CDC’s Message to Healthcare Workers: “Think Ebola, Care Carefully”

As the nation follows the progress of Ebola-infected healthcare workers being treated in US hospitals, the US Centers for Disease Control and Prevention (CDC) urges all professionals on the front lines of the Ebola wars to exercise greater caution.  CDC released more stringent new guidance October 20 that highlights additional personal protective equipment (PPE) for caregivers and the critical matter of properly donning and removing personal protective equipment.  CDC notes: “Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.”

Colorized scanning electron micrograph of filamentous Ebola virus particles (green) attached to and budding from a chronically infected VERO E6 cell (blue) (25,000x magnification). PhotoCredit: National Institute of Allergy and Infectious Diseases

Three Principles of the Enhanced Guidance

Ebola Disinfectants

Ebola is an enveloped virus, susceptible to many disinfectants. Non-enveloped viruses are more resistant to disinfection.  As a precautionary measure, EPA-registered hospital disinfectants with label claims for non-enveloped viruses are recommended for Ebola disinfection, along with instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids. Non-enveloped viruses include norovirus, rotavirus, adenovirus and poliovirus.

CDC provides additional online information regarding Ebola virus environmental infection control in hospitals.

The new, tightened guidance focuses on these three areas:

  1. Rigorous and repeated training:  CDC and its partners will increase training in the proper use of equipment, “especially in the step by step putting on and taking off of PPE.”
  2. No skin exposure when PPE is worn:  For example, single-use, disposable, full-face shields are recommended under the new guidance instead of goggles.  The reason:  Goggles may not provide full cover, are not disposable, and healthcare workers may be tempted to manipulate them with contaminated gloved hands.
  3. Trained monitor:  CDC recommends a dedicated, trained monitor  actively observe and supervise workers as they put on and take off PPE.  This is particularly important when removing visibly contaminated PPE.  In that circumstance, CDC recommends disinfecting visibly contaminated PPE with an EPA-registered disinfectant wipe before removing the PPE.  CDC also recommends disinfecting gloved hands with an EPA-registered disinfectant or alcohol-based hand rub between steps of taking off PPE.

The current Ebola outbreak is the largest in history and the first Ebola pandemic the world has ever known (see the CNN interactive global outbreak map).  It is to CDC’s credit that in the spirit of continual improvement it is using current evidence to improve infection control recommendations.  In the meantime, we echo CDC’s message to the brave and committed healthcare workers:  “Think Ebola, Care Carefully.”

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Barbara M. Soule, R.N. MPA, CIC, FSHEA is an Infection Preventionist and a member of the Water Quality & Health Council. 

State and local public health officials:  See CDC’s list of top 10 Ebola response planning tips.