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Case Study: Nebraska’s Ebola Isolation and Decontamination Approach

Article describes cost-effective way to ensure safety

The Nebraska Biocontainment Unit (NBU), located at the Nebraska Medical Center in Omaha, has shared its protocol for Ebola patient discharge, for handling a patient’s body after death, and for environmental disinfection. The information was published in the March issue of the American Journal of Infection Control.

Discharge Process for Patient Treated for Ebola Virus Disease (EVD)

Patients are discharged after two consecutive blood samples taken 24 hours apart are confirmed to be undetectable for Ebola virus, the report says. After all surfaces are cleaned and mopped by health care workers, the patient dons a clean, disposable gown and takes a 10-minute chlorhexidine-gluconate (CHG) shower. While the patient is showering, the path he or she walked to the shower is mopped with hospital-grade disinfectant. Then the patient dons another clean, disposable gown with shoe covers and is met by a health care worker in full personal protective equipment (PPE), who escorts the patient to the NBU exit corridor. Here the patient undergoes another 10-minute CHG shower before changing into clean street clothes and leaving the facility.

Body Removal for Patient With EVD

After a patient with EVD dies, the patient is identified by a family member through a video link, and then health care workers place dressings over the body and wrap it in bed sheets. The body is then moved to a double heat-sealed, biosafety level-4 containment bag, and the bag and the bed are disinfected with bleach. Two health care workers in PPE transfer the body into two 18-mil-thick leak-proof, laminated vinyl bags and close, seal, and disinfect the bags. This process is repeated with a second, identical vinyl bag before the body is removed from the hospital to the funeral home, where, after receiving permission from the family, it is cremated.

Environmental Decontamination of Isolation Unit

After discharge, the patient room is cleared of linen and solid waste by personnel in full PPE, and the unit is sealed and left undisturbed for 48 hours while 15 to 19 high-efficiency particulate absorption-filtered air exchanges per hour flow throughout the unit to promote the desiccation of EVD. Health care workers then decontaminate the unit via manual disinfection and ultraviolet germicidal irradiation (UVGI). All floors are mopped twice with hospital-grade disinfectant, and medical equipment is disinfected according to manufacturers’ recommendations. Four UVGI generators are used as a final step after all surfaces have been bleach-wiped, clustering multiple generators around equipment to reduce shadows. After UVGI, the unit is sealed once again for 48-hours to promote further desiccation. After this, the unit is deemed safe for entry without PPE.

“We acknowledge that our cleaning procedures go well beyond what is required to return the patient care area back to a safe environment,” the authors state. “However, given the morbidity and mortality of EVD, and the misinformation regarding the spread of the Ebola virus, our additional cleaning measures represent a cost-effective way to ensure safety and to address public perception.”

 Source: EurekAlert; March 25, 2015.

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