The only confirmed Ebola cases on U.S. soil so far have been two American aid workers flown from Liberia for treatment at Emory University Hospital. They were discharged this week after recovering from the disease that has killed more than 1,400 people in Africa.
While calling the extra steps "understandable given the horrific mortality of this disease," Dr. Michael Klompas of Harvard Medical School and lead author of the paper in Annals of Internal Medicine, said they are unnecessary and could backfire.
For instance, if nurses and doctors wear unfamiliar gear such as head-to-toe hazmat suits, "there is absolutely a risk of making mistakes and contaminating yourself" with a patient's bodily fluids, said Dr. David Kuhar of the Centers for Disease Control and Prevention.
Going overboard could also hurt patients, Klompas said. If workers need to don hazmat suits before entering a patient's room, they will likely examine, test and care for patients less frequently.
Hospitals in 29 states have contacted CDC about 68 suspected cases: 66 were not Ebola and two test results are pending.
Ebola is spread only by direct contact with patients' bodily fluids. A 2007 study of an African outbreak found no traces of virus on a bed frame, chair, bowl, floor, or even a stethoscope used to examine a patient - only on a blood-stained glove.
CDC advises hospitals to place suspected Ebola cases in a one-patient room and have doctors and others wear a fluid-impermeable gown, gloves, surgical mask, and goggles or a face shield.
If the patient has "copious" secretions, CDC guidelines call for shoe and leg coverings plus a second pair of gloves. During procedures that might allow viruses to become airborne, such as inserting a breathing tube, workers should wear respirators.
The American Hospital Association has urged its members "to follow CDC's guidance for this and all infectious diseases," said Vice President Nancy Foster.
There is nevertheless a "temptation to maximize precautions that exceed CDC recommendations," Klompas said. Many of the 60 or so hospitals he has been in contact with plan to go beyond CDC's guidelines, usually at the request of worried doctors, nurses, and other front-line workers.
For instance, some are planning to place all suspected Ebola patients in negative-pressure rooms, and have personnel wear hazmat suits and respirators at all times.
At Emory, healthcare workers initially wore full-body suits with respirators.
"They were caring for the patients for several hours at a time and this gear was more comfortable and provided better air circulation," Dr. Bruce Ribner, director of Emory's infectious disease unit, said by email. After a few days staffers dialed back to what CDC recommended.