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Preparing America’s Hospitals, Health Care Facilities, and Health Care Providers for Ebola

Posted on by CDC

Safety GearSince the first appearance of Ebola in West Africa earlier this year, CDC has been working to prepare the American health care system for the diagnosis and safe care of a patient with Ebola here on our shores.

We have learned immensely from this first U.S.-diagnosed case and we are implementing additional actions to make sure health care workers and hospitals around the nation are as prepared and informed as possible.

CDC is committed to making sure every U.S. health care system and health care worker is prepared for Ebola. Key is first noting if the patient exhibits symptoms consistent with Ebola, and if so, working with that patient using the most meticulous infection control procedures, and then taking a careful and complete travel history of each patient who comes in their door.

In the past three months, CDC has been in close communication with hundreds of thousands of clinicians through notices distributed through CDC’s Health Alert Network, our primary means of reaching the nation’s health care community — and one they are already very familiar with. The Ebola-related notices have included recommendations for evaluating patients, guidance for the nation’s Emergency Medical Services systems and 911 offices, and guidelines for infection control should a hospital or health care facility find themselves caring for a patient with known or suspected Ebola.

We’re holding daily press conferences which include information specifically for those in the health care profession. To prepare health care workers to go to West Africa and safely care for Ebola patients, CDC organized the first course on safety and infection control training which is now being offered every week.

We’ve conducted clinician education webinars, reaching more than 8,000 doctors, nurses, and other health care professionals. We’ve worked closely with the nation’s associations of hospitals, infection specialists, infection disease clinicians, and hospital epidemiologists, among others, to reach their members with critical information on preparing for Ebola to arrive unannounced in the United States and continue to hold calls on a daily basis. Upcoming webinars are planned for emergency room doctors, emergency medical system workers, nurses, health insurance providers, and state and local public health departments.

We’ve answered thousands of telephone calls – and nearly 20 times as many per day in the past week as previously.

We have a hotline —800-CDC-INFO (800-232-4636) —where medical personnel can call and be connected with public health experts.

Care of patients with Ebola is complex. That is why CDC has provided checklists and decision guides to aid health workers in doing their jobs.

Some of the materials include guidance on infection control for hospitals, a decision guide  and checklist  for evaluating someone who has come to the United States from West Africa, and a detailed checklist  for those working in Emergency Medical Services.

These materials and much more are available on CDC’s website which is updated daily or more frequently, as needed.

Ebola is a serious disease and people are scared. It’s normal to be scared. We want health care workers to have a healthy respect for the risk that any lapse in infection control procedures could have. We want them to channel their acute awareness of the disease into being rigorously meticulous about infection control. This is what these professionals are trained to do and what our guidance, education, and outreach is continuing to help them do.

Today we hosted a conference call with the fifty state health commissioners to arm them as they work with their state hospitals and health care facilities. We shared lessons learned in many areas including how to prepare hospital emergency departments, how to take travel histories, and how to deal with potentially infected waste.

In addition, we’re working closely with hospitals across the nation. This includes assisting hospitals with holding drills to make sure hospital staff are properly prepared for the arrival of a patient who might have Ebola.

And we working with Dallas County, Texas, health officials and others to create a catalogue of information, The Big Book of Ebola, for clinicians who need to know in the moment how to respond to a concern about Ebola.

We will continue to be a resource for clinicians across the country by holding webinars, sending out Health Alert Network notices, communicating via social media and news media, and working even more closely with our federal, state, and local government partners to keep our commitment to the American people. Their health and safety is our first priority.

But while our top priority at CDC is to protect Americans from threats, we cannot lose sight of the work that must be done in West Africa. Until we stop the Ebola outbreak there, we will not get to zero risk of Ebola here.

Posted on by CDC

75 comments on “Preparing America’s Hospitals, Health Care Facilities, and Health Care Providers for Ebola”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I hope for all our sake’s that what happened in Texas won’t happen again. Please ensure that all parties from customs officials, airlines workers, ER staff etc ask about travel from Ebola affected areas and properly monitor/isolate people as needed.

    My Opinion: NO ONE LEAVES EBOLA AFFECTED COUNTRIES WITHOUT A 21 DAY INCUBATION PERIOD! NO SYMPTOMS FOR 21 DAYS, THEN THEY CAN LEAVE! PERIOD! NO EXCEPTIONS!!!

    That is the rules for our Military for them to return, then it must be the rule for ANYONE TO LEAVE to ANYWHERE IN THE WORLD!

    About a week ago, I asked one physician whether he had received CDC notices about ebola. He said that he gets notices from CDC all the time. I followed by asking him whether he was concerned about ebola. He said no, because it could only be transmitted via blood, vomit, and diarrhea, and he seemed a little surprised that it could be transmitted in other ways. On Sunday, Oct. 5, I asked a different physician whether she had received recent notices from CDC regarding ebola. She also said that she gets CDC notices all the time and added that she rarely had time to read them. The reason I’m reporting this is because it seems to me that well meaning efforts intended to reassure the public may be backfiring by excessively reassuring some physicians instead. You’re doing fantastic good work, Dr. Frieden – don’t get me wrong. But while I see signs that some of our health care providers are really taking this seriously, I also see what I’ve just reported, and that’s troubling.

    “CDC is committed to making sure every U.S. health care system and health care worker is prepared for Ebola. Key is first noting if the patient exhibits symptoms consistent with Ebola, and if so, working with that patient using the most meticulous infection control procedures, and then taking a careful and complete travel history of each patient who comes in their door.” ~ Tom Frieden, Director, CDC

    Translation — Evidently, here’s the best be safe or be sorry ‪#‎ebola‬ drill. 1. See patient. 2. Assess symptoms. 3. Adopt meticulous infection control if patient exhibits ebola symptoms (e.g. a fever). 4. Then take patient travel history whether or not patient exhibits ebola symptoms. 5. Isolate and test for ebola based on results of #2 and #4

    I guess this means that providers need to use “the most meticulous infection control procedures” for every patient they contact who has (say) a temperature (ebola symptom). Then, later in the encounter, if the patient’s travel history doesn’t suggest the possibility of an ebola infection, I guess the patient need not be isolated and tested?

