Case Study: Nebraska’s Ebola isolation and decontamination approach

Washington, DC, March 2, 2015

The Nebraska Biocontainment Unit (NBU), located at the Nebraska Medical Center, has shared its protocol for Ebola patient discharge, handling a patient’s body after death and environmental disinfection in the March issue of the American Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

Discharge process for a patient treated for EVD
Patients are discharged after two consecutive blood samples taken 24-hours apart are confirmed undetectable for Ebola virus (EVD). After all surfaces are cleaned and mopped by healthcare workers, the patient dons a clean, disposable gown and takes a 10-minute chlorhexidine-gluconate shower. While showering, the path the patient walked to the shower is mopped with hospital-grade disinfectant. Then the patient dons another clean, disposable gown with shoe covers and is met by a healthcare worker in full personal protective equipment (PPE), who escorts the patient to the NBU exit corridor. Here the patient undergoes another 10-minute CHG shower before changing into clean street clothes and leaving the facility.

Body removal for a patient with EVD
After a patient with EVD dies, the patient is identified by a family member through a video link and then healthcare workers place dressings over the body and wrap it in bed sheets. The body is then moved to a double heat sealed, biosafety level 4 containment bag, and the bag and the bed are then disinfected with bleach.  Two healthcare workers in PPE transfer the body into two 18-mil-thick leak-proof, laminated vinyl bags and close, seal, and disinfect the bags. This process is repeated with a second, identical vinyl bag before the body is removed from the hospital to the funeral home, where, after receiving permission from the family, it is cremated.

Environmental decontamination of isolation unit
After discharge, the patient room is cleared of linen and solid waste by personnel in full PPE and the unit is sealed and left undisturbed for 48 hours while 15-19 high-efficiency particulate absorption-filtered air exchanges per hour flow throughout the unit to promote desiccation of EVD. Healthcare workers then decontaminate the unit via manual disinfection and ultraviolet germicidal irradiation (UVGI). All floors are mopped twice with hospital-grade disinfectant and medical equipment is disinfected according to manufacturer recommendations. Four UVGI generators are used as a final step after all surfaces have been bleach wiped, clustering multiple generators around equipment to reduce shadows. After UVGI, the unit is sealed once again for 48-hours to promote further desiccation. After this, the unit is deemed safe for entry without PPE.

“We acknowledge that our cleaning procedures go well beyond what is required to return the patient care area back to a safe environment,” state the study authors. “However, given the morbidity and mortality of EVD, and the misinformation regarding the spread of the Ebola virus, our additional cleaning measures represent a cost-effective way to ensure safety and address public perception.”

APIC has compiled a resource center for healthcare workers looking for more information on Ebola.

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Notes for Editors  
“Nebraska Biocontainment Unit patient discharge and environmental contamination after Ebola care,” by Katelyn C. Jelden, Shawn G. Gibbs, Philip W. Smith, Michelle M. Schwedhelm, Peter C. Iwen, Elizabeth L. Beam, A. Kim Hayes, Nedra Marion, Christopher J. Kratochvil, Kathleen C. Boulter, Angela L. Hewlett, and John J. Lowe appears in the American Journal of Infection Control, Volume 43, Issue 3 (March 2015).

Authors
Katelyn C. Jelden, BS
Department of Environmental, Agricultural and Occupational Health
University of Nebraska Medical Center
Omaha, NE

Shawn G. Gibbs, PhD
Department of Environmental, Agricultural and Occupational Health
University of Nebraska Medical Center
Omaha, NE

Philip W. Smith, MD
Nebraska Biocontainment Unit, Nebraska Medicine
Omaha, NE

Michelle M. Schwedhelm, MSN
Nebraska Biocontainment Unit, Nebraska Medicine
Omaha, NE

Peter C. Iwen, PhD
Department of Pathology and Microbiology
University of Nebraska Medical Center
Omaha, NE

Elizabeth L. Beam, MSN
Nebraska Biocontainment Unit, Nebraska Medicine
Omaha, NE

A. Kim Hayes, RN
Division of Infection Control and Epidemiology, Nebraska Medicine
Omaha, NE

Nedra Marion, MPA
Division of Infection Control and Epidemiology, Nebraska Medicine
Omaha, NE

Christopher J. Kratochvil, MD
Office of the Vice Chancellor for Research
University of Nebraska Medical Center
Omaha, NE

Kathleen C. Boulter, BA
Nebraska Biocontainment Unit, Nebraska Medicine
Omaha, NE

Angela L. Hewlett, MD
Nebraska Biocontainment Unit, Nebraska Medicine
Omaha, NE

John J. Lowe, PhD (*Corresponding Author)
Department of Environmental, Agricultural and Occupational Health
University of Nebraska Medical Center
Omaha, NE

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control (www.ajicjournal.org) covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

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APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: http://twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou

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Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Elsevier Research Intelligenceand ClinicalKey — and publishes nearly 2,200 journals, including The Lancet and Cell, and over 33,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group plc, a world-leading provider of information solutions for professional customers across industries.

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries. www.elsevier.com

Media contact
Liz Garman
+1 202 454 2604
egarman@apic.org