Ebola Q&A for Health Care Workers

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.