My thoughts on PPE. Brought to you by It's All About Me.
My thoughts on PPE. Brought to you by It's All About Me.
I did infectious disease research in a BSL 3 lab that worked with viruses. Ebola is BSL 4, so it's a whole different ball of wax (how many categories of wax ball are there?). That being said, we had very specific protocols and procedures for wearing PPE. The physical set-up was very specific, as well. Aside from having to get through two key-code locked sets of doors, there was an outer room with autoclaves in it (pertinent because it relates to how some of the specialty infectious disease hospitals are set-up). Then, there was the room where we garbbed up and washed up and had whatever else stored or filed. After that, you got into the lab room itself.
This particular lab had determined that it was more effective to use cloth gowns that could be autoclaved, rather than disposable ones, so that's what we had. They are what surgical gowns were before there were disposable ones. We used boot covers, face masks, face shields, and double gloved, as well. There was a very specific order for putting it all on, and taking it all off. And there was a specific protocol for hand washing immediately after you got out of all the gear. We used to joke about safe hand washing because one of the ingredients in the soap/disinfectant we had to use is also used as a spermicide. This is not a comment on where we had been putting our hands; it is a comment on how difficult it is to kill sperm.
I've also taken care of patients in isolation. Most notably, XDR TB patients. What I can tell you is that this is not easy to catch, unless someone is actively coughing in close physical proximity. In addition, you generally have to inhale it. People are carefully trained and fitted with disposable TB masks, significantly reducing the risk. The paper gowns were not terribly substantial, but sufficient if someone coughed up some blood or sputum; no one is expecting a huge amount of body fluid exposure. The disposable gowns for the ebola patients would be much heavier and liquid resistant, more like disposable surgical gowns.
You were supposed to take off your white coat and leave all your stuff, including stethoscopes and such in the anteroom. There were disposable versions of all of that in the room with the patient. You only had to single glove. When you came out, you were supposed to take everything off and put it into the appropriate receptacle, and wash your hands.
Realistically, because it is possible but not easy to catch TB, people were either scared to go in at all, or sometimes got a little desensitized to the risk and forgot and brought their stethoscope with them, or weren't particularly careful about taking off the PPE. This is not smart, but less risky than ebola.
People are likely to be scared, and therefore much more careful with ebola. However, unless you have worked overseas in these situations, or are a specialist in such extremely infectious illnesses, you have not been trained to do this. It is not the same as TB, or a lot of other things commonly encountered in the US. Two asides: chickenpox and smallpox.
We had the unusual situation of an adult with chickenpox when I was in school. This can be a very serious infection if you first get it as an adult. Chickenpox is highly contagious, airborne, and you are infectious before you are sick. The main precautions, though, were that anyone who didn't have proven immunity was not allowed into the room, and basic gloves, gown, and mask if you went in. It was less of a big deal than the TB (unless you weren't immune, in which case as I mentioned you simply weren't allowed anywhere near).
Immediately following 9/11, there were serious concerns about bioterrorism, including smallpox. Which none of us had been trained to deal with or recognize or anything. They immediately found the old pictures and teaching materials, as well as faculty and staff who had dealt with it when it was still around. We were trained to recognize it, how to implement isolation procedures, discussed some of the possible new anti-HIV meds and hypothetical treatment protocols, and we were taught how to give the smallpox immunizations, should that become necessary (P.S. It's not just a shot in the arm.) Overall, the mortality was about 30%, but there's more than one form, and some of the rarer are generally fatal. It's a little more difficult to catch than chickenpox, but, as evidenced by history, it's plenty infectious, although not until the person is ill.
Some of the debates right now are around the specific protective equipment and procedures that should be implemented because of ebola. There are discussions of the risks of making them too complex. You know, the more pieces and steps, the more chance of a mistake. There are also discussions of the risks of not protective enough. Any exposed skin is a potential risk.
Some of the current issues with infection control in hospitals come from complacency. I don't think people will become complacent with this because it's too rare and too dangerous. People have become ill, someone has died, so that should be enough to prevent casual carelessness. Therefore, I think people will try to scrupulously follow whatever procedures, but it may help to find the minimum safe level of complexity.
While ebola is apparently relatively easy to kill on surfaces with standard dilute bleach, it is extremely virulent. One reference I saw suggested as few as 10 virus particles might be enough to cause illness. I wish I could explain how vanishingly small that is, how impossibly tiny an amount to be so dangerous.
Personally, I think this is sufficiently risky that a higher level of PPE is warranted. Exactly how much higher is a balance of realistic risk and realistic daily use, as well as what is available. Even at the currently recommended levels, an intensive level of training should be implemented nationally for all first responders and health care providers.
It's not realistic, so Don't Panic, but even community private clinics and medical offices need to be trained. Why? Because this is going to look for all the world like a bad stomach bug, or the flu, or something else. What happened in Dallas is an object lesson that every point of entry needs to be trained.
