table 1. Protecting Healthcare Personnel from Acquisition of Ebola: Defining the Problems and Possible Solutions Issue


Possible Solutions


1. Unrecognized EVD in a patient presenting to a clinic or emergency department


2. Nonvalidated protection from PPE and current doffing method


3. PPE shortages 4. Proper training in PPE donning and doffing


∙ Screening arriving travelers from Ebola epidemic country by the TSA ∙ Active screening of returned travelers by health departments ∙ Signage at all medical facility entrances ∙ Screening at initial triage or clinic sign-in of all patients ∙ Scripting by phone for all patient notifications and appointments ∙ Management plan for how to handle a traveler with epidemiologic risk for Ebola and symptoms


∙ Use of PPE that should prevent any patient body fluid contact with mucous membranes or nonintact skin of HCP ∙ Assess PPE protection and doffing procedure using MS2 ∙ Assess enhanced protection by spraying front of PPE with 1:10 diluted hypochlorite prior to doffing ∙ Assess enhanced protection using a UV-C booth for PPE decontamination ∙ Develop national or regional repositories


5. Maintain PPE proficiency 6. General safety of Ebola care team


∙ Use of PPE monitors during donning and doffing ∙ Three-tiered approach 1. Basic PPE donning and doffing (plus cleaning/disinfection of environmental spills andmanagement of PPE breach) 2. Simulation laboratory training, specialty specific (eg, nursing, physicians) 3. Team training in Ebola care unit


∙ Periodic retraining


∙ Assess health status of prospective Ebola care team members ∙ Exclude from Ebola care team HCP who cannot safely wear PPE, including an N95 respirator ∙ Exclude from the Ebola care team HCP who are trainees, immunocompromised, pregnant, or have nonintact skin ∙ Obtain the temperature of Ebola care team members after they doff PPE following providing care—if hyperthermic, provide treatment


∙ Provide shower facilities for Ebola care team members to use immediately after providing care to a patient with EVD ∙ Develop methods for safe disposal of patient’s liquid and solid wastes (eg, lid on toilet)


7. Prevent HCP fatigue 8. Define high- and low-risk zones in an Ebola care unit 9. Environmental survival of Ebola virus


10. Disinfectant susceptibility 11. Management of PPE breaches


∙ Develop proper unidirectional flow throughout the unit ∙ Develop areas for donning and doffing ∙ Develop an area for point of care lab testing


∙ Short shifts ∙ Buddy system ∙ Enforced rest periods ∙ Provide adequate numbers of Ebola care team to prevent fatigue


∙ Assess environmental survival on variety of hospital surfaces ∙ Routinely disinfect the environment surrounding a patient with EVD ∙ Provide terminal disinfection of a room housing an EVD patient with vaporized hydrogen peroxide ∙ Disinfect or safely discard all possibly contaminated medical devices or equipment


∙ Assess susceptibility to standard hospital disinfectants ∙ Until such testing is published, use a disinfectant with a disinfectant claim against nonenveloped viruses or spores


∙ Develop and training HCP in management of breaches including contamination of intact skin, non-intact skin, mucous membranes, and percutaneous injury


∙ In the case of high-risk exposure, provide experimental vaccine, and/or convalescent serum NOTE. TSA, Transportation Security Administration; ED, emergency department; EVD, Ebola vial disease; HCP, healthcare personnel; PPE, personal protective equipment.


1230 infection control & hospital epidemiology october 2015, vol. 36, no. 10


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