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What PPE should be used when caring for an Ebola patient?

There’s been a lot of chatter on twitter as far as whether hospitals are doing enough to protect nurses who come in contact with an Ebola patient. I’ve also seen the sentiment that we shouldn’t be spreading fear, because Ebola isn’t an airborne virus. And the rallying cry that, “Protocols work if we follow them correctly!” There’s no question that these discussions are needed. There seems to be much confusion over what we should be doing.

Do we really know what PPE is best to wear when caring for an Ebola patient?

According to the CDC: “Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola virus disease.” In the hospital where I worked, droplet precaution gear included a full face shield, hat, gloves, gown, and shoe covers. This did leave parts of the skin exposed, particularly around the neck.

And yet when you see images of  Doctors Without Borders caring for Ebola patients, their gear is definitely more comprehensive, to the point of having zero skin exposed.

When I worked in the MICU, it was part of our nursing culture that we took our PPE very seriously. If we saw a colleague cutting corners, we could call them out on it; and rightly so. On a daily basis were caring for patients with MDR Acinetobacter and TB, as well as the usual suspects, MRSA and VRE. That’s why I was honestly a little furious to hear CDC director, Dr. Tom Frieden claim that Nurse Nina Pham’s infection was due to a breach in protocol (although he later walked that statement back. Walked it waayyyyyy back.)

There’s also a major difference between caring for patients with the usual MDR bugs and Ebola: The MDR bugs mainly harm the already immunocompromised patient, while Ebola seems to quickly infect an otherwise healthy person. I’m not an infectious disease specialist, but that alone should require heightened precautions.

So we now have 2 nurses who have contracted the disease while caring for index patient, Thomas Duncan. The CDC website still says that droplet precaution gear is adequate in protecting the health care provider. Would Dr. Frieden feel comfortable cleaning up Ebola infected stool while wearing droplet gear? I know I wouldn’t. My prediction is that this is going to change very quickly. I also would not be surprised if US Ebola patients (and there will be more) are transported to hospitals that are thoroughly trained on dealing with Ebola, like Emory or Nebraska Med.

My heart goes out to those two nurses. I can’t imagine the fear they are living with at this moment. They are truly brave and I wish them a quick recovery. In the mean time let’s start giving our nurses the protection they need.

UPDATE: The second nurse diagnosed with the Ebola virus, Amber Vinson, is being flown to Emory for treatment.

One more thought: Why do the Ebola cleanup hazmat crews in Dallas have better protective gear than the nurses?

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