CDC issuing new infection control guidelines after debacle in Dallas

March 18th, 2015

Stung by a series of disastrous events at a Dallas hospital, the Centers for Disease Control and Prevention is expected to release new infection control guidelines focusing on more stringent and clear recommendations for personal protective equipment (PPE).

The guidelines are expected to ensure that health care workers have no skin exposed, a unit manager monitors donning and removal of PPE, and possibly a more standardized protective suit so hospitals are all on the same PPE page.

The guidelines will likely be similar to what the CDC has established at Texas Health Presbyterian Hospital in Dallas, where PPE was apparently used with overkill in some instances and haphazardly in others in the care of U.S. index Ebola case Thomas Duncan. He died Oct. 8 and two nurses that treated him tested positive for Ebola and are currently hospitalized.

The hospital issued an apology letter Sunday that acknowledged that mistakes were made, including not admitting Duncan when he first presented for care on Sept. 25 because his travel history to West Africa was not “communicated effectively" among medical staff. He came back to the hospital several days later and was admitted for suspected Ebola. In addition, the letter, signed by Texas Health Resources CEO Barclay Berdan, conceded that “training and education programs had not been fully deployed before the virus struck."

The CDC has taken considerable heat for the situation, in part because it had been stressing that any U.S. hospital could handle Ebola with established infection control measures. One wonders if the Dallas hospital reflected a general lack of preparedness nationally, or if the CDC had the misfortune to have the first case arrive at a singularly unprepared facility. In any case, the “any hospital can handle Ebola” dogma imploded as events unraveled, moving the CDC to form rapid response teams and enact several specific improvements in Ebola protocols at the hospital. These measures for PPE will likely form the basis for the updated CDC guidelines:

• PPE suits will be standardized, to include a specific type of suit to ensure consistency in both training and use, possibly using only full-body suits.
• Use of a model of hood that protects health care worker’s neck so the neck will not be exposed.
• Removing PPE with a detailed step-by-step disinfection of hands process with specific sequencing for removal of each piece of equipment and hand washing.
• A site manager on the Ebola care unit at all times who oversees donning and removing of PPE.