On March 12, 2015, a British Military Nurse was diagnosed with Ebola in Sierra Leone and subsequently flown back to the UK for treatment. She, like Pauline Cafferkey who returned to the UK from Sierra Leone on December 28, 2014, was working in the Save the Children facility in Kerry Town. Over the past week, 20 Health Care Works (HCWs) have been repatriated to the UK and USA as a result of possible exposure to Ebola for further monitoring. “Save the Children” have concluded that they believe her infection was as a result of wearing non-standard equipment. Since returning home Nurse Cafferkey has been called to partake in a GMC investigation into the events. Having reviewed much of the recent footage and delivered our own training program, we find it unlikely that personal protective equipment (PPE) failure or a lack of training is the root cause. However, it is apparent that there are a number of stark procedural errors being employed by professionals assisting with the current Ebola outbreak. Current figures suggest that there are approaching 1,000 HCWs who have become infected with Ebola, over 50% of whom have died. The high infection rate of HCWs v Non-HCWs is concerning; a ratio like this would normally have set alarm bells ringing.
Current dress standard protocols, which were updated by the Centre for Disease Control (CDC) in October 2014, have been amended to include a “no bare skin policy”, advising at-risk individuals to wear a full face shield with an oral nasal mask or alternatively a full face respirator. But provides no guidelines on the order to don or doff PPE however, this need to dress and undress in a particular order is at the core of every chemical, biological, radiological and nuclear (CBRN) standard operating procedures. As an experienced CBRN operator, operating in a high risk and potentially contaminated environment such as could be found in an Ebola treatment facility, I am taught to protect the routes of entry to the body: airway, eyes, mucus membranes and skin (in priority order). This need to protect the routes of entry is then used to develop and adopt safe undressing and decontamination procedures, which in turn inform the order in which you don your protective equipment at the start of the mission. By considering the routes of entry and the priority order for dressing, the oral nasal mask and goggles should be donned first and consequently removed last. However, the current situation sees the oral nasal mask and goggles being worn on the outside of hoods and are therefore, the first item to be removed thereby, exposing the most vulnerable areas of the body first. In my view, it is absolutely apparent that current standards and dress protocols are not only unsuitable for high risk environments but also potentially life threatening to HCW; which is arguably supported by the statistics.
Questions that should be asked are:
- Who has tested and approved the wearing of the PPE, decontamination and Undressing procedures that our personnel are adopting? It is my understanding that all procedures of this nature are approved and tested by DSTL Porton down (The UK Military PPE, Decontamination authority).
- What Testing has been conducted on the Decontamination solutions adopted?
- Who has the lead on the ground with regards to dress standards, improvising standards, decon procedures etc.? And who conducts the regular reviews?
— Iain Thomson, Technical Director at SecureBio Limited