Special Ebola Prevention Measures for Healthcare Workers

By Edward K. Chapnick

Some healthcare workers in affected areas have been infected in nearly every Ebola outbreak since the first one in 1976. Losing healthcare workers to infection has devastating consequences, including the ability to provide services, closures of medical centers, and distrust in the system.

During an outbreak, healthcare workers take specific preventive measures to protect themselves and others in the affected areas, called standard and other additional precautions. Following these evidence-based guidelines is imperative for the stoppage of an outbreak.

Identify, isolate, inform

For the general public that may come into contact with Ebola patients, remember the simple Centers for Disease Control and Prevention (CDC) procedure of “identify, isolate, inform.” If someone is suspected of Ebola, the healthcare worker should place the patient in a room with the door closed and call the local health department.

Doing so is important because many localities have designated receiving hospitals with prepared isolation facilities and trained staff. When the suspected ill patient is identified, he then can be directly transported to an appropriate facility. If the individual is sent directly to an emergency room, further spread may occur before appropriate isolation has been implemented.

Using personal protective equipment (PPE)

Personal protective equipment (PPE) is all the stuff that healthcare workers put on to protect themselves. When you watch the news, you may have seen the workers covered from head to toe in suits and masks and so on. As the outbreak rages on, health officials (mostly at the World Health Organization [WHO] and CDC) continue to tweak procedures for donning (putting on) and doffing (taking off), amount and type of equipment, and more.

[Credit: CDC Public Health Image Library]
Credit: CDC Public Health Image Library

PPE for Ebola currently consists of the following:

  • Powered air purifying respirator (PAPR) or high-filtration mask (n95 respirator).

  • Fluid-resistant medical mask that doesn’t collapse against the mouth.

  • Coveralls with single-use disposable hoods.

  • Single-use disposable full-face shields (instead of goggles).

  • Single-use disposable nitrile gloves with extended cuffs (two pairs at the same time). The healthcare worker uses heavy-duty rubber gloves for waste management and environmental cleaning.

  • Single-use disposable fluid-resistant boots that extend to mid-calf.

  • Single-use disposable fluid-resistant or impermeable apron that covers torso to mid-calf if vomit or diarrhea are present.

Healthcare workers are to don and doff PPE in a specific order and under observation. In fact, there are 12 steps for donning and between 20 and 30 for doffing! That gives you a sense of just how intense the protocol is — and why, especially in the early days of the outbreak, protocol can unknowingly be breached, leading to exposure.

After the disposable items on that list are used, they’re removed, placed into temporary secure, fluid-proof bags or containers, and then incinerated. In some instances, they’re autoclaved (steam cleaned under high pressure) before they’re incinerated. The ashes are then disposed of according to local regulations.

Follow good hygiene

Hand hygiene is a specific term and is the most effective strategy for preventing the spread of infections, Ebola-affected settings included. Healthcare workers perform hand hygiene with alcohol-based hand sanitizer, soap and water, or, in settings where neither is locally available, a mild (0.05 percent) chlorine solution. Soap and warm water is usually the best option for killing the most germs.

Sanitizer is a good option in an Ebola environment because it kills the virus, is easy to put on, and dries quickly. However, whenever a healthcare worker’s hands become visibly soiled with dirt, blood, or body fluids, he needs to use soap and water because sanitizer doesn’t work as well when hands are dirty.

Clean and maintain work surfaces

Another key precaution that healthcare workers adhere to is regularly and rigorously cleaning the environment (environment refers to the room or ward in which patients with Ebola are cared for), including decontaminating surfaces and equipment. Note: All approved disinfectant cleaning solutions used in healthcare facilities kill Ebola.

Dispose properly of human remains and medical waste

Human remains and medical waste associated with Ebola are highly contagious, so healthcare workers must handle them according to specific and thorough guidelines. For the purposes of this book, I outline some parts of the major points as examples so you can get a sense of just how involved this process is. This little glimpse of a much larger process (and processes within processes) illustrates why getting Ebola under control is so difficult.

And keep in mind, too, that as conditions change, these protocols change. These guidelines are current as of the time of publishing.

Here are the general principles that apply to all healthcare workers in all situations involving remains and medical waste:

  • Only personnel trained in handling infected human remains and wearing PPE should touch or move any Ebola-infected remains.

  • Handling of human remains should be kept to a minimum.

  • Autopsies on patients who die of Ebola should be avoided. If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions.

  • Always take into account religious and cultural concerns.