caring for ebola patients

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MONDAY, Oct. 20, 2014 (HealthDay News) -- U.S. health officials on Monday officially tightened guidelines for health workers treating Ebola patients, now requiring full body suits with no skin exposure and use of a respirator at all times.

The U.S. Centers for Disease Control and Prevention decided to issue the tougher rules after two Dallas nurses contracted Ebola while caring for the first patient diagnosed in the United States, Liberian national Thomas Eric Duncan. Nina Pham is currently being treated for her infection at the Clinical Center at the U.S. National Institutes of Health in Bethesda, Md., while Amber Vinson is being treated at Emory University Hospital in Atlanta.

Those nurses, who are employees at Texas Health Presbyterian Hospital in Dallas, had been following Ebola guidelines that the CDC first issued in 2008 and updated this August, CDC Director Tom Frieden said during a Monday evening news briefing.

"The hospital caring for the first patient, Mr. Duncan, relied on these guidelines. Two health care workers became infected. This is unacceptable," Frieden said. "We may never know exactly how that happened, but the bottom line is the guidelines didn't work for that hospital."

The enhanced guidelines issued Monday, which are intended to create an "increased margin of safety," call for heavy training in the use of protective equipment; suits that cover the entire body; and designated monitors to ensure gear is worn and removed properly.

The CDC now recommends a very specific set of gear to be worn by health care workers treating Ebola patients, which includes:

  • Double gloves,
  • Waterproof boot covers that go to at least mid-calf,
  • Single-use waterproof or water-resistant gowns that extend to mid-calf,
  • Single-use full-face shields that are disposable,
  • Surgical hoods to ensure complete coverage of the head and neck,
  • Waterproof apron that covers the torso down to the mid-calf if the patient is vomiting or experiencing diarrhea,
  • Use of a respirator at all times -- either an N95 respirator or a powered air purifying respirator.

Health care workers must undergo rigorous and repeated training in donning and doffing all this gear, until it becomes "ritualized," Frieden said.

The CDC also now recommends that hospitals have a trained monitor to observe workers as they are putting on and taking off the suits, as well as when they are caring for patients.

Hospitals also need to designate areas for putting on and taking off equipment, with enough space to allow for clear separation between clean and potentially contaminated areas, a CDC fact sheet said.

"While a lot of attention has been paid to the equipment, the greatest risk in Ebola care is in taking off whatever equipment the health care worker has on," Frieden said.

The guidance issued by the CDC represents a consensus from experts in dealing with Ebola, including health care workers at Emory University Hospital in Atlanta, Nebraska Medical Center in Omaha and the NIH. The Atlanta and Omaha hospitals have treated Ebola patients in recent weeks.

Frieden said the stricter guidelines are needed because the experience in Dallas has shown that U.S. health care workers face different challenges than health care professionals working in West Africa, scene of the worst Ebola outbreak in history.

"The way care is given in this country is riskier than in Africa," Frieden said. "There's more hands-on nursing care, and there are more high-risk procedures, such as intubation."

The Ebola outbreak in West Africa has killed nearly 4,500 people out of an estimated 9,000 reported cases, according to the World Health Organization.

SOURCE: Oct. 20, 2013, news conference with Tom Frieden, M.D., director, U.S. Centers for Disease Control and Prevention

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Published: October 2014

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