CDC Guidelines for Proper Handling of Ebola

The proper safeguards healthcare providers and facilities should be following when caring for patients with Ebola, and patients suspected of having Ebola, are still evolving. Recently, the CDC revised its guidance for the use of personal protective equipment (PPE) when treating Ebola patients in hospitals. The CDC has also issued guidance for Ebola preparedness in ambulatory care settings, and for emergency medical service (EMS) personnel.

The CDC recommends the following PPE for hospital personnel treating Ebola patients:

1.  Powered Air Purifying Respirator (PAPR) or N95 Respirator.
   
   
2. Single-use (disposable) fluid-resistant or impermeable gown that extends to at least mid-calf or  coverall without integrated hood. Coveralls with or without integrated socks are acceptable.
      
3. Single-use (disposable) nitrile examination gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.
   
   
4. Single-use (disposable), fluid-resistant or impermeable boot covers that extend to at least mid-calf or single-use (disposable) shoe covers. Single-use (disposable) fluid-resistant or impermeable shoe covers are acceptable only if they will be used in combination with a coverall with integrated socks.
   
   
5. Single-use (disposable), fluid-resistant or impermeable apron that covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea. An apron provides additional protection against exposure of the front of the body to body fluids or excrement. If a PAPR will be worn, consider selecting an apron that ties behind the neck to facilitate easier removal during the doffing procedure.

The CDC published additional material explaining these specific recommendations on its website.

More patients are treated in physician offices and other ambulatory care settings than in hospitals. The CDC has issued guidance for ambulatory care settings including walk-in clinics and physician offices. According to the CDC, healthcare personnel in ambulatory care settings should be aware of the signs and symptoms of Ebola and the proper screening of patients for possible exposure to Ebola. The symptoms of Ebola are any of the following: fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal (stomach) pain or unexplained hemorrhage. The CDC’s Ebola screening criteria are:

1. Fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, with additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain or unexplained hemorrhage, AND
   
   
2. Travel to West Africa (Guinea, Liberia, Nigeria, Senegal, Sierra Leone or other countries where Ebola transmission has been reported) within 21 days of symptom onset.

According to the CDC, any patient meeting both criteria should be moved to a private room with a bathroom, and standard, contact, and droplet precautions should be followed during further assessment. Most likely, any physician office or walk-in clinic that encounters a suspected Ebola patient will immediately transfer the patient to a hospital because the patient’s condition is likely to deteriorate, and most ambulatory care settings do not have rooms with bathrooms, or the proper PPE available that hospitals routinely have on-hand. Hospitals should be screening patients for Ebola with the same screening criteria.

The CDC guidance for EMS services and personnel regarding Ebola are as follows:

1.     Public Safety Answering Points (911 operators) should question callers about:

•         Residence in, or travel to, a country where an Ebola outbreak is occurring (Liberia,
          Guinea, Sierra Leone);

•         Signs and symptoms of Ebola (such as fever, vomiting, diarrhea); and

•         Other risk factors, such as direct contact with someone who is sick with Ebola.

The Public Safety Answering Points (911 operators) should advise the EMS personnel of this information before the EMS personnel arrive at the location so they can implement the same PPE guidelines the CDC recommends for hospital personnel. The CDC also recommends that EMS staff immediately check for symptoms and risk factors for Ebola, and notify the receiving healthcare facility in advance when they are transporting a patient with suspected Ebola, so that receiving facility can take the necessary precautions.

Ebola is a health crisis and healthcare providers and facilities need to be prepared to handle the crisis. Unfortunately, the Ebola crisis has been met with hysteria and misinformation similar to the AIDS crisis in the 1980s. When AIDS first emerged there was no information on how it was caused, or how it was transmitted. While there is significantly more information currently available regarding Ebola, the measures that healthcare providers need to implement to handle the crisis are still being established so those healthcare providers need to keep themselves apprised of the most current guidelines.

Michael L. Smith, JD, RRT is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla. This article is for general information only and is not a substitute for formal legal advice.

This article was originally published in: Advance for Respiratory Care and Sleep Medicine.