Since contracting Ebola can only happen when people come in contact with infected fluids, caregivers need to be protected. Personal Protection Equipment (PPE) are actually the solution but current PPE come with drawbacks. Improving PPE is a major goal of Fighting Ebola and it’s one area where makers can have an impact. What follows is an introduction to PPE because we can’t improve them if we don’t understand them.
PPE as pictured above is a series of layers put on in a specified order. The first layer is body cloth cover, followed by Tyvek, followed by Tychem where each progressive layer breathes less, is less permeable. Layers of gloves are also put on in a specific sequence. Lastly, to protect the mucus membranes located in the eyes, nose and mouth healthcare workers dawn head covers such as hoods, duckbill masks and goggles. Getting the sequence right is important to being protected; even more important is taking the PPE off properly as that’s when a slip-up poses the risk of infection.
At this point caregivers are dressed and ready to work so what do they do in this getup? In an Ebola Care Unit (ECU) they provide care to the sick. This means monitoring patients’ conditions, examining them and doing procedures like drawing blood. Patients often need assistance eating, drinking and taking their medicine. Caregivers will also clean the sick and provide emotional support. Remember, they’re doing all this from inside this layered getup, in close proximity to the virus, and with the utmost need to be careful while at the same time being helpful.
Ebola patients in the ECU are not in good physical condition. They’re weak and need help walking or they need to be carried. They produce lots of fluids such as vomit and diarrhea which are filled with Ebola virus. Patients are understandably restless, depressed and anxious. Having to deliver care is difficult enough but these factors complicate matters.
A care giver’s life inside the PPE is not pleasant. By design the suit doesn’t allow for much ventilation so as you generate heat the temperature in the PPE goes up. In an air conditioned room a person would get hot; in the warmth of West Africa they quickly overheat and dehydrate as their body sweats in an effort to cool itself. In addition to heat there are issues with how their senses are impaired. You might have goggles on which are probably fogged and their peripheral vision is restricted. Their head is covered so their face is hidden, their voice is muffled, their hearing and situational awareness are impaired. It’s suffocating, requires constant vigilance and restraint of habits to not become infected, and there’s a feeling of physical and emotional isolation. These introduce serious challenges to effective care delivery!
Conditions in this gear are so bad that there are serious impacts on scheduling care givers. A worker can only realistically withstand conditions for 40 – 60 minutes inside a Tychem-C PPE before needing to disrobe. With such short windows of uptime there’s pressure to optimize how care time is spent. Physical and psychological conditions in the suit are such that there’s a required recuperation period before suiting up again. Resource planning is greatly complicated by this cycle of downtime to recovery. Planning must be done by the man hour of labor. In the context of too few healthcare workers and a rapidly growing epidemic the PPE issues become a real challenge.
Oh and what’s the per unit cost for this outfit? The Ebola outfit at the top of this post is roughly $60 and, again, it’s almost all thrown away after one hour. Seems to me there’s lots of opportunity for makers to improve on this situation!