EbolaHow are nurses becoming infected with Ebola?
WHO, CDC, and health authorities in many countries recommend health workers treating Ebola wear surgical masks for protection, along with other personal protective equipment such gowns, gloves, and goggles. A glaring inconsistency of these guidelines is that lab scientists working with Ebola are recommended to use respirators, which offer more protection than surgical masks, while masks are deemed adequate for doctors and nurses at the front line. The hospital ward, however, is a far more contaminated and volatile environment than the sterile, highly controlled lab, and nurses have the closest contact with patients, and deserve all available protection for their occupational health and safety. In most responses, lack of knowledge about infection control may not be critical, but in the case of Ebola it may cost lives. The price of getting it wrong with flu guidelines might be a week in bed, but for Ebola it is far more likely to be death. The risk analysis equation we need to use must consider not only the probability of Ebola turning up on our shores, but also the consequences.
American nurse Nina Pham is the second health worker to contract Ebola outside of West Africa while caring for patients with the virus, despite using personal protective equipment. Authorities were quick to attribute lapses in protocol for Pham’s and Madrid nurse Teresa Romero Ramos’ infection. But inadequate guidelines for personal protective equipment (PPE) may equally be to blame.
The World Health Organization (WHO), United States Centers for Disease Control (CDC), Australia and many countries recommend health workers treating Ebola wear surgical masks for protection, along with other personal protective equipment such gowns, gloves and goggles.
A glaring inconsistency of these guidelines is that lab scientists working with Ebola are recommended to use respirators, which offer more protection than surgical masks, while masks are deemed adequate for doctors and nurses at the front line. The hospital ward, however, is a far more contaminated and volatile environment than the sterile, highly controlled lab.
Nurses have the closest contact with patients, and deserve all available protection for their occupational health and safety. This means higher personal protective equipment, including respirators.
The CDC’s most recent guideline update for putting on and removing protective wear suggest the second glove can be removed by hooking a bare finger under the glove (risking contact with the outside of the glove which could be contaminated), and does not mention protective boots at all.
Non-government organizations such as Medecins Sans Frontieres (MSF), however, have more comprehensive Ebola-specific protocols on glove removal, footwear and the use of respirators.
Ebola kills 50 percent to 90 percent of people who become infected, which is much higher than any other infection we are used to dealing with. The 2009 influenza pandemic killed less than 0.01 percent of those infected, and SARS killed 15 percent.
The price of getting it wrong with flu guidelines might be a week in bed, but for Ebola it is far more likely to be death. The risk analysis equation we need to use must consider not only the probability of Ebola turning up on our shores, but also the consequences.
Unprecedented epidemic
The current West African Ebola outbreak has caused more than 8,000 cases and more than 4,000 deaths, with the epicenter being Guinea, Sierra Leone and Liberia. Official figures are underestimated because many cases are not reaching health-care facilities or being reported.
