The Centers for Disease Control and Prevention announced new, revised guidelines for health workers treating Ebola patients on Monday. The new protocol comes in the wake of two nurses treating Thomas Eric Duncan at Presbyterian Hospital Dallas contracting the virus. The changes called for increased training, heightened supervision, and new requirements on the type of protective gear worn by medical staff treating Ebola patients. The CDC described the changes as “tightening previous infection control guidance for health care workers caring for patients with Ebola, to ensure there is no ambiguity.”
Here are the CDC’s new guidelines:
1. Rigorous and repeated training
Focusing only on [personal protective equipment or 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.
2. No skin exposure when [personal protective equipment] is worn
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:
–Boot covers that are waterproof and go to at least mid-calf or leg covers
–Single use fluid resistant or imperable gown that extends to at least mid-calf or coverall without intergraded hood.
–Respirators, including either N95 respirators or powered air purifying respirator(PAPR)
–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 should be used if Ebola patients have vomiting or diarrhea
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:
–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 allows 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
–Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.
3. Trained monitor
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.
“Prior to the three Ebola infections in Dallas, including two health care workers, the CDC did not recommend full body coverage for Ebola, but instead recommended at least gloves, a gown, eye protection and a face mask,” according to Time.