How protective against Ebola is protection gear?
The effectiveness of protection gear – also known as personal protective equipment or PPE – has been questioned after a nurse in Texas contracted the Ebola virus from a patient even though she was wearing full protective gear. Before that, a Spanish nurse also became infected, and back in July Dr. Sheik Umar Khan caught the virus and died in Sierra Leone in spite of using PPE. Though this might seem to establish a precedent regarding the safety – or lack thereof – of protective equipment, the fact is though that PPE is probably as effective as it has ever been and the contamination of health workers is more than likely due to human error.
As medical adviser to Doctors Without Borders Armand Sprecher told NPR.org in a July interview, “where we see healthcare worker infections when the PPE is in place, [the worker] did something to override the PPE: They didn't wear it appropriately or contaminated their hands in the process of getting [the suit] off.” In other words, the suit is not the problem; it’s just that accidents happen. “You can stick yourself with a needle, you can use your gear improperly, or you can undress improperly,” Sprecher said. He added that the suit only works as long as it is used together with a series of protocols.
For example, PPE suits can heat up very quickly, especially in tropical weather. Or as Sprecher put it, “it’s hotter than hell.” This can make it very tempting for healthcare staff to breach protocol and skip protection gear. As Fox News reported in September, doctors in West Africa tend to eschew protective equipment in temperatures of up to 100 degrees, in particular if they are in the general part of the hospital – outside of the Ebola unit – where there is no air condition. As it turns out, Dr. Rick Sacra – the third U.S. doctor to be diagnosed with the virus in Liberia –, an obstetrician who had no direct contact with Ebola patients made a conscious choice to forgo PPE and as a result contracted the disease. That comes to show that you can never be too careful.
In the specific case of the Texas nurse, CDC director Tom Frieden agrees with Sprecher’s point of view. “When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material,” Frieden said, “touching you and being then on your clothes or face or skin ... is not easy to do right.” An official with first-hand knowledge of the case told CNN that CDC detectives who interviewed the nurse found “inconsistencies” in the type of PPE she used and how she put it on and took it off. Frieden said health workers are sometimes guilty of overzealousness, which is actually a very fine line to cross. For instance, double gloving is recommended in some situations, but triple gloving is a violation of protocol.