COMMENTARY

Ebola: Environmental Infection Control Guidance

Thoughts From CDC Director Tom Frieden, MD, MPH

Tom Frieden, MD, MPH

Disclosures

September 16, 2014

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Editor's Note: This post originally appeared at the Centers for Disease Control and Prevention's CDC Director Blog.

Ebola and Risks to the Healthcare Team

The Ebola outbreak in West Africa is an international public health emergency. As the world responds, there is a risk that American responders working on the ground may be exposed to the virus or become ill. This summer, two American healthcare workers infected with Ebola while working in West Africa were successfully treated at Emory University Hospital. Their healthcare team used the proper infection control practices and there was no transmission of the virus to the healthcare team or others in the hospital and community.

Tom Frieden, MD, MPH, Director, US Centers for Disease Control and Prevention, Atlanta, Georgia

Now two more American healthcare workers working in West Africa have become infected with Ebola virus and are being treated in the United States.

CDC has already consulted with state and local health departments on almost 100 cases where travelers had recently returned from West Africa and showed symptoms that might have been caused by Ebola. Of those cases, only 11 were considered to be truly at risk. Specimens from all 11 patients were tested and fortunately Ebola was ruled out in all cases.

There is understandably a lot of fear surrounding Ebola. The healthcare workers who might need to care for Ebola patients are right to be concerned, and they should use that concern to increase their awareness and motivation to practice the meticulous infection control measures we know will prevent transmission of the virus.

Hospitals and healthcare facilities must review their infection control practices, including how they're handling environmental infection control.

Infection Prevention and Control Recommendations

When we issued our infection prevention and control recommendations for hospitalized patients with known or suspected Ebola virus disease (Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals), we began hearing from those concerned that standard environmental infection control procedures might not be sufficient.

Part of the concern is that no EPA-registered disinfectant has a labeling claim specifying that it is effective against the Ebola virus. You cannot go to the shelf and find a product that says it will be effective in killing Ebola. However, because Ebola is readily killed by soap and water, bleach, or hospital disinfectants that are labeled as being effective against nonenveloped viruses, standard infection control procedures are indeed sufficient.

There has been no evidence of Ebola virus transmission from either the environment or from surfaces such as bed rails, door knobs, and laundry that could be contaminated during patient care. The Ebola virus is a fragile virus; once the envelope of the virus is destroyed, it cannot survive long-term in the environment. This is unlike nonenveloped viruses such as norovirus, rotavirus, and adenovirus, which do survive and transmit from person to person off environmental surfaces.

Early recognition of patients is critical for implementing infection control measures that will ensure that other patients and staff are protected. Diligent environmental cleaning and disinfection, as well as safe handling of potentially contaminated materials, are of paramount importance.

CDC has now issued further specific guidance and answers to frequently asked questions (Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus) on environmental infection control procedures where there is a confirmed case of Ebola virus disease, such as how to handle disposable materials and patient waste.

Review these guidelines with your staff. Any US hospital that is following CDC's infection control recommendations, and can isolate a patient in a private room,‎ is capable of safely managing a patient with Ebola virus disease. Whether for Ebola or any other infectious disease, it is essential to be prepared.

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