    You all ROCK!!!!!! I mean it. Thanks so much for incredible clinicians and sleuth officers. I have so much respect for all of you at CDC. THANK-YOU!!!

    I am a medical supplier in Upstate New York and 3M N95 Masks (1860 & 1870) and other Isolation Supplies are already on Nationwide Backorder. I am a large supplier that supplies hospitals, nursing homes etc. and I already can’t supply some of the facilities that buy from me. I think things are going to get a lot worse before they get better.

    I find these resources very useful. Do you have any in Spanish, to share them with my Spanish colleagues?

    Thank you.

    Can the CDC print a PPE guide if staff are wearing the full protection eg. coverall suit . IT would be good to have a standard of what to wear and what to take off where eg ante room vs room. I feel like all US hosptials should be standardized in this and not dependent on current financial status and available supplies. If some staff are wearing full protection at major hosptials other should be too. There should be exact directions and a fund .
    When i t comes to worker safety there should be no competition between institutions on who can protect workers more.

    From anedoctal evidence it appears that blood transfusions from Ebola survivors may help other patients. If it were possible to harvest donated blood and immunoglobulins from patients who have survived Ebola infection and cleared the virus and use these to produce IVIG stocks, this may help control the epidemic, since IVIG would contain anti-ebola antibodies, can be stored at room temperature for up to two years and can be more easily transported than fresh serum. Now that the US military is getting involved, it may be possible to set up a collaboration between private industry and the military to harvest blood from Ebola survivors, produce IVIG and then treat early stage Ebola patients with IVIG infusions, which should contain high titers of anti-ebola antibodies.

    From anecdotal evidence it appears that blood transfusions from Ebola survivors may help other patients. If it were possible to harvest donated blood and immunoglobulins from patients who have survived Ebola infection and cleared the virus and use these to produce IVIG stocks, this may help control the epidemic. IVIG obtained from ebola survivors would contain anti-ebola antibodies and furthermore IVIG can be stored at room temperature for up to two years and can be more easily transported than fresh serum. Now that the US military is getting involved, it may be possible to set up a collaboration between private industry and the military to harvest blood from Ebola survivors, produce IVIG and stockpile it and use it to treat early stage Ebola patients with these IVIG infusions, which should contain high titers of anti-ebola antibodies.

    Dear Tom Frieden, MD, MPH: Do enjoy lying to the America public? Just curious. Please check out what the WHO has to say about your ways to contract Ebola. You should be ashamed of yourself.

    ‘increased’ screening measures at airports are a joke. people will lie to get into this country and seek treatment. people will take tylenol to reduce potential fevers. wake up and realize that your screening measures will do nothing to contain the virus.

    you all should be ashamed that you let this get so out of control in africa. first world countries turned their back on those folks months ago and now are scrambling and trying to save face. do what is necessary – do not allow travel from liberian/west african nationals abroad until this is better contained. this is not rocket science.

    check out what the firestone rubber tree farm did in liberia to reach ZERO ebola cases in their hospital. order #1: no one allowed in. gee, that sounds like common sense.

    The President and Congress should reconsider the leadership at the CDC. Dr. Frieden’s public comments on Ebola – first, his overpromising last week of how CDC will stop it in its tracks and, today, his misrepresentative analogy about how Ebola is like AIDS – indicate he is inside a mental box about the risks from Ebola and how to manage public concerns. Ebola is not like AIDS. AIDS was transmitted principally through sexual contact and only secondarily (and statistically it was a relatively small ‘secondarily’) through contact with blood or fluids, typically via transfusion. Ebola is being transferred by contact, and seemingly the most passing of contacts (like sweat). From what I recall, people treating AIDS patients weren’t in hazmat suits. Some of those recently under observation for possible infection (like the police officer in Frisco, Texas) almost make you wonder if Ebola has mutated to where aspiration is possible. But our government and the CDC seem more concerned about managing us like children than doing the hard and rational things necessary to contain and eliminate this from our country. The CDC was under pressure in the months before the Ebola outbreak over its screw-ups with anthrax and lax lab protocols. In my opinion, it decided to ride to the rescue on Ebola by bringing a few folks into the U.S. to prove how great the CDC is at managing things. Great PR, great way to change the public debate on CDC. But it is now influencing their representations to the President on what to do – as evidenced by Dr. Frieden’s own comments in his blog, delays in airport screening, etc. I hope the President and Congress put this nation’s health and safety first, and get the CDC in line before we see this stuff spreading across the US, killing who knows how many. The first week in Texas was only a sample of what can happen. Day 1-2, officials indicated only immediate family of around 4-5 people needed to be watched. Each day thereafter that number steadily went up until it was around 100 or something, at which point I stopped listening to the Keystone Kops who said they “would stop it in its tracks.” You have a police officer now potentially infected, what was he doing this past week? And some Good Samaritan out touting how he helped move Duncan’s family to an undisclosed location without so much as changing his own shirt. How many has he put at risk, besides himself? The government needs to get on top of this thing now and stop jeopardizing the health and safety of America in an effort to achieve some larger global goal of noblesse oblige. This isn’t AIDS and the paradigm of AIDS is coloring the CDC’s conceptual response, probably its recommendations to the White House, and it is deeply flawed. Personally, I think the CDC Director should go. He doesn’t inspire any confidence with his foolish public statements. But at a minimum, he and his colleagues should be given a stern reality check on protecting this nation and its citizens first and foremost. Because if Bush caught flack for an inept response to Katrina, what do they think the consequences will be of letting a plague proliferate through the entire country?

