Earlier this spring, I had the opportunity to represent AAMI at a World Health Organization (WHO) meeting on personal protective equipment (PPE) for use in treating the Ebola virus. Though I’m not an expert in infectious disease, I think I have a good understanding of the issues involved in protecting oneself from exposure to highly infectious diseases. At this meeting, I learned about some aspects of using PPE that I had not previously considered.
In the United States, we believe that gowns provide adequate protection to exposure to blood-borne pathogens. Both of the AAMI documents on PPE (PB70 and TIR11) discuss the use of gowns to protect a person from exposure to blood-borne pathogens and other potentially infectious material (OPIM). Nowhere in our documents do we even consider the possibility of other types of PPE being appropriate for protecting the body and arms from exposure to blood-borne pathogens and OPIM. Additional PPE is needed, e.g. eye protection, hair protection, gloves and shoe or boot covers, but we do not consider coveralls to be part of the PPE that could be used for exposure control to blood or OPIM.
At the meeting, I discovered that in the Ebola-affected countries of West Africa, gowns were considered totally unacceptable for use in protecting people from exposure to Ebola, and only coveralls were acceptable. In fact, even in situations where only gowns were available, healthcare workers would refuse to use the gown; they insisted on needing coveralls. Even with training that demonstrated that gowns provided adequate protection and were actually easier to don and doff without contaminating oneself, the majority of people still did not want to use the gown. I learned that science and perception do not always coincide, and that perception must be considered when determining how to deal with a major outbreak such as Ebola.
Another area where I found my ideas to be different involved the level of protection that is needed to protect oneself from Ebola. My personal opinion is that Ebola protection requires use of an AAMI Level 4 isolation gown. However, people at the meeting discussed being able to use a lower level of protection or having portions of the PPE be a lower level of protection. This was because of the environmental conditions that make it difficult for a person to work in the PPE for extended time periods. Most people agreed that current PPE limits use to about one hour. Current WHO guidelines allow for use of AAMI Level 3 protection for some situations. I disagree with this when it comes to Ebola virus. In later discussions there were presentations made on products that can be used to keep a person cool while wearing PPE. I find these alternatives to be more acceptable than reducing levels of protection.
It was eye opening to realize how unprepared the world—not only the West African countries—was to deal with an outbreak of a highly infectious disease such as the Ebola virus. Physicians from the front lines described situations where PPE was not available for extended periods of time. The West African physicians at the meeting well understood how to fight Ebola and the precautions that were needed, but they did not have the resources readily available. Reaction from the rest of the world demonstrated there is poor understanding of how to deal with highly infectious diseases, even among healthcare workers.
Though there are many issues connected with Ebola virus that concern me, I am encouraged by the number of groups and individuals working on this issue. At the end of the meeting, a list of action steps was created. WHO has asked that AAMI be involved in these action steps by providing it with information on reprocessing of reusable medical devices, including development of standards/guidance that include the use of coveralls as PPE for protection against blood-borne pathogens and OPIM. I look forward to being a part of this process and to working with AAMI and WHO to ensure that the next time there is an outbreak the world will be better prepared to deal with the issue.
Donna Swenson, president and CEO of Sterile Processing Quality Services, Inc., is a sterilization expert with more than 30 years of experience in the field. Active on AAMI sterilization standards committees, she also is the author of Basic Concepts in Sterilization Processes: Verification, Validation, and Qualification, an AAMI textbook.