The Centers for Disease Control and Prevention has set up new guidelines for health workers taking care of patients infected with Ebola. (Reuters)

Federal health officials Monday tightened infection-control guidelines for health-care workers caring for Ebola patients, explicitly recommending that no skin be exposed.

The beefed-up guidelines also call for health-care workers to undergo rigorous training, and to be supervised by trained monitors when putting on and taking off personal protective equipment. The government will issue step-by-step instructions for workers to follow in doing that.

The revised protocols from the Centers for Disease Control and Prevention are being issued amid a debate over whether protection is adequate for nurses and doctors caring for Ebola patients. The controversy flared when two nurses became ill in Dallas after caring for Thomas Eric Duncan, the Liberian who became the first person diagnosed with Ebola in this country and died Oct. 8.

Some hospitals, including Texas Health Presbyterian, which treated Duncan, began using the stricter protocols last week.

At a media briefing late Monday, CDC Director Thomas Frieden said the updated guidelines give a greater margin of safety to health-care workers. They are modeled on those used by Doctors Without Borders, the aid group that has worked most extensively in West Africa, where the virus has killed more than 4,400 people in Guinea, Sierra Leone and Liberia. The guidance also reflects the consensus of specialists at Emory University Hospital, Nebraska Medical Center and the National Institutes of Health, which are currently treating Ebola patients.

Tougher armor recommended for the fight against Ebola

Nursing and other health-care groups have criticized previous guidelines as confusing. The Dallas hospital failed to diagnose Duncan initially. As he became sicker, the hospital changed what the nurses wore. Frieden said it was not clear exactly how the two nurses became infected.

“The bottom line is the guidelines didn’t work for that hospital,” he said.

Previous guidelines did not make clear that all skin must be protected. They also reflected the experience of care in Africa, Frieden said. But health-care workers in the United States face greater risk in caring for Ebola patients because hospitals use more high-risk procedures that can expose workers to more of a patient’s bodily fluids.

The CDC does not have regulatory authority to make sure hospitals follow these guidelines. That is the job of the federal Occupational Safety and Health Administration and state officials, Frieden said.

Last week, the CDC said it would send “Ebola response teams” to any hospital in the United States with a confirmed Ebola case. Already, one of those teams is in Texas and has put in place a site-manager system, requiring that someone monitor the use of personal protective equipment.

The guidance lets facilities choose the type of protective equipment based on availability, workers’ familiarity with the equipment and comfort. The guidelines also call for designated areas for putting on and taking off protective gear. The recommendations call for full-body garb and hoods that protect worker’s necks.

Meanwhile, dozens of people who possibly had contact with Duncan have been deemed free of the virus, officials said Monday morning. The 43 people cleared included health-care workers, school-age children and other members of the community who may have interacted with Duncan.

Here's how the Ebola virus spreads and how contact tracing works to stop outbreaks. (Gillian Brockell/The Washington Post)

“They have no Ebola symptoms and are not at risk of developing Ebola,” the Texas Department of State Health Services said in a statement Monday. “They are able to continue normal daily activities without being monitored for symptoms.”

It was a rare bit of positive news amid a steady drumbeat of anxiety and fear.

The last day any of these 43 people could have had contact with Duncan was Sept. 28, when he was isolated at the Dallas hospital. Since then, they have been monitored and had their temperatures taken during the 21-day period recommended by both the CDC and the World Health Organization.

“They are people who need our compassion, our respect and our love,” Dallas County Judge Clay Jenkins said at a news conference Monday morning. “Treat them the way you would want your own family treated if you were in their place and they were in yours.”

There were five other people who were also being monitored as part of the initial group, and they should all be cleared this week, Dallas Mayor Mike Rawlings said at the same news conference.

While Rawlings said he was “lifted up” by the news that 43 people were being cleared, he did note that authorities are still monitoring about 75 health-care workers who came into contact with Duncan while he was being treated at the Dallas hospital. Duncan was diagnosed on Sept. 30 and died eight days later.

The two nurses who treated Duncan and contracted the virus have been moved to other medical facilities that have special units for such cases. Before she was diagnosed and isolated, one of the nurses, Amber Vinson, traveled on a pair of commercial flights. As a result, the CDC said it is monitoring people who flew on those planes along with Vinson.

lena.sun@washpost.com

Abby Phillip contributed to this report.