Ebola raises health care PPE skills risk

Health care PPE against ebola and other deadly viruses should include a protocol for decontamination and removal. USA workers are using active respirator packs in addition to full suits.

Ebola virus infection of some health care workers, despite wearing PPE, demonstrate the need to raise health care PPE skills.

Breach of health care protocol and PPE removal procedures at a USA hospital where Ebola victim Thomas Eric Duncan was treated before his death, led to the infection of a health care worker with the deadly virus. Other caregivers may have been exposed.

The infected health care worker’s personal protective equipment (PPE) included a gown, gloves, mask, and shield. She could not explain how the breach might have occurred, said Dr Tom Frieden, head of the Centers for Disease Control and Prevention. Duncan was the first person in the USA diagnosed with Ebola.

Some workers take off their PPE incorrectly, leading to contamination. Investigators will also check procedures for dialysis and intubation, the insertion of a breathing tube in a patient’s airway. Both procedures have the potential to spread infectious material.

[RISK ASSESSMENT UPDATE; See comment by Mabila Mathebula at the end of this post].

At the end of a health care or emergency response shift, a worker leaves through a sterile exit and undresses under the direction of a monitor, involving 20 steps.

The disrobing process starts with a chlorine disinfectant spray; rinse hands in chlorine solution; remove outer gloves, spray, rinse, remove apron; spray; remove goggles and hood; unzip and roll down coveralls; remove inner gloves; spray the boots, step into low-risk area, spray them again.

Gloved hands are rinsed in the chlorine solution eight times during the process. Staff members are rotated out of high-risk areas every four weeks to prevent them from becoming complacent.]

A Spanish nurse assistant became the first health care worker infected outside West Africa during the ongoing outbreak.

She helped care for two priests who were brought to a Madrid hospital and later died. More than 370 health care workers in West Africa have fallen ill or died since the epidemic began earlier this year. A dog belonging to the Spanish nurse was euthanised.

The USA CDC said the “missteps” with the first patient and the infection of a caregiver was a warning to all health care workers worldwide

Police stood guard outside her apartment complex and told people not to go inside. Officers made automated phone calls and passed out fliers to notify people in a four-block radius, although the risk is confined to close contact with Ebola patients.

The deceased patient came from Liberia to visit family, sought medical care for ‘fever and abdominal pain’, and told a nurse he had traveled from Africa. He was later placed in isolation.

Liberia is one of the three West African countries most affected by the Ebola epidemic, which has killed more than 4000 people, according to World Health Organisation figures. The others are Sierra Leone and Guinea.

Ebola symptoms and exposure management

Ebola is caused by a virus. Initial symptoms could start within two days of contact with an infected person or body: fever, tiredness, headache and nausea.

Later symptoms may include vomiting, diarrhoea, cough (which may contain blood), and bleeding from nose and mouth.

It spreads by people in direct contact with people who have ebola, or contact with dead bodies, or some animals.

Keep away from sick or dead patients with Ebola. Do not touch an infected person or their body fluids. Wash your hands often with soap.

Do not touch or eat bush meat or bats.

If you suspect ebola, call your medical centre and tell them about your illness. Listen to the advice, you may be sent to a special hospital.

Keep away from others so they don’t get sick. Be especially careful with your bodily fluids such as spittle, cough, blood, urine, feces.

USA health authorities confirmed; “Ebola spreads through close contact with a symptomatic person’s bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen. Those fluids must have an entry point, like a cut or scrape or someone touching the nose, mouth or eyes with contaminated hands, or being splashed.”

The World Health Organisation confirmed that “blood, feces and vomit are the most infectious fluids, while the virus is found in saliva mostly once patients are severely ill. The whole live virus has never been culled from sweat.”

USA customs and health officials began taking the temperatures of passengers arriving at airports from Liberia, Sierra Leone and Guinea in a stepped-up screening effort.

The health care worker had reported a fever as part of a self-monitoring regimen required by the CDC. The hospital has stopped accepting new emergency room patients.

In the health worker’s neighborhood, one police officer said an industrial barrel outside contained hazardous biological waste taken from inside the building.

Officials said they also received information that there may be a pet in the health care worker’s apartment, and they have a plan to care for the animal. They do not believe the pet has signs of having contracted Ebola.

Disclaimer: This post is to raise awareness. It is not a substitute for professional medical advice. Should you have questions or concerns about any topic described here, consult your medical professional.

