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CDC releases recommendations for preventing Zika spread in delivery, labor settings

It is essential that health providers in obstetrical care, including in labor and delivery settings, follow Standard Precautions to prevent the transmission of Zika virus from patients to personnel, according to report published in Morbidity and Mortality Weekly Report.

According to the CDC report, there are “varying levels of adherence to Stand Precautions in health care settings, including labor and delivery units,” despite the substantial risk for exposure to blood and bodily fluids. Reported obstacles to meeting the standards include the perceived discomfort associated with certain protective equipment, the lack of time in urgent clinical situations, thinking the patient poses a minimal risk, and concerns regarding interference with patient care.

“Zika virus RNA has been detected in a number of bodily fluids, including blood, urine, saliva and amniotic fluid, and whereas transmission associated with occupational exposure to these body fluids is theoretically possible, it has not been documented,” Christine K. Olson, MD, of the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and colleagues wrote. “Although there are no reports of transmission of Zika virus from infected patients to health care personnel or other patients, minimizing exposures to body fluids is important to reduce the possibility of such transmission.”

The CDC recommends the use of Standard Precautions in all health care settings, stating they represent the minimum of infection prevention expectations. They include:

• hand hygiene;
• use of personal protective equipment (PPE);
• respiratory hygiene and cough etiquette;
• safe injection practices; and
• safe handling of potentially contaminated equipment or surfaces in the patient environment.

In labor and delivery settings specifically, the CDC recommends the use of eye protection during deliveries, and the use of double gloves to minimize the risk for injury while handling sharp objects.

“Health care personnel must assess the likelihood of body fluid exposure, based on the type of contact and the nature of the procedure or activity, and the use of appropriate PPE,” Olson and colleagues wrote. “For example, because the risk for splashes to areas of the body other than the hands is small when performing vaginal examinations of pregnant women with minimal cervical dilation and intact membranes, only gloves are required.”

According to the CDC, the increased risk of exposure should be paired with an increase in the use of appropriate PPE, including gloves, impermeable gowns, eye protection and masks.

“When performing procedures including vaginal deliveries, manual placenta removal, bimanual uterine massage and repair of vaginal lacerations, PPE should include (in addition to mucous membrane skin protection) impermeable gowns and knee-high impermeable shoe covers,” Olson and colleagues wrote. “Clothing, skin and mucous membrane protections should be maintained for procedures performed in operating room settings.”

First detected in the Americas in May 2015 in Brazil, local mosquito-borne transmission of Zika virus has, as of March 21, been reported in 32 countries and territories in the region, including Puerto Rico and the U.S. Virgin Islands.

According to the CDC, increasing evidence supports a link between infection during pregnancy and adverse pregnancy and birth outcomes, including a possible association with Guillain-Barré syndrome. – by Jason Laday

Disclosure: The authors report no relevant financial disclosures.