In wake of Ebola healthworker toll, challenge builds better personal protective equipment

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One of the most dangerous times for health workers during the 2014 – 2016 Ebola crisis in West Africa came when they took off the protective gear that covered them head to toe as they cared for patients. An intricate process of removing at least half a dozen overlapping layers of equipment, the “doffing” of gown, mask, hood, goggles, apron, boots, gloves, created an opportunity for error, and exposure to fluids carrying the virus at each step. In addition, the equipment itself couldn’t be counted on to stay in place when in use.

Of the more than 20,00 people stricken during the two years that Ebola ravaged communities in Sierra Leone, Guinea and Liberia, and travelled to well populated cities from Lagos in Nigeria, to Dallas, Texas, at least 800 were health workers. And of the more than 11.300 who died, at least 500 were health workers.

It is likely some of their risks dropped as the outbreak continued, and experience ingrained the ritualistic “donning” and “doffing” of personal protective equipment, a report in USAID’s Global Health Science and Practice Journal says. But the challenges of maintaining a shield between caregiver and patient weren’t limited to that. The ritual of properly “donning” to put on the full set of personal protective equipment consumed time that was in short supply. the goggles limited the scope of vision and fogged over. The mask, hood and goggles covered caregivers’ faces so completely as to add to the fear patients and their families faced when they sought medical help, and the entire getup was steaming hot, further limiting the time health workers could spend with patients to short increments.

In the first year of the crisis USAID challenged innovators across the scope of medical innovation to come up with a better way. In response, Johns Hopkins University  invited more than 80 people from disciplines spanning medical care and design to a three-day meeting to build more efficient and effective alternatives that would allow those confronting infectious outbreaks to avoid becoming patients themselves.

With input from health providers who had served patients during the outbreak,  as well as support from Johns Hopkins University’s Center for Bioengineering and Design, from Hopkins-affiliated nonprofit Jhpiego, and from the Maryland-based medical device company Clinvue, the “hackathon-type event” led to more than 100 ideas, and three potential products — improved neck-down apparel, an improved hood, and a product that combined both hood and coverall. Preliminary testing of these concepts has indicated improved efficiencies and effectiveness.

Challenges remain, and include regulatory approval,  competition — perhaps that’s a good thing — as well as evolving standards for protective medical equipment. And USAID concludes, the results showed what a challenge to protect health workers and improve infectious disease responses can accomplish.

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