A second health care worker at Texas Health Presbyterian Hospital who tended to Thomas Eric Duncan as he died of Ebola has tested positive for the lethal virus and a hospital official said this morning that additional cases among the hospital's health care workers is a "very real possibility."
Ill take this update as an opportunity to also add some of the good suggestions from the comments section. Specifically health care workers should demand that the CDC work with MSF to identify specific changes to protocols and protective gear.
These protections should include:
Full face masks
full head covering
Full suits (NOT open backed gowns)
Revised doffing procedures
Spray down with bleach as part of decontamination
For healthcare workers with direct contact with the patient.
I've seen lots of comments on Dailykos around whether we have the right health care infrastructure, procedures etc to take care of Ebola patients and stop the spread. The CDC is blaming a "breach of protocol" for the Texas Nurse's Ebola infection.
Unfortunately the CDC recommendations are bad and it might not be a breach of protocol at all that is the issue. The current recommendations are not sufficient and may cause the infection of more health care workers until they get revised.
Ebola is a BSL4 rated disease. Unfortunately the CDC recommendations are based on BSL2 (not even BSL3) procedures and equipment. Until these procedures change, health workers will continue to get infected.
Here are the high level guidelines
Here are the very detailed droplet protection guidelines
Here is what BSL 2 covers. This level is for diseases that either don't kill you or that have a cure.
This level is similar to Biosafety Level 1 and is suitable for work involving agents of moderate potential hazard to personnel and the environment. It includes various bacteria and viruses that cause only mild disease to humans, or are difficult to contract via aerosol in a lab setting, such as C. difficile, most Chlamydiae, hepatitis A, B, and C, orthopoxviruses (other than smallpox), influenza A, Lyme disease, Salmonella, mumps, measles, scrapie, MRSA, and VRSA.
BSL 4 is as follows
This level is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections, agents which cause severe to fatal disease in humans for which vaccines or other treatments are not available, such as Bolivian and Argentine hemorrhagic fevers, Marburg virus, Ebola virus, Lassa virus, Crimean-Congo hemorrhagic fever, and various other hemorrhagic diseases.
Here are the CDC recommendations for Ebola prevention and control
HCP should wear gloves, a gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit-tested N95 filtering facepiece respirator or higher (e.g., powered air purifying respiratory or elastomeric respirator) during aerosol generating procedures.
Of course hospitals will choose the cheapest filters and N95 are much more cost effective than n100. Masks are more cost effective than fitted full face filters.
Unfortunately N95 is not sufficient to filter Ebola. The masks that just cover the mouth and nose are notoriously hard to fit to the face. Without a tight fit there is a huge amount of air going through spaces. Even if they are fitted tight to the face, N95 provides minimal protection against Ebola.
Ebola particles are around 800 nm (.8um) X 80 nm. They probably can be smaller as they arent fully stretched out.
In this experiment the investigators showed penetration of various particle sizes through the N95 mask. There are many others showing the same kind of info. Particles of Ebola's size have at least a 1% penetration rate.
N95 masks are absolutely NOT sufficient for health care workers taking care of Ebola patients.
You might have seen people walking around in white biohazard suits. Most likely they are Dupont Tyvek suits. You might have seen different colors, yellow and white.
You will notice these guys have taped seams, gloves are taped to suit, hair covering and full face respirators.
Unfortunately the CDC guidance related to outwear is limited to specifying that gowns be worn.
II.E.2. Isolation gowns Isolation gowns are used as specified by Standard and
Transmission-Based Precautions, to protect the HCW’s arms and exposed body
areas and prevent contamination of clothing with blood, body fluids, and other
potentially infectious material 24, 88, 262, 744-746
Clearly people are using both and there is a huge difference in the quality of protection between them.
Dupont (the maker of Tyvek suits) has published this information about which suits are appropriate for handling Ebola patients. The yellow suits are Tychem and the white suits are (usually) Tyvek.
Which DuPont garments comply with
North American standards for blood-borne
pathogens (ASTM F1670 and ASTM F1671)?
DuPont™ Tychem® QC and DuPont™ Tychem® SL
fabrics and their taped seams have been tested
and passed the requirements of North America
ASTM Standards F1670 and ASTM F1671.
Product compliance to those two standards
can be found here:
When you click the links you will see that all the suits that meet the standard are Tychem suits (although the Tychem SL suits are white).
Unfortunately Tyvek suits have huge pore sizes and Ebola can pass through Tyvek suits relatively easily.
Masks and gowns are two of the most important pieces for health care worker protection against Ebola infections. Unfortunately the current CDC recommendations are simply not sufficient to ensure protection of health care workers.
This is an example from a University of Mississippi press release.
The University of Mississippi Medical Center Stands ready to care for victims of Ebola
This is from a CDC release:
Keeping Ebola in Check: Advice From the CDC
CDC addresses the top questions asked by healthcare providers about the Ebola virus outbreak and possible spread to the United States.
They arent done dressing, but they have surgical masks (not even N95), open backed paper gowns, gloves not taped to gown and very pretty cloth hair covers.
Here is a diagram of the insufficient CDC guidelines for droplet protection (from NY Times, but originally from the CDC guidelines):
At the very least the CDC should be recommending full face mask n100 respirators along with full body Tychem gowns, taped sleeves and they need to be covering their hair with Tychem hoods. Until they do, a small percentage of health care workers will contract the virus from their patients.
Especially if you are a health care worker, please contact the CDC or your union (yes this conservative does believe that unions can play a useful role) to get the right protection and changes in protocol which could save your life.