Ebola infection control — DTM&H MCQ

Correct answer: A — Strict isolation with full PPE including fluid-resistant coverall and respirator

The correct answer is A, strict isolation with full PPE including fluid-resistant coverall and respirator. This healthcare worker shows classic evolving Ebola virus disease (fever, myalgia, diarrhoea, then bleeding from venepuncture sites) after high-risk exposure to a confirmed VHF fatality, placing them in the highest UK risk category for viral haemorrhagic fever. UK guidance mandates strict single-room isolation with full high consequence infectious disease PPE: fluid-resistant coverall, double gloves, apron, full-face shield, and filtering respirator, because Ebola transmits via direct contact with blood and body fluids, and aerosol-generating procedures add further risk. This containment level reflects the extreme case fatality and nosocomial spread seen in prior outbreaks, where inadequate barrier protection caused extensive healthcare worker infection. Why the other options are wrong: E. Standard contact and droplet precautions: insufficient for a Hazard Group 4 pathogen with active bleeding, as droplet precautions lack the fluid-resistant, near total body coverage needed against blood and secretions. B. Airborne precautions with negative pressure room only: Ebola is not primarily airborne, so a negative pressure room without full body and mucous membrane protection misses the real contact and splash risk. C. Barrier nursing with surgical mask and gloves only: leaves eyes, face, and body exposed to splashes of blood and bloody diarrhoea, precisely how prior healthcare worker infections occurred. D. Cohort isolation with other suspected cases: risks cross-contamination between cases of differing status or viral load; single-room isolation is required until VHF is excluded or confirmed. Key point: A healthcare worker with high-risk VHF exposure and compatible bleeding symptoms needs immediate single-room strict isolation with full PPE (fluid-resistant coverall, respirator, face shield, double gloves) pending urgent virological testing, per UK HCID protocols.

Reference: UKHSA (GOV.UK), 'Viral haemorrhagic fever: ACDP algorithm and guidance on management of patients' and 'Risk assessment and immediate management of viral haemorrhagic fevers (contact high consequence infectious diseases) in acute hospitals', 2024, https://www.gov.uk/government/publications/viral-haemorrhagic-fever-algorithm-and-guidance-on-management-of-patients