Ebola: Why Respiratory Protection MUST Be Worn

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Specializes in RN, CHPN.

On another post, a reader replied to someone concerned about transmission of Ebola virus through the air:

Do you have the same concern when caring for patients with Hepatitis C or HIV? Do you fear that they will suddenly change to airborne (aerosolized) transmission? If you don't, what makes Ebola so special? Please, don't let fear affect your logical/critical thinking.

First of all, there is a difference between 'airborne' and 'aerosolized' transmission.

Airborne transmission occurs when bacteria or viruses travel on air currents over considerable distances. These droplets are loaded with infectious particles.

Infections that can spread by airborne transmission:

Anthrax, Chickenpox, Influenza, Smallpox, Measles, etc.

Aerosol (or droplet) transmission occurs when contagious droplets produced by the infected host are propelled a short distance and come into contact with another person's conjunctiva, mouth or nasal mucosa, or are inhaled. These droplets travel 3 to 6 feet. They can remain suspended in the air for up to 90 minutes.

Aerosols (droplets) are produced by things like coughing, sneezing, projectile vomiting, flushing a toilet containing diarrhea, or aerosol-generating medical procedures like intubation, cardiopulmonary resuscitation, bronchoscopy, open suctioning of respiratory tract (including trach care), and nebulizer therapy.

There IS as risk of aerosol transmission of Ebola. And because Ebola is such a deadly disease that has no treatment or cure, healthcare workers MUST protect themselves from potential aerosol transmission. Think about it -- you're working in a closed isolation room with a patient who may be producing aerosols. It's a concentrated environment.

And there is still controversy surrounding how Ebola is transmitted, no matter how sure POTUS and the CDC seem to be. Because of that,

"Personal protective equipment guidelines should not be based on presumed mode of transmission alone, but also on uncertainty around transmission, on the severity of the disease, on health worker factors, and on available treatments or preventions."

The CDC website says this about Ebola:

There are a small number of BSL-4 (Biosafety Level 4, the highest) labs in the United States and around the world. The microbes in a BSL-4 lab are dangerous and exotic, posing a high risk of aerosol-transmitted infections. Infections caused by these microbes are frequently fatal and without treatment or vaccines. Two examples of microbes worked with in a BSL-4 laboratory include Ebola and Marburg viruses.

In speaking about Ebola transmission, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota said this:

"Some scientists are urging health officials to acknowledge what they don't know. At a meeting on Ebola Tuesday, one infectious disease researcher told an audience at Johns Hopkins University in Baltimore that scientists should get comfortable with uncertainty and be honest with the public about gaps in knowledge about Ebola.

"We're making this up as we go. We have to be mindful that we're making it up. One of the worst enemies we can have today is dogma."

http://www.usatoday.com/story/news/nation/2014/10/15/nurses-protest-ebola/17302987/

Ebola is capable of infecting a wide variety of cells:

"Some pathogens are limited in the cell type and location they infect. Influenza, for example, is generally restricted to respiratory epithelial cells, which explains why flu is primarily a respiratory infection and is most likely aerosol transmissible. HIV infects T-helper cells in the lymphoid tissues and is primarily a bloodborne pathogen with low probability for transmission via aerosols.

Ebola virus, on the other hand, is a broader-acting and more non-specific pathogen that can impede the proper functioning of macrophages and dendritic cells--immune response cells located throughout the epithelium. Epithelial tissues are found throughout the body, including in the respiratory tract. Ebola prevents these cells from carrying out their antiviral functions but does not interfere with the initial inflammatory response, which attracts additional cells to the infection site. The latter contribute to further dissemination of the virus and similar adverse consequences far beyond the initial infection site.

The potential for transmission via inhalation of aerosols, therefore, cannot be ruled out..."

http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

"University of Minnesota CIDRAP scientists are now warning both health care providers and the general public that surgical facemasks will not prevent the transmission of Ebola. According to the airborne Ebola report, medical workers must immediately be given full-hooded protective gear and powered air-purifying respirators."

http://www.dailykos.com/story/2014/10/16/1336994/-Ebola-Is-Already-Airborne-Say-Two-Professors

Ebola isn't a disease to take chances with. It's very unforgiving virus that kills 70% of those it infects. There is no vaccine, and there is no cure. There are still unknowns about Ebola. Healthcare workers need to wear respiratory protection no matter how small the possibility of aerosol transmission may be, as long as that possibility exists. Why take a chance?

