Ebola PPE: New Guidance From CDC

Bryan Christensen, PhD, MEPC


November 11, 2015

Editorial Collaboration

Medscape &

The 2014 Ebola outbreak underlines the pivotal role that healthcare settings can play in either containing or amplifying an infectious disease threat in a community. Because infection prevention and control practices must be implemented properly for every patient, every day, effective training and staff competency of the recommended protocols are essential.

While personal protective equipment (PPE) is just one component of infection control protocol, it is vital to ensure that staff can use it properly while caring for patients. Centers for Disease Control and Prevention (CDC) provides guidance on the use of PPE, including the proper steps for putting it on and taking it off (donning and doffing). In August 2015, CDC clarified its PPE guidance for healthcare personnel caring for suspected and confirmed Ebola patients in US healthcare facilities.

The clarification focuses on the use of impermeable and fluid-resistant gowns and coveralls because the terms "fluid-resistant" and "impermeable" have been a source of confusion for healthcare professionals. The reason for the confusion is that gowns and coveralls are not always labeled with these specific terms and can be resistant to fluids at different levels depending on the design and type of material used.

The guidance posted in August 2015 states that impermeable gowns and coveralls are recommended when caring for patients with confirmed Ebola virus disease or persons under investigation (PUIs) who are clinically unstable or have bleeding, vomiting, or diarrhea. Fluid-resistant gowns or coveralls are recommended for PUIs who are stable and do not exhibit symptoms mentioned above.

In addition to clarifying the specifications of gowns and coveralls recommended, the PPE guidance for confirmed Ebola patients is being updated with additional explanation, including:

  • Expanding the rationale for why respiratory protection is recommended when caring for an Ebola patient;

  • Clarifying that the trained observer should not serve as an assistant for taking off (doffing) PPE;

  • Suggesting that a designated doffing assistant or "buddy" might be helpful, especially in doffing the powered air purifying respirator (PAPR) option;

  • Modifying the PAPR doffing procedure to make the steps more clear;

  • Changing the order of boot cover removal. Boot covers are now removed after the gown or coverall; and

  • Emphasizing the importance of frequent cleaning of the floor in the doffing area.

Web Resources

Updated PPE Guidance for Confirmed Ebola Patients

CDC's PPE Guidance for Clinically Stable Ebola Patients or Persons Under Investigation for Ebola

Frequently Asked Questions