The federal government on Monday tightened its infection control regulations for health care workers who care for Ebola patients.
The Centers for Disease Control and Prevention will now require that medical personnel train, practice and show competency in the donning and removal of personal protective equipment before they’re allowed to treat Ebola patients.
The new rules also require that a trained supervisor monitor workers to make sure they’re safely putting on and removing the equipment and that no skin be exposed when protective gear is worn in the presence of Ebola patients.
Before visibly contaminated protective gear is removed, the CDC is now recommending that the garments, including gloves, be wiped with a disinfectant. CDC Director Tom Frieden said some facilities might require staff to undergo a disinfecting shower when they remove their protective equipment.
The CDC is also recommending that facilities provide separate rooms or areas for staff to put on protective equipment and another where they can remove it.
The new protocols come after two nurses at Texas Health Presbyterian Hospital Dallas, 26-year-old Nina Pham and 29-year-old Amber Vinson, contracted Ebola after treating a Liberian man who died of the disease.
Both nurses were wearing protective gear in accordance with previous CDC guidelines. The equipment left parts of one nurse’s wrists and neck areas exposed.
The new regulations replace those previous guidelines, which were issued in 2008 and updated in August of this year. Frieden said “we may never know exactly why” Pham and Vinson became infected, but he said the old CDC guidelines “didn’t work for that hospital.”
To ensure the safe care of Ebola patients nationwide, Frieden said the CDC is calling for local areas to designate specialized “centers of risk” that will agree to care for Ebola patients. Frieden said many hospitals have already stated their willingness to do so.
The new guidelines were based on infection control procedures adopted by the humanitarian organization Doctors Without Borders, which is treating patients in Ebola-stricken nations in West Africa.
Guidelines in place at the University of Nebraska Medical Center, the National Institutes of Health Clinical Center in Maryland and Emory University Hospital in Atlanta, where Vinson is being treated, also helped inform the new rules.
Each of those facilities has cared for Ebola patients and none of their workers has become infected.
The new CDC recommendations requires healthcare workers treating Ebola patients to wear double gloves, waterproof boot covers that extend at least to the mid-calf, and single-use, fluid-resistant or impermeable gowns that extend to at least the mid-calf.
In addition, the CDC is recommending that medical staff wear either an N-95 respirator or a positive air pressure respirator when treating Ebola patients, but not goggles.
Frieden said goggles don’t provide full skin coverage and could fog up after extended use, tempting staffers to adjust them with a contaminated gloved hand.
The respirator should be with a disposable, single-use, full-face shield and surgical hoods that completely cover the head and neck, under the new guidelines.
A waterproof apron that covers the torso to the mid-calf should also be used if a patient is vomiting or has diarrhea.
The Occupational Health and Safety Administration would enforce the new regulations along with state health officials, Frieden said.
Frieden also appeared to soften his stance against suspending the issuance of travel visas to non-citizens from West Africa, saying he would have “absolutely no objection” to the move as long as it doesn’t undermine current efforts to screen people leaving West Africa and to track and screen West Africans who fly to America.
If the Ebola outbreak were to spread to other countries in Africa, Frieden indicated that suspending visas to West Africans might be in order, calling that a “very different” and “much more challenging” situation.
Frieden said he was delighted that President Barack Obama had appointed a new Ebola Czar, Ron Klain, calling the move a “terrific development.” Klain is expected to visit the CDC next week and Frieden said he looks forward to working with Klain.