US Hospitals Capable of Averting Ebola Outbreak, CDC Says

August 07, 2014

US hospitals know how to safely manage patients with the deadly Ebola virus and avoid the kind of outbreak devastating West Africa, the head of the Centers for Disease Control and Prevention (CDC) told lawmakers today.

"We know how to stop Ebola with strict infection control practices, which are already in widespread use in American hospitals, and by stopping Ebola at its source in Africa," said CDC Director Thomas Frieden, MD, MPH, in prepared testimony before a subcommittee of the House Committee on Foreign Affairs. "We are confident that a large Ebola outbreak will not occur."

Emory University Hospital in Atlanta is caring for 2 American missionaries who were stricken by Ebola virus disease in Liberia, 1 of 4 West African nations where more than 900 people have died from the infection.

Dr. Frieden's statement of confidence about US hospitals handling Ebola virus infections doesn't mean that the agency is taking a business-as-usual approach to the current outbreak. The agency has put its Emergency Operations Center on level 1 alert, its highest response level.

As of August 4, 31 CDC disease control experts were deployed in Liberia, Nigeria, Sierra Leone, and Guinea to help find everyone exposed to the virus along with their contacts, educate the public about avoiding infection, and aid healthcare personnel in strictly following infection-control protocols.

Updated Infection-Control Guidance for Ebola

Yesterday, the CDC issued updated infection-control protocols for hospitals where travelers from West Africa may show up at the emergency department with suspected exposure to the virus. The protocols factor in the risk for human-to-human transmission, the lack of an FDA approved vaccine and treatment, and the Ebola virus' high rate of morbidity and mortality. The World Health Organization reports that 54% of the cases in West Africa so far have resulted in death.

Besides recommending that patients with known or suspected Ebola virus infection be assigned a single-bed room, the CDC said hospitals may want to consider posting someone at the patient's door to ensure that all individuals entering the room consistently use the correct personal protective equipment (PPE). They should at least wear gloves, a fluid-resistant or impermeable gown, goggles or face shield, and facemask. Copious amounts of blood and other body fluids, vomit, or feces may require extra PPE such as double gloving and leg coverings.

Clinicians should limit phlebotomy, laboratory tests, and other procedures to the minimum necessary to properly evaluate and treat the patient. If possible, they should avoid aerosol-generating procedures such as sputum induction, intubation and extubation, and open suctioning of airways. If such procedures must be performed, clinicians ideally should conduct them in an airborne infection isolation room and take measures to reduce their exposure to patient aerosols.

Healthcare personnel who develop symptoms of Ebola virus infection, such as fever, intense weakness, vomiting, and signs of hemorrhage, after an unprotected exposure should immediately stop working — or not report to work — and notify their supervisor. Personnel who are asymptomatic after an unprotected exposure may continue working provided they receive fever checks twice a day for 21 days after the last known exposure.

Along with infection control protocols, the CDC yesterday issued guidance on collecting, transporting, submitting, and testing specimens from patients with suspected Ebola virus disease.

False Alarm in New York City

A spokesperson for Emory University Hospital told Medscape Medical News today that she could not disclose the medical condition of Kent Brantly, MD, and Nancy Writebol, the 2 missionaries infected with Ebola virus.

Dr. Brantly's wife Amber issued a statement on August 5 — posted on the Web site of her husband's missionary organization, Samaritan's Purse — saying that his condition was improving. Writebol's son Jeremy said yesterday in a statement posted on the Web site of his mother's missionary organization, SIM, that "Mom is tired from her travel (from Liberia to the United States), but continues to fight the virus."

"We were able to spend a few minutes with her to encourage her," wrote Jeremy Writebol, "and be encouraged by her condition."

A suspected case of Ebola infection in New York City has turned out to be a false alarm. Mount Sinai Hospital announced yesterday that a person it had kept in isolation since August 4 tested negative for the virus. "The patient is in stable condition, is improving, and remains in the care of our physicians and nurses," the hospital stated.

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