Some stories about Ebola say the risks are real, while others say we shouldn’t fear. The Centers for Disease Control and Prevention (CDC) released new guidance for U.S. healthcare workers on personal protective equipment for Ebola. Would that suggest the risks of Ebola are very real?
The CDC is tightening previous infection control guidance for healthcare workers caring for patients with Ebola. The guidance focuses on specific personal protective equipment health care workers should use including step by step instructions how to put the equipment on and take it off safely. According to the CDC, workers who have followed the enhanced guidance have not contracted the illness.
The enhanced guidance from the CDC is centered on three principles:
- All healthcare workers undergo rigorous training and are practiced and competent with PPE, including taking it on and off in a systematic manner.
- No skin exposure when PPE is worn.
- All workers are supervised by a trained monitor who watches each worker taking PPE on and off.
In anticipation of this tightened guidance, we sat down with Timothy J. Sullivan, MD, a physician with several years’ experience in tropical medicine. We asked him some questions about Ebola and guidance from the CDC. In addition, we had a discussion about the upcoming influenza season, as many of the signs and symptoms of influenza and Ebola may be similar.
There have been conflicting reports in the media. Some say the fear of Ebola outweighs the risks. Other reports say the risks of Ebola are very real. In your professional opinion, should healthcare workers be concerned?
So far, Ebola has cost millions and millions of dollars. Healthcare workers ought to be aware of Ebola including the signs and symptoms. It is not unreasonable to require a patient who is coughing or sneezing to put a mask on. In addition, if a patient has a fever or gastrointestinal issues, it is important to take caution. For adequate protection, healthcare workers should wear masks that can protect against droplets, such as a N100 mask.
With concerns about Ebola and with influenza season just around the corner, if a patient or visitor to your practice is coughing or sneezing while waiting to see the physician, what measures should be taken to ensure the safety of other patients?
The likelihood of the patient having Ebola is small. However, if someone is coughing they should be required to have a mask on. This should be a high priority.
Are there specific questions that should be asked to a patient to determine if they may have been exposed to Ebola?
It is not unreasonable to ask these patients if they have traveled to West Africa or if they were potentially exposed to someone with Ebola. If a patient is showing signs and symptoms of Ebola or if the patient states they have been exposed to someone with Ebola, you are obligated to make a phone call to the local health department.
Do you have any additional recommendations for healthcare workers?
The CDC is publishing updated guidelines for healthcare workers. Whoever is taking care of someone with Ebola should have their skin covered. Because Ebola may be spread by respiratory secretions, it is important to have a mask on a patient who is coughing or sneezing. We ought to protect against the droplets. Speaking of droplets, it is important for healthcare workers to be aware that a surgical mask doesn’t protect against droplets. The big gap is not using a mask that can protect against droplets, such as a N100 mask.
Currently, are there any other illnesses that healthcare workers should be concerned about?
Influenza is at the top of the list. Each year over 30 million people are infected with influenza. If a patient has not received a flu shot, they should be encouraged to do so. However, those with a severe allergy to chicken eggs, anyone who has had a severe allergic reaction to the influenza vaccine in the past, and children younger than six months should not be immunized.
According to Vicki Lyons, MD and Timothy J. Sullivan, MD in a publication titled Ignoring the Flu Can Be Deadly, “Flu season is from late November through March. Each year 35 to 50 million people are infected with influenza. Annual deaths from influenza in the United States have ranged from as few as 3,000 to as high as 49,000.”
Some of the suggestions Dr. Lyons and Dr. Sullivan recommend for preventing the spread of germs that cause respiratory illnesses like the flu include:
- Cover your nose and mouth with a tissue when you cough or sneeze, and then discard the tissue in the trash.
- Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
- Avoid touching your eyes, nose or mouth. Germs spread this way.
OSHA Guidance for Healthcare Workers and Healthcare Employers
OSHA has a publication titled “Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers.” One of the sections in the publication is titled “Respiratory Hygiene / Cough Etiquette.” OSHA recommends:
- Posting signs requesting that patients and family members immediately report symptoms of respiratory illness on arrival to the facility and use cough etiquette.
- Posting signs requesting that persons with respiratory illness refrain from visiting the healthcare facility if they are not seeking medical treatment.
- Providing conveniently located masks, tissues, and alcohol-based hand rubs for waiting areas and patient evaluation areas to facilitate source control.
- Providing no-touch receptacles for used tissue disposal.
- Ensuring that supplies for hand washing (i.e., soap, disposable towels) are consistently available where sinks are located.
- Educating healthcare workers, patients, family members, and visitors on the importance of containing respiratory droplets and secretions to help prevent transmission of influenza and other infections.
Healthcare workers should be aware of the signs and symptoms of Ebola. The CDC released updated guidance on specific personal protective equipment health care workers should use including step by step instructions how to put the equipment on and take it off safely. Because Ebola may be spread by respiratory secretions, it is important to have a mask on a patient who is coughing or sneezing. While the risks of Ebola are real, the likelihood of a patient having Ebola is small. When it comes to illnesses healthcare workers should be concerned about, influenza is on top of the list. Some ways to protect patients and healthcare workers include requiring patients who are coughing or sneezing to wear masks while they are visiting your facility and ensuring the supplies for hand washing are consistently available where sinks are located.