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The World Health Organization's (WHO) updated infection prevention and control (IPC) guideline for Ebola and Marburg disease aims to address "inappropriate practices" in the management of these outbreaks, according to a summary of the recommendations.

"Cumulative experience during past outbreaks justified a review of existing IPC recommendations," wrote Victoria Willet, RN, of the WHO in Geneva, and colleagues in .

"Examples include the notion that more personal protective equipment (PPE) is always better than less personal PPE, as well as the routine spraying of chlorine for disinfection despite previous WHO recommendations against this practice," they commented.

Outbreaks of Ebola and Marburg disease have continued to occur since the Zaire Ebola virus outbreak in West Africa during 2014 to 2016. For example, the latest outbreak of Ebola occurred in Uganda, beginning in September 2022 and ending in January 2023.

Excessive or inappropriate use of PPE is associated with adverse effects for healthcare workers and negative impacts on the environment, they noted. Spraying workers and the environment with chlorine during Ebola and Marburg virus outbreaks remains a common practice, but causes adverse ocular, respiratory, and skin reactions. Instead, the WHO recommends wiping potentially contaminated surfaces with disinfectant.

One example of confusion surrounding PPE use is that some facilities rely on double gloving with variable approaches to changing gloves between patients and glove disinfection, Willet and colleagues pointed out. The new , which were published last August, clarify when double or single gloving should be used, how to disinfect gloves, and when to change gloves between patients.

The updated guideline, which replaces those issued in 2014 and 2016, includes 11 new recommendations and 10 new good practice statements. Although the guideline continues to strongly recommend the appropriate use of PPE as a control measure, the authors of the summary emphasized that isolating people from infected individuals (engineering controls) and changing the way people work (administrative controls) should be prioritized because they create a barrier between infected patients and healthcare workers. However, such an approach requires knowledge about these principles and collaboration among different agencies and stakeholders to be successful, they noted.

The guideline also focuses on the concept of the IPC "ring" approach -- rapid mobilization of teams in geographical at-risk areas where there are infected individuals -- as well as recommendations for screening, triage, patient care, environmental cleaning, and safe burial practices to limit potential exposure of healthcare workers. Willet and colleagues also offered a visual summary that clearly outlines these recommendations.

"Consistently and rigorously applied IPC measures against potentially highly fatal Ebolavirus and Marburgvirus are essential to halt transmission of the diseases caused by these viruses," they emphasized.

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