Protection Measures in U.S. Hospitals

Personal Protective Equipment (PPE) Used in U.S. Hospitals

Four options for PPE were used effectively to protect healthcare workers in the three facilities where patients with Ebola were treated in the United States. Each hospital evaluated which version of the recommended PPE was most comfortable to wear and work in, and what they were able to put on and take off most effectively, consistently, and safely. 

CDC guidance permitted options for PPE as long as the essential principles were followed. The differences among the PPEs displayed are examples of three effective but varied protocols. Nebraska Biocontainment Unit staff used a fluid-resistant head cover with a full face shield and surgical mask to protect the face, mouth, nose and eyes. The face shield covered the forehead, extended below the chin, and wrapped around the side of the face. Emory staff used a power air purifying respirator (PAPR) hood shroud to ensure that no facial or neck skin was exposed. Bellevue added the PAPR battery-powered helmet under the hood shroud.  All variations were in compliance with CDC’s recommendations for U.S. healthcare workers caring for patients with Ebola.

Below is an example of the PPE head cover used in hospitals in the U.S.

These signs with detailed PPE donning and doffing instructions hung in the Ebola isolation unit at Bellevue Hospital. Doffing began in the “hot,” or red zone (the patient room), moved to the “warm,” or yellow zone (the ante-room), and, finally, the “cold,” or green zone. Only specific PPE items were removed in each of the zones as the caregiver moved from red to green. Photographs courtesy of NYC Health + Hospitals/Bellevue.

Waste Management 

A single Ebola patient treated in a U.S. hospital generates eight 55-gallon barrels of medical waste each day. The term “waste” includes PPE such as gloves, gowns, respirators, and shoe covers donned and doffed by all who attended to the patient; disposable medical instruments; packaging; bed linens; cups; plates; tissues; towels; and anything used to clean up after the patient.  All of these items are considered infectious “waste,” and have to be destroyed. 

How hospitals handled and disposed of medical waste without triggering new infections was one of the main challenges facing U.S. hospitals preparing for an Ebola patient. In response, along with enhanced guidelines and strict oversight for tightened PPE use, CDC provided detailed guidance for environmental infection control in hospitals, which outlined measures to address the safe handling and management of Ebola-associated waste.

Nebraska Autoclave

An autoclave uses steam under pressure to sterilize equipment, and was a surefire way to destroy infected waste materials. The Nebraska Medical Center Biocontainment Unit was equipped with an autoclave and used it as their effective form of sterilization. Photograph courtesy of University of Nebraska Medical Center

Mamora, Josia

Josia Mamora

Josia Mamora, nurse at Emory University Hospital, discusses donning and doffing procedures in preparation for the Ebola patients they would care for.