AHA strongly questions CDC smallpox plan
Agency inconsistent with other standards
The Centers for Disease Control and Prevention’s (CDC) smallpox response plan is not consistent with its existing standards and those set by other authoritative groups, the American Hospital Association (AHA) warns. "Some of the recommendations could substantially increase confusion or promote misinformation at a time when implementation of standard procedures would be critical," the AHA stated in comments to the CDC.
The CDC released the Interim Smallpox Response Plan and Guidelines as a working document subject to comment and revision. Dated March 8, 2002, the comments sent to the CDC by the AHA and the other aforementioned hospital groups included the following points:
The current version of the plan’s recommendations appears to draw heavily from experiences from outbreaks in Europe in the early 1970s. However, review of primary references that described these outbreaks reveals physical facility and ventilation designs that differ dramatically from contemporary U.S. health care facilities. Descriptions of the smallpox outbreak investigations, particularly the numerous reports concerning the outbreak at the Meschede hospital in Germany, reveal that the air supply was shared and ventilation was accomplished by opening windows and doors.
By contrast, U.S. hospitals today require the use of more effective procedures, such as airborne infection isolation rooms (AIIRs) that supply negative air pressure at 6-12 air changes/hour. According to current standards, exhaust from AIIRs is either direct to the outside or, if recirculated, passed initially through HEPA (high efficiency particulate air) filters. This design is deemed effective for tuberculosis and chicken-pox, and therefore, also likely effective for the less hardy smallpox virus.
The [CDC] recommendations call for the use of buildings other than hospitals for "contagious patients, such as nursing homes and hotels." Yet hospitals are the only buildings likely to have negative pressure rooms with 100% exhausted air (or recirculated air through HEPA filters). Further, the complexity of equipment needed to care for critically ill persons is also unlikely to be readily available in a facility that does not provide health care.
The plan should not limit recommendations regarding medical waste treatment to incineration and/or autoclaving. Instead, CDC should consider other methods of waste disposal that reflects newer technologies and alternatives to managing medical waste in a manner that is consistent with local, state and federal regulations.
We do not believe fogging the facility with formaldehyde as a means of "disinfecting the facility," as described in the draft plan, is warranted based on the known mode of transmission and evidence demonstrating susceptibility of related orthopox viruses to a broad range of chemical disinfectants applied to surfaces.
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