remain the same as its previously issued 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, according to the release. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands.
PPE recommendations for U.S. healthcare workers caring for patients with Ebola include the following.
Boot covers that are waterproof and go to at least mid-calf or leg covers
Single-use, fluid resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood
Respirators, including either N95 respirators or powered air purifying respirator
Single-use, full-face shield that is disposable
Surgical hoods to ensure complete coverage of the head and neck
Apron that is waterproof and covers the torso to the level of the mid-calf if Ebola patients have vomiting or diarrhea
The guidance, which describes different options for PPE protocols at facilities based on availability, healthcare personnel familiarity and preference, among others, includes the following.
Two specific, recommended PPE options for facilities to choose from; both options provide equivalent protection if worn, donned and doffed correctly.
Designated areas for putting on and taking off PPE; facilities should ensure that space and lay-out allow 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, and disinfecting gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.
Due to differences in the U.S. healthcare system and West African healthcare settings, MSFs (Medecins San Frontieres/Doctors Without Borders) guidance recommends spraying as a method for PPE disinfection rather than disinfectant wipes, the release said.
Besides addressing PPE guidelines, the news release stated, It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings. These include the prompt screening and triage of potential patients, using designated site managers to ensure proper implementation of precautions, limiting personnel in the isolation room and implementing effective environmental cleaning.
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, according to the release. 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 CDC also addressed the Five Pillars of Safety for infection control and providing safe care to patients with Ebola. They include the following.
Facility leadership has the responsibility to provide resources and support for implementation of effective prevention precautions. Management should maintain a culture of worker safety in which appropriate PPE is available and correctly maintained, and workers are provided with appropriate training.
A designated on-site Ebola site manager is responsible for the oversight of implementing precautions for healthcare personnel and patient safety in the healthcare facility.
There should be clear, standardized procedures where facilities choose one of two options and there should be a backup plan in case supplies are not available.
Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment.
Oversight of practices are critical to ensuring that implementation protocols are done accurately, and any error in putting on or taking off PPE is identified in real-time, corrected and addressed, in case potential exposure occurred.
Read the updated CDC guidelines at http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html