CDC Issues New Guidelines for Ebola Care

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, 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.

Among other changes, the guidelines say, no skin should be uncovered, street clothes and shoes should be replaced with waterproof fabric and boots, and every step of putting on and taking off equipment must be done under the watch of a supervisor whose job is to prevent mistakes.

The procedures were reviewed by Doctors Without Borders, a medical aid group based in Brussels, and by specialists at the three American hospitals that have successfully cared for Ebola patients - those at Emory University, the University of Nebraska and the National Institutes of Health.

The guidelines represent a recognition by the C.D.C. that Ebola victims require precautions quite different from those taken for airborne diseases like SARS, MERS, avian flu or tuberculosis.

It has never been proved that victims infected anyone 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 gets 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 infectious particles cover its surfaces.

There are some differences between the C.D.C. guidelines intended for American hospitals and those of Doctors Without Borders, which treats 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 spray nurses and doctors down with a chlorine solution as they stand in a gravel pit. That would create slippery puddles in a hospital corridor, so the guidelines recommend bleach wipes.

Since the infection of two nurses at Texas Health Presbyterian Hospital, where the only death from Ebola in the United States occurred, there has been a lot of finger-pointing. Dr. Frieden initially implied that some staff members at Presbyterian had not followed protocols.

A nurses' union responded that the hospital had no protocols, had given the nurses no training and had forced them to work in gear that left skin exposed.

The hospital said it had followed C.D.C. protocols - which were voluntary, not required by law. But those turned out to be inadequate and outdated, designed to prevent routine infections and airborne diseases.

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