    CLOSE ALL OF THE BORDERS IN AND OUT OF THE COUNTRIES THAT HAVE EBOLA…

    so that YOU will not have to do all that you are doing in TRAINING individuals to take TEMPERATURES.

    You are so smart your STUPID….

    Is there some reason people aren’t quarantined for a short period of time when they come from an infected area? It would give a chance to arrest cases early and protect the rest of the population. I don’t think taking a temperature on arrival is a very effective method of arresting this deadly disease. If the CDC is committed to prevention, then I would suggest quarantining is the only effective method. Historically this method was effectively used in outbreaks of highly communicable diseases. It works.

    An ankle bracelet that monitored location with a GPS and body temp with a thermometer could be an alternative option to quarantine during the 21 days after someone comes to the US from a heavily infected area. If they developed a fever during the 21 days, the would need to be checked out by a doctor immediately. After 21 days the bracelet would be turned in for cleaning and reused.

    If you were doing your jobs you wouldn’t have to prepare us for anything. You look so uncomfortable telling the the public that allowing travel is a better strategy than restricting travel to combat any threat that there is still hope you will blow the whistle on this whole scam in order to prevent the all out shame you have brought to your family, and help the country get rid of this disgraceful President. If not, you’ll be remembered in the way that that Lois Lerner, Holder and the other traitors will be and hopefully end up in jail where you belong.

    Now that a healthcare worker who treated the Duncan Dallas patient has been diagnosed with Ebola this demonstrates that the healthcare facility is not prepared to safely treat this disease. Why is it that some patients like the doctors and the newsman who are flown to the US for treatment are put in the special isolation hospitals but Duncan wasn’t? This is the tip of the iceberg. A 21 day quarantine for travelers is a more thorough way to catch this disease. Temperature screening has already been said that it wouldn’t have caught Duncan’s case so why are we wasting time doing procedures that are known not to be the most thorough?

    Does the CDC protocol include spaying down the health care worker with bleach while still in full protective gear to decontaminate the outside of the protective gear and thereby reduce the risk that contamination of the gear will be transferred to the worker as s/he removes the gear?
    What about decontamination of the workers body after removing the gear? Even a shower?
    If not, why not?
    I’ve seen these things going on in video from W. African Ebola treatment centers.

    We are very worried about the Ebola virus and our current open door policy for travel. The U.S. can provide aid and support without allowing unrestricted travel. Our current policy is foolish and dangerous. There is an abundance of evidence that migration behavior and epidemics are intrinsically linked. The recent situation in Dallas has shown how flawed our current policy is. Responsible public policy would restrict migration away from Ebola ravaged countries. The risk of future infection of a healthy individual is proportional to exposure. The risk of healthy Americans contracting Ebola comes solely from the importation of exposed individuals into the U.S. As we have seen in Dallas, the introduction of just one infected individual into the population exponentially increases the risk in the community where he interacts. It makes no sense to allow free travel to and from the affected West African countries. We are currently depending on airport personal to screen all travelers to contain the spread of Ebola. This is ludicrous on many levels. 1. Passengers could be in the incubation period and not currently symptomatic, as in the case of Mr. Duncan. 2. Passengers could take analgesics to alleviate visible symptoms. 3. Airport screeners are not health care workers no matter how much training they receive. It is also important to realize that infected individuals have incentive to come to the U.S. to receive medical treatment.

    We are certain that the majority of Americans strongly disagree with current public policy regarding unrestricted travel to and from Ebola stricken countries. The current policy is irresponsible and a breach of the public health contract to protect the citizens of the U.S. from communicable disease. We urge you to use the authority given to you by the citizens of Michigan, to protect those citizens!

    A lot of what is said here is true. Yuo should check the visas of all international flights and all border access points, including Canada. If the visas indicate travel to an Ebola infected country or one surrounding the those countries should be quarantined for 21 days. When a case is found say in a hospital, seal it like Macedonia sealed the hotel. Don’t let people exposed go home and self monitor, it won’t matter if they come back once they’re symptomatic, they’ve already had contact with people. It’s not a wimpy virus outside the body.

    BTW, for those blaming the CDC for not changing screening policy, don’t. They don’t have the authority. Only the Dec. of HHS has the authority to order quarantines, but what would she know, She has zero medical experience. She’s a good administrator though (acc. to her bio).

    Prior to any comprehensive analysis of the circumstance in Dallas, the CDC commented publically that the Dallas nurse “breached protocol.” Such speculation borders on arrogance and is dangerous. I found it interesting that dialysis was initiated with patient, Thomas Duncan. Was that really a necessary procedure for a patient in the last stages of Ebola? As healthcare professionals, it is our duty to be honest with the public. As of now, the most forthright information is that not all healthcare providers/facilities are adequately educated or prepared to handle Ebola patients. Further, the resources necessary to treat even one Ebola patient are staggering and place any healthcare facility and the community it was meant to serve, in a precarious position. At the current time, all non-emergent flights from Ebola stricken countries to the U.S. need to cease.

    It is alarming that all these health care workers are contracting Ebola. I read somewhere that the virus cannot survive or really dislikes high temperatures (above 108). My question is why workers are not exposed to high heat or UV after contact with a patient? This would make sense and is worth a try.

    Historically villages with Ebola outbreaks were isolated. In light of that, why are we continuing to allow commercial airplane travel from the effected countries into the US? I understand the need to allow transport of Aid Workers in and out. However, it is irresponsible to allow standard citizens simple access into the US. All one has to do is take a fever reliever to lower one’s temperature with the onset of symptoms.
    Anyone can and will lie about symptoms. People with money from the effected countries are going to want to seek treatment here. The minimal that should be done is Quarantine on entry for 21 days. Commercial airline travel should be stopped. It is UNBELIEVEABLE to me that we are continuing to allow a pipeline of infection to the US unstaunched. Obviously we can’t isolate the countries but we can stop commercial airline flights to the general population or require quarantine with symptom assessment for 21 days. Why are we continuing to allow commercial flights in and out??!?

