Sunday, October 05, 2014

CDC Updated Guidance: Environmental Infection Control in Hospitals for Ebola Virus



# 9148


The CDC continues to roll out interim guidance documents for dealing with possible introduction of Ebola cases into the United States, and on Friday updated and reworked their previously published Hospital Environmental Infection Control guidance.


As always, these are `works in progress’, and are subject to revision over time as more is learned about dealing with this virus.


While laboratory experiments have shown that the Ebola virus can remain viable on solid surfaces for up to 6 daysat least under ideal environmental conditions -  very limited `real world’  field testing has suggested a far less hardy organism; one that is susceptible to degradation by sunlight, desiccation, and time.


The precise role of environmental transmission of Ebola is far from settled - but given its lethality and low infectious dose - guidance in these matters tends to err on the side of caution. Also included is a Frequently Asked Questions section (FAQ), which poses (and answers) several interesting questions, including:


3. How should spills of blood or other body substances be managed?
4. How should disposable materials (e.g., any single-use PPE, cleaning cloths, wipes, single-use microfiber cloths, linens, food service) and linens, privacy curtains, and other textiles be managed after their use in the patient room?
5. Is it safe for Ebola patients to use the bathroom?


I’ve only reproduced a few excerpts from this guidance, so follow the link to read it, and the accompanying FAQ in its entirety.


Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus


As part of the care of patients who are persons under investigation, or with probable or confirmed Ebola virus infections, hospitals are recommended to:

  • Be sure environmental services staff wear recommended personal protective equipment (PPE) including, at a minimum, disposable gloves, gown (fluid resistant/ impermeable), eye protection (goggles or face shield), and facemask to protect against direct skin and mucous membrane exposure of cleaning chemicals, contamination, and splashes or spatters during environmental cleaning and disinfection activities. Additional barriers (e.g., leg covers, shoe covers) should be used as needed. If reusable heavy-duty gloves are used for cleaning and disinfecting, they should be disinfected and kept in the room or anteroom. Be sure staff are instructed in the proper use of personal protective equipment including safe removal to prevent contaminating themselves or others in the process, and that contaminated equipment is disposed of appropriately. (see question 8).
  • Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.
  • Avoid contamination of reusable porous surfaces that cannot be made single use. Use only a mattress and pillow with plastic or other covering that fluids cannot get through. Do not place patients with suspected or confirmed Ebola virus infection in carpeted rooms and remove all upholstered furniture and decorative curtains from patient rooms before use.
  • To reduce exposure among staff to potentially contaminated textiles (cloth products) while laundering, discard all linens, non-fluid-impermeable pillows or mattresses, and textile privacy curtains into the waste stream and disposed of appropriately.
  • The Ebola virus is a classified as a Category A infectious substance by and regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180). Any item transported offsite for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, and used health care products (such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, used Personal Protection Equipment (gowns, masks, gloves, goggles, face shields, respirators, booties, etc.) or byproducts of cleaning) contaminated or suspected of being contaminated with a Category A infectious substance.6, 7 (see question 8).

(Continue. . .)