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Protecting Workers from Ebola: Eight Knowledge Generation Priorities

Posted on by John Howard, MD; Margaret Kitt, MD; Maryann D’Alessandro, PhD; Lisa Delaney, MS, CIH; Chad Dowell MS, CIH


On November 3, the Institute of Medicine and the National Research Council of the National Academies convened a workshop of distinguished representatives from the public and private sectors.   The participants were asked to suggest priorities for research that will “provide public health officials, healthcare providers, and the general public with the most up-to-date information about transmission, health risks, and measures that should be taken to prevent spread of [Ebola virus disease] in the U.S.” NIOSH was pleased to contribute to this dialogue, specifically by addressing issues critical for protecting heath care workers from work-related infection.

Researchers and practitioners have decades of experience related to the use of sampling, analysis, personal protective equipment (PPE) and other traditional measures for assessing exposures and minimizing the risks of occupational illness and injury in the industrial setting. That knowledge underpins standard industrial hygiene practices in factories, mines, and construction sites. Strategic research is vital for building a comparably robust base of evidence for reducing occupational risks from infectious diseases in the complex health care setting. By stimulating the knowledge needed to better meet the challenges of Ebola today, we also lay a stronger foundation for anticipating tomorrow’s potential threats from other novel infectious diseases in our 21st Century world of international commerce and rapid air travel.

NIOSH’s recommendations on priorities for generating new knowledge to protect workers from Ebola were summarized in a plenary presentation by NIOSH Director John Howard, M.D. The recommendations address priorities in two general areas: PPE and biological behavior of the Ebola virus.

In the category of research on PPE, NIOSH suggests five questions for priority attention:

  • How do we quantify worker exposure to match appropriate PPE with the required level of exposure protection?
  • What are the best test methods to determine if a given type of PPE will protect the worker?
  • What are the most effective donning and doffing procedures to prevent worker self-contamination?
  • Are there novel PPE designs that will be more effective for health care workers to use in patient care settings?
  • How can we prioritize PPE distribution in the health care system to best utilize the supply chain?

In the category of biological behavior, we suggest three questions for priority attention:

  • How long does Ebola virus remain viable on surfaces, including on PPE?
  • What types of disinfectants and contact times are needed to inactivate Ebola virus?
  • What are the best sampling methods to detect viable Ebola virus on surfaces and on PPE?

A video of Dr. Howard’s presentation at the workshop, which provides further details on the recommendations for research, can be found on the IOM website .In some cases, the recommendations reflect studies that address needs that have already been identified by our stakeholders, and that already are under way in our laboratories, and we look forward to discussing those studies at greater length in future NIOSH Science Blogs. We also look forward to the report that will come out of the November 3 workshop. For additional information about the workshop, click here.  These efforts are building on President Obama’s announcement of a Grand Challenge to help health care workers on the front lines provide better care and stop the spread of Ebola. More information about the Grand Challenge is available on the website.

In the meantime, we invite you to share your questions and comments as we continue to work with diverse colleagues to identify needs and opportunities for world-class research on Ebola virus disease.


John Howard, MD, is the NIOSH Director.

Margaret Kitt, MD, is the NIOSH Deputy Director.

Maryann D’Alessandro, PhD, is the Director of the NIOSH National Personal Protective Technology Laboratory.

CDR Lisa Delaney, MS, CIH, is Associate Director for the NIOSH Emergency Preparedness and Response.

Chad Dowell MS, CIH, is an Industrial Hygienist with the NIOSH Emergency Preparedness and Response Office.


Posted on by John Howard, MD; Margaret Kitt, MD; Maryann D’Alessandro, PhD; Lisa Delaney, MS, CIH; Chad Dowell MS, CIH

11 comments on “Protecting Workers from Ebola: Eight Knowledge Generation Priorities”

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 ».

    We need more research on aerosol transmission- particularly what happens to ebola containing aerosols in US hospital conditions in the winter (very dry, which can lead to creating small airborne particles very quickly ), since all outbreaks have previously been in central Africa, often near the equator.

