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Thanks for posting. Health/life BTTT!

http://blogs.cdc.gov/cdcdirector/2014/10/02/why-u-s-can-stop-ebola-in-its-tracks/

For all healthcare workers…(from the cdc link above)…

112. October 14, 2014 at 2:24 pm ET - Lawrence Herbst

Dear Dr. Freiden,

I recognize that the CDC has no enforcement authority. However its recommendations and guidance obviously carry great weight. As I read the CDC’s recommendations for health care worker precautions in caring for patients with ebola infection, I am concerned regarding the lack of rigor in making specific recommendations for the types of personal protective equipment (PPE) and procedures for doffing and donning PPE. Ebola is a CDC-BMBL Biosafety level-4 agent. CDC should at least be strongly recommending Biosafety-level 3 PPE!

Recommendations posted on the CDC website (most recent dated June 2014) recommend gloves, mask, water resistant gown, face shield. However, given the high infectious titer in fluids (Emesis, urine, fecal, blood) and potential for environmental persistence for days in moist organic matter, as well as low infectious dose, I would hope, that you are upgrading the recommendations and will post them quickly. Meanwhile I respectfully urge the CDC to strengthen its recommendations as follows:

1. All recommendations should be “musts” [statements such as extra precautions might be considered are just useless!]

2. All gloving procedures should be double glove procedures with outer gloves decontaminated (bleach) and removed first and then the last pair removed after all other PPE. Gloves should be taped to the cuffs of the gown.

3. All gowns should be complete coverall types with integrated shoe covers (Tyvek jumpsuits) to cover any clothing that would continue to be worn after leaving the patient’s room!. Why: Because high titer fluids (vomit, blood, urine) splashed onto surfaces (bedrails, floor) may contaminate shoes, pant legs, etc.

4. Masks should be something better than surgeons masks (these are designed to protect the patient from the HCW more than vice versa). N95 at least is designed for wearer protection from droplet exposure (and required for BSL-3 agents!!!- ebola is level 4!!!).

5. All PPE should be sprayed with disinfectant prior to exiting the room. A buddy should be required to assist with donning and doffing PPE. The advantage of a full jumpsuit is that it can easily be rolled inside out (contaminated side inward) as it is removed.

I sincerely hope that the CDC is already making ungraded recommendations based on the unfortunate virus transmissions to nursing staff in Texas and Spain. In my opinion it is not particularly useful to evaluate “accidents” by assuming that an existing SOP would have been 100% effective, if only it had been properly followed. We are wiser to examine this from the perspective that the SOP was followed perfectly and that maybe this virus is not behaving exactly as we expect and then find ways to improve the SOP. Cost of implementing enhanced PPE that is closer in line to BSL-3 / 4 may be more expensive, but those suggested above are not that expensive!

Our understanding of ebola virus transmission is based on only a few decades experience and a small number of self-limiting outbreaks in that time. This outbreak may be different and our PPE recommendations should respect the fact that we do not know everything about this virus and its behavior in human populations.