    As a prior member of the Texas State Board of Infection Control Practitioners, I was sorely disappointed with Dr. Freidman’s attribution of the new Ebola Healthcare Worker infection in Dallas to a “breach of protocol-” a clearly inflammatory claim at multiple levels of the local Health Care Community and our Healthcare Professionals, that carries with it the insinuation of ineptitude at one of our local major Medical Care Providers, their healthcare team, the infected Nursing professional and her family. A claim of “breach of barrier” or “break in barrier” would remove the personal and individual institutional implications, while more realistically defining a situation that in the end may well prove to be a flaw in the care level application of current CDC PPE recommendations from a practical application standpoint.

    If the receptor site for Ebola has been identified

    http://www.sciencedaily.com/releases/2011/05/110502151349.htm

    It makes sense that we could use either Phosphatidylserine or Bavituximab to either fill the receptor, or signal the body’s microphages to attack the infected cell…
    http://en.wikipedia.org/wiki/Bavituximab
    http://www.nature.com/nrd/journal/v8/n1/full/nrd2788.html
    http://www.sciencedirect.com/science/article/pii/S1074761307005468

    Does anyone have further thoughts on this?

    The examples of the protective clothing for healthcare workers dealing with ebola (like the one above) show that the hair is not covered. In my opinion all people coming into close proximaty to anyone infected with ebola ought to have their hair and entire head covered. Humans are often running their hands through their hair without even realizing it. Any droplets that land in the hair will have a very good chance of ending up on the hands of the worker or someone they later come into close contact with. Another scenario would be droplets of sweat drawing the infection down from the hair and onto the face of the healthcare worker.

    Dr. Frieden, its time for you to resign. The US needs a CDC leader who understands medical, public relations, and logistics areas. The events of the last few weeks show you are clueless of the last two. Your comments about the Dallas nurse are disgraceful.

    The USA is a country of about 319 million people with 50 states, 5700+ hospitals, and 980,000+ beds. Ebola is a global problem and has the potential to severly affect this country. We need a CDC leader than can actually manage the details associated with these facts as the Ebola outbreak continues. That person is not you.

    I am very eager to understand what personal protective gear the CDC’s protocol recommends and what was used by the nurse in Dallas who became infected with Ebola. I viewed a document that shows a gown which is open in the back, but overlaps, double glove, a mask or respirator, goggles and a face shield. My understanding is that this is the minimum the protocol requires and these are the items the hospital mentioned in the news conference on Sunday. However, many people have noted that some facilities choose to provide protection that exceeds the minimum.

    Looking at the minimum gear, I don’t feel that it would be sufficient to prevent the spread of Ebola from a patient to a health care worker. There are just too many points through which a virus could gain access to the human body. Plus, if the gown is just a cotton fabric, there would be very little protection from contaminated bodily fluids being wicked through layers of the clothing.

    The Director has mentioned that other teams in the U.S. and Doctors Without Borders have a high success rate in preventing transmission to health care workers. I suspect that they may be using a higher level of protective gear including: Tyvec gowns plus apron, complete hood over goggles, respirator or self-contained breathing apparatus, boots, and sealing gloves to sleeves and pants to boots. Really, I think the body should be completely and impermeably sealed if you want to make the statement that the protocol will prevent health care workers from contracting Ebola, and if it doesn’t, then the protocol was breached.

    An additional layer of protection,that I believe they use at facilities in W. Africa, is to completely disinfect the outside of the protective gear with a bleach solution prior to removing the gear, and then again, decontaminating the body of the worker after removing the gear according to protocol.

    So, based on what I’ve seen, I think the protocol may be flawed, and thereby insufficient protection even if followed to the letter. Please correct me if I’m wrong.

    The NHS in the UK has published one phone number to call if you think you might have Ebola or have been exposed etc. Then you are directed as to what to do or where to go. I think this might be something to consider. This would enable the CDC /local health authorites to direct people to the proper facility and would avoid spreading the disease or contaminating waiting rooms and exposing others while waiting with the general population to be seen in ERs or walk-in clinics. It would also alert people at a hospital or clinic that they had an incoming “possible” Ebola patient.
    Perhaps a machine could answer the nationwide Ebola Hotline and the person could input their zip code and they would be given a local number or the call could be automatically forwarded. It seems that having an ambulance pick them up or sending them to waiting health care staff would be better than the situation in Dallas where a law enforcement officer went to a walk-in clinic.
    Thanks —-
    A. S. Louisiana

    From what I see on news media outlets health care workers in Africa are wearing full body suits while caring for patients and are sprayed down with a bleach or chlorine solution after patient contact to help prevent infection. In Texas, the news outlets are showing that health care workers wore a mask, face shield, partial body suit, gloves, apron, and shoe covers; leaving their head and hair exposed and it is unknown if they were disinfected afterwards before removing these items. Many of the health care workers in Africa are following (as much as feasibly possible despite limited resources) more stringent infection prevention protocols than the hospital in Texas did and they are still getting sick. Why would the hospitals in the U.S. use less preventative measures than they are using in Africa? The CDC needs to either actively prepare and train ALL health care workers in the U.S. on stringent Ebola infection protocols, or have all infected patients moved to a facility that has doctors and nurses that are highly trained and experienced with deadly infectious diseases. Furthermore, there needs to be a ban on all flights from affected countries or a mandatory 21 day quarantine for those flying from West Africa. Supplies that are needed in West Africa do not need to be flown in on a commercial airliner, and can be brought via charter and military planes. We have now seen the first person to die from Ebola in the U.S., as well as the first person to contract Ebola in the U.S. These cases may or may not lead to more cases in the U.S. Hopefully, there will be no more. But lets not take the risk and unknowingly allow more people with Ebola to fly into the U.S. and infect unprepared and untrained doctors and nurses.

