• Aligned guidance to the most recent Centers for Disease Control and Prevention (CDC) guidance on PPE in U.S. healthcare settings for Clinically Stable Patients Suspected to have VHF and for Confirmed Patients and Clinically Unstable Patients Suspected to have VHF, which applies to selected VHFs in addition to Ebola.
• Applied guidance to the expanded list of selected VHFs included in CDC's guidance:  Ebola, Marburg, Lassa, Crimean Congo Hemorrhagic Fever (CCHF) and the South American Hemorrhagic Fevers (i.e., those caused by Junin, Machupo, Chapare, Guanarito and Sabia viruses).
• Maintained alignment with Cal/OSHA Interim Guidance on EVD (PDF) and Cal/OSHA Interim Guidance on EVD for Hospitals (PDF) which can reasonably be applied to the expanded list of selected VHFs in CDC's guidance.​
  

Since the last revision of this guidance in November 2022, there have been four outbreaks of Marburg Virus Disease (MVD) and one outbreak of Ebola disease caused by Sudan virus. A fatal case of Lassa fever in a U.S. resident who had recently returned from West Africa was reported in 2024. There is growing awareness of the potential risks of VHFs to HCP from travelers returning from VHF-affected countries. CDC has updated their Ebola infection prevention and control recommendations to apply to selected VHFs including Ebola, Marburg, Lassa, Crimean Congo Hemorrhagic Fever (CCHF) and the South American Hemorrhagic Fevers (i.e., those caused by Junin, Machupo, Chapare, Guanarito and Sabia viruses).

The CDC recommendations for PPE use in the care of patients with selected VHFs in U.S. healthcare settings, along with Cal/OSHA Interim Guidance on EVD for Hospitals (PDF), provide a framework for California hospitals to successfully evaluate and manage patients with these suspected or confirmed VHF infections while protecting HCP.

Key features of CDC's and Cal/OSHA's guidance remain:

• The use of an ensemble of PPE intended to prevent skin and mucous membrane exposure and inhalation of infectious aerosols, including gloves, fluid-resistant or impermeable body coverings, hood, eye and face protection (face shield, not goggles), and respiratory protection;
• The implementation of rigorous and repeated employee training with demonstration of competency on the correct use of PPE, particularly when removing (doffing) PPE;
• The use of an onsite manager to supervise HCP providing care at all times, as well as a trained observer to ensure that PPE is donned, used, and doffed correctly; and
• The designation and management of specific areas for PPE donning and doffing.

CDC's guidance on the level and use of PPE for the protection of HCP caring for patients with suspected or confirmed infection with selected VHF differs depending on the clinical symptoms and presentation of the patient and the associated risks for HCP exposures to infectious blood or body fluids. In addition, recognizing that aerosol-generating procedures (e.g., intubation, suctioning, resuscitation) may be unexpected, Cal/OSHA's guidance on EVD for hospitals, which can reasonably be applied to the expanded list of selected VHF in CDC's guidance, includes respiratory protection at all times, including for HCP caring for patients suspected to have selected VHF who are clinically stable and do not have bleeding, vomiting, or diarrhea.

Therefore, CDPH maintains the following California-specific guidance:

PPE recommendations for HCP caring for the clinically stable patient with suspected or confirmed infection with selected VHF without symptoms of bleeding, vomiting, or diarrhea and without a clinical condition that may warrant invasive or aerosol-generating procedures include:

• PPE material that is single-use (disposable) and fluid resistant or impermeable;
• PPE that covers all surfaces of the body, including the head and neck, coverings for the eyes, mouth, nose, and skin. The hair must be completely enclosed;
• A face shield (not goggles) and surgical N95 (or higher) respirator (i.e., Powered Air-Purifying Respirator [PAPR] not required);
• An isolation gown extending to at least mid-calf (i.e., coverall not required);
• Two or more pairs of gloves with extended cuffs on outer gloves (to facilitate the doffing of PPE and decontamination); and
• Boots or coverings for the feet and lower legs.

For patients with suspected or confirmed infection with selected VHF who exhibit bleeding, vomiting, diarrhea, a clinical condition that may warrant invasive or aerosol-generating procedures (e.g., intubation, suctioning, resuscitation), or overall worsening of symptoms, the recommended level of PPE for HCP caring for or moving the patient and for all persons working in the patient room includes:

• PPE material that is single-use (disposable) and fluid impermeable;
• PPE that covers all surfaces of the body, including the head and neck, coverings for the eyes, mouth, nose, and skin. The hair must be completely enclosed;
• A coverall with integrated feet;
• An apron covering torso to mid-calf;
• Two or more pairs of gloves with extended cuffs on outer gloves (to facilitate the doffing of PPE and decontamination);
• Boots or coverings for the feet and lower legs. To provide continuous fluid protection, under socks or under boots that are integrated into the coverall, or protection that is equivalent, should be provided; and
• A Powered Air-Purifying Respirator (PAPR) with full cowl or hood.
  

HCP who assist other HCP with the doffing of contaminated or potentially contaminated PPE must use PPE with the same level of protection as the person who is doffing PPE.​

CDPH recommends that the hospital's Medical Director for Infection Prevention and Control and/or Infection Preventionist regularly assess the status of the patient with suspected or confirmed selected VHF and determine the appropriate level of PPE based on symptoms and clinical status on an ongoing basis during the care of the patient.​

Originally published November 6, 2014​