The 2013-2016 Ebola outbreak in West Africa showed amongst other things how much currently available protection equipment is inappropriate in the context of Ebola case management centers. Local health care workers as well as staff from international relief agencies have had to improvise quick fixes and manage with whatever was available.
This lack of appropriate equipment prevents preparedness against the virus and hampers the enforcement of infection prevention and control guidelines. The lack of standardized material and procedures also increases the risk of improper handling and of self-contamination for health care workers.
Lack of human contact between caregivers and patients: Healthcare workers are fully covered by the PPE, so that the patients can only see their eyes. It is thus difficult for them to read their doctor’s or nurse’s facial expression, or even to recognize them. For workers, it is difficult to speak through their mask and to make themselves understood.
Heat inside the PPE: As the protective equipment is fully impermeable, the lack of fresh air causes a rapid temperature increase. The air is also quickly saturated with water vapor, and transpiration is no longer efficient in cooling the body. Fog forms on the goggles, reducing the already limited field of view of the workers.
Fatigue and self-contamination: After spending an hour in such an environment, healthcare workers are exhausted, often dehydrated, and eager to remove their PPE and to breathe freely. They are thus prone to errors during the doffing procedure, which can lead to self-contamination.
Cost and waste: Current protective equipment are a combination of 8 different items, some of which are reusable while others are single-use. Even though each item in itself is relatively cheap, the number of items and the number of times they must be changed every day (remember that working shifts are limited to a maximum of 1 hour before workers overheat or faint) make it very expensive in the long run. Besides this cost issue, all single-use items must be disposed of safely. This means that an incinerator must be available and functional – inside the high risk zone – or that a waste pit must be dug – and can fill up quite quickly with all this waste.
Deddeh takes over young Elijah (whose mother has passed away in the CMC because of Ebola) © Martin Zinggl/MSF