Source; Buildsafe SA. Press of Atlantic City.

Mabila Mathebula comments;
A society that lamentably fails to draw a line of separation between an illusion and reality needs some ‘reality regeneration’. The Ebola disease is a reality! Currently, the Ebola disease is managed at the national level by monitoring people who enter the country through our international airports. There is a fallacy among our people that we are insulated from the disease because ‘we are not like the other African countries!’

The words of Liberian President Helen Johnson Sirleaf, debunks this myth: “This disease respects no borders”, she said. “The damage is already reverberating across the world”. If this disease is cruelly disrespectful of borders in nature and form as aptly put by Liberian leader, are we hundred percent safe from the scourge of this ‘border blind disease’?

The government’s plans to fight the disease are paved with good intention, but we should not lose sight of Robert Burns’ advice that: “The best laid schemes o’ mice and men oft go astray”. The ability of humans to control their own destiny has not changed much since Burns’ observation of over two centuries ago.

Events never quite work out as anticipated; nevertheless, organisations should start in earnest to develop organisational plans to fight the deadly disease. “By failing to prepare, you are preparing to fail” warned Benjamin Franklin! The sun is currently shinning over us and we should galvanise into action and make hay out of this window of opportunity.

According to medical science, Ebola is classified as an idiopathic disease (diseases whose causes are unknown are called ‘idiopathic’). For example, the devout biblical Job suffered from an idiopathic disease. Idiopathic diseases have been there from time in memorial. The Israel of old had to deal with leprosy whose causes were never known. The national strategy that was employed by the Israelites to manage the disease was to isolate the effected person from society. “…He shall live alone. His dwelling shall be outside the camp” (Leviticus 13: 46). In Israel the law took priority over human rights and human dignity. The victims had no option to object but, to acquiesce. I appreciate the truth is saying that in today’s society human right have taken priority over the law and it would be difficult to isolate Ebola victims from society and put them at the entrance gate because of their rights which are firmly entrenched in the constitution.

The tug of war between medical science and spiritual healing regarding HIV and AIDS is still rages on. There should be some common understanding between the Department of Health as well as religious organisations. In a nutshell, we need to employ a holistic approach. The Right General J.C Smuts wrote a book on Holism and Evolution in 1927. In my view, this book should be read by each and every South African regardless of their colour, creed or political affiliation. To be holistic; is a tendency to see the connection between diverse things. Let me hazard a guess that Occupational Health and Safety, ‘Domestic Health and Safety’ and ‘Religious Health and Safety’ and are inextricably interwoven. The later is very important but, receives little or no attention from journalists, writers and academics – it is still an uncharted path and a road less travelled.

I may be dismissed as a prophet of doom and gloom, but I maintain that the first place where the disease could hit society hard would be the church. The majority of believers in South Africa believe in spiritual healing and their hopes are hinged on spiritual leaders. Regrettably, churches do not have the monitoring equipments as well as proper PPEs to manage this deadly disease. The ritual of laying hands on the sick will spread this contagious disease to innocent victims; including the pastors. Some effected individual will mingle with other believers freely in the church. The disease would eventually be taken home from the place of worship. Contagiously, the homes and eventually the work place will be severely affected and to reverse the tide would be a titanic labour. “It is not the strongest of the species that survive, nor the most intelligence, but the one most responsive to change” Charles Darwin. The church needs to evolve and change and manage health and safety issues strategically.

I suggested that Ebola should be managed by employing the following E.B.O.L.A strategy:
E = Educational awareness.
B = Boldness to challenge the old paradigms.
O = Open-mindedness to accept change.
L = Leadership with a purpose.
A = Assertiveness (Saying ‘no’ without feeling guilty)

It is obvious that Ebola will disturb international peace; which peace is more slippery than an oiled eel because countries will feel reluctant to welcome visitors from other countries. This may open up wound of xenophobia as well as racism. For example, if South Africa declines the offer of hosting the African Cup of Nations; we would be labelled as being xenophobic. On the other side of the coin, if one is refused a passport to do an assignment overseas; that could be perceived as active racism.

The United Nations should step in and harmonise relations amongst the nations of the world because the disease is also disrespectful of harmonious relationships amongst nations. If this situation goes unbridled; it will result into international entropy and the nations of the world will be disunited like what happened during the Tower of Babel.

