How To Suit Up for Potential Ebola Cases

Levels of protective gear for Ebola

NY Times

Changes to Ebola Protection Worn by U.S. Hospital Workers

October 15, 2014

After two nurses in Dallas tested positive for Ebola after helping to care for Thomas Eric Duncan, the Liberian who died of the disease last week, federal health officials decided to tighten the guidelines for American hospitals with Ebola patients. Many hospitals, including those in the North Shore Long Island Jewish Health System and the Nebraska Medical Center in Omaha — one of four facilities in the country with biocontainment units equipped to isolate patients with dangerous infectious diseases — have long had more stringent guidelines than the C.D.C. OCT. 15, 2014

Levels of protective gear

Original C.D.C. Guidelines -- The suit above represents the C.D.C.’s original guidelines for health care workers who would come in contact with Ebola patients but would not be exposed to their blood or bodily fluids.

North Shore-L.I.J. Level 2 Suit -- The C.D.C. has recommended extra levels of protection, like those above, in cases where workers could come into contact with a patient’s bodily fluids. Many hospitals,
including the Nebraska center, have required these levels as the minimum. Before this week, this suit was used by North Shore-L.I.J. hospitals for patients who were suspected of having Ebola, but they have since decided to upgrade to the Level 3 Suit instead.

North Shore-L.I.J. Level 3 Suit --  After the second nurse in Dallas was diagnosed with Ebola, the North Shore system upgraded their Level 3 suit by adding an impermeable gown on top. The suit
shown above begins to approach the standard of protection used by health care workers
in West Africa. The C.D.C. may soon require full-body suits in the United States.

The Difficult Process of Removing Protective Gear

Removing the layers of protective clothing is difficult, and many health officials have identified this process as a likely cause of infection. The C.D.C. director, Dr. Thomas R. Frieden, said the most important way to protect health workers is for a site manager to oversee them as they put on and take off the gear; this system has been implemented in Texas.

1. Gloves

ORIGINAL C.D.C. GUIDANCE The gloves come off first. The rest of the disrobing process can be done with bare hands. A bare hand can safely pull off a glove by slipping it under the wristband.
THE HOSPITALSWorkers at some hospitals use two pairs of gloves so that the inner pair remains on during the disrobing process.

2. Face Shield

C.D.C. Goggles, safety glasses or face shields should be grasped from the band or ear pieces, which are considered “clean” and safe to touch with bare hands.
THE HOSPITALS Nebraska’s protocol calls for removing these only after the gown and second gloves are removed, and a third pair of sterile gloves are put on.

 3. Gown

C.D.C. Bare hands untie knots in the back, which are not considered contaminated. A peeling motion is used to turn the gown inside out for disposal. 
THE HOSPITALS The protocol at North Shore, like that in Nebraska, specifies that the gown be removed before the second pair of gloves are taken off.

4. Mask

C.D.C. Masks are removed last by grasping behind the ears without touching the front, which is considered contaminated. 
THE HOSPITALS Hospitals specify using the second or third pair of gloves to remove masks.



How To Suit Up for Potential Ebola Cases

October 15, 2014

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