Safe Management of Patients With Serious Communicable Diseases: Recent Experience With Ebola Virus

Health care workers (HCWs) in the emergency medicalservices (EMS) and hospital settings often encounter patients infected with dangerous communicable diseases. Such patients are usually managed without fanfare, but when it was announced on 1 August 2014 that 2 American HCWs infected with Ebola virus disease would return to the United States for treatment, it drew the world’s attention. The means by which Ebola is spread are well-known. Careful adherence to standard, contact, and droplet pre-cautions, as outlined for HCWs by the Centers for Disease Control and Prevention (CDC) (1), prevents exposure to blood or bodily fluids contaminated with this virus. How-ever, images of infected patients arriving at Emory Univer-sity Hospital looked much different from what might have been expected. How can the sight of HCWs in “space suits ” be reconciled with published CDC infection control guidelines? In this essay, we offer our rationale for adopting the safeguards that were used. Prevention of disease transmission in health care set-tings, including EMS transport, involves more than the proper use of personal protective equipment (PPE). It also depends on the development and implementation of ap-propriate administrative policies, work practices, and envi-ronmental controls accompanied by focused education, training, and supervision. Health care workers inconsis-tently adhere to such basic infection control practices as hand hygiene (2), and EMS provider adherence to infec-tion control precautions and equipment disinfection can be suboptimal (3). Environmental samples from clinical settings inside and outside the hospital have revealed con-tamination with serious pathogens (4–6)