Thanks to Greg Folkers for sending the link to this opinion piece in Annals of Internal Medicine: Protecting Health Care Workers From Ebola: Personal Protective Equipment Is Critical but Is Not EnoughProtecting Health Care Workers From Ebola. Excerpt:
Although PPE is effective at decreasing exposure to infected bodily fluids among health care workers, its presence is simply not enough. Ebola is transmitted through direct or indirect contact between bodily fluids from an infected patient and breaks in the skin or exposed mucous membranes of an uninfected person. The various PPE used and advocated by Médecins Sans Frontières, the World Health Organization, and the Centers for Disease Control and Prevention accomplishes a reduction in the risk for direct exposure.
However, even with PPE, a health care worker is still at risk if removal of protective clothing that is contaminated with infectious bodily fluids is not done in a manner that prevents exposure. The physical exhaustion and emotional fatigue that come with caring for patients infected with Ebola may further increase the chance of an inadvertent exposure to bodily fluids on the outside of the PPE. In addition, the impulse to wipe away sweat in the ever-present hot, humid environment during PPE removal may lead to inadvertent inoculation of mucous membranes.
The treatment sites administered by Médecins Sans Frontières have addressed this critical need by creating both a structure and a systematic and measured process to mitigate the risks associated with removal of PPE.
First, a separate exit, physically removed from the entrance, is created to ensure that persons donning PPE do not come into contact with PPE from exiting health care workers that may be contaminated with bodily fluids.
Second, and more important, a dedicated person is stationed at the exit with the sole focus of guiding the health care provider through each step of PPE removal, regardless of how many times the provider has been through the process.
This standard of operations ensures that the process becomes ritualized, thereby protecting and reassuring the health care worker.
Despite its lethal nature, Ebola transmission can be interrupted with simple interventions and by focusing on basics. Improvement in basic health care infrastructure and providing an adequate supply of PPE along with a ritualized process for donning and doffing PPE is desperately needed to prevent further unnecessary infection and loss of life among the heroic health care workers who are on the frontlines of this war.
Protection of health care workers in Ebola outbreaks does not happen by accident—it is achieved through the provision of adequate PPE and, more important, a focus on systems processes that enforce the safe use and removal of PPE.
The challenges and successes in Africa should inform the discussion in the rest of the world about reducing the risk for transmission and refocus the conversation on the process of donning and doffing PPE rather than simply increasing the amount of it.