Monkeypox Safety for Healthcare Workers: Protective Clothing, Safety Strategies, and More
Recently, several countries throughout the world—including the United States—have reported an outbreak of a rare viral disease not usually reported in those areas. The disease, called monkeypox, is causing heightened concern due to the still-ongoing COVID-19 pandemic.
As of January 11, 2023, the U.S. Centers for Disease Control and Prevention (CDC) have reported at least 29,980 cases of monkeypox in the United States, although the spread remains much slower than that of COVID-19.
The purpose of this article is to discuss safety considerations for healthcare workers who may encounter the virus while caring for infected individuals and/or while collecting specimens for diagnostic purposes. Keep reading to learn more about what this disease is, what healthcare workers should do if they are exposed to the virus, how to prevent and control viral spread, and what sort of personal protective equipment (PPE) and other safety protocols are required to keep healthcare workers, patients, and the community at large safer.
What is Monkeypox?
The World Health Organization (WHO) defines monkeypox as a zoonotic viral disease. This means it is a disease caused by a virus that originated in animals and then passed to humans. The disease earned its name after it was first discovered in two monkeys within a Danish research laboratory in 1958; the first human case was reported in 1970 in the Democratic Republic of the Congo.
The monkeypox virus belongs to the orthopoxvirus genus of the Poxviridae family.
How is Monkeypox Spread?
Like other zoonotic viruses, the monkeypox virus spreads from infected animals to humans. According to the WHO, monkeypox can also spread from human-to-human via close contact with lesions, body fluids, respiratory droplets, or contaminated materials and personal objects such as bedding or utensils. Eating inadequately cooked meat of infected animals may also put someone at risk of contracting the disease.
The WHO notes that much remains unknown about the monkeypox virus to this day, including its natural origin and how circulation of the virus is maintained in nature.
What Are the Symptoms of Monkeypox?
The symptoms of monkeypox are similar to the symptoms caused by a now-eradicated disease called smallpox, although generally the symptoms are less severe. The primary early signs and symptoms of monkeypox include:
- Muscle aches
- Back aches
- Fatigue or exhaustion
- Swollen lymph nodes in the periauricular, axillary, cervical, or inguinal areas (this does not happen with smallpox)
Typically, a rash will develop within a few days following a fever. The rash may start on a person's face and spread to other parts of the body. A monkeypox rash generally progresses from a flat lesion (macule), to a firm nodule (papule), to a blister (vesicle), to a blister containing pus (pustule), before finally scabbing over.
How is Monkeypox Treated?
Overall, monkeypox tends to be a self-limiting disease, and most people will recover on their own within a matter of two to four weeks, especially if they follow general self-care principles such as getting adequate rest and hydration. However, some individuals, including children, pregnant women, and people with suppressed or weakened immune systems, may be at a greater risk of severe illness or death due to the disease.
Currently, there are no specific medications or therapies approved for the treatment of monkeypox. Antiviral medications that exist to treat other diseases, such as smallpox and cytomegalovirus, can be used for the treatment of orthopoxviruses (including monkeypox) in the event of an outbreak, according to the CDC. These medications include tecovirimat (TPOXX) and cidofovir.
What's Different About The Current Global Outbreak of Monkeypox?
Monkeypox is considered endemic (consistently present in a given area, much like the seasonal flu) in the following countries: Benin, Cameroon, the Central African Republic, the Democratic Republic of the Congo, Gabon, Ghana, Ivory Coast, Liberia, Nigeria, the Republic of the Congo, Sierra Leone, and South Sudan.
The current global outbreak of monkeypox is unusual because it is impacting countries where monkeypox is non-endemic (not typically found). Early reported cases also had no established travel links to endemic areas, according to the WHO.
While current data indicates that men who have sex with men make up the majority of cases, monkeypox is not considered a sexually transmitted infection (STI). Anyone who has had close contact with an infected person is considered at risk.
Monkeypox Personal Protective Clothing and Other Safety Protocols for Healthcare Workers
The current monkeypox outbreak is an ongoing and developing public health concern that is being carefully monitored by local and global health officials. It's not clear what the course of this outbreak will look like—but what is clear is that minimizing further spread and protecting healthcare workers is essential. Healthcare workers, after all, represent the demographic most likely to come across this virus within their occupational setting.
According to the CDC, healthcare workers caring for infected patients or handling specimens for diagnosis should have ready access to the following items of PPE:
- Eye protection, such as goggles or a face shield that covers the front and sides of a person's face
- NIOSH-approved particulate respirator equipped with an N95 filter or higher
Healthcare workers or anyone else expected to come across the monkeypox virus during typical occupational duties (e.g., direct patient care, specimen collection, waste management, etc.) should know how to properly don, doff, discard, and/or handle PPE. Employers must provide their healthcare workforce with PPE that is durable, comfortable, and aligned with best practice standards for protection within high-risk environments, so as not to compromise patient care nor patient/provider safety.
Additional Protection Protocols in the Healthcare Setting
- A patient with a confirmed monkeypox infection should remain under isolation precautions until all skin lesions are healed, all scabs have crusted over, and a fresh layer of healthy skin has formed.
- Positive patients should be placed in single-person rooms with the door closed (if safe to do so) and only be transported outside the room for medically essential purposes. During transportation, infected patients should wear medical masks and cover any skin lesions covered with a sheet or gown.
- When collecting specimens for diagnosis, personnel must wear appropriate PPE. The CDC recommends the use of plastic materials for specimen collection (not glass). Workers should be aware that accidental laboratory exposures to pox viruses primarily occur via needle-sticks, contact with aerosols generated by lab procedures, or direct contact with the specimen itself. Therefore, standard protocols to mitigate these routes of exposure (e.g., PPE, proper sharps disposal) must be taken.
- Finally, infection control, occupational health, and/or the local health department should be notified and consulted regarding the potential need for medical evaluations if known or suspected cases of monkeypox are present within the clinical environment.
What Healthcare Workers Should Do If They Are Exposed
The CDC notes that the incubation period for monkeypox (i.e., the time from infection to the onset of symptoms) is usually 7−14 days but can range from 5−21 days. Current data suggests that a person infected with monkeypox may be contagious as soon as they begin showing fever and other symptoms, and may remain infectious until their rash scabs over and heals.
According to the CDC, any healthcare worker caring for individuals infected with monkeypox should self-monitor for the development of monkeypox signs and symptoms, even if they had only low or intermediate degrees of exposure (e.g., were wearing appropriate PPE at the time of exposure).
The CDC also says that healthcare workers with unprotected or high degree of exposure (i.e., were not wearing appropriate PPE at the time of direct contact or exposure to infectious aerosols) "do not need to be excluded from work." However, these workers should undergo more involved surveillance, including temperature taking at least twice per day for 21 days starting on the date of known exposure and daily interviews assessing for the presence of fever or rash before reporting to work.
Individuals with a high degree of exposure are also recommended to undergo postexposure prophylaxis (PEP), such as the use of antiviral medications. The smallpox vaccine has been shown to offer some level of protection against monkeypox virus, and may prevent infection or reduce the severity of an infection if given up to two weeks after exposure. Ultimately, the CDC advises informed clinical decision-making on an individual basis in order to "determine whether [the] benefits of PEP outweigh [the] risk."
Global viral outbreaks can and do happen, as we've seen with the COVID-19 pandemic. One of the most important components to controlling the current monkeypox outbreak is ensuring that all healthcare personnel working with infected patients or handling infectious specimens have regular access to high quality PPE. To prepare for monkeypox in your setting or to learn more about how disposable PPE can protect your workforce, contact International Enviroguard today.