    Engineering controls for airborne transmission are not getting the emphasis that they should.

    Sampling for viable viruses as an indicator of infection risks is drought with practical and technical difficulties. If the agent is infectious at tiny viral counts then this is especially challenging. Other models in use suggest that sampling and analysis for an appropriate surrogate organism or bodily substance could be more practical and feasible. I suggest efforts towards identifying appropriate surrogates and sampling and analytical methods for those could yield more timely and cost effective risk assessment methods.

    A test for contamination by bodily fluids where they are not supposed to be could be a valuable test for presumed Ebola (or other infectious agents) where you are treating infected individuals. Why test for the viral needle in the bodily fluids haystack when in most cases it should be enough to know patient bodily substances are on your equipment/ facilities?

    In india a man tested negative for Ebola in Nigeria, when tested in India it was found that he has traces of Ebola in his semen

    We are not familiar with this situation and not able to corroborate it, however we do know Ebola virus can persist in semen for three months with men who have recovered from Ebola.

    When treating an Ebola patient, wouldn’t a surgical N95 be preferred over a standard N95? Fluid resistance seems important based on what CDC is telling us. This is particularly true for aerosol-generating procedures, I would think.

    California is requiring PAPR use for aerosol-generating procedures. I think they should at least be encouraged vs N95 for those procedures.

    I am also very concerned with hearing that N95 and PAPR offer “equivalent” protection. CDC needs to be more precise with terminology.

    The current CDC recommendation for respiratory protection for healthcare workers managing patients with Ebola Virus Disease (EVD) is an N95 respirator (in combination with a faceshield and hood) OR a powered air purifying respirator (PAPR). Both configurations are considered acceptable based on each configuration being used successfully to treat patients with EVD in Nebraska (N95 combination) and Emory (PAPR). These recommended configurations are based on the current data indicating that in healthcare settings, Ebola is spread through direct contact ( (e.g., through broken skin or the mucous membranes of the eyes, nose, or mouth) from the blood or body fluids of a person who is sick with Ebola or with objects (e.g., bathroom surfaces, medical equipment) that have been contaminated with infectious blood or body fluids. Additional research and evaluation is necessary to make a definitive statement regarding whether one configuration should be preferred over another configuration.

    N95 respirators that are both certified by NIOSH and cleared by FDA as medical devices for use by healthcare personnel are called “surgical N95 respirators.” As with all NIOSH-certified N95 respirators, these products have been evaluated by NIOSH certification process and have demonstrated that they can filter out a minimum of 95% of airborne particles (both aerosols and droplets) under worse case test conditions. These products have also been determined by the FDA to have demonstrated an acceptable level of fluid and flame resistance, which may be important in healthcare occupational settings, such as surgical suites. The FDA clearance process also requires that these products have labeling that is relevant to healthcare personnel, such as information about the presence of natural rubber latex.

    The CDC guidance on personal protective equipment to be used by healthcare workers during management of patients with Ebola does not specify the use of “surgical N95 respirators.” Institutions can select from either surgical N95 respirators or N95 respirators when using the N95 configuration, as the faceshield and hood covering the exposed areas of the neck and face are expected to address any hazards from body fluids.

    Thank you all for coming up with this project. EVD is spreading more fastly as a result of lapses in handling patients. Health care practitioners are falling because of poor knowledge in handling PPE, and interestingly there are various types being used in Sierra Leone.
    The program is also vital for future challenges and perhaps, the outbreak in West Africa could serve as lesson for any future occurence.

    It has become obvious in 2014 that the HCWs are not Hand Aware enough as exposed by the Ebola infections and that Flu, and other vaccinations alone do not protect the individual from “giving” (inoculating) themselves with the flu and many other respiratory infections. The techniques we have been teaching since 2001 are science based using social marketing and Posititve Deviance strategies to train adults and children to be more “Hand Aware” (hand hygiene, respiratory etiquette and cross contamination awareness) that will keep our schools in session, create healthier, safer home environments and will increase employee productivity in our workplaces

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