Questions and Answers: Infection Control in General Healthcare Settings in Countries with Widespread Ebola Transmission

Why is infection prevention and control among healthcare workers important during an Ebola outbreak?

Ebola infections among healthcare workers can have devastating effects on healthcare systems and the communities they serve. These infections have led to closing health facilities, distrust in the healthcare system, and sickness and death in many healthcare workers. These effects weaken efforts to control the epidemic and can lead to a collapse of the basic healthcare infrastructure needed to treat more common diseases in the region, like malaria and cholera.

Infection control is a key strategy in stopping the Ebola epidemic and in preventing future outbreaks of disease. Many actions may be taken to improve infection control in both the community and in healthcare settings.

What is CDC doing in West Africa to help improve infection prevention and control?

As part of the overall response, CDC has provided technical guidance and assistance with infection prevention and control trainings in general healthcare settings (non-Ebola treatment units) in Liberia, Sierra Leone, Guinea, and Nigeria. CDC staff are working closely with the World Health Organization (WHO), nongovernmental organizations, and local governments in West Africa to develop and implement training that helps healthcare workers keep themselves and their patients safe. The trainings include information on the transmission of Ebola, infection prevention and control, proper use of personal protective equipment (PPE), and how to safely screen patients for Ebola and isolate PUIs for Ebola.

What are the best ways to prevent the spread of Ebola in general healthcare settings in countries with Ebola outbreaks?

Preventing transmission of Ebola virus requires a well-considered infection control plan that prioritizes four main actions:

1. Identifying and isolating PUIs for Ebola virus disease (EVD)
2. Providing care in a way that protects patients and healthcare workers
3. Cleaning up safely after caring for PUIs  
4. Managing PUIs safely and compassionately

Infection control begins before the patient even enters a facility. Facility staff should designate appropriate areas for screening patients and for safely isolating PUIs. Plans also should include informing the proper public health authorities of PUIs or patients with confirmed EVD, as well as ensuring that PUIs and their families receive appropriate support and information at all stages of care.

What can healthcare workers in general healthcare settings do to protect themselves and their patients from EVD?

Healthcare facilities can take several critical steps to keep healthcare workers safe, even if PPE is not currently available.

One of the most important components of infection control is to immediately screen all patients. Screening should happen as soon as a patient arrives at a healthcare facility. It is very important that all patients be screened before proceeding to the main clinic.

The purpose of screening is to identify patients who may have EVD so they can be separated from other patients and so healthcare workers know when to use appropriate PPE while caring for these patients.

During patient care, healthcare staff also must take steps to prevent the spread of the virus, such as practicing rigorous hand hygiene, wearing appropriate PPE at all times, using proper precautions when handling sharps, and cleaning and disinfecting all patient care areas meticulously according to strict protocols.

What are the guidelines for performing hand hygiene when caring for patients with EVD?

Hand hygiene is the most effective strategy for preventing the spread of infections in any healthcare setting. In addition to proper use of PPE (for example, gloves), hand hygiene helps prevent the spread of Ebola virus.

Hand hygiene should be performed

• Before putting on gloves and PPE
• Before any clean or sterile procedures are performed on a patient
• After any exposure risk or actual exposure to a patient’s blood and body fluids
• After touching (even potentially) contaminated surfaces/items/equipment in the patient’s surroundings
• After removing PPE
• After disposing of PPE

Hand hygiene may be performed with alcohol-based hand sanitizer, soap and water, or, in settings where neither is locally available, a mild (0.05%) chlorine solution.

If hands are visibly soiled, use soap and water, not alcohol-based hand sanitizer.

What PPE should be worn by healthcare workers in general healthcare settings?

PPE alone is not sufficient to prevent the spread of infection. PPE use needs to go hand-in-hand with other infection control measures, including screening and isolating PUIs, handwashing, injection safety, and environmental cleaning and waste management.

Elements of PPE include

• Impermeable (waterproof) gown
• Gloves
• Head cover
• Face mask
• Face shield (goggles can be used if face shield is not available)
• Boots

The process of putting on and removing PPE is just as important as the type of PPE being worn. WHO provides basic instructions for putting on PPE [PDF – 1 page] and for removing PPE [PDF – 1 page].

More information on PPE and other infection control measures [PDF – 134 pages].

For more information from World Health Organization, see Infection Prevention and Control (IPC) Guidance Summary: Ebola Guidance Package.

How often should healthcare workers in general healthcare settings be monitored for symptoms of EVD?

All healthcare workers in areas affected by Ebola should be screened for fever and asked about signs and symptoms every day when arriving at work. Signs and symptoms of Ebola include fever, severe headache, fatigue, muscle pain, vomiting, diarrhea, abdominal (stomach) pain, or unexplained hemorrhage (bruising or bleeding). Healthcare workers who meet the case definition must be removed from patient care to protect other facility staff and patients.