Tuesday, October 14, 2014

UNMC: The Complex Procedures To Don & Doff PPEs For Ebola



# 9190


Although we don’t know by what mechanism the nurses in Texas and Madrid were inadvertently exposed to the Ebola virus, investigators are looking for possible flaws in the complex procedures of donning or doffing  PPEs as a possible point of contact. 


These breaches have some experts calling for more PPEs, while others suggest less complex or cumbersome procedures may be safer.


A review is underway by the CDC, and infection control specialists at Texas Health Presbyterian Hospital, to try to determine what happened in Dallas, and how PPE protocols might be improved. 


  • One suggestion has been to spray down the outside of PPEs with a disinfectant prior to their removal to help prevent self-contamination, a step that is commonly employed by MSF in West Africa, but which has not been adopted in the United States (gloves are disinfected prior to removal).
  • Another is always having a PPE safety coordinator or `dresser’  whose job is to watch, and correct, HCWs as they don and doff PPEs. 


As you will see from the twin PDFs below - produced by the  Nebraska Medical Center - the steps involved with both procedures are complex and cumbersome. While protective, when dealing with a deadly hemorrhagic fever, any mistake or lapse can have serious ramifications.



Viral Hemorrhagic Fever - Donning & Doffing PPE


Free Handout - Donning PPE for VHF: Ebola Patient Care



Free Poster - Doffing Personal Protective Equipment

View Handout


1 comment:

David Leith said...

You have to think, particularly for doffing, that there must be a better way. It's also interesting to compare this with what MSF does in Africa, where they are spraying with each step. Here they are relying much more on wipes. I wonder if some sort of disinfectant shower when fully suited might be the best way to start, maybe more of a misting, with the idea to decontaminate as much of the exposed surface as possible as quickly as possible. Then strip a layer, and repeat again. It's interesting, too, that they have added a step for decontaminating boots. Again, you could step in buckets of bleach water or you could use wipes - I think I'd like the more aggressive approach. I think there is too much reliance on wipes on surfaces that aren't fully smooth. Also, do they allow enough residence time to destroy the virus? I wonder if a more rushed pace might be part of the problem.