By Meg Whynot-Young
In order to learn a bit more about Ebola and what it means for the people taking care of Ebola patients, I contacted our instructor Charles Gilbert, Ph.D., M.S., of the Epidemiology and Toxicology Institute. Dr. Gilbert is an expert in epidemiology, toxicology and public health education, among other things. He has also been appointed as the lead scientist for the Ebola taskforce for Suffolk County, NY Dept. of Health Emergency Medical Services. United Alliance Services is proud to partner with Dr. Charles Gilbert to provide Ebola training for healthcare workers in New York and New England. He provided me with more information than I could possibly distill in one blog; however he did give me one very memorable takeaway. He said “If it is wet and gooey and not yours, do not touch it!” This seems like pretty basic information, similar to what our mothers have been telling us since kindergarten. However- how does one get around that when other people’s “wet and gooey” is part of your job? Keeping the goo contained is not just a job for the Ghostbusters; it is called body substance isolation, and there is a proper way to deal with body substances, with very specific precautions that need to be taken in order to stop the transmission of the virus during patient care.
Here are a few things that I learned about Ebola, which every healthcare worker should know.
1) Transmission of the Ebola virus is through direct contact with bodily fluids, especially blood, vomitus, and feces. Ebola is not an airborne virus, and it is very unlikely that the virus will mutate to become transmissible through inhalation of the virus. However, in the case of projectile vomiting, it is possible for large droplets of vomitus to land on a nearby caretaker, and if the droplet contacts a mucus membrane or a cut then transmission of the virus could occur.
2) Signs and symptoms of Ebola include fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and unexplained bleeding or bruising. A patient who has contracted the Ebola virus can exhibit symptoms anywhere from 2-21 days after being exposed.
3) The virus is communicable once a patient exhibits symptoms of the virus, i.e., once the patient develops a fever. The virus will continue to multiply if unchecked by an adequate immune response, and the patient will therefore be increasingly contagious until they have fully recovered from the disease. Once the patient is fully recovered, antibodies are present in the patient’s body and the patient is no longer contagious. However, if a patient dies from Ebola, the deceased’s body is highly contagious. Therefore, proper training and precautions must be taken when preparing the body for burial.
4) Contact with surfaces contaminated with bodily fluids from an Ebola patient can expose you to the Ebola virus. This is a less likely mode of transmission, but every precaution should be taken. This means all surfaces, including objects such as needles and syringes, which an Ebola patient has come into contact with, should be disinfected and all direct contact should be avoided until decontamination is complete. Proper personal protective equipment (PPE) and training is required for those who are responsible for this decontamination process.
5) The World Health Organization (WHO), has put together very specific and detailed guidelines on administrative and environmental controls for healthcare facilities to protect healthcare workers and to prevent the spread of the virus. These controls include appointing properly trained site managers, proper triage and care protocols, isolation, and training staff on all protocols and proper use of PPE.
6) Proper training and use of PPE is key to protecting healthcare workers. No skin should be exposed while wearing PPE. Donning and doffing of PPE is a process that must be taken slowly and carefully, and must be done under the supervision of trained monitors (also wearing PPE) in a designated area. Checklists must be made and followed carefully. Médecins Sans Frontières (Doctors Without Borders), who are arguably the world experts on Ebola, have the most comprehensive PPE checklist.
Ultimately, our greatest defense against Ebola is proper training and practice. Many hospitals and healthcare facilities all over the country have begun training and drilling on dealing with Ebola cases. While some of the protocols may be unique to Ebola, many are similar to the infectious disease control protocols hospitals have been following for years.
There are a lot of articles out there regarding Ebola right now, and a lot of misinformation. It is important to know your sources, and make sure that you are relying on those who have the expertise to provide your staff with Ebola training. If your facility would like to schedule Ebola training with Dr. Gilbert and United Alliance Services, please contact us at (877)399-1698.