Home Front: eww, don't get your Ebola on me!

So, I've been asked by a few different people "just what CAN we do to be safe from Ebola?"

Before I get into the details of PPE and other practices and procedures, I think it's worthwhile checking out some details on how you CAN'T get Ebola: I go to the CDC for all my Ebola guidance, and take their advice to heart. These are the people who know. Listen to the local guides ....

"In healthcare settings, Ebola is spread through direct contact (e.g., through broken skin or through mucous membranes of the eyes, nose, or mouth) with blood or body fluids of a person who is sick with Ebola or with objects (e.g., needles, syringes) that have been contaminated with the virus. For all healthcare workers caring for Ebola patients, PPE with full body coverage is recommended to further reduce the risk of self-contamination.

• Avoid contact with blood and body fluids of any person, particularly someone who is sick.
• Do not handle items that may have come in contact with an infected person’s blood or body fluids.
• Do not touch the body of someone who has died from Ebola."

 So, if you aren't currently in an Ebola affected area, treating suspected Ebola patients or planning to either eat bushmeat or take up embalming in West Africa, you probably don't need to worry much, right now.

That said, we're all about being prepared here, so in the interest of education and edification, here are some guidelines for how to protect against a virulent, non-airborne, aerosol-capable infective agent like the Ebola virus.


 N95 Respirator: Here is what the FDA have to say about the N95 rating on a facemask, or respirator

"An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. In addition to blocking splashes, sprays and large droplets, the respirator is also designed to prevent the wearer from breathing in very small particles that may be in the air.
To work as expected, an N95 respirator requires a proper fit to your face. Generally, to check for proper fit, you should put on your respirator and adjust the straps so that the respirator fits tight but comfortably to your face. For information on proper fit, refer to the manufacturer’s instructions.
The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95% of very small test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.

N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection."

Sorry kids and Tactical Beard Owners ...

Nitrile Examination Gloves:
 These tough and resistant gloves have a different feel to the more common latex examination glove, somewhat less tactile and more stiff, they have the become the standard for infection control PPE for this kind of situation.

Alcohol Based Hand Rubs are more effective against most bacteria and many viruses than either medicated or non-medicated soaps. Its common for me to squirt my hands with this stuff at work (even in my technical role) two or three times a day. It's ubiquitious at ever ward entrance and lift-well.

There is even some debate around alcohol-only ABHR versus alcohol-chlorhexidine ABHR: The addition of a low concentration of chlorhexidine to an ABHR results in significantly greater residual activity than alcohol alone and therefore potentially improves efficacy.

Then there is the "what do I do if I really, really don't want to be exposed, clinical worker level protection. Guidelines from the CDC again:

Recommended PPE for Trained Observer during Observations of PPE Doffing

The trained observer should not enter the room of a patient with Ebola, but will be in the PPE removal area to observe and assist with removal of specific components of PPE, as outlined below. The observer should not participate in any Ebola patient care activities while conducting observations. The following PPE are recommended for trained observers:

• Single-use (disposable) fluid-resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood.
• Single-use (disposable) full face shield.
• Single-use (disposable) nitrile examination gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.
• Single-use (disposable) fluid-resistant or impermeable shoe covers. Shoe covers should allow for ease of movement and not present a slip hazard to the worker.

Trained observers should don and doff selected PPE according to same procedures outlined below. Of note, if the trained observer assists with PPE doffing, then the trained observer should disinfect outer-gloved hands with an *EPA-registered disinfectant wipe or ABHR immediately after contact with healthcare worker’s PPE.

So, there you go: full fluid-proof gown, double-gloved, face-mask, booties. Even then, getting all this gear ON right isn't the only challenge. Getting it OFF again, when you have potientially been exposed is another task entirely. Which is why in hospital settings hey have those "Trained Observer" positions in the first place. All the PPE in the world isn't going to do you a lick of good if you rub that last contaminated piece of clothing on your face as you are getting it all off.

The University of Nebraska Medical Centre have these two excellent visual guides, which you may find useful:

Donning Visual Guide

Doffing Visual Guide

The question of "how long until it is safe to go back in there? "comes up: Again the CDC have all the answers:

How long does the Ebola virus persist in indoor environments?

