Discussion and anxiety about Ebola is rampant, particularly with the more recent diagnosis of Nina Pham and Amber Vinson, nurses at Texas Health Presbyterian Hospital who treated the now-deceased Thomas Duncan, the only U.S. Ebola fatality. The current Ebola epidemic in West Africa is the largest in history; alongside the thousands of diagnosed patients have been thousands of healthcare workers helping to care for those infected and prevent the spread of the disease.
To help better protect workers in contact with the virus and therefore prevent increased transfer of Ebola, the Centers for Disease Control and Prevention (CDC) issued new, stricter guidelines on Monday, October 20. The guidelines—which were developed with input from Emory University, Nebraska Medical Center in Omaha, and National Institutes of Health Clinical Center in Bethesda, all locations where Ebola patients have been or are being treated—focus on the personal protective equipment (PPE) that should be used and include step-by-step instructions for putting on PPE and safely removing it. Healthcare workers are at the highest risk of exposure during PPE removal, when the bodily fluids of an infected individual are most likely to come in contact with the skin of the healthcare worker. The new guidelines stress the following three principles:
- Rigorously and repeatedly training healthcare workers in putting on and removing PPE. While PPE keeps workers safe, they must gain confidence in their ability to contain infection through repeated practice. In response to the call for increased training, more than 5,000 healthcare workers gathered in New York City on Tuesday for live training on Ebola treatment from CDC experts.
- Eliminating skin exposure when wearing PPE. In addition to previously recommended equipment, the CDC now recommends the use of coveralls, single-use disposable hoods, and single-use full-face shields instead of non-disposable goggles. Other equipment recommendations include double gloves, boot covers, respirators (while Ebola is not airborne, respirators are a stronger barrier to bodily fluids), and waterproof aprons. To allow for increased flexibility based on varying facility infrastructure, equipment availability, and worker familiarity and comfort with the equipment, the guidelines also provide multiple PPE options to choose from that all meet the necessary standards. To reduce contamination during PPE removal, the guidelines recommend the use of an EPA-registered disinfectant on gloved hands and all visibly contaminated PPE.
- Putting on and removing PPE in the presence of a trained monitor. A second set of eyes is always helpful, particularly when dealing with infectious diseases. This new CDC guideline ensures that workers follow the step-by-step directions for putting on and removing PPE and provides an opportunity for immediate action in the event of a misstep or protocol breach unnoticed by the worker removing his or her equipment.
In addition to these new guidelines, the CDC also released a Fact sheet to help healthcare workers diagnose and respond to potential Ebola cases. One of the key messages is for healthcare workers to “Think Ebola” to facilitate prompt screening, quick isolation if Ebola is suspected, and effective cleaning.
It is critical for healthcare workers to remain cautious and vigilant of Ebola and for the rest of us to support their efforts at the front lines of the epidemic. Because of them and the care they take in treating patients and improving protocols to reduce the spread of infection, we are unlikely to come in contact with Ebola. There are other viruses we should be far more worried about than Ebola. For example, flu season is upon us. In the U.S., flu and pneumonia may kill one person out of every 5,000 each year; in 2003–2004 we saw the highest U.S. flu fatality rate in several decades with more than 48,000 influenza-associated deaths. Instead of worrying about Ebola, I suggest you keep your distance from the sneezing guy on the metro, wash your hands often and thoroughly, and get a flu shot.