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4 Comments on "Ebola raises health care PPE skills risk"

  1. vincent holloway | 16 October 2014 at 08:42 |

    Hi Edmond, thanks for information! This is a incredibly valid point about the PPE and the Protocol for making use of it.
    It’s better to be informed and prepared than uniformed and panicked. I have been following this since March when I got a Toolbox Talk from International SOS.
    I must admit that I have not been taking this situation seriously enough as I should have. I do not want to alarm anyone as there is nothing to worry about yet, but we must start increasing awareness here in South Africa, while we have the current climate/environment/opportunity.
    I encourage people to do the research which is freely available on the internet. If you just have to take a look at a simple website called Wikipedia.
    See what Hazmat suit is required for handling this level of Biological Agent as listed under some other article called Bioterrorism, to draw your own conclusions as to what you need in order to safely treat people with the virus.

    We are dealing with a that has killed more than 200 doctors, nurses, and other healthcare workers since June. Monday there were 4000 dead, Friday theere were known to be 9000 dead.
    Stay Calm and be informed, be prepared.

    ==== Former editor notes; Awareness is the first resort of risk management. Use your resources, communication media such as notice boards, newsletters, talks. Raise your bio-hazard awareness and management. Renew your HIV /AIDS impact management measures, emergency drills, contacts with emergency services, evacuation drills, and business continuity plan.
    This is one of the rare occupational and public risks where PPE is one of the major required responses. Keep a sample of some of the recommended respirators, face masks, gloves, suits, gumbboots, chemicals, spray and shower equipment, and find out where to get more if required.

  2. Rudy Maritz | 16 October 2014 at 20:15 |

    On this issue of PPE, selection is critical. The Ebola virus in the Filoviridae family range from 0.08 micron in diameter and between 0.79 and 0.97 micron in length. It is thus rod shaped, or a filament, much like an earthworm. Some have been seen is the shape of a 6 too.
    The industry standard ISO 14644 for testing nanofilters in respirators are 0.3 or the size of an aerosol droplet, which is believed to be the carrier of the ebola virus as it is transmitted by air. The theory is that the virus would be inside or attached to the droplet, and not free on its own, as it dies if not suspended in a medium.
    It has however been reported that the N95 filters recommended by the CDC, is insufficient, and still let the virus through the membrane.
    Ideally, HCP should wear gloves, a gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit-tested N95 filtering facepiece respirator or higher (eg, powered air purifying respiratory or elastomeric respirator) during aerosol generating procedures.
    Viral infections with ebola has also been reported since its first discovery in 1976 to be transmitted by certain animals, like the fruit bat, but the vector is uncertain.
    And like all virusses, there is no antidote. Treatment is symptomatic.
    Opinions among scientists vary. A new study supports what epidemiologists have long suspected: Ebola is not an airborne virus and is transmitted via contact with bodily fluids. The research was led by Gary Kobinger of the University of Manitoba and the results were published in Scientific Reports.
    And in the South African political tradition of course… add a shower!

  3. Johan O'Neill | 17 October 2014 at 07:58 |

    That is why PPE and C is refered to as the last resort. I always preach to my audience that PPE & C will not safe your life, it is the last protection agaisnt hazards if all the other measures in the hiearcy of controls fail. Don’t assume that if you are issued with PPE &C that you are safe.

    • Rudy Maritz | 17 October 2014 at 12:49 |

      I agree, but with BIO-agents, PPE & C is not the last resort, but first line of defence. There is very little engineering and administrative controls that will prevent micro-organisms, specially those capable of aerosol transmission, from entering the human body. Only after knowing the nature of the bio-agent, can engineering and administrative controls be considered. The ebola outbreak is a typical example.
      Unlike bio-technology factilities, where engineering can be used at a fixed installation, the public health realm works totally different.

      ==== Former editor notes; Doctors without Borders (MSF) and other aid operations use tented quarantine arrangements, or adjust the use of buildings, with due regard to airflow, which are measures of engineering and administration of site conditions. So is the spraying and PPE removal regime (see an addition to the article noting some of the steps in PPE disrobing).
      Again PPE is not a talisman or magic wand, but part of a management system.
      Ebola is present in all body fluids of patients, including sweat, so workers must be prevented from touching their own faces. Workers themselves sweat very much in full suits.

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