Shiloh
Editor, Senior Moderator
Source: http://annals.org/article.aspx?articleid=1900481
Ideas and Opinions | 26 August 2014
Protecting Health Care Workers From Ebola: Personal Protective Equipment Is Critical but Is Not Enough FREE ONLINE FIRST
William A. Fischer II, MD; Noreen A. Hynes, MD, MPH; and Trish M. Perl, MD, MSc
Ann Intern Med. Published online 26 August 2014 doi:10.7326/M14-1953
...If transmission of Ebola is effectively interrupted with the use of barrier protection, why are so many health care workers in the current outbreak being infected, particularly this late in the epidemic? Two contributing factors include an insufficient supply of PPE and a lack of emphasis on the process of donning and doffing PPE.
The current Ebola outbreak is occurring in 3 of the world's poorest countries. Guinea, Liberia, and Sierra Leone are not only among the countries with the lowest per-capita gross national incomes but also have among the fewest physicians to serve their populations, with fewer than 0.1 physician per capita (4?5). As a result, the health care infrastructure is unable to sustain basic health care needs, let alone the surge in medical need brought on by this epidemic. The lack of sufficient PPE thus forces health care workers to choose between providing care with a heightened risk of infection or abandoning patients afflicted by this terrible disease. As of 16 August 2014, approximately 36 health care workers in Liberia alone (a country with a reported total of 51 physicians) have died of the disease and others are struggling with the infection (6). The absence of sufficient PPE is a major reversible reason underlying the recent increase in infections among health care workers that have occurred thus far in this Ebola epidemic.
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 M?decins Sans Fronti?res, 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....
Ideas and Opinions | 26 August 2014
Protecting Health Care Workers From Ebola: Personal Protective Equipment Is Critical but Is Not Enough FREE ONLINE FIRST
William A. Fischer II, MD; Noreen A. Hynes, MD, MPH; and Trish M. Perl, MD, MSc
Ann Intern Med. Published online 26 August 2014 doi:10.7326/M14-1953
...If transmission of Ebola is effectively interrupted with the use of barrier protection, why are so many health care workers in the current outbreak being infected, particularly this late in the epidemic? Two contributing factors include an insufficient supply of PPE and a lack of emphasis on the process of donning and doffing PPE.
The current Ebola outbreak is occurring in 3 of the world's poorest countries. Guinea, Liberia, and Sierra Leone are not only among the countries with the lowest per-capita gross national incomes but also have among the fewest physicians to serve their populations, with fewer than 0.1 physician per capita (4?5). As a result, the health care infrastructure is unable to sustain basic health care needs, let alone the surge in medical need brought on by this epidemic. The lack of sufficient PPE thus forces health care workers to choose between providing care with a heightened risk of infection or abandoning patients afflicted by this terrible disease. As of 16 August 2014, approximately 36 health care workers in Liberia alone (a country with a reported total of 51 physicians) have died of the disease and others are struggling with the infection (6). The absence of sufficient PPE is a major reversible reason underlying the recent increase in infections among health care workers that have occurred thus far in this Ebola epidemic.
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 M?decins Sans Fronti?res, 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....