To Halt Ebola Outbreak, Rigorous Safety Measures for Health Care Workers Are Needed

Commentary stresses importance of safe removal of protective gear among those caring for infected patients.

Proper removal of protective equipment by health care workers is vital for stopping the spread of the Ebola virus, according to a recent commentary published online in the Annals of Internal Medicine.

The commentary, which was posted on August 26, 2014, stated that rigorous safety practices must be employed to reduce instances of inadvertent contact between exposed skin and infected body fluids.

“Personal protective equipment, including goggles or face shields, gloves, and gowns are effectively decreasing West African caregivers’ exposure to infected bodily fluids, but workers are still at risk if removal of protective clothing that is contaminated with infectious bodily fluids is not done in a manner that prevents exposure,” wrote a team of infectious disease experts from Johns Hopkins Health System and the University of North Carolina (UNC).

The current outbreak in West Africa has caused 4269 confirmed and suspected cases and 2288 Ebola-related deaths as of September 6, 2014, according to the World Health Organization (WHO). The organization warned that the hardest-hit regions are expected to see a surge of thousands of new cases over the next 3 weeks through an intense transmission of the virus.

The most recent figures show more than 240 health care workers have contracted the disease in Guinea, Liberia, Nigeria, and Sierra Leone, with more than 120 fatalities, according to the WHO. In Liberia alone, an estimated 152 health care workers have been infected, with 79 fatalities.

“Local health workers try to care for Ebola patients without the proper training or equipment and become sick themselves, infecting their own families before dying,” said Doctors Without Borders health promoter Ella Watson-Stryker in a statement on the group’s website.

WHO called the number of health care workers who have contracted the disease unprecedented in light of previous epidemics involving Ebola and other infectious diseases.

The organization attributed the high numbers of infected health care workers to several factors, including the improper use and/or shortage of personal protective equipment, a limited number of medical staff trying to handle a large patient population, and compassion-driven work in isolation wards far beyond the number of safe recommended hours.

Beyond instances where gloves and facemasks are unavailable, WHO said proper training for the use of protective equipment is essential, in addition to strict procedures for prevention and control. Even with these limitations, many doctors are working 12-hour daily shifts, making them more prone to mistakes.

“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 personal protective equipment, leading to unwanted contact when the gear is removed,” wrote the experts from Johns Hopkins and UNC. “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.”

The commentary highlighted the importance of safety measures taken by Doctors Without Borders in Africa, including a rigorous process for the removal of personal protective equipment with a buddy system whereby health care workers walk each other through the removal process to reduce instances of inadvertent transmission.

“Despite its lethal nature, Ebola transmission can be interrupted with simple interventions and by focusing on basics,” the authors wrote. “Improvement in basic health care infrastructure and providing an adequate supply of personal protective equipment, along with a ritualized process for donning and doffing personal protective equipment, are desperately needed to prevent further unnecessary infection and loss of life among the heroic health care workers who are on the front lines of this war.”