CDC Updates Ebola Guidelines After Criticism Increases hospital worker protection, mandates monitoring of certain travelers

By Roy Maurer Oct 23, 2014
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The Centers for Disease Control and Prevention (CDC) announced updated protocols for the protection of hospital workers caring for patients infected with Ebola.

The new guidelines, released Oct. 20, 2014, follow revisions put in place just last week and come after the agency was roundly criticized when two nurses at Texas Health Presbyterian Hospital in Dallas were infected with Ebola after treating a man who died of the disease.

Hospital officials and nurses said they had followed inadequate CDC protocols that left skin exposed.

The revamped measures are based on “the very strict protocols used for years by Doctors Without Borders” a French humanitarian organization, said CDC Executive Director Dr. Thomas Frieden, during a press conference.

Frieden said the two infections in Texas showed that the existing protocols were not adequate. “We may never know exactly [how two health workers became infected], but the bottom line is [the guidelines] didn’t work for that hospital,” he said.

The new guidelines are based on the following three principles:

  • All health care workers involved with Ebola patients must have received repeated training and have demonstrated competency in performing all Ebola-related infection-control procedures, specifically donning/doffing proper personal protective equipment (PPE).
  • No skin should be exposed while working in PPE and caring for Ebola patients.
  • The overall safe care of Ebola patients must be overseen by an onsite manager at all times, and each step of every PPE donning/doffing procedure must be supervised by a trained observer.

The specific recommendations for the personal protective equipment are:

  • Wearing two pairs of gloves.
  • Wearing waterproof boot covers that go to at least the middle of a worker’s calf.
  • Single-use impermeable or fluid-resistant gowns that go down to at least the middle of the calf and do not include an integrated hood.
  • Using respirators.
  • A full-face, disposable shield.
  • Surgical hoods that provide full coverage of the worker’s head and neck.
  • A waterproof apron that should be used if a patient is vomiting or suffering from diarrhea.

“All patients treated at Emory University Hospital, Nebraska Medical Center and the NIH Clinical Center have followed the three principles, and none of the workers at these facilities have contracted the illness,” said Frieden.

Not Enforceable

The guidelines have been welcomed, but characterized as insufficient by labor leader Richard Trumka, president of the AFL-CIO. “Existing protocols, standards and guidelines, and adherence to them, are deficient,” Trumka wrote in an Oct. 21, 2014, letter to President Barack Obama.

Following CDC recommendations is voluntary and not enforceable by law. “We find that the hospital generally follows CDC guidelines … but the CDC is not a regulatory agency,” Frieden said.

Trumka advised the White House to use executive action to impose comprehensive infectious disease standards for health care workers, including specific rules ordering the use of air purifying respirators and full-body suits and requiring extensive training.

He said treatment guidelines should be a part of mandatory Occupational Safety and Health Administration (OSHA) standards. OSHA is currently in the early stages of proposing an infectious diseases standard.

Travelers from West Africa to Be ‘Closely Watched’

Frieden announced Oct. 22, 2014, that all travelers arriving in the United States from Ebola-stricken countries—–Guinea, Liberia and Sierra Leone—will be closely watched by public health officials.

Travelers from these countries will be required to report their temperature and any potential symptoms and also face new rules about where they can travel within the United States.

“These new measures I’m announcing today will give additional levels of safety so that people who develop symptoms of Ebola are isolated quickly,” Frieden said during a press briefing.

These travelers are now arriving to the U.S. at one of five airports (New York’s JFK; Newark, N.J.; Washington, D.C.’s Dulles; Atlanta; and Chicago’s O’Hare) where entry screening is being conducted by Customs and Border Protection and CDC.

Post-arrival monitoring begins Oct. 27, 2014 for all travelers from the impacted countries--even those without Ebola symptoms--who will be contacted daily by state and local health departments for 21 days from the date of their departure from West Africa. Twenty-one days is the longest time it can take from the time a person is infected with Ebola until that person shows symptoms, according to the CDC.

Specifically, state and local authorities will require travelers to report the following information daily:

  • Their temperature and if they have other Ebola symptoms such as headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, or abnormal bleeding.
  • Their intent to travel further.

If a traveler does not report in, state or local public health officials will take immediate steps to locate the individual to ensure that active monitoring continues on a daily basis.

“Post arrival monitoring is an added safeguard that complements the existing exit-screening protocols, which require all outbound passengers from the affected West African countries to be screened for fever, Ebola symptoms, and contact with Ebola and enhanced screening protocols at the five U.S. airports that will now receive all travelers from the affected countries,” the CDC said.

Roy Maurer is an online editor/manager for SHRM.

Follow him @SHRMRoy

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