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Do the CDC’s Ebola precautions for U.S. hospitals go far enough?

By Steven Ross Johnson
Posted: August 21, 2014 - 7:30 pm ET

U.S. hospitals have gone on alert since two American healthcare workers were brought to Emory University Hospital in Atlanta this month after being infected with the Ebola virus while treating Ebola patients in West Africa.

The head of the Centers for Disease Control and Prevention has said it's likely that an Ebola-infected traveler from West Africa will turn up in a U.S. emergency department, and the CDC has issued guidelines for hospitals on identifying and treating Ebola patients. But those recommendations, which do not include the head-to-toe “moon suits” used in field hospitals in West Africa and at Emory, have drawn widespread criticism for not going far enough in protecting U.S. healthcare workers from infection.

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“There is a lot of angst and consternation among healthcare workers when they look at full-body suits and full facial protection, leggings and everything else they see in Africa and they wonder, 'Why are we not having the same recommendations for the same level of protection for ourselves?' ” said Wava Truscott, director of medical services and clinical education for Kimberly-Clark Health Care, a Dallas-based supplier of infection prevention products.

This week, a patient at Kaiser Permanente South Sacramento Medical Center was being tested for possible Ebola infection. A 30-year-old female patient at University of New Mexico Hospital in Albuquerque also was being tested for the virus after returning recently from Sierra Leone.

Over the past month, the CDC said it has received 68 calls regarding possible cases of Ebola, with calls coming from hospitals in 29 states. Of those 68 cases, 59 were deemed to be false alarms. The agency conducted tests in the other nine cases, with seven testing negative and results pending for the remaining two.

CDC Director Dr. Tom Frieden told a House panel Aug. 7 that it's very unlikely an outbreak of the virus will occur in the U.S. but that hospitals could see isolated cases of returning travelers who exhibit symptoms associated with the disease.

“We are all connected, and inevitably there will be travelers—American citizens and others—who go from these three countries, or from Lagos if it doesn't get it under control, and are here with symptoms,” Frieden said. “And those symptoms might be Ebola or something else, so we're having to deal with Ebola in the U.S. in a way that we've never had to deal with it before.”

The CDC said all healthcare personnel should at least wear gloves, a fluid-resistant gown, eye protection such as goggles or a face shield, and a face mask. Additional protection, including two sets of gloves, disposable shoe covers and leggings, also might be needed in certain situations, such as when a patient enters the latter stages of the disease when excessive bleeding, vomiting and loss of body fluids is known to occur. Environmental recommendations include keeping a patient isolated in a single room with no shared bathroom, using mattresses and pillows that are covered in plastic, and discarding all linens to reduce the risk of staff being exposed during laundering.

In addition, the CDC said that when a procedure is performed on Ebola patients that could release contaminated droplets into the air, such as insertion of a breathing tube, use of an air-purifying respirator is recommended.

“What's needed to fight Ebola is not fancy equipment,” Frieden said in a message posted during a Twitter chat. “What's needed is standard infection control, rigorously applied.”

The American Hospital Association endorsed the CDC guidelines. “We urge our hospital members to pay attention to and follow CDC's guidance for this and all infectious diseases,” said Akin Demehin, AHA senior associate director of policy. “In its own guidance, CDC states that hospitals can use additional protective gear if the situation, such as one where the patient is producing a large amount of body fluids, warrants extra protection.”

Researchers from Harvard Medical School, University of Iowa Carver College of Medicine and University of Pennsylvania Health Systems wrote Thursday in the Annals of Internal Medicine that the CDC's recommendations were appropriate. They argued that additional protective measures could increase contamination risks. “Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear,” the authors wrote. “Requiring hazmat suits and respirators will probably decrease the frequency of provider-patient contacts, inhibit providers' ability to examine patients and curtail the use of diagnostic tests.”

Dr. Stephen Parodi, director of hospital operations for Kaiser Permanente Northern California, said the Kaiser facility where one patient is being observed for potential Ebola infection is complying with the CDC recommendations. Dr. Gil Chavez, deputy director of the Center for Infectious Diseases at the California Department of Public Health, said that the patient represented a low risk for having the Ebola virus and that test results are expected over the next few days.

A spokesman at University of New Mexico Hospital, where the second patient is being tested, said only that the facility is following CDC guidelines.

Some hospital officials elsewhere have said they intend to outfit their workers in full-body protective gear. Wearing gloves, a gown, eye protection and a face mask is “not going to be enough for my healthcare workers to feel comfortable going into an isolation room,” Peggy Thompson, director of infection prevention at Tampa General Hospital, told the New York Times. “We don't always know when a patient is going to vomit. You get into that situation quickly, so you better go in to the room prepared for that exposure.”

Follow Steven Ross Johnson on Twitter: @MHsjohnson

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