Re: Preparing a Community Hospital for Ebola
As I was reading about the Spanish case, the physician said that his sleeves were too short. This kind of thing is an obvious problem. The equipment they're using needs to have a way to join the sleeve to the glove. Gaps are an obvious problem. He may not have known how that was supposed to look until he actually got into the work area and realized he had a problem.
Also, there have to be provisions for different sizes of anti-contamination clothing. Something that fits a 225 lb 6 foot man is going to be a work hazard for a 5 foot 100 pound woman. This can CAUSE contamination to occur. I don't know if this applies to a medical situation, but in a pinch in nuclear plants you can tape tucks into an anti-C, so that if you're small you don't have to fight your equipment. If you're too tall for the attire, you can't do that though. (Don't tape too much though. Anti-contamination clothing should not be worn tight. This can also be a factor in safety.)
When people dress out for the first few times, they don't feel comfortable and they tend to get the details a bit skewed unless someone is standing right there. The first time they wear the clothing, they discover things that they'd probably ought not to do, like touch their cheek to their shoulder and such things. Dry runs, observed by an experienced worker or at least a keen observer like a good lab technician, are absolutely necessary before anyone goes into a contaminated area.
A dry run ought to include a full dress-out, some practice with equipment and walking around, long enough to get hot and uncomfortable, and then the step-off routine where they remove the clothing in the right order. Special attention needs to be paid to the step-off part. It's where they're most likely to get low-level contaminated (as opposed to the acute sort of thing out in the work area). In the step-off area, there is a certain order things have to come off in.
The step-off area should actually be quite tightly defined. Traffic coming out should be funneled into one passage wide enough so that you don't have to bump your elbows getting out of the clothes, and there should be a line on the floor or something like that in that passage. It shouldn't be a whole room, like a prep room or anything like that because the gray area is too much to control, and the gray area will offer too much chance for contamination. In nuclear plants, a step-off pad is a pad on the floor with striped tape on both ends, and drums to hold various kinds of waste and used materials next to it. Very *hot* areas (and Ebola would be that case) have multiple step-off pads that you have to cross. There are decided stages to the process of getting undressed and marks on the floor to go with that process, such that when you step over that last mark, you have removed everything and you are done, back down to the clothes you wear in the break-room or whatever.
Very Important: The step-off area (coming out) should be different than the dress-out area (going in). They should be in two completely different locations, not in close proximity to each other. Otherwise you will end up with contaminations going in and you won't be able to figure out what's going on.
People also, being people, form habits. So every so often, even a really experienced person needs to be watched by someone, to see what habits they've picked up that might be putting them in danger of contamination. (You can start doing things you don't realize you're doing because your attention has shifted from the attire to the work at hand.) To catch this kind of thing, it's just a matter of dressing out and coming back across the step-off pad in front of someone with a check-list. You pass or you fail. If you fail, you get retrained and are warned to watch your habits. And that's not a bad thing, it's a safety precaution that is appreciated. It keeps everyone safe and keeps things running smoothly.
