The Centers for Disease Control and Prevention (CDC) Monday revised its recommendations to help clinicians evaluate and manage patients with possible Ebola who arrive in hospital emergency rooms (ERs) for treatment.
The new guidelines reflect the lessons learned from the recent experiences of U.S. hospitals caring for Ebola patients, according to the CDC.
The risk of an Ebola patient with early, limited symptoms transmitting the deadly virus to a healthcare worker in the ER is lower than a patient hospitalized with more severe symptoms. However, emergency departments (EDs) must know how to assess patients for the possibility they have the illness and follow best practices, including proper use of personal protective equipment (PPE).
The guidelines call on ED workers to take the following steps when treating a patient who exhibits symptoms of the deadly virus:
Take the patient's exposure history to determine whether the patient lived or traveled in a country with widespread Ebola transmission or had contact with a patient with confirmed Ebola in the previous 21 days.
If the patient meets the exposure criteria, determine if they have signs or symptoms, including a fever greater than 100.4 degrees, headache, weakness, muscle pain, vomiting, diarrhea, abdominal pain or hemorrhage.
If the patient with a relevant exposure history has the signs and symptoms, the ED must isolate the patient in a private room or separate enclosed area with private bathroom or covered, bedside commode and adhere to procedures and precautions designed to prevent transmission by direct or indirect contact (e.g. dedicated equipment, hand hygiene, and restricted patient movement).
If the patient arrives by ambulance, ED workers should meet the patient in a designated area away from other patients and have a process in place for safely transporting the patient on the stretcher to the isolation area with minimal contact with non-essential healthcare workers or the public.
To minimize transmission risk, only essential healthcare workers with designated roles should provide patient care. Maintain a log of all personnel who enter the patient's room. All healthcare workers who have contact with the patient should put on appropriate PPE based on the patient's clinical status.
Healthcare workers should follow the PPE recommendations if patients require invasive or aerosol-generating procedures, such as intubation, suctioning or active resuscitation) and use equipment dedicated to the patient in a pre-designated area.
At minimum, healthcare workers should wear a face shield, surgical face mask, impermeable gown and two pairs of gloves. Do not use the same equipment used to care for these patients on others until appropriate evaluation and decontamination.
Notify the hospital's infection control staff and report the case to local health departments.
In addition to the ED guidelines, the CDC also released interim guidelines for travelers exposed to Ebola in response to several states demanding that the travelers be placed in mandatory isolation upon their return from West Africa. The new guidelines recommend that people at high risk of developing Ebola voluntarily isolate themselves from others for 21 days.
White House officials said mandatory quarantines might deter volunteers from offering assistance in communities where the Ebola virus is widespread or may result in the volunteers concealing their exposure.
"We are concerned about policies that we've seen in various places that might have the effect of increasing stigma or creating false impressions," CDC Director Thomas Frieden, M.D., said Monday during a press conference to announce the new guidelines.
"You don't get Ebola from someone unless they're sick and you have direct contact with them or their body fluids," he said. "It's not nearly as contagious as the flu, the common cold, measles, or many other infectious diseases and we have to tailor our approach to the science of Ebola."