    So now i’m hearing that the CDC has been reluctant to suggest or mandate full body suits and higher levels of protection because there could be a risk of the health care worker being infected if the gear is removed improperly. This issue seems to be the Achilles heal of Ebola treatment in the US!!
    The officials in Dallas have said they are following CDC guidelines; they are relying on the CDC to know what to do. But if the guidelines are insufficient, and those facilities that successfully protect workers are using a higher level of protection, the CDC should be suggesting or requiring that higher level.
    If it is too risky to have workers carry out the high protection protocol, then something is seriously wrong!! Why can’t the CDC set up a certification program for using the gear? If there’s too much politics between state, local and federal over who is responsible, it seems that just having a certification would be enough for hospitals to require certification because failure to do so would be grounds for a claim of negligence. If the CDC can’t implement it, get Doctors without borders to do it.

    It seems to me you may want to select a subset of hospitals across the country to respond to and treat ebola and then train the heck out of the personel in those hospitals. In other words. Limit the number of access points and then insure those points are well trained. This should limit or prevent the protocol breaches.

    I would like to be so bold as to suggest that certification of health care workers be required as indicated in my last post, and should include an objective test for certification. A final exam, if you will. Use a sensitive tracer. Have the worker suit up in the protective gear, apply the tracer to the worker under conditions that mimic exposure the most extensive exposure to Ebola a worker would get, and see if the worker can take the gear off without contaminating themselves. Use something like a solution of DNA, and detect it on skin after removing the protective gear using something like Luminol; or use a fluorescent reagent alone and detect it under excitation with a suitable light source. Or use some other tracer that can be detected in low amounts using MRI or CT.

    The comments made by the director were shameful – misleading (falsely indicating that the cause was actually known) and insulting, attempting to place the blame on sloppy technique by the nurse. All because he wanted to convince us that things were under control even though they weren’t.

    Eliminate travel to the US from African countries. Americans who need to return should be required (forced) to be in quarantine for the incubation period.

    We need a new CDC director. One who will be honest and realistic and with attention to vital details. The current director just doesn’t have what it takes.

    I think you need to beef up your guidelines on protective clothing. Current standard is not adequate. Too much exposed skin. Please look at the Doctors without Borders standards. Need full coverage of all skin surfaces. No exposed skin at all.

    You now have 2 confirmed cases in Dallas of workers who followed current guidelines. I don’t think it was a “breach in protocol”, more a case of insufficient protocols.

    This step should be taken immediately!

    Having been in the PPE world it’s all about Doffing and Decontamination. No matter how well one prepares for entry, gloves, suit face shield, etc. it’s after exposure that’s the most critical. We learned in the WMD world that even after doffing attire one should still be showered to ensure removable of any possible contamination during doffing. With the minimal amount of viral cells causing infection this is no casual situation. At this time the current procedure, which the majority of health care works don’t know or were inadequately trained due to funding we have a big problem.

    Note that the direction of training that is being proposed may not be in the correct area. Yes hospitals are important BUT they are not the front line of healthcare anymore. With the up rising of Urgent Care facilities this is where the majority of patients are going with flu like symptoms not the hospitals and I can assure you that these health care workers are not even familiar with PPE.

    The events of the last few days show you to be an incompetent amateur. Resign so the US can find someone who has at least a clue of how to manage a 50+% fatality rate disease and the 5700+ hospitals in this country.

    The “we should have done more” excuse is just JV. We need senior seasoned professionals that can deal with the scale required here.

    Rather than bring ebola to our hospitals, would it make sense to have off site facilities designated strictly for ebola. This may help to protect the hospitals from an unintentional release of this deadly virus.

    ER waiting rooms are a huge threat to spread infection. How about a drive through system. Registration could be completed via email or text from your vehicle.

    I agree with the 21 day quarantine! Tracking is only going to allow the virus to spread throughout the country and world. How do you spell PANDEMIC? World Health Organization stats from 2012 – 1974 indicated 79% mortality rate with current Zaire strain, current stats in the 80-90%? How many will have to die prior to onset of martial law? LIMIT THE SPREAD NOW.

    October 7, 2014 at 4:56 pm ET – Joseph
    My Opinion: NO ONE LEAVES EBOLA AFFECTED COUNTRIES WITHOUT A 21 DAY INCUBATION PERIOD! NO SYMPTOMS FOR 21 DAYS, THEN THEY CAN LEAVE! PERIOD! NO EXCEPTIONS!!!
    That is the rules for our Military for them to return, then it must be the rule for ANYONE TO LEAVE to ANYWHERE IN THE WORLD!

    Drive up alternate care sites should be considered; we practiced the “drive up” possibility for screening patients in a table top exercise a few years back, and it went pretty well.

    Also, as you learn more about the appropriate PPE and specific isolation procedures to protect staff, it would be helpful to post training video on website to help everyone with this, and as a reminder.

    Thanks for all that you are doing.

    Isn’t the idea of putting Dallas health care workers on a no fly list the ultimate double standard and hypocrisy? On the one hand, you acknowledge that these workers shouldn’t even be on a plane around the members of the public, while on the other hand you refuse to put people coming from W Africa, one of which started all this mess, on a no fly to US list because the health care workers there might not go if they feared they couldn’t get home? Wouldn’t it be safer to charter a plane for the US citizens working in W. Africa and put everyone coming out of that region on a no–fly to US on commercial airline list? Why aren’t you worried that prohibiting travel of US health care workers domestically, along with the threat of a scorched earth decontamination practice that destroys all the personal belongs of someone who becomes infected while fighting this disease is going to drive people out of health care here? Is it not a bigger threat to US citizens to have all the nurses in Dallas walk out than to have a similar walk out in W. Africa??

