CDC issues stronger safety standards for healthcare workers handling Ebola

Conceding its previous Ebola safety protocols failed in Dallas, the Centers for Disease Control and Prevention issued more robust standards aimed at better protecting workers who confront Ebola and other deadly infectious diseases.

CDC Director Dr. Thomas Frieden said late Monday that the new guidelines were designed to increase the margins of safety for healthcare workers. He acknowledged that the previous recommendations, which were first issued in 2008 and last updated this past August, did not work in the case of Texas Health Presbyterian Hospital Dallas, where two nurses were infected while treating Ebola patient Thomas Eric Duncan.

The previous guidelines called for healthcare workers to wear a minimum of gloves, a fluid-resistant gown and eye protection. The updated protocols, however, include personal protective equipment that covers the entire body and leaves no skin exposed.

“Dallas shows that taking care of Ebola is hard,” Frieden said. “The way care is given in this country is riskier than in Africa. There's more hands-on nursing care, and there are more high-risk procedures.”

Frieden said the new guidelines were reviewed by healthcare professionals with experience treating for Ebola in the U.S., as well as personnel from the international medical-relief organization Doctors without Borders.

Other PPE-related recommendations include:

• Wearing two sets of gloves
• Wearing boot covers that are waterproof and go to at least mid-calf or cover the legs

• Single-use fluid resistant or impermeable gown that extends to at least mid-calf or coverall without intergraded hood
• Using respirators, including either N95 respirator masks or powered-air purifying respirator (PAPR)
• Single-use, full-face shield that is disposable
• Surgical hoods to ensure complete coverage of the head and neck
• An apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea

Also, new protocols for Ebola care will call for hospitals to name a site manager who will be charged with overseeing all processes and protocols related to that treatment. Healthcare personnel providing care will be required to undergo repeated and rigorous training and show competency in putting on and removing personal protective equipment. The agency recommends a trained monitor actively observe and supervise each worker taking on and off protective equipment.

In addition, Frieden said plans were underway to designate a number of hospitals throughout the country as Ebola care centers where cases would be transferred for treatment. He said a number of facilities have started training personnel to prepare to become a dedicated Ebola care center, but he declined to say how many there would be throughout the country.

On Sunday, National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci called for more training of healthcare workers and said the four hospitals in the country considered to be specially equipped to handle Ebola cases are probably not enough. A CDC official last week stated a plan could call for at least one Ebola-designated hospital in each state.

The new recommendations come on the heels of recent criticism the agency has received regarding its handling of U.S. Ebola cases. Frieden said it is still not known exactly how the two nurses, Nina Pham, 26, and Amber Vinson, 29, got infected. “Any infection is unacceptable,” Frieden said.

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