Ebola Infection control is not working ProMED-Mail Post

Ebola Infection control is not working
A ProMED-mail post
Date: 14 Sep 2014
From: Bjorg Marit Andersen

Infection control concerning EVD is not working, especially when more than 240 [now 300] healthcare personnel have been infected, and more than 120 workers have died. Guidelines used to control SARS in 2003 should be used, not “contact and droplet protection of 1-2 meters,” as is still recommended by WHO.

Personal protective equipment (PPE) for contact and airborne infections should be used because of
a) respiratory symptoms,
b) a big distance — up to 9 meters — for droplets when coughing and sneezing (Bourouiba et al. J Fluid Mechanics 2014;745:537-563.),
c) re-aerolization from the environment, bed clothes etc.,
d) long survival of the virus outside the body, and
e) high lethality.

Healthcare workers (HCW) and helpers should be protected with PPE as they were during the SARS epidemic. The SARS epidemic was an infection control success by the healthcare system of some countries in Asia in 2003. But WHO should not repeat the same failure as was done during the early phase of the SARS-epidemic by using “contact and droplet isolation.” Separate hospitals for EVD should be built, like in China (1000 beds in 8 days for SARS), and only patients with laboratory documented EVD should be cohorted. Suspected cases should be isolated separately.

HCW and helpers should be trained and especially observed concerning [putting] PPE on and taking [it] off. The observers should also use PPE. During the SARS epidemic, HCW were re-contaminated by not knowing how to take off PPE.

Exposed people and patients with other diseases should be treated in professional triages to reduce the population’s fear of being EVD-infected during contact with healthcare. Exposed people should be taken care of by professional helpers.

There is a need for a lot of resources, especially concerning infection control work.

Bjorg Marit Andersen, MD, PhD
Professor in Hygiene and Infection Control
Speciality: Medical Microbiology
Former chief, Department of Hospital Infections
Oslo University Hospital – Ulleval
Gaustadveien 1a 0372 Oslo, Norway

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