Ebola Q&A for Health Care Workers

EPA’s website provides the list of products registered for use against Ebola: https://www.epa.gov/pesticide-registration/list-l-disinfectants-use-against-ebola-virus, and list of disinfectants for emerging viral pathogens: https://www.epa.gov/pesticide-registration/emerging-viral-pathogen-guidance-and-status-antimicrobial-pesticides.

We are working on some updates to videos and other materials. However, videos and tools from NETEC can be found here: https://repository.netecweb.org/exhibits/show/ebola2021/ebola

Each HHS/ASPR region has a Regional Ebola and other Special Pathogen Treatment Center. Hospitals should work with their local and state health authorities to develop a plan for these transfers. Each region, and most states, have these plans already, but it is a good time to review and update. CDC has a hotline for the Emergency Operations Center that is very helpful. There is also a NETEC hotline that providers and facilities can call during these events to help get information and resources for their healthcare workers and help connect to the RESPTC in their region.

There are six species of ebolavirus, four of which are known to cause disease in humans.

At this time there are not data to indicate differences in transmissibility between Sudan and Zaire ebolaviruses. However, there is ongoing research in this area. For the time being, we suggest assuming similar transmissibility.

There have been no reports of dogs or cats becoming sick with Ebola virus or of being able to spread Ebola to people or other animals. However, it is important to keep people and animals away from blood or body fluids of a person with symptoms of Ebola infection.

NETEC has a number of exercise templates that can be adapted to you facility: https://repository.netecweb.org/exhibits/show/exercisetemplates/exercises. In particular, look at the “Secret Shopper” template: https://repository.netecweb.org/pdfs/specialpathogenmysterydrill.zip.

We hope so! We think there’s a great benefit to being able to go through these things in person and we love seeing the creative solutions people find to common issues! Stay tuned, and consider signing up for our e-newsletter to hear about upcoming events: https://netec.org/newsletter-sign-up/

Once a patient with concern for Ebola or any special pathogen has been identified and isolated, it is important to inform your local infection control and prevention team and consider contacting local or state public health authorities. Broader communications should be coordinated with public health agencies and healthcare system leadership.

Discussion about what tests can safetly be done in your facilicy should be done prior to receiving a patient if possible. Discuss with physicians, nurses, lab leadership and personnel about what is safe and what will not be able to be done based on risk assessment. Some tests may not be able to done safely, so physicians, nurses and lab staff need to know that information if a patient is in-house.

We currently use the Hemochron, however, this will be facility dependent. The CDC has a resource as to what some facilities are using for different tests. Do the risk assessment to determine what will work for your facility. Check out this blog post: https://netec.org/2022/10/11/laboratory-testing-for-ebola/

We are looking into whether there are agencies that would be able to be deployed in this situation. This avenue has not been identified at this time, but discussions are on-going.

Thirty minutes should be sufficient. Here is an article with more info: https://journals.asm.org/doi/full/10.1128/JCM.02960-15

Contact your public health department to discuss your role. Size of your facility and location in relation to a Treatment Center may determine the testing that is requested. See the CDC’s link on testing that is anticipated for a VHF patient in each of the tiers: https://www.cdc.gov/viral-hemorrhagic-fevers/php/laboratories/specimen-collection.html.

The recommendation would be to clean and disinfect the instrumentation after each patient specimen.

The CDC does give recommendations on patient care management, however the ordering guidelines at your facility will be dependent on your care team and their protocols. Discuss with your care team the expectations for patient management in your facility. If blood cultures are expected, discuss with your lab and care team the risks involved in collection and how to safely mitigate those risks.

Testing on certain larger analyzers is possible, however it would be dependent on your facilities risk assessment. Looking at the workflow, any areas that may be aerosol generating, and the ability to decontaminate after a patient sample should all be taken in to consideration.

It is not required, however it is recommended to document every tube (including waste tubes) so that everything is accounted for and does not accidentally get mixed with other laboratory specimens.

The NSPS consists of a tiered System of Care, made up of health care facilities across the country, and is operationalized by the National Emerging Special Pathogens Training and Education Center (NETEC) as its Coordinating Body. The mission of the NSPS is to develop a coordinated network of high-quality special pathogen care dedicated to protecting patients, communities, and the health care workforce in the United States.

Special pathogens pose a grave threat to the nation’s health, economy, and national security. The Ebola virus disease outbreak and COVID-19 pandemic created an urgent need to address gaps and inefficiencies in our existing national infrastructure for special pathogens.

Prioritize equity so 100% of the U.S. population has access to high-quality special pathogen care; create a rapid coordinated response to mobilize the System of Care within two hours; and deliver safe, high-quality care aiming for zero preventable deaths from a special pathogen infection.

The System of Care is designed as a “hub-and-spoke” model where “hubs” (Level 1s) provide supporting services to “spokes” (Level 2-4s) within their regions.

Level 1 or Regional Emerging Special Pathogen Treatment Centers (RESPTCs) serve as care facilities for patients suspected or confirmed to have High-Consequence Infectious Disease (HCID). RESPTCs also provide regional coordination, outreach, and resources.

1. Level 2 or Special Pathogen Treatment Centers (SPTCs) have the capacity to deliver specialized care to clusters of patients suspected of or infected by a special pathogen and serve as primary patient care delivery centers.

1. Level 3 or Assessment Centers are widely accessible care delivery facilities, able to conduct limited basic laboratory testing, stabilize the patient and coordinate rapid patient transfer to a Level 1 or 2 facility to minimize impact to normal facility operations.

