Lab+Life Scientist Nov 2014

Page 47


of the personal protective equipment, leading to unwanted contact when the gear is removed,” the © Serrabassa Sito Garcia

authors say. “The impulse to wipe away sweat in the ever-present hot, humid environment during personal protective equipment removal may lead to inadvertent inoculation of mucous membranes” in and on the nose, mouth and eyes. According to the World Health Organization, the unprecedented outbreak of Ebola in West Africa has resulted in a “high proportion of doctors, nurses and other health care workers who have been infected”. The World Health Organization claims that more than 240 health care workers have developed the disease in Guinea, Liberia, Nigeria and Sierra Leone. More than 120 have died, including prominent doctors in Sierra Leone and Liberia. Despite the challenges of preventing inadvertent exposure from improper personal protective equipment removal, they say that health care workers are generally aware of and are using proper precautions. For example, treatment sites in Africa administered by Médecins Sans Frontières, a medical

Donning and doffing - why protective gear protocols are crucial

humanitarian organisation, have established a systematic process to mitigate the risks associated with removal of personal protective equipment, including a buddy system in which health care workers walk each other through each step of the removal process to help ensure safety. Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR), in collaboration with Perl, has established a number of clinical guidelines and tools to ensure Johns Hopkins hospitals, outpatient clinics and primary care offices take adequate precautions when encountering patients who have had a history of recent travel to West Africa. Such precautions include proper procedures

The current Ebola crisis has demonstrated that ‘inadvertent’ contamination is very hard to eradicate and can have deadly consequences.

for the donning and doffing of PPE for any patient


can be interrupted with simple interventions and by

identified as having such a travel history and who has symptoms associated with Ebola. “Despite its lethal nature, Ebola transmission

personal protective equipment, including goggles or

focusing on basics. Improvement in basic health care

face shields, gloves and gowns, is effectively decreasing

infrastructure and providing an adequate supply of

West African caregivers’ exposure to infected bodily

personal protective equipment, along with a ritualized

fluids, but workers are still at risk “if removal of

process for donning and doffing personal protective

ersonal protective gear offers scientists

protective clothing that is contaminated with infectious

equipment, are desperately needed to prevent further

and healthcare workers very high levels of protection

bodily fluids is not done in a manner that prevents

unnecessary infection and loss of life among the heroic

but just wearing it while you work is not enough.

exposure”. Trish M Perl, MD, MS and Noreen Hynes,

health care workers who are on the front lines of this

How personal protective gear is removed is just as

MD, MPH are two Johns Hopkins infectious disease

war,” the authors write in the commentary.

crucial as wearing it if you want to prevent exposure to

experts who authored a commentary published online

contaminants such as viruses. Rigorous steps exist - and

in the Annals of Internal Medicine.

Perl is senior epidemiologist for the Johns Hopkins Health System and a consultant to the

must be taken - to avoid inadvertent contact of exposed

“The physical exhaustion and emotional

CEPAR, which is overseeing and coordinating Johns

skin and mucous membranes to infected body fluids.

fatigue that come with caring for patients infected

Hopkins’ readiness for any potential Ebola patient.

According to physician-specialists from Johns

with Ebola may further increase the chance of an

Hynes is the director of the Geographic Medicine

Hopkins and the University of North Carolina,

inadvertent exposure to bodily fluids on the outside

Center in the Division of Infectious Diseases. |

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