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Specializes in Oncology; medical specialty website.

Missy, thank you so much for your informative posts. We need this kind of information, not suppositions and guesstimates. It's not going to be hospital admin. putting their butts on the line caring for these patients, so it's of little consequence to them if they err in the type of PPE they provide for their staff.

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Specializes in RN, CHPN.
Missy, thank you so much for your informative posts

You're welcome. We deserve the best protection available, through PPE and the protocols for its use, because there is no margin for error with this virus.

I'm tired of hearing officials sound so 'sure' of the 'facts' about Ebola. The truth is, there is still uncertainty and and there are still unknowns. It's important to read a wide variety of sources because much of the news media dumbs things down and tries to avoid creating panic. But the information nurses and other healthcare workers need is different from the information the public needs.

ETA: It's too bad we can't get that from the CDC. It took two nurses infected with Ebola for them to realize their PPE guidelines fell short, and they're still not good enough.

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First of all, I’d really appreciate it if you quote me, don’t quote parts of one paragraph and a part of another and join it into one statement. Anyway, that’s just a minor detail :)

I am aware of the distinction between droplet and airborne. (Assuming these two terms are indeed the correct ones. I’m having a bit of a problem with the different terms, English is my fourth language and I’m far from fluent in it. To complicate things further I’ve noticed that there also seems to be some confusion even among native English speakers on this site, as to which term means what).

Are you saying that you believe that the Ebola Virus Disease is transmitted the same way as for example measles? I don’t believe that it is.

No one’s arguing that you can’t catch Ebola if an infected person coughs you straight in the face from a short distance or that there could be risk involved when you for example intubate said patient. (The highest viral load in humans is as I understand it not in the respiratory system, but rather in other organs/blood. It would however be reckless to claim, that it can’t be transmitted that way, since there is virus present in saliva and there might also be blood in the oral/nasal cavities, airways. Better safe than sorry).

What I’m trying to convince those who fear that Ebola is airborne or will mutate to that, is that you’re perfectly safe standing 30 yards away from an Ebola infected patient. Ebola does not spread the same way that measles and chickenpox do.

Why do you say that Ebola kills 70%? Do you have a reference for that number? It is my understanding that the mortality rate has been quite varied in the various outbreaks since 1976, it varies between the subtypes as well between individual outbreaks of the same subtype.

The 2013-2014 outbreak in West Africa seems to have a current cumulative mortality rate of 50% (combined average for Guinea, Liberia and Sierra Leone). Admittedly 50% isn’t exactly cause for celebration, but at least it’s better than 70%.

2014 Ebola Outbreak in West Africa | Ebola Hemorrhagic Fever | CDC

I’ve noticed that you’ve gathered quite a following here in the short time you’ve been posting. I can tell that you are an ardent advocate for more PPE, and you’re quite adept at rallying people in support of your beliefs/cause. (That’s a compliment by the way). Are you a nurse? Are you or do you perhaps know nurses who’ve been involved in the care of Ebola patients? Do you sell PPE?

The reason I ask is the large amount of posts you’ve made in a short time, often the same or very similar text posted in different threads. Please note that I’m not saying that more PPE isn’t a good idea (I actually happen to think that it is a good idea), I’m just wondering about your noticeable passion for the topic.

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Specializes in ICU, Pre-Op, OR, PACU.

I’ve noticed that you’ve gathered quite a following here in the short time you’ve been posting. I can tell that you are an ardent advocate for more PPE, and you’re quite adept at rallying people in support of your beliefs/cause. (That’s a compliment by the way). Are you a nurse? Are you or do you perhaps know nurses who’ve been involved in the care of Ebola patients? Do you sell PPE?

The reason I ask is the large amount of posts you’ve made in a short time, often the same or very similar text posted in different threads. Please note that I’m not saying that more PPE isn’t a good idea (I actually happen to think that it is a good idea), I’m just wondering about your noticeable passion for the topic.

I'm glad I'm not the only one who felt this way. I can understand how nurses who maybe weren't aware of these forums prior to the ebola mess might have found their way to these forums, it just seems a little odd how the OP's posts have been popping up.

Anyway on to the topic... I'm not even a nurse yet (still working on pre-req's!) and I am thinking of every single one of you ladies/gents putting yourself on the line right now and hope for your safety and the speedy recovery of those who have been impacted by this situation. I hope you all get the training and equipment you need to make everyone safe!

