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CDC Issues Guidelines for Evaluation of U.S. Patients Suspected of Having Ebola Virus Disease

Agency recommends steps for hospital safety

The Centers for Disease Control and Prevention (CDC) is working with the World Health Organization (WHO); the ministries of health of Guinea, Liberia, and Sierra Leone; and other international organizations in response to an outbreak of Ebola virus disease (EVD) in West Africa, which was first reported in late March 2014.

As of July 27, according to WHO, a total of 1,323 cases and 729 deaths had been reported in the three affected countries. This is the largest outbreak of EVD ever documented and the first recorded in West Africa.

EVD is characterized by the sudden onset of fever and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache, vomiting, and diarrhea. Patients with severe forms of the disease may develop hemorrhagic symptoms and multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system involvement, leading to shock and death. The fatality rate has varied from 40% to 90%.

Health care providers should be alert for and evaluate suspected patients for Ebola virus infection who have both consistent symptoms and risk factors, as follows: 1) clinical criteria, which include fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms, such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) epidemiologic risk factors within the previous 3 weeks before the onset of symptoms, such as contact with blood or other body fluids of a patient known or suspected to have EVD; residence in — or travel to — an area where EVD transmission is active; or direct handling of bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of initial testing because malaria is a common cause of febrile illness in persons with a history of travel to the affected countries.

According to the CDC, U.S. hospitals can safely manage patients with EVD by following recommended isolation and infection-control procedures, including standard, contact, and droplet precautions. Early recognition and identification of patients with potential EVD is critical. Any U.S. hospital with suspected patients should follow the CDC’s Infection Prevention and Control Recommendations for Hospitalized Patients With Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals. These recommendations include the following:

  • Patient placement: Patients should be placed in a single-patient room (containing a private bathroom) with the door closed.
  • Health care provider protection: Health care providers should wear gloves, gown (fluid resistant or impermeable), shoe covers, eye protection (goggles or face shield), and a face mask. Additional personal protective equipment (PPE) might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.
  • Aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 filtering face-piece respirator or higher), and the procedure should be performed in an airborne isolation room.
  • Environmental infection control: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials are paramount as blood, sweat, emesis, feces, and other body secretions represent potentially infectious materials. Appropriate disinfectants for Ebola virus and other filoviruses include 10% sodium hypochlorite (bleach) solution, or hospital-grade quaternary ammonium or phenolic products. Health care providers performing environmental cleaning and disinfection should wear recommended PPE (described above) and should consider the use of additional barriers (e.g., shoe and leg coverings), if needed. Face protection (face shield or face mask with goggles) should be worn when performing tasks that can generate splashes, such as liquid waste disposal. Health care providers should follow standard procedures, per hospital policy and manufacturers’ instructions, for cleaning and/or disinfection of environmental surfaces, equipment, textiles, laundry, food utensils, and dishware.

Sources: CDC; August 1, 2014; and Infection Recommendations; August 1, 2014.

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