Traffic control bundling is essential for protecting healthcare workers and controlling the 2014 Ebola epidemic.

TO THE EDITOR—A global health crisis, the 2014 Ebola outbreak has now struck healthcare workers (HCWs) at unprecedented levels. Whereas historically, Ebola epidemics spread via person-to-person transmission, the current outbreak in West Africa has seen unexpectedly extensive spread of nosocomial disease, despite HCWs' reliance on previously effective infection control procedures such as patient isolation, barrier nursing procedures, and required personal protective equipment (PPE) [1]. Indeed, infection struck even among HCWs caring for patients with Ebola virus disease (EVD) in Western hospitals equipped with modern facilities and procedures. This has sparked growing concerns regarding how to protect HCWs [2], even those working outside the ill-prepared and overwhelmed regions of West Africa now grappling with Ebola [1]. In our view, the most concerning examples include Dr Khan [3], a Sierra Le-onean virologist who contracted Ebola despite his extensive experience and careful adherence to procedures; Dr Spencer [4], a Médecins Sans Frontières physician who became symptomatic upon returning to New York despite working in well-designed isolation units built specifically to protect HCWs from EVD infection ; and Dr Sacra, an obstetrician who contracted Ebola without having knowingly cared for any EVD patients [5]. Based on these developments and the knowledge that Ebola may remain viable to a certain degree on dry solid surfaces with fomites for approximately 1 day [6, 7], we hypothesize that fomite transmission of Ebola may best explain some of these unanticipated cases. Fomite transmission is facilitated by the practice of situating patients with acute symptoms and potentially extremely high viral loads outside isolation rooms in environments where adherence to routine disinfection practices is rare [7]. Taiwan's experience with severe acute respiratory syndrome (SARS) in 2003 is instructive. We contend that during the height of the SARS epidemic, HCWs in institutions that failed to identify designated zones of risk simply assumed they were secure from risk as long as they were not in proximity to patients with highly contagious pathogens. However, their confidence in existing barrier precautions and PPE as providing sufficient protection when away from heavily contaminated areas proved unwarranted [8]. As it turned out, consistent use of PPE and negative pressure isolation rooms was insufficient because the main cause of nosocomial SARS transmission was casual contact with fomites in contaminated environments either outside of isolation zones or during removal of PPE [8, 9]. Unlike when dealing with contamination by nuclear or chemical spills, there exist no distinct boundaries …