Level 4 or All Other Healthcare Facilities can identify, isolate, inform, and initiate stabilizing medical care; protect staff; and arrange timely transport to minimize impact to facility operations.

NETEC was designated by Congress as the Coordinating Body of the NSPS and helps to coordinate and convene System of Care facilities and provides services to facilities such as education, training, technical assistance, and assessment. In addition, NETEC supports response and coordination efforts as requested.

Through a symbiotic relationship, NETEC coordinates—and the System of Care delivers—care. Together, they help prepare for, protect against, and respond to special pathogens.

From the CDC: Airborne transmission of Ebola has not been documented in hospitals or households during any of the human outbreaks investigated to date. However, certain procedures (e.g., bronchoscopy, endotracheal intubation) might create mechanically generated aerosols that could be infectious. Such aerosol-generating procedures require additional precautions. Experience in the care of patients hospitalized with Ebola in the United States indicates that the level of care may change unexpectedly and could require an aerosol-generating procedure. Because there might not be time for staff to leave the room to don proper PPE for an aerosol-generating procedure, CDC recommends that all healthcare workers entering the room of a patient with Ebola wear respiratory protection that would protect them during an aerosol-generating procedure. This would include a NIOSH-certified, fit-tested N-95 or higher respirator, or a PAPR.

There is no certification, but the CDC has guidance for what trained observers should watch for and what PPE they may also need to wear:  https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/guidance/index.html.  You can also reference this NETEC guide.

Our staff shower after patient care but it is for comfort only, after being in PPE for and extended period of time. It was not a decon shower.

We train a cohort of “super users” in the emergency department (e.g., charge nurses) that can assist others who need to doff PPE under these circumstances. This personnel would be trained by our special pathgens team in donning and doffing PPE required for PUIs with Ebola virus disease. This would include super users for all shifts. We also have super users from among the isolation unit care team that are available to assist staff with less frequent training.

There are many surgical shrouds out there that would be suitable. You may wish to ask your surgery folks what they use for joint replacements.

You can find the PPE Matrix for Viral Hemorrhagic Fevers here: https://repository.netecweb.org/items/show/1693

The safest first choice is to close off the space until the diagnosis is confirmed. Facilities are much more likely to have PUIs that rule out than actually have Ebola. Ebola can remain transmissible on surfaces, so primary cleaning should occur in at least the minimum PPE (fluid resistant gown, mask, face shield, and double gloves) and ideally the care team will ensure that waste is in appropriate containers, any spills of body fluids have been cleaned up with an EPA-approved disinfectant, and there are no hidden dangers like sharps or grossly contaminated items before the space is handed off to EVS. Waste should receive a primary packaging in the designated care space in leak proof bags that are securely closed. You may wish to contact your waste transport company now to determine what secondary packaging they require. We have a link to the federal guidelines that go over the requirements.

Yes, EMS providers should follow the identify, isolate, and inform strategy and screen patients suspected of being infected with a special pathogen like Ebolavirus. See the EMS Infectious Disease Playbook for more information: https://repository.netecweb.org/items/show/16

Portable isolation units provide a level of barrier protection preferred by many personnel managing and transporting patients with high consequence infectious diseases. They are an alternative to using barrier drapes and other methods of source control. Personnel planning to use a portable isolation unit should consider operating procedures for patient management and the unit’s cleaning and disinfection, or disposal. If the plan calls for disposal and the patient was infected with a special pathogen, like Ebola virus, it would need to be managed as Category A waste (HMR, 49 C.F.R., Parts 171-180). In addition, in some cases, portable isolation units may not be tolerated well by patients due to the confines of the unit. Patient access is also curtailed potentially interfering with patient management.

Yes, you can find the EMS Infectious Disease Playbook here: https://repository.netecweb.org/exhibits/show/ebola2021/item/16

What would trigger a “positive” travel screen depends on some local contexts. We encourage facilities to discuss with their hospital epidemiologists and infection preventionists the best process and triggers for their facilities. At this time, the Sudan Ebolavirus is contained to specific areas of Uganda, thus CDC is only screening returning travelers that have been to Uganda recently.

The airports are: JFK International Airport in New York, Washington Dulles International Airport, Newark Liberty International Airport, Chicago O’Hare International Airport and Hartsfield-Jackson Atlanta International Airport.

This is up to your local public health authority and municipal water departments. You will also want to involve your own infection prevention and control and maintenance people. The goal is to use appropriate PPE to avoid health care worker skin or clothing contamination.

Using a solidifier can make waste handling safer for staff but the decision on solidifying and packaging human waste should include its impact on your on-site inactivation plan and/or the requirements of your waste vendor.

We recommend using a lid on a toilet to reduce splash risk and contamination of the surrounding space. It is important to work with your internal partners, in facilities operations and your Infection Prevention department, along with your local public health partners to develop protocols for toilet use in confirmed patients. A risk assessment would include splash and potential aerosolization, maintenance of plumbing fixtures within the care space and “downstream” from the high-consequence patient, any effect on municipal sewer either from the pathogen of concern or the type, frequency, and concentration of any disinfectant used. This study has additional information: Lin, K., & Marr, L. C. (2017). “Aerosolization of Ebola virus surrogates in wastewater systems.” Environmental Science & Technology, 51(5), 2669-2675.

Because many body fluids, including sweat, tears, and urine, are infectious, the waste generated in the care of confirmed patients should be handled as contaminated and therefore Category A waste until inactivated or incinerated.

We recommend sequestering packaged waste from a PUI until you have confirmation.