Ebola Information for Respiratory Therapists
December 9, 2014
In 2014, the first case of Ebola outside of Africa was reported in Dallas, Texas, and was soon followed by the first case of Ebola contracted in the United States from an infected person. Many hospitals are increasing screening for Ebola to help stop the spread of the virus. In this document, the AARC provides vital answers to the questions many respiratory therapists are asking.
The AARC understands that, while this document may answer a few questions, it is not inclusive of all information regarding Ebola virus disease. It is recommended to visit the following websites for complete Ebola virus disease information.
In addition to the above websites, the CDC has archived webinars:
Personal Protective Equipment
The CDC updated the PPE recommendations on Oct. 20, 2014. The CDC emphasizes training, practice, competence, and observation of healthcare providers with regards to necessary PPE procedures to ensure safety of the HCP and the reduced risk of transmission of Ebola. In addition to the updated, comprehensive CDC guidelines, the webpage provides access to PPE materials from Emory Healthcare, the University of Nebraska Medical Center, Medecins Sans Frontieres (Doctors without Boarders), and the World Health Organization. The Oct. 20, 2014 press release provides a review of the updated guidelines.
The AARC is communicating regularly with the Centers for Disease Control and Prevention and other agencies to ensure that respiratory therapists have the most up to date information. If you would like to monitor the frequent updates from the CDC, follow them on Twitter @CDCgov or “like” their Facebook page (CDC).
How is the Ebola virus transmitted?
The virus is spread from human to human by direct contact with blood or body fluids of a person who has been infected with Ebola. Infection is transmitted through broken skin or mucous membranes (eyes, nose, mouth) that have come into contact with blood or body fluids like urine, saliva, sweat, feces, vomit, breast milk, and semen from a person with the Ebola virus. Objects like needles and syringes that have been contaminated with the virus can be a source of transmission as well.1
Ebola is not spread by air, water, or food. It can be spread by infected animals.1
What are the signs and symptoms of Ebola?
The typical signs and symptoms of Ebola infection include a fever greater than 101.5 degrees Fahrenheit (38.6 degrees Celsius), severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and unexplained hemorrhage. It is important to know that symptoms caused by the Ebola virus will not show up right after exposure. Symptoms manifest between 2 and 21 days after exposure, though most patients show signs and symptoms around days 8–10.2
Is it possible to survive Ebola infection?
Yes. The Centers for Disease Control and Prevention states, “Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.”2
What is the most effective way to screen patients for Ebola?
The CDC has a checklist for patients being evaluated for Ebola virus in the US.
Should the respiratory therapist take special precautions when delivering nebulized medication to patients infected with Ebola?
The CDC list of aerosol generating procedures includes BiPAP, bronchoscopy, sputum induction, intubation, extubation, and open suctioning of the airway. While nebulization of aerosolized medication is not listed, it is logical to include this procedure in the list of aerosol generating procedures. If performing an aerosol generating procedure is deemed necessary, it is ideal for the patient to be located in a private, airborne infection isolation room. The doors should remain shut during the procedure except when leaving and entering the room. It is important to minimize entry and exit for the room during and after the procedure. The guidelines for performing aerosol generating procedures add the use of an N95 filtered mask respirator during the procedure to the list of personal protective equipment for health care providers. Visitors should not be present during the procedure and the number of health care providers in the room during the procedure should be minimized. The CDC does recommend avoiding these procedures for patients infected with Ebola, if possible. It is prudent to suggest delivering inhaled medications via metered dose inhaler with spacer instead of nebulizer whenever possible.3
Should the respiratory therapist take special precautions or steps when cleaning non-disposable equipment used by patients infected with Ebola?
Ebola can be killed with hospital-grade disinfectants (including bleach). The virus can last on surfaces (desks, countertops, etc.) for several hours. If there is a bodily fluid on the surface (like a drop of blood), the virus can survive up to several days at room temperature. It is very important to clean all surfaces thoroughly with hospital-grade disinfectants.4
OSHA states to cover a spill with a paper towel or other absorbent material and then pour disinfectant on the towel to saturate the area. Allow the bleach to soak into spills at least 30 minutes before cleaning to ensure the virus has been killed. It is recommended to use an EPA-registered disinfectant suitable for non-enveloped viruses (like adenovirus and poliovirus) to treat contaminations or spills.5,6
It is also important to remember that each room should have adequate ventilation prior to using these very strong substances to clean surfaces and to remain clothed in your personal protective equipment, including face masks, during the cleaning process. Note that your facemask uses to prevent the spread of Ebola may not be enough to protect you from the cleaning agent. Make sure to follow the Material Safety Data Sheet recommendations for each agent.6
Reusable equipment, including mechanical ventilators, should be cleaned and disinfected according to the manufacturer’s instructions.7 Please remember to wear correct personal protective equipment while cleaning non-disposable equipment.