CDC Updates Ebola Treatment Guidelines Amid Criticism
CDC Director Tom Frieden said the guidelines represent a "consensus" by workers who have already treated Ebola patients in the U.S. (Peralta, "The Two-Way," NPR, 10/20).
Necessity for New Guidelines
The new guidelines come a little more than one week after two Texas Health Presbyterian Hospital nurses contracted the disease after treating the first U.S. Ebola patient, heightening concerns about the U.S. health system's ability to contain the spread of Ebola.
Further, many health care experts took issue with CDC's previous guidelines for hospitals, saying they were too lax. They said the original guidelines did not outline adequate protective gear for health workers. For example, CDC recommended only a minimum of gloves, a fluid-resistant gown and eye protection for workers dealing with Ebola patients (Johnson, Modern Healthcare, 10/20).
Experts also said the CDC guidelines did not include important steps used by Doctors Without Borders and other groups to prevent infections, such as the presence of a "site supervisor" watching for errors.
Sean Kaufman -- who oversaw infection control at Emory University Hospital -- said that that the original CDC guidelines issued to hospitals were "absolutely irresponsible and dead wrong."
Last week, CDC issued preliminary changes to its guidelines to address the concerns (McNeil, New York Times, 10/15).
Frieden said the two infections in Texas showed that the existing protocols were not stringent enough. "We may never know exactly [how two health workers became infected], but the bottom line is [the guidelines] didn't work for that hospital," he said (Fox, NBC News, 10/20). He added, "Even one health care worker infection is too many" (Yan/Fantz, CNN, 10/20).
Details of New Guidelines
According to Frieden, the new guidelines were created with input from medical personnel who have already treated Ebola patients in the U.S. ("The Two-Way," NPR, 10/20). They are based on the strict protocols that Doctors Without Borders has been using for years and were reviewed by that organization.
The new guidelines are voluntary and not mandated by law, according to the New York Times (New York Times, 10/20).
Broadly, the guidelines recommend three main changes to previous guidelines:
- "Repeatedly training" health care workers treating Ebola patients, especially in how to properly dress and undress in protective gear;
- Personal protective equipment that leaves no skin exposed; and
- A "trained observer" or site manager should watch each employee put on and take off their PPE ("The Two-Way," NPR, 10/20).
The specific recommendations for the personal protective equipment include:
- Wearing two pairs of gloves;
- Wearing waterproof boot covers that go to at least the middle of a worker's calf;
- Single-use impermeable or fluid-resistant gowns that go down to at least the middle of the calf and do not include an integrated hood;
- Using respirators;
- A full-face, disposable shield;
- Surgical hoods that provide full coverage of the worker's head and neck; and
- A waterproof apron that should be used if a patient is vomiting or suffering from diarrhea (Modern Healthcare, 10/20).
In addition, workers will be required to wipe down their PPE with a virucidal wipe before they begin undressing and will be required to shower after they take off their equipment ("The Two-Way," NPR, 10/20).
Frieden said, "All patients treated at Emory University Hospital, Nebraska Medical Center and the NIH Clinical Center have followed the three principles, [and] [n]one of the workers at these facilities have contracted the illness" (NBC News, 10/20).
Dedicated Ebola Treatment Centers?
Meanwhile, Frieden said that CDC is planning to designate certain hospitals as Ebola centers where patients would be transferred for treatment. Frieden said various facilities have begun preparations to become an Ebola center, but he did not say how many centers would be designated (Modern Healthcare, 10/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.