The Devil and the Angels are in the Details: Healthcare Worker Personal Protective Equipment, Designed to Prevent the Spread of Infection, is Failing Us – And the Problem isn’t With the Equipment

The continuing Ebola outbreak in West Africa has so far infected more than 800 doctors and nurses, killing close to 500 of them, despite the fact that they wore personal protective equipment (PPE) – gowns, gloves, goggles, and masks.

The problem isn’t confined to Africa. Cases where PPE-wearing nurses have contracted Ebola in top notch US and Spanish hospitals reveals an underlying and tricky issue: The equipment isn’t protecting us, it’s because of improper use not the gear itself, and the problem extends to bad bugs in general, not just to Ebola.

PPEJust last week at a medical conference in Orlando, Florida, researchers presented a study which found that contamination occurred almost 50% of the time in PPE-wearing US healthcare workers.

Myreen Tomas, MD, and her colleagues at the Cleveland Veterans Affairs Medical Center, enlisted in their study, nurses, nurses aids, phlebotomists, radiology technicians, physical and occupational therapists, and other healthcare personnel who use PPE and interact with patients.

In 435 simulations they had them remove gowns and gloves that were “contaminated” with a fluorescent lotion. They used black light to identify sites on skin and clothing contaminated with the lotion.

“We were very surprised by what we found,” said Dr. Thomas: Of the 435 PPE removal simulations, there were 200 instances (46%) of contamination, mostly to the hands and neck.

Here’s the good news. If healthcare workers paid attention to the details of using PPE, Dr. Thomas says they could reduce contamination rates to as low as 5%. For example: ensure the gown and gloves are the right size because they come prepackaged so often times they’re too large for most nurses and techs; put the gown on before the gloves; ensure the wrists are completely covered by the gown and that there is no exposed skin; and remove the gown by pulling it away from the body instead of over the head.

This matters because the wearing of PPE is standard practice for dealing with the vast number of people who contract contagious disease. A conservative estimate by the Centers for Disease Control and Prevention says that every year in the US more than two million people are sickened with antibiotic-resistant infections, with at least 23,000 dying as a result. MRSA alone is responsible for almost half of those deaths (p.77). The Canadian rates, population adjusted, are similar.

It’s understood that well-meaning healthcare workers are major conveyers of infectious disease simply because they are so exposed to it.

Thus the question: How much of this harm could we avoid if we paid attention to the details of PPE usage – and thereby reduced worker contamination rates to near 5% – as suggested by Dr. Thomas?

 

 

 

 

 

 

 

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