Ebola patient carers at risk of infection when removing protective
24 October 2014
A team of American infectious disease and critical care experts
have issued an alert for clinicians caring for Ebola patients that
how they remove their personal protective gear can be just as
crucial as wearing it to prevent exposure to the deadly virus.
In a commentary published online on Aug. 26 in the Annals of
Internal Medicine, the physician-specialists from Johns Hopkins
and the University of North Carolina say rigorous steps exist — and
must be taken — to avoid “inadvertent” contact of frontline
caregivers’ exposed skin and mucous membranes to infected body
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,” say the authors.
“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,” the authors say. “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.
According to the World Health Organization, the unprecedented
outbreak of Ebola in West Africa has resulted in a “high proportion
of doctors, nurses and other health care workers who have been
infected.” These are mainly in the countries of the outbreak, but
also some returning to the US have contracted the disease in the
last few days.
To date, says the World Health Organization, more than 240 health
care workers have developed the disease in Guinea, Liberia, Nigeria
and Sierra Leone. More than 120 have died, including prominent
doctors in Sierra Leone and Liberia.
Despite the challenges of preventing inadvertent exposure from
improper personal protective equipment removal, they say that health
care workers are generally aware of and are using proper
For example, treatment sites in Africa administered by Médecins
Sans Frontières, have established a systematic process to mitigate
the risks associated with removal of personal protective equipment,
including a buddy system in which health care workers walk each
other through each step of the removal process to help ensure
In the US, CEPAR, in collaboration with Perl, has established a
number of clinical guidelines and tools to ensure Johns Hopkins
hospitals, outpatient clinics and primary care offices take adequate
precautions when encountering patients who have had a history of
recent travel to West Africa.
Such precautions include proper procedures for the donning and
doffing of PPE for any patient identified as having such a travel
history and who has symptoms associated with Ebola.
“Despite its lethal nature, Ebola transmission can be interrupted
with simple interventions and by focusing on basics. 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,” the authors write in the commentary.