Which leads into a discussion of public health and all that jazz, which I will save for another ramble on the virucide.
I did infectious disease research in a BSL 3 lab that worked with viruses. Ebola is BSL 4, so it's a whole different ball of wax (how many categories of wax ball are there?). That being said, we had very specific protocols and procedures for wearing PPE. The physical set-up was very specific, as well. Aside from having to get through two key-code locked sets of doors, there was an outer room with autoclaves in it (pertinent because it relates to how some of the specialty infectious disease hospitals are set-up). Then, there was the room where we garbbed up and washed up and had whatever else stored or filed. After that, you got into the lab room itself.
This particular lab had determined that it was more effective to use cloth gowns that could be autoclaved, rather than disposable ones, so that's what we had. They are what surgical gowns were before there were disposable ones. We used boot covers, face masks, face shields, and double gloved, as well. There was a very specific order for putting it all on, and taking it all off. And there was a specific protocol for hand washing immediately after you got out of all the gear. We used to joke about safe hand washing because one of the ingredients in the soap/disinfectant we had to use is also used as a spermicide. This is not a comment on where we had been putting our hands; it is a comment on how difficult it is to kill sperm.
I've also taken care of patients in isolation. Most notably, XDR TB patients. What I can tell you is that this is not easy to catch, unless someone is actively coughing in close physical proximity. In addition, you generally have to inhale it. People are carefully trained and fitted with disposable TB masks, significantly reducing the risk. The paper gowns were not terribly substantial, but sufficient if someone coughed up some blood or sputum; no one is expecting a huge amount of body fluid exposure. The disposable gowns for the ebola patients would be much heavier and liquid resistant, more like disposable surgical gowns.
You were supposed to take off your white coat and leave all your stuff, including stethoscopes and such in the anteroom. There were disposable versions of all of that in the room with the patient. You only had to single glove. When you came out, you were supposed to take everything off and put it into the appropriate receptacle, and wash your hands.
Realistically, because it is possible but not easy to catch TB, people were either scared to go in at all, or sometimes got a little desensitized to the risk and forgot and brought their stethoscope with them, or weren't particularly careful about taking off the PPE. This is not smart, but less risky than ebola.
People are likely to be scared, and therefore much more careful with ebola. However, unless you have worked overseas in these situations, or are a specialist in such extremely infectious illnesses, you have not been trained to do this. It is not the same as TB, or a lot of other things commonly encountered in the US. Two asides: chickenpox and smallpox.
We had the unusual situation of an adult with chickenpox when I was in school. This can be a very serious infection if you first get it as an adult. Chickenpox is highly contagious, airborne, and you are infectious before you are sick. The main precautions, though, were that anyone who didn't have proven immunity was not allowed into the room, and basic gloves, gown, and mask if you went in. It was less of a big deal than the TB (unless you weren't immune, in which case as I mentioned you simply weren't allowed anywhere near).
Immediately following 9/11, there were serious concerns about bioterrorism, including smallpox. Which none of us had been trained to deal with or recognize or anything. They immediately found the old pictures and teaching materials, as well as faculty and staff who had dealt with it when it was still around. We were trained to recognize it, how to implement isolation procedures, discussed some of the possible new anti-HIV meds and hypothetical treatment protocols, and we were taught how to give the smallpox immunizations, should that become necessary (P.S. It's not just a shot in the arm.) Overall, the mortality was about 30%, but there's more than one form, and some of the rarer are generally fatal. It's a little more difficult to catch than chickenpox, but, as evidenced by history, it's plenty infectious, although not until the person is ill.
Some of the debates right now are around the specific protective equipment and procedures that should be implemented because of ebola. There are discussions of the risks of making them too complex. You know, the more pieces and steps, the more chance of a mistake. There are also discussions of the risks of not protective enough. Any exposed skin is a potential risk.
Some of the current issues with infection control in hospitals come from complacency. I don't think people will become complacent with this because it's too rare and too dangerous. People have become ill, someone has died, so that should be enough to prevent casual carelessness. Therefore, I think people will try to scrupulously follow whatever procedures, but it may help to find the minimum safe level of complexity.
While ebola is apparently relatively easy to kill on surfaces with standard dilute bleach, it is extremely virulent. One reference I saw suggested as few as 10 virus particles might be enough to cause illness. I wish I could explain how vanishingly small that is, how impossibly tiny an amount to be so dangerous.
Personally, I think this is sufficiently risky that a higher level of PPE is warranted. Exactly how much higher is a balance of realistic risk and realistic daily use, as well as what is available. Even at the currently recommended levels, an intensive level of training should be implemented nationally for all first responders and health care providers.
It's not realistic, so Don't Panic, but even community private clinics and medical offices need to be trained. Why? Because this is going to look for all the world like a bad stomach bug, or the flu, or something else. What happened in Dallas is an object lesson that every point of entry needs to be trained.
Which leads into a discussion of public health and all that jazz, which I will save for another ramble on the virucide.
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