of the personal protective equipment, leading to unwanted contact when the gear is removed,” the © iStockphoto.com/Eva 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.
www.LabOnline.com.au | www.LifeScientist.com.au
LAB+LIFE SCIENTIST - November 2014 | 47