    I am concerned about the way Director Dr. Tom Frieden handles the Ebola crisis. The information and guidelines given out by him clearly are erroneous and dangerous. It is scary to watch him on Television trying to play down the danger of the current situation. My husband is a former Medical Service Corp Officer, and I know about the danger of this particular disease. He flew yesterday from Frankfurt via Dallas to Killen, Texas, and at no point during his trip did he go through any checks, or was questioned about where he was before this trip. Germany is right next to Italy where daily thousands of refugees come from Africa and travel through the rest of Europe. This issue has not been mentioned anywhere so far. Maybe your agency should consider finding a replacement more competent in such a scary situation.
    Sincerely,
    Barbara Kindred

    How do we tell whether someone has the flu or ebola?

    The symptoms for ebola are:
    Fever (greater than 38.6°C or 101.5°F)
    Severe headache
    Muscle pain
    Weakness
    Diarrhea
    Vomiting
    Abdominal (stomach) pain
    Unexplained hemorrhage (bleeding or bruising)

    The some of the similar symptoms for flu are:
    Fever or feeling feverish/chills (most of the time above 101.5°F)
    Muscle or body aches
    Headaches
    Fatigue (tiredness)
    Some people may have vomiting and diarrhea, though this is more common in children than adults.

    As an administrative employee at a medical facility and being first in line when receiving patients, I need to know what I’m looking for.

    For the longer term better isolation wards need to be developed. Rather that focus just on protective clothing actual barriers to the patient ought to be considered. Using the glove box technology (used in laboratories through out the world to handle dangerous material) routine care could be provided from behind a protective barrier. The patient could communicate to the care givers and relatives via electronic means. Since Ebola is not airborne there would be no need to make such a unit airtight. Local storage for body waste should be provided behind the barrier.

    At this point, I think hospitals have to isolate anyone coming into an ER, maybe behind a glass partition, and ask question about symptoms, exposure and travel history before they are even allowed into the waiting room around other patients.

    Cruise lines need to understand how serious disease control and prevention is. We just returned from a Royal Caribbean cruise. We were given a cabin where we were placed in danger of disease or infection. Unknowingly, we laid down on beds covered with dry coverlets but came into contact with someones bodily fluid contained in the soaked (not just damp) mattresses. We were moved, only for the night, and told to return to the original cabin the next morning. When we returned, clean bedding was put out and when my husband lifted the dry mattress pads the same urinated soaked mattresses were under the replaced mattress pads. We were told by guest services that it was urine. When we questioned if analyzing of the bodily fluid found in the mattresses was done the answer was no only for a crime would that be done. Body fluids may contain and pass on viruses such as HIV, hepatitis B and C and is it possible EBOLA. When you come in contact with an unknown persons body fluids that should be taken as potentially infectious. They did not offer to send us to the ship doctor. I mentioned several times why they did not think we be seen by the doctor. Finally, they sent us to the ship doctor. We had temperatures taken and our bodies were checked for a rash. We were told we were fine and not to worry about lying in someone’s urine. A proper investigation was not done regarding this disgusting and serious incident where we may have been exposed to an infectious disease. Staff did not use an infectious control procedure when they placed us at risk in a contaminated room. This cruise line needs to be informed of more awareness and training for disease control and prevention.

    I am not at all impressed with the CDC’s handling of Ebola in the U.S. This is how we define world class health care? Your lack of a basic, common sense approach to protecting health care workers and the public against a devastating virus we know little about is alarming. You are supposed to be the experts! What about data that suggests a 21 day quarantine may not be enough? Do we want to meet the basic safety threshold or respond differently out of an abundance of caution?

    All available data collected in almost 40 years of experience fighting Ebola outbreaks throughout Africa, including this outbreak, strongly supports a 21-day incubation period.

    Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

    Incubation period resources:
    Eichner M, Dowell SF, Firese N. Incubation Period of Eboba Hemorrhagic Virus Subtype Zaire. Osong Public Health Res Perspect 2011; 2(1): 3-7.
    Analyzing data from the EBOV outbreak in Kikwit, DRC, “The mean incubation period was estimated to be 12.7 days (standard deviation 4.31 days), indicating that about 4.1% of patients may have incubation periods longer than 21 days.”

    Legrand J, Gairs RF, Boelle PY, et al. Understanding the dynamics of Ebola epidemics. Epidemiol. Infect. 2007; 135:610-21.
    Duration of the incubation period using data from Kikwit, DRC, 2005: 7 days (mean)

    WHO Ebola Response Team. Ebola Virus Disease in West Africa – The First 9 Months of the Epidemic and Forward Projections. N Engl J Med 2014; 371:1481-1895.
    “The course of infection, including signs and symptoms, incubation period (11.4 days), and serial interval (15.3 days), is similar to that reported in previous outbreaks of EVD.”

    Leroy EM, Gonzalez JP, Baize S. Ebola and Marburg haemorrhagic fever viruses: major scientific advances, but a relatively minor public health threat for Africa. Clin Microbiol Infect 2011; 17:964-976.
    “Generally, after an incubation period ranging from 2 to 21 days (mean 4–9 days), non-specific symptoms such as fever, headache, nausea and muscle pain occur abruptly.”

    Kortepeter MG, Bausch DG, Bray M. Basic Clinical and Laboratory Features of Filoviral Hemorrhagic Fever. J Infect Dis 2011; 204:S810-16.
    “the incubation period after a needlestick injury with Ebola Sudan virus was 6 days [35], and it was 7 days for a similar exposure to Ebola Zaire virus.”

