Federal officials announced new guidelines on Monday evening for the protection of hospital workers caring for patients infected with Ebola — guidelines that might have prevented the infection of two nurses had they been in place a month ago.
The new guidelines, from the Centers for Disease Control and Prevention, follow broad revisions announced just last week. The new recommendations provide considerably more detail, however, and have been reviewed by specialists at American hospitals that have successfully cared for Ebola patients.
The procedures are based on the very strict protocols used for years by Doctors Without Borders, Dr. Thomas R. Frieden, the C.D.C.′s executive director, said during an unusual late-evening telephone news conference. That organization also reviewed the new guidelines, he said.
They are voluntary, not required by law.
Among other changes, the guidelines say that no skin should be left uncovered; that street clothes and shoes should be replaced with waterproof fabric and boots; and that every step of putting on and taking off equipment must be done under the eyes of a supervisor whose job is to prevent mistakes.
Graphic
Changes to Ebola Protection Worn by U.S. Hospital Workers
Some hospitals had extra protections in place even before the C.D.C. tightened its guidelines Tuesday.
The revamped guidelines, posted on the C.D.C. website, represent the agency’s recognition that Ebola victims require precautions quite different from those for patients with airborne diseases like SARS, MERS, avian flu or tuberculosis.
Ebola patients have never been proven to infect others by coughing or sneezing, but they emit copious amounts of highly infectious vomit, blood and diarrhea, so it is crucial that not even a speck of it get into a medical worker’s eyes, mouth, nose or cuts.
The most difficult and dangerous part of the process, experts agree, is removing safety gear when its surfaces are covered with infectious particles.
There are some differences between the new guidelines, intended for American hospitals, and those of Doctors Without Borders, which tends Ebola patients in makeshift field hospitals in Africa, some of which are tents built on open ground.
For example, Dr. Frieden said, in Africa it is possible to disinfect workers with a sprayed chlorine solution as they stand in a gravel pit. But that would create slippery puddles in hospital corridors, so the guidelines now recommend bleach wipes.
Since the nurses at Texas Health Presbyterian Hospital were infected after treating a man who died of Ebola, there has been a great deal of finger-pointing.
Dr. Frieden had said some hospital staff members had not followed protocols. The nurses’ union replied that the hospital had no protocols, had given no training, and had forced staff to work in gear that left skin exposed.
Hospital officials said they had followed C.D.C. protocols, but those turned out to be inadequate and outdated, designed to prevent routine infections and airborne diseases. For example, under them, workers could wear only one set of gloves, leave their heads and necks uncovered, and wear street clothes and shoes that could become soaked with lethal fluids.
Last week, the C.D.C. issued a preliminary one-page summary of changes it recommended; they included waterproof head-to-toe garments and supervised removal of gear. Agency officials said they would announce the details soon — which they did Monday evening.
Graphic: A Cascade of Contacts From a Single Case of Ebola in Dallas
Over this past weekend, as hospitals waited, Dr. Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, appeared on several TV news shows to discuss the administration’s Ebola response, which included the appointment of an “Ebola czar.”
Dr. Fauci has been on television hundreds of times since the 1980s, when he became the face of the government’s response to the AIDS epidemic, and it appeared that the administration was tentatively using him as its top medical spokesman in Dr. Frieden’s place.
Dr. Frieden has been heavily criticized in public and in Congress for saying that virtually any American hospital could handle an Ebola patient.
In fact, his answers to this question had been more nuanced, explaining that any hospital with a properly trained staff could treat patients without needing isolation rooms with negative pressure airlocks and other gear that make them resemble a space station more than a field hospital.
In answer to questions over the weekend from news anchors, Dr. Fauci said the C.D.C.′s old guidelines had been based on those issued by the World Health Organization and were meant for use “in the field, in the bush” rather than in a modern hospital.
In fact, W.H.O. guidelines are far more strict, although not quite as rigorous as those of Doctors Without Borders. The W.H.O. guidelines do mandate supervised gear removal, rubber aprons and boots, extra gloves and other steps.
In an interview on Monday, Dr. Fauci said that personal protective gear was not his specialty, and that he had been told by C.D.C. officials that their old guidelines were based on the W.H.O.′s.
Some critics claimed that his remark that W.H.O. guidelines were suitable “in the bush” implied that he felt African nurses needed less protection than American ones, because they were somehow expendable.
That was not remotely his intent, Dr. Fauci said. He said he meant that the desperate measures that advanced hospitals have tried on Ebola patients — such as dialysis, intubation, arterial puncture and rectal drainage tubes — can produce gushes of dangerous fluids while nurses are close and vulnerable.
Doctors Without Borders protocols do call for doing as few risky procedures as possible, including even drawing blood as seldom as is medically necessary.