Nurses at the UC Davis Medical Center in Sacramento will be protected head-to-toe and are prepared to handle the Ebola virus if it shows up at their doors, they said at a media briefing Thursday.
The most recent protocols for what is called the “donning and doffing” of protective equipment, released earlier this week, detail an intricate and painstaking 42-step process for putting on and taking off the gear. The protocols are intended to minimize transmission of the Ebola virus, which spreads through bodily fluids, but not air, and can be killed with basic sanitizing materials.
Putting on protective equipment in the proper order is essential in protecting the caregiver from exposure to bodily fluids, according to the U.S. Centers for Disease Control and Prevention. The period after patient care, when the garb is taken off, is an especially high-risk moment, when steps need to be followed meticulously. Dallas nurse Nina Pham, one of two people to have contracted Ebola while in the United States, was wearing a gown, gloves and a mask when she contracted the virus from patient Thomas Duncan.
The nurses at UC Davis “either meet or exceed CDC expectations” when it comes to use of the protective gear, said Nicole Mahr, clinical resource nurse and infection preventionist who spoke at the briefing Thursday. The medical center is one of five hospitals in California designated by the state as a treatment center for officially diagnosed and confirmed Ebola cases.
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“Most of the equipment they’re utilizing is nothing new to them,” she said. “However, we know that Ebola is a novel virus here in the U.S. and is more infectious than most diseases we see because it has a very high viral load. We’re making sure that staff has extra resources and gets lots of practice.”
Protocol instructors are running protective equipment training sessions for nurses and physicians eight to 10 hours a day, five days a week, said Carol Robinson, the medical center’s chief patient care services officer.
Putting on the liquid-impervious, Ebola-safe outfit begins with simple steps, such as tying back hair and tucking pant legs into socks. Next comes a hair cover, a battery-powered air-purifying respirator, a set of gloves (the first of three), a full-body coverall, leg and shoe covers, a blue gown and finally a large hood with a face shield.
The donning process takes about 20 minutes, and the doffing process takes about 25, all of which needs to be done in the presence of a trained observer, also in garb, and a protocol supervisor responsible for holding the checklist. The nurse and the trained observer are both required to take a three to five minute shower after patient care.
“It’s a process that takes some time,” said Mahr. “We are emphasizing to staff that your safety comes first. Take the time, be deliberate and be conscious when you’re putting this on.”
Mahr is part of the 15-member Infection Prevention Group, which meets two times a day – once in the morning and once at night – to discuss how the donning and doffing protocol is going over in training. They address questions raised by nurses about how to make the garb more practical and make adjustments accordingly.
UC Davis Medical Center has had three suspected cases of Ebola since October. Robinson said the staff now views those cases as a learning tools. They’ve since instituted more thorough screening protocols in the emergency room and have also begun calling any incoming patients before their appointments to ask them about their travel history.
The facility has one isolation room for housing Ebola-infected patients and is looking into creating a second, Robinson said. They have 500 air-purifying respirators, the most significant piece of the outfit, in stock and are ordering another 1,000. She estimates that they would go through about 35 respirators while treating a single Ebola patient. In those situations, all protective medical garb worn in the treatment of the infected patient would be disposed of immediately after each use. Each full protective outfit costs about $50.
“We’ve gone through various iterations of the suit as we’ve found better products,” said Robinson. “It’s all about the nurses. If they don’t feel safe and they don’t feel comfortable, we’re going to change it.”
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