    AS you may already know by now , hospitals in this country are incapable of providing a very low level of transmission to healthcare workers. Budgets of hospitals in poor communities are incapable of providing the standard of care required to protect healthcare workers.
    I know there is risk of aerosol transmission of viruses when cleaning up feces, and when a patient vomits. There are many articles in the journal of infectious diseases that state this aerosol risk. When a state health department and hospital tell me that a N95 respirator is sufficient it is incorrect. When all of my skin is not fully covered it is incorrect. An N95 respirator and various gowns are too porous for a healthcare worker to wear while taking care of a patient with a communicable disease that kills 40% of those who contract it. This risk must be minimized to nil or near nil, due to the 40% (Nigeria) death rate in order for the CDC, State Health Dept. , or Hospital or they have not met their moral obligation to minimize risk for the healthcare worker.
    Additionally, I have heard that some hospitals are requiring workers to gown up and stay in the room with the patient for a number of hours because doffing is a risky business. I would say that staying in the room and waiting for an aerosolized product is more than a risk any healthcare worker should be willing to take. The healthcare workers in Africa are better prepared than US Hospitals at this current time. They are getting decontaminated before doffing PPE.
    The 2 nurses in the biocontainment centers did very well exceed the nursing code of ethics and their moral obligation to care for the patient. Taken directly from the code of ethics for nurses: 4 Criteria must be met for a nurse to have met her moral obligation. Number 4 stating “The benefit the patient will gain outweighs any harm the nurse might incur and does not present more than an acceptable risk to the nurse”. I am a nurse working in an ED, I will not be exceeding my moral obligation to care for any patient . In order for me to provide care I request at the very minimum a full impermeable suit , an N100 respirator and to be decontaminated with bleach, before doffing. This should be the minimum standard of care.
    At the ED where I work , the nurses will be doffing in the hallway of the ED? and they have yet to get full coverage gowns, head covers, or impermeable leg covers and they want the nurse to remain in the room for 2 hours. Do you think that is safe practice? For a virus that has a mortality rate of 40%, I don’t.
    Even more so , recovered survivors of the current outbreak should be the ones who provide direct care to current ebola victims in West Africa as they will have antibodies and be safe .
    Thank you

    Governors Cuomo and Christie, one, an opportunistic Machine-politician, the other, an owner of a dunce cap for every year since first grade, have done more for public health of the American people than the entire corps of MD’s and PhD’s of the United States Health Service.

    I’m having a hard time being confident in the order of doffing of the Belt mounted PAPR jumpsuit combination. CDC guidelines say to remove the hood prior to the suit. Thus leaves the face uncovered for the remainder of the doffing process thus leaving it vulnerable to contamination. In addition you are trying to remove a hood when the shroud is inside the suit. Have you actually tried this? This is the reverse order from what I have ever been taught in multiple hazmat courses over the years. It is also in contrast to the doffing order used at the University of Nebraska biocontainment unit. This discrepancy has put our hospital training efforts on hold. This needs to be reviewed and clarified by not only Infection control experts but hazmat experts with years of experience in donning and doffing.

    I’m having a hard time being confident in the order of doffing of the Belt mounted PAPR jumpsuit combination. CDC guidelines say to remove the hood prior to the suit. Thus leaves the face uncovered for the remainder of the doffing process thus leaving it vulnerable to contamination. In addition you are trying to remove a hood when the shroud is inside the suit. Have you actually tried this? This is the reverse order from what I have ever been taught in multiple hazmat courses over the years. It is also in contrast to the doffing order used at the Universpity of Nebraska biocontainment unit. This discrepancy has put our hospital training efforts on hold. This needs to be reviewed and clarified by not only Infection control experts but hazmat experts with years of experience in donning and doffing.

    Dr Frieden,
    Aren’t you the same person who shoved an illegal ban on Big Gulps down the throat of New Yorkers? How can you look yourself in the mirror? Your extremist, parochial attitude in that situation but inexplicable diffidence and deference to the media grabbing, petulant Princess of Maine demonstrates a complete lack of common sense. PLEASE EXPLAIN how 32 oz of soda pop is more of a public health threat worthy of a ban, than someone who has has had direct contact with people dying from one of the deadliest viruses man has ever encountered, and who is a member of the CDC-identified group most likely to contract the disease? I predict that my grandchildren will read about your policies in their history books under the title “MAN WHO WELCOMED DEADLY EBOLA VIRUS INTO AMERCA”.

    Oh, by the way, the Princess of Maine disputes the accuracy of CDC airport monitoring instruments. Care to comment?

    Deja Vu? Is the CDC training team coming to a hospital near me?

    California nurses say they are not ready for Ebola

    SAN DIEGO – The California Nurses Association says five hospitals designated to treat the Ebola virus are unprepared.

    The union representing 12,000 nurses at the five hospitals began a statewide campaign Tuesday to call attention to what it describes as inadequate training and equipment. The effort comes four days after University of California hospitals in Los Angeles, San Francisco, San Diego, Davis and Irvine said they are ready to treat Ebola patients.

    The University of California system says it welcomes suggestions from nurses and other employees on how to be more prepared.

    In San Diego, nurses say they lack intensive, hands-on training and that protective gear leaves some skin exposed. Hospital officials dispute those claims.

    Michael Jackson of National Nurses United said, “Our organization is appalled by that finger-pointing. We need to move on from that. They’ve begun the training; I’ve been told new equipment is coming out, but as of now they’re not prepared if a patient were to walk in the door.”

    The Nurses Association is asking for:

    — Full-body hazmat suits that leave no skin exposed
    — Air purifying respirators
    — At least 2 nurses per Ebola patient
    — Continuous training

    UC San Diego Medical Center representative Jacqueline Carr issued this statement:
    “UC San Diego Health System is fully prepared to care for any adult patient who is confirmed to have the Ebola virus, if needed.”

