Ebola Resources for Respiratory Therapists
In late 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. This AARC website provides vital answers to the questions many respiratory therapists are asking.
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.
The AARC understands that, while the FAQ may answer a few questions, it is not inclusive of all information regarding Ebola virus disease. It is recommended to visit the websites below for complete Ebola virus disease information.
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. Ebola is not spread by air, water, or food. It can be spread by infected animals.
The CDC has several resources for understanding the transmission of Ebola virus, including an infographic about transmission and an infographic about why Ebola is not likely to become airborne.
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.
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.”
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.
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. The CDC has published guidance for cleaning and disinfecting hospital equipment.
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.
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.
Reusable equipment, including mechanical ventilators, should be cleaned and disinfected according to the manufacturer’s instructions. Please remember to wear correct personal protective equipment while cleaning non-disposable equipment.
Guidance on Ebola
- American Hospital Association CME Education Package (Oct. 14, 2014).
- Extracorporeal Life Support Organization (ELSO): Position Statement on the Use of Extracorporeal Life Support in Patients with Ebola Virus Disease (Oct. 20, 2014)
- Occupational Safety & Health Administration: Ebola.
- U.S. Department of Health and Human Services/Public Health Emergency Ebola Information for Healthcare Professionals and Healthcare Settings
- Ansari AA. Clinical features and pathobiology of Ebolavirus infection. J Autoimmunology, 2014 [Epub ahead of print] doi: 10.1016/j.jaut.2014.09.001
- Dawson AJ. Ebola: what it tells us about medical ethics. J Med Ethics 2015;41:107-110.
- Decker BK, Sevransky JE, Barrett K, Davey RT, Chertow DS. Preparing for critical care services to patients with Ebola. Ann Intern Med 2014 [Epub ahead of print] doi:10.7326/M14-2141
- Epstein JM, Sauer LM, Chelen J, Hatna E, Parker J, Rothman RE, Rubinson L. Infectious disease: mobilizing Ebola survivors to curb the epidemic. Nature 2014;516(7531):323-5.
- Gostin LO, Hodge JG, Burris S. Is the United States prepared for Ebola? JAMA 2014 [Epub ahead of print] doi:10.1001/jama.2014.15041
- Hodge JG, Gostin LO, Hanfling D, Hick JL. Law, medicine, and public health preparedness: the case of ebola. Law and the Public’s Health, 2015;130:1-4.
- Kortepeter MG, Smith PW, Hewlette A, Cieslak TJ. Caring for patients with Ebola: a challenge in any care facility. Ann Intern Med 2014 [Epub ahead of print] doi:10.7326/M14-2289
- Kreuels B, Wichmann D, Emmerich P, Schmidt-Chanasit J, de Heer G, Kluge S, Sow A, et al. A case of severe ebola virus infection complicated by gram-negative septicemia. N Engl J Med 2014. [Epub ahead of print] doi: 10.1056/NEJMoa1411677.
- Mandl KD. Ebola in the United States: EHRs as a public health tool at the point of care. JAMA 2014 [Epub ahead of print] doi:10.1001/jama.2014.15064
- Matlock AM, Gutierrez D, Wallen G, Hastings C. Providing nursing care to Ebola patients on the national stage: the National Institutes of Health experience. Nurs Outlook 2015;63:21-24.
- Rubinson L. From clinician to suspect case: my experience after a needle stick in an Ebola Treatment Unit in Sierra Leone. Am J Trop Med Hyg 2015 [Epub ahead of print] doi:0.4269/ajtmh.14-0769
- Schwedhelm S, Beam EL, Morris RD, Sebastian JG. Reflections on interprofessional team-based clinical care in the Ebola epidemic: the Nebraska Medicine experience. Nurs Outlook 2015;63:27-29.
- Ulrich CM, Grady C. Cardiopulmonary resuscitation for Ebola patients: ethical considerations. Nurs Outlook 2015;63:16-18.
Archived webinars from the CDC
- CDC COCA Call: Caring for Patients with Ebola in U.S Hospitals. (Nov. 24, 2014)
- CDC/Joint Commission Webinar: Ebola Preparedness (Oct. 30, 2014)
- Public Health Emergency National Call: Preparing America’s Nurses to Safely Care for a Patient with Ebola (Oct. 16, 2014)
- Public Health Emergency Hospital Preparedness Call: Preparing Your Healthcare System for Ebola (Oct. 20, 2014)
- CDC COCA Call: Approaches to Clinical Management for Patients with Ebola treated in U.S. Hospitals (Oct. 20, 2014)
- Greater New York Hospital Association: Ebola Educational Session (Oct. 21, 2014)
- Public Health Emergency Webinar: Ebola Preparedness for Emergency Medical Services (Oct. 22, 2014)
- CDC COCA Call: Preparing for Ebola: What U.S. Hospitals Can Learn from Emory Healthcare and Nebraska Medical Center (Oct. 14, 2014)
- Ebola Preparedness for the U.S. Healthcare System (Sept. 29, 2014)
CDC Websites of Interest
- Q&A about the Transport of Pediatric Patients (<18 years) Under Investigation or with Confirmed Ebola. (Feb. 2, 2015)
- Guidance for U.S. Laboratories for Managing and Testing Routine Clinical Specimens When There is a Concern about Ebola Virus Disease. (Jan. 30, 2015)
- Interim Guidance for U.S. Hospital Preparedness for Patients with Possible or Confirmed Ebola Virus Disease (Dec. 2, 2014)
- Interim Guidance for Preparing Ebola Assessment Hospitals (Dec. 2, 2014)
- Interim Guidance for Preparing Ebola Treatment Centers (Dec. 2, 2014)
- Current Ebola Treatment Centers (Dec. 2, 2014)
- Determining Risk of Ebola Transmission in Healthcare and Community Settings. (Nov. 25, 2014)
- Respiratory Protection for Ebola for use in U.S. Hospitals. (video) (Nov. 10, 2014)
- Guidance for Screening and Caring for Pregnant Women with Ebola Virus Disease for Healthcare Providers in U.S. Hospitals. (Nov. 12, 2014)
- Resources for Parents, Schools, and Pediatric Healthcare Professionals (Nov. 4, 2014)
- Interim Guidance for the U.S. Residence Decontamination for Ebola and Removal of Contaminated Waste (Nov. 4, 2014)
- Ambulatory Care Evaluation of Patients with Possible Ebola Virus Disease (Nov. 1, 2014)
- Considerations for Discharging Persons Under Investigation (PUI) for Ebola Virus Disease (Ebola) (Oct. 30, 2014)
- Interim US Guidance for Monitoring and Movement of Persons with Potential Ebola Virus Exposure (Oct. 29, 2014)
- Case Definition for Ebola Virus Disease (EVD) (Oct. 27, 2014)
- Epidemiologic Risk Factors to Consider when Evaluating a Person for Exposure to Ebola Virus (Oct. 27, 2014)
- Emergency Department Evaluation and Management for Patient Who Present with Possible Ebola Virus Disease. (Oct. 25, 2014)
- When Caring for Suspect or Confirmed Patients with Ebola (Oct. 20, 2014)
- Information for Healthcare Workers and Settings (Oct. 20, 2014)
- Review of Human-to-Human Transmission of Ebola Virus (Updated Oct. 17, 2014).
- Ebola (Ebola Virus Disease).
- Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings.