Texas Ebola case - where are the hazmat suits?

Sloan RN · Oct 15, 2014

I'll just cut and paste what I put in another thread:

A word on Hazmat suits. Have you ever used one? Do you have any idea how to use one? My hospital has chosen not to use them if we were to get an Ebola patient because:

1. They open in the front. If you are taking care of a patient with Ebola, what part of you is most likely to become contaminated with infected bodily fluids? Yup, the front. How are you going to get out of a Hazmat suit with blood/diarrhea/vomit on the front without contaminating yourself? It's extraordinarily difficult. It's a little easier if you're standing in the middle of a field tent in Africa where they can just dump chlorine or bleach on your suit every time you want to take it off. That's not going to work in a hospital room.

2. Hospital workers aren't familiar with them. I've never touched a Hazmat suit, let alone worn one or taken one off. On the other hand, I've put on surgical gowns, gloves, N-95s and face shields hundreds of times. It's equipment I'm familiar with, therefore I'm more likely to don and doff it correctly.

You have seen Hazmat suits on the news because:

1. In Africa: In many places there is no disposable PPE that can be changed between patients available, so Hazmat suits are safer. Also, it's super hot there. It's been found that if you're sweating like crazy in hospital-style PPE, you're tempted to reach up and wipe your brow...thereby contaminating yourself. Hazmat suits circulate cool air to help with this. Also, stuff like goggles can be difficult in hot environments due to sweat and fog.

2. For EMS: The people at Emory spoke to this...ambulances are tight quarters and often hot as well. EMS guys in drills were seen wiping their brows from sweating in hospital-style PPE. Therefore Hazmat suits were better for them.

3. For people cleaning patients' apartments, etc: Overkill. The virus doesn't live long on surfaces (various surfaces have been swabbed in patients' rooms in both Africa and Emory, and no Ebola has been found anywhere except on a visibly bloody glove and one other visibly bloody article). It's probably not even necessary to decontaminate these peoples' houses at all, since Ebola has only been shown to live for significant periods of time when dried in tissue culture media in the dark at 4 degrees Celsius. Nonetheless, I imagine these people are suiting up because they're not sure what bodily fluids might be found where and don't want to be surprised by any splashes while cleaning, and because the public would probably freak out if they wore less. It's really just an abundance of caution.

We need to remember that Ebola is spread by CONTACT. It is not droplet and it is not airborne. It is not magic. To get it, you have to get the bodily fluids (blood, emesis and stool are the most infectious ones) of a symptomatic infected patient into your mucous membranes or through a cut in your skin somehow. There is no reason hospital-style PPE should not be adequate. My facility is recommending booties, a surgical gown (b/c they are waterproof and have the wrist cuffs), an N-95 (b/c suctioning and intubating can cause temporary aerosolization), a face shield and double-gloving. There is no reason that should not protect you. The trick is in getting it off, and I suspect that's how the nurse in Dallas was infected: some breach that led to her infecting herself while taking PPE off. THAT is why wearing unfamiliar PPE like a Hazmat suit is a bad idea.