Reconciling Ebola planning with Ebola risk in U.S. hospitals

Ebola virus disease is spread through contact with blood, secretions, organs or other bodily fluids of infected people.

In a recent commentary in the Annals of Internal Medicine, Michael Klompas, MD, MPH, and Deborah Yokoe, MD, BWH Division of Infectious Disease, share information about how infection prevention and control teams are struggling to reconcile official guidance from the Centers for Disease Control and Prevention (CDC) with the temptation to maximize precautions that exceed CDC recommendations.

The CDC recommends placing patients with suspected or confirmed Ebola in a single-patient room and instituting contact and droplet precautions. These entail donning a fluid-impermeable gown, gloves, surgical mask, and either goggles or face shield. However, despite this guidance, many hospitals are planning to place all patients in negative-pressure rooms at all times, to compel all personnel to wear full-body hazardous material (HazMat) suits, and to require N95 masks or powered air-purifying respirators rather than surgical masks at all times.

The authors wrote, “Previous investigations affirm the appropriateness of the infection control practices recommended by the CDC. A fluid-impervious gown, gloves, a surgical mask, and a face shield are adequate to protect health care personnel from direct contact with blood or other body fluids during routine care. N95 masks or personal respirators are only necessary during aerosol-generating procedures. Exceeding these recommendations may paradoxically increase risk. Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear.”

In addition, Klompas noted that “exceeding CDC recommendations risks compromising quality of care for patients with and without Ebola. Ironically, the people most likely to be hurt by these recommendations are patients without Ebola since they will be treated as suspect cases until Ebola can be ruled out. In the interim, these patients will likely suffer from less clinician-patient contact, less diagnostic testing, and a great deal of anxiety.”