Ebola: Excessive Precautions in US Hospitals May Be Harmful

Larry Hand

August 22, 2014

As hospitals in the United States rush to devise plans to manage patients with suspected or confirmed Ebola virus, many are unnecessarily going beyond the Centers for Disease Control and Prevention (CDC) guidelines, according to a commentary published online August 21 in the Annals of Internal Medicine.

Doing so, paradoxically, may increase risk for virus transmission and "[fan] a culture of mistrust and cynicism about our nation's public health agency," write Michael Klompas, MD, MPH, from the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, Massachusetts, and colleagues.

They note that hospitals are specifying measures to prevent transmission within healthcare centers and to protect healthcare workers."However, infection prevention and control teams are struggling to reconcile official guidance from the [CDC] with the temptation to maximize precautions that exceed CDC recommendations."

The CDC recommends placing suspected or confirmed Ebola patients in single-patient rooms and starting contact and droplet precautions. Those include donning:

  • a fluid-impermeable gown,

  • gloves,

  • a surgical mask, and

  • either goggles or a face shield.

The CDC also recommends:

  • shoe and leg coverings if a patient has "copious" secretions;

  • if an aerosol-generating procedure is done, wearing an N95 mask, which filters at least 95% of airborne particles; and

  • placing the patient in a negative-pressure room.

"Despite this guidance, many hospitals are planning to place all patients in negative-pressure rooms at all times, to compel all personnel to wear full-body hazardous material (HazMat) suits, and to require N95 masks or powered air-purifying respirators rather than surgical masks at all times," Dr. Klompas and colleagues write.

The CDC guidance is evidence-based, gleaned from experience gained during more than 20 Ebola outbreaks during the last 40 years, they emphasize.

Ebola transmission from person to person is inefficient and requires direct physical contact with an infected person's bodily fluids, especially blood, they continue.

In addition to increasing patients' and caregivers' anxiety and fear levels and raising healthcare costs, "Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear," Dr. Klompas and colleagues write. "Requiring HazMat suits and respirators will probably decrease the frequency of provider–patient contacts, inhibit providers' ability to examine patients, and curtail the use of diagnostic tests. Patients without Ebola may also inadvertently be harmed because Ebola precautions will be required for all suspected cases even though malaria and other infections are more likely in patients from West Africa presenting with fever."

They conclude, "As health care professionals, we strive to provide evidence-based care driven by science rather than by the media or mass hysteria. We need to apply these principles to planning for Ebola as well."

"Important Considerations"

"The authors have laid out some important considerations for US hospitals in this article," David T. Kuhar, MD, from the CDC's National Center for Emerging and Zoonotic Infectious Diseases, told Medscape Medical News. "This piece could serve as a good resource for hospitals as they continue to develop their preparedness plans."

Dr. Kuhar provided an expert commentary for Medscape on this topic, published earlier this month.

One coauthor has reported that he is the chairman of the Healthcare Infection Control Practices Advisory Committee to the CDC and chairman of the board of trustees of the Society for Healthcare Epidemiology of America Education and Research Foundation; another coauthor reports currently serving as president of the Society for Healthcare Epidemiology of America and as a member of the Healthcare Infection Control Practices Advisory Committee. The other authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online August 21, 2014. Full text

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