Research for infection protection

Hand and Surface decontamination in case of Ebola Virus

On July 17th, 2019 the WHO declared the current Ebola outbreak in the Democratic Republic of the Congo (DRC) as a Public Health Emergency of International Concern (PHEIC). This decision was in response to the risk of geographical expansion of the virus specially to neighboring regions or countries (e.g. Rwanda, Uganda) [1]. According to the European Centre for Disease Prevention and Control (ECDC), the risk of introduction and spread of the virus within the EU remains very low [2]. Nevertheless, certain hand and surface disinfection measures are recommended for the rare occasions when an Ebola patient needs to be treated.


Haemorrhagic fever: symptoms, transmission route and course of the disease

The highly infectious Ebola virus causes haemorrhagic fever in humans, leading to damage of the inner organs and haemorrhages. It has a mortality rate of 30 to 90 per cent. The Ebola virus is transmitted through direct contact with body fluids such as saliva, blood or faeces from patients with Ebola virus disease (EVD) or dead EVD patients. The virus can also be transmitted from infected animals (e.g. monkeys, bats) or surfaces contaminated with infectious fluids.


Recommended hygiene measures

When treating an infected patient, suitable personal protective equipment (PPE) must be worn, especially gloves [3-6]. Wearing two pairs of gloves is recommended during patient care, especially when dealing with large volumes of body fluids and excretions. This helps to reduce any residual risk posed by possible micro perforations in the gloves. In a recently published recommendation (status: 30 Aug. 2018) the CDC recommends two pairs of gloves as a standard protection measure [4].

It is essential that all health workers decontaminate their hands after removing the gloves or after having contact with body fluids or excretions/secretions of Ebola patients. The WHO, CDC and the German Robert Koch-Institute (RKI) recommend decontamination of hands using an alcohol-based hand rub [4-7].  The RKI recommends alcohol-based hand rubs with a proven efficacy against at least enveloped viruses [6-7], as for example Sterillium®. Many hand disinfectants are known to be broadly effective against enveloped viruses [8]. The WHO recommends decontamination of visibly soiled hands using soap and water [5], however we believe that hand washing alone is not the most effective decontamination method.


Disinfection of gloved hands

According to CDC gloved hands should be disinfected frequently during patient care, particularly after handling body fluids, and several times during the process of PPE donning and doffing. CDC recommends an alcohol based hand rub for disinfection of gloved hands, in certain cases also EPA-registered disinfectant wipes can be used [4].


Recommendations for the decontamination of surfaces in patient rooms

There is evidence that surfaces close to the patient are rarely contaminated with Ebola virus, if not visibly soiled [9]. Ebola belongs to the family of filoviruses (Filoviridae). These can remain infectious between five days [10] and three weeks [11]. The following recommendations apply to the surface disinfection for Ebola virus:

  • CDC and RKI recommend surface disinfection in patient rooms, including surfaces that are not visibly contaminated [3,4,7].
  • WHO recommends cleaning and disinfecting surfaces or objects contaminated with body fluids, secretions or excretions as quickly as possible. Surfaces should be cleaned prior to disinfection. Floors and horizontal work surfaces are to be cleaned with clean water and cleaning agent at least once per day [5].
  • RKI recommends removing visible soiling, for example, blood with a single-use wipe saturated with disinfectant. These areas should be wipe-disinfected twice before the disinfection of the entire surface [7].
  • The RKI recommends the use of a pathogen specific disinfectant (effective against enveloped viruses) [6,7]. For smaller surfaces, Bacillol® 30 Tissues are well suitable, for larger surfaces Mikrobac® forte can be used.

The Ebola virus will usually spread via body fluids. Therefore, it is recommended to use the surface disinfectant under "dirty conditions". The disinfected areas should only be used after the exposure time specified by the manufacturer has elapsed.

Products with activity against enveloped viruses are required to render Ebola virus inactive. Find relevant products here.

Use biocides safely. Always read the label and product information before use.

References:
1. WHO. 51. Situation report on the Ebola outbreak in North Kivu. Status: 23.07.2019 (last reviewed on 14.08.2019)
2. ECDC. Ebola virus disease outbreak in North Kivu and Ituri Provinces, Democratic Republic of the Congo – fifth update. Status: 19.07.2019 (last reviewed on 14.08.2019)
3. CDC. Infection Prevention and Control Recommendations for Hospitalized Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD) in U.S. Hospitals. Status: 30.08.2018. (last reviewed on 14.08.2019)
4. CDC. Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE. Status: 30.08.2018. (last reviewed on 14.08.2019).
5. WHO. Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola. Status: September 2014 (last reviewed on 14.08.2019).
6. Robert Koch-Institut. Rahmenkonzept Ebolafieber. Status: 01.03.2019 (last reviewed on 14.08.2019).
7.  Robert Koch-Institut. Maßnahmen zur Desinfektion und Abfall/Abwasserentsorgung im Zusammenhang mit einem begründeten Ebolafieber-Verdachtsfall in Deutschland. Status: 27.12.2018 (last reviewed on 14.08.2019). 
8. Kampf G, Steinmann J, Rabenau H. Suitability of vaccinia virus and bovine viral diarrhea virus (BVDV) for determining activities of three commonly-used alcohol-based hand rubs against enveloped viruses. BMC Infectious Diseases. 2007;7:5.
9. Bausch DG, Towner JS, Dowell SF, et al. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J Infect Dis. 2007;196 Suppl 2:S142-7.
10. Belanov EF, Muntianov VP, Kriuk VD, et al. Survival of Marburg virus infectivity on contaminated surfaces and in aerosols. Vopr Virusol. 1996;41(1):32-4.
11. Piercy TJ, Smither SJ, Steward JA, Eastaugh L, Lever MS. The survival of filoviruses in liquids, on solid substrates and in a dynamic aerosol. J Appl Microbiol.109, 1531-1539.