Episode 7: Dress for Success

AKA "All About Personal Protective Equipment" or PPE

See Dallas hospitals...this is how the US Military keeps Medical Personnel safe from Ebola:

NMRC Ebola Testing Lab: Photo credit of US AFRICOM Chief Petty Officer Jerrold Diederich
http://www.africom.mil/newsroom/photo/23721/naval-medical-center-labs-support-operation-united-assistance

Let's go over what this fine young Navy Medical Corps officer is wearing. PPE- the only line of defense between our health care workers and a nasty end.

Talking points:

1.       Why is PPE important for Healthcare workers but not the rest of us?

a.       Well, here’s the deal guys. Mr. Ebola is not very infectious early on in the disease; there are not enough viral particles in the blood to cause high levels of sustained spillage into a bodily fluid (spit, sweat, urine, vomit, poop). It takes a few days for Mr. Ebola to really get ramped up. Once he’s had the time to get going, then your fluids are way more infectious. But by then, most people are pretty sick and getting medical care. So while it is possible to still spread Mr. Ebola while you’re in the “I have a fever, ugh” stage, it would require a lot of exposure to the infected person. 

             i. For example, a spouse would be what we Epidemiologists call a “high risk contact”, because chances are you have been exposed to their kisses and other stuff, which unfortunately for said spouse, are potentially virus-ridden. If you, random stranger sitting next to them on a plane, happened to bump into their leg or share air space, you’re not going to get the virus. I mean, unless they sneezed in your face or something gross like that. But once the infected go to a hospital in the “I can’t stop puking” phase…they’re shedding virus all over the place. And the nurses cleaning up after them and taking their blood and getting up close and personal are the ones in danger. There is way more virus hanging around in that hospital waiting for someone to get sloppy or for an accident to happen.

2      So why are all these doctors and nurses getting infected?

A.       So this plague bomb patient is sitting in a hospital bed, most likely the ER or urgent care. They’re puking into bags and having diarrhea all over the toilet. Mr. Ebola is starting to hang out. Hopefully, we sweep them away into an isolation room and then decontaminate the heck out of whatever space the infected were in. The nurses and doctors taking care of the patient are going to have to deal with getting all that biohazardous waste away from the patient and away from anyone else. Without getting exposed themselves!! So there are a lot of pieces of clothing these health care folks need to use. Like the following:

                   i.      The base layer: Clean scrubs, latex non sterile surgical gloves.

                   ii.      The main layer: moisture proof surgical gown or preferably Tychem coveralls, Nitrile examination gloves snugly fit over the cuffs of the gown/coverall, surgical cap, FFP or N95 respirator at minimum, knee high PVC boots

                  iii.      The top layer: Waterproof apron long enough to cover top of boots, Face protection: Either a Wrap-around Face Shield OR Tyvek hood and wrap-around Goggles/Face Shield.

                               *****       Order of removal: 1. Apron, 2. Gown/coveralls and outer gloves as one unit, 3. Boots, 4. Hood/Goggles or Face shield, 5. Inner gloves-- Respirator (There is a nifty way to remove these concurrently depending on what kind of respirator you have). Health care people have to pay attention as they remove layers that they A. Do NOT Contaminate the inner layer and B. watch for ANY suspicious signs of rips, tears or penetration into inner layers. And if you screw up at any step in the sequence, you’ll be wanting a shower with quaternary ammonium compounds depending on what got contaminated during what part of the sequence.

**     That sounds difficult to manage getting on and off in the right order every single time.

                     B. It is. The folks at USAMRIID, Emory and Nebraska and NIH have trained for YEARS to get it right. Clearly the rest of the nation’s healthcare workers have not. Otherwise, the Nursing Unions would not be gearing up to throw their employers under a very large bus. Also, even if you train perfectly and reduce your risk of a slip up to like 1-2% per time, that gets cumulative when you estimate one nurse might put on and take off PPE a good 250 times in the case of one patient. So that’s now a ~15% chance, give or take, to get Ebola over the course of ONE patient.  
                     C.  Now imagine you have 50 patients, like the Ebola Treatment Units in Africa. This is why so many doctors and nurses in Africa are getting sick and dying. And why Doctors without Borders trains the heck out of the people they send into those countries to work their hospital/treatment centers. 

The CDC has finally updated their PPE guidelines to come more in line with what I'd consider gold standard, probably in response to having their assess chewed on live television. Funny how that works.... Check out their website. Otherwise remember, love the Tyvek.

I also want to share a cool website with you guys, it's called Eboladeeply.org. There are some seriously awesome interactive bits that are of a level most lay people can grasp.

-Dr. M