Updated CDC guidelines are good, but need improvement

In the wake of criticism from nurses and other healthcare workers over the absence of clear guidelines for protecting hospital personnel treating patients infected with Ebola, the Centers for Disease Control and Prevention issued updated recommendations on the proper use of personal protective equipment (PPE). The 17-page document outlines administrative, environmental, and management efforts needed to prevent hospital personnel from contracting the virus and to ensure their safety.

The CDC guidelines came weeks after two Dallas nurses were infected with Ebola while caring for a man who had recently traveled from Liberia. The West African countries of Liberia, Sierra Leone and Guinea are currently suffering the largest Ebola epidemic in history. The guidelines were updated on Oct. 20 to include the following substantive changes: the use of respirators (N95s) during screening and routine Ebola patient care, double gloving with gloves taped to sleeves to completely cover skin on arms, and using a “buddy” system to monitor PPE process.

What’s missing?

Nurses and other health professionals are quick to note that the guidelines are just that—voluntary guidelines. The CDC does not have the authority to enforce them in every hospital. Only local and state health departments can make these guidelines mandatory. In the absence of any other enforcement mechanism, the OSHA Bloodborne Pathogens Standard provides some protection.

Despite early promises, the CDC cannot send a team to every location where Ebola is suspected, given that hundreds of suspected cases have been reported since the traveler and nurses in Dallas contracted the disease. But if a case is confirmed, the CDC will send a team of medical personnel to help out and ensure compliance with the guidelines. Equally important, these extensive protection guidelines require both more time and staff to ensure no breaks in protocol. No staff caring for suspected cases should move beyond the screening and isolation areas to care for other patients. And, the layers of protective clothing result in an accumulation of heat and physical stress that limit the time the nurse is able to care for patients. U.S. hospitals with sophisticated cooling capacity allow nurses to spend 60 minutes in PPE; nurses in field hospitals are generally limited to 45 minutes in full protective gear.

The AFT will press the CDC to improve this new guidance as follows:

  • Recommendations for the amount of training and practice time required for staff to become proficient in donning and doffing PPE;
  • Recommendations that direct hospitals on whether clinicians caring for an Ebola patient should be restricted in caring for other patients;
  • Recommendations for nonhospital settings such as ambulatory care centers or offices, home health care and public health clinics;
  • Recommendations on follow-up of clinicians who have had exposure to an Ebola patient’s blood or body fluid;
  • Guidance that encourages hospitals to provide administrative pay (wages and benefits) to healthcare workers who are quarantined or put under precautionary isolation; and
  • Guidance on providing emotional and social support to exposed nurses/clinicians and assistance in returning to work when they are released from quarantine.

“The AFT is working to keep our communities safe and healthy,” says AFT President Randi Weingarten. “That is why we are calling on the CDC to issue additional Ebola guidance for non-hospital healthcare settings and expanded guidance to guarantee wages and benefits for quarantined healthcare workers. And we renew our call for hospitals to incorporate the voices of nurses and healthcare workers in the development and implementation of Ebola protocols.”

Healthwire, Winter 2014
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