Overprotection Does Not Equal Protection: Ebola and Healthcare Worker Deaths

There is a disturbing, if not surprising, post in Bloomberg describing the horrible conditions that healthcare workers face when caring for patients with Ebola. In the current outbreak it is estimated that over 300 healthcare workers have been infected and 150 have died. It is clear that the systems designed to protect healthcare workers are failing. The central problem is that the temperatures inside the "Ebola Suits" can reach 115 degrees and can take a long time to safely remove. To begin to understand the problem, all you have to do is read this quote from Douglas Lyon:

“The first 15 minutes I was just hot...After that I was hot and had a wicked headache. Each breath in was a mix of a hint of cool relief and the feeling of suffocation. Each breath out was as warm and hot and humid as the rest of you.”

How long can you wear such a suit? How carefully will you remove such a suit? I suspect that it's hard to be deliberately slow when you're suffocating. On top of that, these suits are expensive. A facility caring for 70 patients is estimated to go through 200 sets of protective equipment per day at $77 each - $15,400. This is in countries where they can't normally afford to purchase alcohol hand rub, so hospitals distill it themselves from sugar cane or other sources.

The suffering and cost would be fine if bodysuits were both effective and necessary; however, this might not be the case. Our co-blogger Dan and colleagues wrote a wonderful opinion in the Annals last month that highlighted CDC recommendations: contact and droplet precautions - a fluid-impermeable gown, gloves, a surgical mask, and either goggles or a face shield along with shoe/leg coverings if the patient has “copious” secretions and N95 mask if they are undergoing an aerosol-generating procedure.

CDC does not recommend full-body HazMat suits.

Apart from asking you to read the paragraph below and suggesting that if we had better science around infection prevention, we'd have safer hospitals and less debate around things like HazMat suits, I would like to close with a quote from the Annals commentary: "Exceeding these recommendations may paradoxically increase risk. Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear. Requiring HazMat suits and respirators will probably decrease the frequency of provider–patient contacts, inhibit providers' ability to examine patients, and curtail the use of diagnostic tests...Using extra gear inflates patients' and caregivers' anxiety levels, increases costs, and wastes valuable resources."

-----

Usually, when I'm frustrated about the lack of science around infection prevention, I end my post by requesting adequate research funding. What is entirely obvious is that we take infection prevention for granted. We know hand hygiene should be 100% and we have gloves, gowns, masks, bodysuits, yet we fund NO research on how to improve hand hygiene compliance, develop better gloves or design new bodysuits that clinicians can remove safely. We are now paying a price for this lack of attention. I hope that federal agencies or the Gates Foundation will fund infection prevention studies that determine ways to improve systems of prevention so that caring for patients with Ebola isn't life threatening and so we no longer transmit deadly pathogens in our hospitals.