Protective Clothing Ensembles for Ebola

Recently, the media and many politicians have focused a great deal of attention on the Ebola outbreaks in West Africa, where at this writing, some 10,000 have died, and on the few cases that have surfaced in the United States. This has led to some false assumptions, misinformation, and confusion, particularly about the appropriate protection for healthcare workers and others who might come in contact with the Ebola virus.

When two health care workers at a Texas hospital were exposed and subsequently developed symptoms of Ebola, hospital management was called before a congressional committee. It was learned that the workers had been provided with personal protection, but had received no training or supervision in the use of the equipment. Another revelation was that the Centers for Disease Control’s (CDC) recommendations were based on the World Health Organization’s (WHO) model. The WHO model was designed for situations in which “care is given in remote places,” where it would be likely “intensive training would not be available for health care workers,” such as remote villages in Liberia, Sierra Leone, and Guinea.

This begs the question of why the WHO model would be put forth by the CDC here in the United States where we have the world’s most comprehensive standards on personal protective clothing and equipment. The standards have been developed by government agencies and national standards making organizations and products that meet or exceed the standards are well known and widely available. Subsequently, in late October 2014, the CDC revised its recommendations. The latest CDC recommendations are a vast improvement, yet it seems likely that more revisions will follow.

The major mover in the field of protective clothing continues to be the National Fire Protection Association (NFPA) headquartered in Quincy, MA. They have two standards that apply, NFPA 1991, Standard on Vapor Protective Ensembles for Hazardous Materials Emergencies and NFPA 1994, Standard for Protective Ensembles for First Responders to CBRN Terrorism Incidents. In case there is any question here, the Ebola virus is a hazardous material, Hazard Class 6, Type A – an infectious substance. As far as the aforementioned CBRN (chemical biological, radiological, nuclear), Ebola has long been thought of as a potential biological agent that could be used as a weapon by terrorists.

Here is the bottom line- protective clothing certified to NFPA 1991 and NFPA 1994 is reliable for protection against Ebola, provided that proper donning and doffing protocols are followed as well as appropriate decontamination and waste management procedures for viral and bacterial threat contaminants.

Testing carried out under NFPA 1991 (totally encapsulating garments, also called vapor protective clothing) includes chemical resistance – how well the fabric repels the movement of the chemical though the CPC material. Each material is tested against a battery of 21 chemicals. No permeation is allowed for a minimum of one hour. One of the chemicals tested is chlorine. A chlorine molecule is about 5000 times smaller than an Ebola virus. So clearly, any ensemble that meets the standard will provide excellent protection against Ebola.

The ensembles designated Class 2 under NFPA 1994 are tested in a similar manner as the 1991 suits, but undergo separate tests for resistance to viral substances in liquid form. In one test, the entire garment is mounted on a mannequin and then sprayed with water from every direction for twenty minutes. If any water penetrates the ensemble, it fails. So, clearly these Class 2 ensembles are excellent barriers against Ebola.

Although it is likely that any garments used in the treatment and care of patients who have or are expected to have the Ebola virus will be of a disposable type, any re-useable equipment will have to be decontaminated. The U.S. Army Medical Research Institute of Infectious Diseases recommends decontamination of Ebola with a solution of five percent sodium hypochlorite, common household bleach, for three to five minutes followed by washing with soft liquid soap and rinsing. Contaminated run-off must be collected. The latest CDC recommendations advise cleaning with an EPA registered disinfectant wipe “with a label claim of potency at least equivalent to that of non-envelope virus.”

While the latest CDC recommendations focus on the hospital environment, it is important to understand that protection is required in any healthcare setting where there is potential for exposure to patients or infected materials including body substances, contaminated medical equipment, contaminated surfaces, or aerosols generated by certain procedures. Potentially at risk are EMTs, members of hazmat teams involved in transporting patients, mortuary personnel, and those involved in handling medical waste.

In the face of this uncertainty, because no FDA approved vaccine or anti-viral drug is available for Ebola, and because of the high morbidity of these infected with the disease, it is important to learn the most basic lesson of self-protection – that those whose duty calls them to work with Ebola patients can do so safely provided they have adequate protective clothing and equipment and are trained to use it.

At Emergency Film Group, we have been training emergency responders and medical personnel how to carry out potentially dangerous tasks safely for more than 35 years. Several years ago, we created a four part series called Hospital First Receiver which is now in use in more than 1,000 hospitals throughout the country. One program in that series is entitled “Self Protection.” It was designed to provide a comprehensive examination of the protective clothing and respiratory protection issues which OSHA says every user of the equipment must be aware.

While designed for the first receiver, the lessons apply equally to any person who is expected to be involved in the care of Ebola patients.  We have re-issued the program in a new edition to speak directly to the protective clothing issues raised by Ebola. More information about the updated program,  PPE for Ebola and Other Hazards: Protecting Healthcare Workers,  can be found here. . .