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Thank you for providing this information. After reading the first link, a very informative commentary by experts on respiratory infection and infectious disease transmission, I am persuaded that a PAPR provides the most appropriate respiratory protection against Ebola, and should be worn by health care workers.

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Specializes in Operating Room.

I bought some of my own equipment today to have in my locker. A box of N95 masks, goggles that are sealed on all sides and a Tyvek suit! I did feel silly at first but you never know.

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Specializes in ICU.

We have evidence that Ebola can hang around in the air for a while... I was just re-reading The Hot Zone a few days back and it's pretty clear there was proof of aerosolized transmission before that book was written. It was published in the '90s, and it was talking about events that happened in the '80s. When they were talking about the experiments at USAMRIID, there were control monkeys who were not deliberately infected separated from deliberately infected monkeys by a lot of airspace, and the control monkeys ended up sick as well. This was inside of a BSL-4 lab, I seriously doubt the scientists made mistakes and the monkeys became infected through human error. That's pretty good evidence to me that Ebola is aerosolized. So, the government has known for 30 ish years that Ebola could be aerosolized and didn't recommend better PPE from the start of this outbreak. That's ridiculous.

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Thank you for this article very informative

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Specializes in RN, CHPN.
Do you sell PPE?

No, LOL, I don't sell PPE. But I wish I did!

I’ve noticed that you’ve gathered quite a following here in the short time you’ve been posting. I can tell that you are an ardent advocate for more PPE, and you’re quite adept at rallying people in support of your beliefs/cause. (That’s a compliment by the way). Are you a nurse? Are you or do you perhaps know nurses who’ve been involved in the care of Ebola patients?

Yes, I'm an RN, since 1985. But I'm in no danger of Ebola, because I retired two years ago.

What I am is a nurse who is deeply concerned about my fellow nurses, especially those who might find themselves having to deal with the Ebola virus. Frankly, I'm outraged at the CDC's lax guidelines, and sickened that two nurses were infected. I've been reading a ton about it, so I decided to share it here, with other nurses. I'm also a writer. There's no more to it than that.

What I’m trying to convince those who fear that Ebola is airborne or will mutate to that, is that you’re perfectly safe standing 30 yards away from an Ebola infected patient. Ebola does not spread the same way that measles and chickenpox do.

You're right, Ebola is not airborne. I'm sorry I didn't make that clear. I don't think there should be fear that it will 'mutate' to become airborne, either -- we just need to deal with it as it is now.

No one’s arguing that you can’t catch Ebola if an infected person coughs you straight in the face from a short distance or that there could be risk involved when you for example intubate said patient.

The CDC's PPE guidelines need to reflect this. Nurses should wear PAPR hoods (Powered air-purifying respirator) when caring for Ebola patients.

Here's a great article (not sure if I posted this one yet) from CIDRAP, the center for infectious disease research and policy:

Health workers need optimal respiratory protection for Ebola

"We strongly urge the US Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) to seek funds for the purchase and transport of PAPRs to all healthcare workers currently fighting the battle against Ebola..."

http://www.cidrap.umn.edu/news-perspective/2014/09/commentary-health-workers-need-optimal-respiratory-protection-ebola

Why do you say that Ebola kills 70%? Do you have a reference for that number?

4 days ago, the WHO put the figure back up to 70% (it had been 50% - 70% for a while).

"The death rate in the Ebola outbreak has risen to 70% and there could be up to 10,000 new cases a week in two months, the World Health Organization warned Tuesday..."

http://www.latimes.com/world/africa/la-fg-ebola-death-rate--70-percent-20141014-story.html

Please stay safe, everyone.

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Specializes in Critical Care, Float Pool Nursing.

I don't plan on working with ebola patients anyway. I'm not risking my health.

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Specializes in Critical Care,Recovery, ED.

We all know that Ebola is deadly and that all health care providers are at risk when they care for an infected patient. But that is a risk we ethically agree to when we enter this profession. That said it is vital that appropriate PPE and techniques be used. Ebola needs a class 4 lab when research is being done, the same level of protection should be available to all who care for these patients.

We don't know what we don't know about this virus, but other filoviruses have been shown to be infectious through aerosol transmission and some Ebola strains have been shown to do this in laboratory settings.

We must err on the side of precaution, have maximum protective equipment including changing rooms, buddy system for donning and removing PPE as well lots of hands on practice.

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