Thanks to the modern-day plague that is Ebola, terms like personal protective equipment, contact tracing, donning and doffing have infused the popular lexicon. Man on his worst day cannot kill as efficiently as Mother Nature, and pandemic disease has served to thin humanity’s ranks cyclically for as long as we have maintained records.
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The key to success when dealing with infectious agents like avian flu, smallpox or Ebola is simply not to get any of it on you. No matter how a disease is transmitted, separating health care workers from the pathogens they strive to eradicate is the key to treatment and survival.
The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are generally recognized as the experts at managing the spread of infectious diseases. The guidance these two organizations issue concerning what equipment to use and how to employ it evolves as we learn more about the microbiological enemies that are bent upon our destruction. In the case of exceptionally deadly pathogens like Ebola, little is left to chance.
The goal is to protect all exposed skin with an impermeable material that serves as an effective barrier to contact. As most infections occur when the gear is being doffed (removed), proper training and supervision in the use of this personal protective gear is as important as the nature of the gear itself.
Starting at the top, the CDC recommends the use of a Powered Air Purifying Respirator (PAPR) with a full face shield, helmet or headpiece. Any reusable helmet or headpiece must be covered with a disposable hood that extends down past the shoulders and fully covers the neck. An N95 single-use disposable respirator with a face shield and disposable hood is a less expensive option, though there is greater danger of health care workers attempting to adjust this device during patient care and risking subsequent contamination.
A single-use, fluid-resistant or impermeable gown that extends at least to mid calf or comparable disposable medical coveralls should also be worn. Gowns or coveralls with thumb hooks are preferable as they keep the sleeves secure beneath the first pair of gloves. Surgical tape may be used for this purpose in the absence of thumb hooks, but experience has shown this to be a potential source of contamination during the doffing process.
Disposable nitrile gloves should be worn in two layers. The top layer should include extended cuffs, and sleeves should be secured to the inner layer. Single-use, fluid-resistant or impermeable shoe covers should be worn that extend at least to mid calf, and attention should be paid to slip-and-fall precautions in the presence of bodily fluids.
A single-use impermeable apron that covers the torso to the level of the mid calf should be worn in the presence of vomit or diarrhea for additional protection. If using a PAPR, the apron should secure behind the neck to facilitate easy removal.
Isolate The Threat
Nothing should be left to chance. Undergarments should be standardized and limited to surgical scrubs for easy access and management. Donning and doffing procedures should be undertaken at a measured pace to minimize the risk of mistakes. Jewelry, rings and watches should be removed to minimize the risk of inadvertent contamination.
While these procedures were developed in response to the Ebola crisis, they should be comparably effective for health care workers dealing with any other severely contagious or potentially catastrophic infectious diseases. Mother Nature surprises us regularly with her creative capacity to kill, and it is through being proactive and methodical that we stay one step ahead of her destruction.
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