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Ebola virus discovered after cleaning procedures in high isolation unit
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Ebola RNA was recovered from cleaned surfaces in a high isolation unit where a patient infected with the disease had been treated and discharged, researchers wrote in Infection Control and Hospital Epidemiology. They said their findings underscore the importance of careful and extensive terminal disinfection.
“Currently, no studies have been published reporting [Ebola virus (EBOV)] transmission through the environment or through fomites, if not visibly contaminated with bodily fluids,” Vincenzo Puro, MD, of the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome, and colleagues wrote. “However, guidelines strongly support a high level of precautions in environmental cleaning.”
To assess the efficacy of cleaning procedures at their institution, Puro and colleagues collected swab samples from cleaned surfaces in a high isolation unit (HIU) where two patients with EBOV previously were hospitalized. According to the researchers, the rooms were cleaned daily during the patients’ hospitalization with wipes and mops saturated with 0.5% sodium hypochlorite. After patient discharge, all surfaces and reusable equipment were extensively scrubbed with the same solution.
The researchers collected environmental samples with nylon-flocked swabs and tested them for the presence of EBOV using quantitative real-time reverse-transcription PCR. Two swabs collected at the bedside and under a table in the HIU where the first patient was treated from Nov. 24, 2014 to Jan. 2, 2015 tested positive for EBOV. Both areas had been heavily contaminated with bloody vomit, but were routinely cleaned. Although genetic material was detected, there was no viable EBOV, suggesting the solution may have effectively killed the virus. Additional swabs collected after terminal cleaning and on other surfaces were negative.
“According to our findings, the daily cleaning of patient rooms with 0.5% hypochlorite was sufficient to remove EBOV in most cases,” they wrote. “However, viral genetic material was found in areas where heavy contamination had occurred. Imperfect cleaning and intensive contamination by bloody vomit may have contributed to this finding.”
The researchers concluded that more studies are needed to assess the efficacy of the cleaning procedures at other health care facilities.
APIC reports improved preparedness since Ebola outbreak
Two surveys conducted by the Association for Professionals in Infection Control and Epidemiology (APIC) demonstrated a positive change in infection preventionists’ perception of how well their institution is prepared for a patient with Ebola virus.
In October 2014, a few months after WHO declared the Ebola outbreak a public health emergency of international concern, only 6.46% of US infection prevention experts practicing in acute care hospitals said their facility was well-prepared to receive a patient with Ebola, compared with 5.11% who said their facility was not prepared. The survey included responses from 1,039 APIC members, most of whom (39.83%) gave an indirect answer between the two extremes. Areas cited most commonly for requiring additional support included waste management, waste removal and personal protective equipment donning and doffing protocols.
Nearly 1 year later, 981 respondents participated in a follow-up survey. Among them, 92% said their facility was better prepared for a highly lethal infectious disease, and more often claimed to be prepared than not. Nearly three-quarters reported adequate personal protective equipment was available, and 62.4% said they were continuing to train staff on Ebola patient management.
“Though progress has been made toward addressing unanticipated, deadly threats like Ebola, there is still more to do to address infection prevention programs overall,” APIC CEO Katrina Crist, MBA, said in a press release. “We can’t wait for the next crisis to get ready.” – by Stephanie Viguers
Disclosure: Puro and colleagues report no relevant financial disclosures.
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