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Nebraska Biocontainment Unit outlines protocol for patient discharge after Ebola
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The Nebraska Biocontainment Unit at the Nebraska Medical Center, which treated several American patients who acquired Ebola virus in West Africa, released its protocol for patient discharge, handling a patient’s body after death and environmental disinfection, as well as handling medical waste.
Patients with Ebola are discharged after two consecutive blood samples, 24 hours apart, are confirmed undetectable. All of the surfaces are cleaned by health care workers, the patient dons a clean, disposable gown and takes a 10-minute chlorhexidine-gluconate shower while the path to the shower is mopped. The patient dons another gown, and is escorted to the exit corridor of the containment unit by a health care worker in full personal protective equipment (PPE). The patient takes another 10 minute chlorhexidine shower, and can change into street clothes and leave.
If a patient dies, the body is identified through a video link. The body is covered with dressings, wrapped in bed sheets and moved to a double heat-sealed, biosafety level 4 containment bag. The back and bed are disinfected with bleach. Two health care workers in PPE transfer the body to two, 18-mil-thick leakproof laminated bags that are closed, sealed and disinfected. The process is repeated with another identical vinyl bag and removed from the hospital to the funeral home.
Lastly, when a patient is discharged, the room is cleared of linen and solid waste, sealed and left undisturbed while 15 to 19 high-efficiency, particulate absorption-filtered air exchanges per hour flow through the unit. After 48 hours, health care workers decontaminate the unit with manual disinfection and ultraviolet germicidal irradiation. The floors are mopped twice with hospital-grade disinfectant, and medical equipment is disinfected. Four ultraviolet germicidal irradiation generators are used after all surfaces have been bleach wiped. The unit is sealed for 48 hours, and then 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,” the researchers wrote in American Journal of Infection Control. “However, given the morbidity and mortality of Ebola, and the misinformation regarding the spread of Ebola virus, our additional cleaning measures represent a cost-effective way to ensure safety and address public perception.”
In a second article, the team also documented the process for the removal of medical waste. Medical waste generated by a patient with Ebola is regulated as category A infectious substances and requires transportation compliant with the Department of Transportation category A infectious substances regulations. Medical waste include textiles, liquid and solid waste.
The Nebraska Biocontainment Unit includes a pass-through autoclave that allows for sterilization of solid waste. After autoclave sterilization, the waste is retrieved and placed into a biohazard bag in a watertight receptacle and disposed as category B medical waste. Caring for one patient generated 1,011 pounds of solid waste, mostly PPE. Liquid waste generated by patients was placed into the toilet with hospital grade disinfectant, held for 2.5 times the recommended contact time and flushed. One patient may generate up to 9 L of waste per day. – by Emily Shafer
Disclosure: The researchers report no relevant financial disclosures.
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