Only one laboratory study, which was done under environmental conditions that favor virus persistence, has been reported. This study found that under these ideal conditions Ebola virus could remain active for up to six days. In a follow up study, Ebolavirus was found, relative to other enveloped viruses, to be quite sensitive to inactivation by ultraviolet light and drying; yet sub-populations did persist in organic debris.
In the only study to assess contamination of the patient care environment during an outbreak, conducted in an African hospital under "real world conditions", virus was not detected by either nucleic acid amplification or culture in any of 33 samples collected from sites that were not visibly bloody. Virus was detected on a blood-stained glove and bloody intravenous insertion site by nucleic acid amplification, which may detect non-viable virus, but not by culture for live, infectious virus.³ Based upon these data and what is known regarding the environmental infection control of other enveloped RNA viruses, the expectation is with consistent daily cleaning and disinfection practices in U.S. hospitals that the persistence of Ebola virus in the patient care environment would be short – with 24 hours considered a cautious upper limit.

Lastly, for area and surface disinfection, the relatively simple method of 1:10 chlorinated bleach in water to decontaminate highly soiled areas, and 1:100 to spray, soak and pre-wash infected areas bedding and equipment,  is believed to be highly effective.

So, be safe out there, but don't panic. There are far more common killers in the microbial world....

When

commercial

disinfectant

products

are

unavailable,

common

household

bleach

and

other

appropriate

disinfectants

may

be

effective

alternatives.

•

Use

a

1:10

solution

of

bleach

to

water

(e.g.,

1

cup

of

bleach

in

9

cups

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Repost - "How To Properly Remove Exam Gloves And A Tyvek Suit Without Contaminating Yourself"

From my friends over at Modern Survival Blog, which I follow happily: This came up recently, and I wanted to share it, not only becasue they are informative, but also becasue sometimes they are funny as well. Heres a post from October 9, 2014 by Ken Jorgustin ...

Here are the two clips he posted.

I've used this particular technique since first year uni. I can flick my used and twist-wrapped gloves across a room and into a biohazard bin


Very handy tricks.

Home Front: Ebola 2014

One of the things that that working in the industry I do, with the academic background I have, when things like the West Africa 2014 Ebola outbreak occur, I have both a cold clinical reaction, and a very fierce panic about all the possibilities.

One of the advantages of working where I do, is that we are kept very well informed of trends and the prospects of this kind of event to affect us as "health workers" but also because of the particular nature of our cohort. We get all the notifications for all the major illness outbreaks from swine flu to gastroenteritis. 

We even get annual influenza immunization as part of our workplace amenities.   The notifications we get are the same kind that hospitals and government agencies around the world issue.

I also follow sources like the CDC, via twitter
through its main site and generally pay attention. I might not be able to tell you who won the World Cup, but this is the kind of news I follow closely.

I lived in Gabon, west Africa when I was 4, and contracted malaria whilst there. Malaria, by way of mosquitoes is one of the biggest killers of humans of all time, nicely tabulated here, and I can personally attest that it is not pleasant at all. However, it is not anywhere as visceral and horrific as Ebola hemorrhagic fever. 

It's also worth noting that Gabon also had it's own Ebola outbreak, in 2002 as did Sudan, and a raft of other central African countries between 1995 and 2014. I've lived and traveled to some exciting places, and have been pretty lucky, health wise.

Given how much air travel has increased since the first modern documented outbreak of Ebola in 1974 has come, and the particularly unpleasant nature of the disease, it's little wonder that it has so vividly peaked our collective imagination.

However, it's methods of transmission, symptoms and prevention methods are now well understood and documented, and the fact that it is so very debilitating runs in favor of public health reaction.

It's horrific presentation and high mortality rates are rightfully alarming, especially when you consider that historically many of its victims were primary healthcare workers. Check out his graphical representation of the history of Ebola outbreaks for some perspective of the current situation. 

The scariest part of this, and other pandemic type threats, especially for a scientifically minded prepper like myself, is that there are diseases with long enough incubation times, and infectivity rates, with symptoms that might be otherwise shrugged off or ignored that we could be exposed to just going about ones normal life.

My recent pieces on public transport, on holiday travel and even going to the supermarket are just reminders of the interactions and environments that most take for granted, that could well leave even the most diligent and forward thinking planners, who happen to look, dress and act like regular folks, without gown, glove and mask.

Who knows what you might be bringing home to your family, into your bunker with you?

The trick, to my mind, however is to not be petrified, but to remain cautious, aware and informed of the risks, likelihoods and trends.