Do Ebola precautions from CDC go far enough?

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 Centers for Disease Control and Prevention 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 West African hospitals and at Emory, have drawn criticism for not going far enough in protecting U.S. healthcare workers.

“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 for Kimberly-Clark Health Care, a Dallas-based supplier of infection prevention products.

Last week, a patient at Kaiser Permanente South Sacramento (Calif.) Medical Center was tested for possible Ebola infection. State health officials announced Thursday that test results were negative.

A 30-year-old female patient at University of New Mexico Hospital in Albuquerque is also being tested for the virus after returning recently from Sierra Leone.

Over the past month, the CDC said it has received 68 calls from hospitals in 29 states regarding possible cases of Ebola. 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. Thomas 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.

The CDC said all healthcare personnel should at least wear gloves, a fluid-resistant gown, eye protection 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 exhibits heavy bleeding, vomiting and diarrhea.

Other recommendations include keeping a patient isolated in a single room with no shared bathroom, using mattresses and pillows covered in plastic, and discarding all linens after use.

When a procedure is performed 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 is standard infection control, rigorously applied,” Frieden said in a Twitter message.

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 an Annals of Internal Medicine article last week, researchers from Harvard and other medical schools argued that the CDC's recommendations were appropriate, saying additional protective measures could interfere with patient care and increase contamination risks by leading to self-contamination during removal of such additional gear.

“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,” they wrote.

Dr. Stephen Parodi, director of hospital operations for Kaiser Permanente Northern California, said the Kaiser facility where one patient was being observed for potential Ebola infection is complying with the CDC recommendations.

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,” she added. “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