    Well, at least CALIFORNIA has the sense to call it a QUARANTINE

    State Health Officer Issues Risk-Based Quarantine Order to Provide Consistent Guidelines for Counties

    Date: 10/29/2014

    Number: 14-089

    Contact: Anita Gore, (916) 440-7259

    SACRAMENTO

    Health care providers and travelers returning from Ebola affected regions will be individually assessed for exposure risk

    While there continue to be no reported or confirmed cases of Ebola in California, State Health Officer and California Department of Public Health (CDPH) Director Dr. Ron Chapman today took action to help prevent any potential spread of the disease in the state by issuing a quarantine order and associated guidelines that require counties to individually assess persons at risk for Ebola and tailor an appropriate level of quarantine as needed. This flexible, case-by-case approach will ensure that local health officers throughout the state prevent spread of the disease, while ensuring that individuals at risk for Ebola are treated fairly and consistently.

    Quarantine Order
    “Today we’re establishing a statewide, standard protocol requiring some level of quarantine for those at highest risk of contracting and spreading Ebola,” said Dr. Chapman. “This order will protect the health and safety of Californians and support the state’s local health officers’ existing authority to develop protections against disease spread.”

    The order, which applies to anyone traveling to California who has 1) traveled to California from an Ebola affected area; and 2) has had contact with someone who has a confirmed case of Ebola, requires those travelers to be quarantined for 21 days. A person traveling to this region that has not come into contact with a person with Ebola will not be subject to quarantine. An Ebola affected area is one determined as an active area by the federal Centers for Disease Control and Prevention (CDC), which currently includes Guinea, Liberia and Sierra Leone.

    California Department of Public Health and Local Health Officers Partner
    Local County health officers will issue quarantine orders for individuals and establish limitations of quarantine on a case-by-case basis. These limitations will be based on new guidance also released today by CDPH. This “Guidance for the Evaluation and Management of Contacts to Ebola Virus Disease” outlines quarantine limitations that local health officers should take based on the level of Ebola risk to which individuals were exposed. Although quarantine can involve isolation at home, it may be tailored to allow for greater movement of individuals who are deemed to be at lower risk.

    “Not everyone who has been to an Ebola affected area should be considered high risk,” Dr. Chapman said. “This order will allow local health officers to determine, for those coming into California, who is most at risk for developing this disease, and to contain any potential spread of infectious disease by responding to those risks appropriately.”

    In California, local health officers currently have the authority to order quarantine of people who may have an infectious disease that threatens public health. This order will ensure consistent application across the state of quarantine for high risk individuals in order to control risks from Ebola.

    California is home to many health care workers who have selflessly volunteered to help combat the current Ebola epidemic in Guinea, Liberia and Sierra Leone. These individuals are engaged in stemming this epidemic at its source through a range of activities, from direct care of confirmed Ebola patients to health education of the general population. California is also receiving residents returning from travel to these three countries as well as visitors from this region.

    “Health care workers who go to Ebola affected countries to treat patients are great humanitarians. They will be treated with respect and dignity when they come home as these important public health actions are taken,” said Dr. Chapman. “We value those who volunteer to help those in need, and appreciate their willingness to serve.”

    Today’s Order is available on the CDPH website, cdph.ca.gov, as is the Guidance to local health officers for implementing the order.

    California Public Health Actions to Date

    Since the Ebola outbreak began in Guinea, Liberia and Sierra Leone, CDPH has worked with state, federal and local health officials to prepare for potential cases of Ebola in California. In August, CDPH launched an informational website compiling information about the outbreak and preparing California health care providers with guidance and protocols from the CDC. CDPH has developed an interim case report form for reporting suspected cases of Ebola to CDPH and has distributed CDC guidance on specimen collection, transport, testing and submission for patients suspected of having Ebola. Last week, CDPH posted interim guidelines for Ebola medical waste management and recommended that all health care facility environmental services personnel and infection control staff work together to develop facility-specific protocols for safe handling of Ebola related medical waste. CDPH has provided these and other documents to health care providers and partners via the California Health Alert Network (CAHAN).

    In September, CDPH convened more than 1,100 health care and public health workers to urge them to assess their Ebola readiness and conduct drills in their facilities. Last week, CDPH officials held a teleconference with health care providers to discuss the latest news and guidance about handling suspected Ebola cases. CDPH is providing weekly updates to local health officials, first responders and health care providers as the Ebola outbreak continues in West Africa. CDPH launched a telephone hotline call center to respond to public inquiries related to Ebola. In October, Governor Brown joined officials from the California Health and Human Services Agency (CHHS), CDPH, Department of Industrial Relations (DIR) and Cal/OSHA to meet with California hospital leaders, nurses, emergency responders, local health directors and medical providers. Last week the University of California Medical Centers were identified as priority hospitals for the treatment of confirmed Ebola cases.

    CDPH is also available to provide consultation about suspect Ebola cases to local health departments and health care providers 24 hours a day, 7 days a week. CDPH joins with a team of state departments and agencies including CHHS, the Governor’s Office of Emergency Services (CalOES), Emergency Medical Services Authority (EMSA) and DIR, to address all aspects of preparedness for a potential Ebola case in California.

    For more information about how the state is preparing for potential cases of Ebola, please read CDPH’s Ebola Virus Disease FAQs and visit the CDPH Ebola Virus Information Page and the Cal/OSHA Ebola Virus Information site.

    Yes.Ebola is very serious disease. It seems to me you really should select a subset of hospitals nationally to respond to and treat Ebola after which it train the heck out of your personel in those hospitals.

    Thank you for sharing valuable information. Nice post! I enjoyed reading this post. The whole blog is very nice I got some information here. Thanks for this post Also visit my site Personal trainer.

    Great post! Thanks for the info, it’s easy to understand. BTW, if anyone needs to fill out a code of ethics for nurses form, I found a blank form here.

    Thanks for sharing this nice article.I read it completely and get some interesting knowledge from this.I again thankful to your for this sharing such a nice blog.

    That’s great. We can feel safe now At this point, I think hospitals have to isolate anyone coming into an ER, maybe behind a glass partition, and ask question about symptoms, exposure and travel history before they are even allowed into the waiting room around other patients.

    6 areas western fumbling makes the WWE peek sane

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