Changes to Ebola Protection
Worn by U.S. Hospital Workers

After two nurses in Dallas tested positive for Ebola after helping to care for Thomas Eric Duncan, the Liberian who died of the disease last week, federal health officials decided to tighten the guidelines for American hospitals with Ebola patients. Many hospitals, including those in the North Shore Long Island Jewish Health System and the Nebraska Medical Center in Omaha — one of four facilities in the country with biocontainment units equipped to isolate patients with dangerous infectious diseases — have long had more stringent guidelines than the C.D.C. OCT. 15, 2014 Related Article





Levels of protective gear

Mask or
respirator

Hood that covers the neck

Goggles, safety glasses or face shield

Sealed hood

A thicker outer glove

Two layers
of gloves

One layer
of gloves

Impermeable body suit made of material that is difficult to tear

Impermeable
gown that fully
covers arms and
the body from
neck to mid-thigh

Breathing pack filters air to protect workers from airborne viruses

Fluid-resistant
leg and shoe
coverings

Seams taped

Original C.D.C. Guidelines
The suit above represents
the C.D.C.’s original guidelines
for health care workers
who would come in contact
with Ebola patients but
would not be exposed to
their blood or bodily fluids.

North Shore-L.I.J. Level 2 Suit
The C.D.C. has recommended extra levels
of protection, like those above, in cases
where workers could come into contact with
a patient’s bodily fluids. Many hospitals,
including the Nebraska center, have required
these levels as the minimum. Before this
week, this suit was used by North Shore-L.I.J.
hospitals for patients who were suspected
of having Ebola, but they have since decided
to upgrade to the Level 3 Suit instead.


North Shore-L.I.J. Level 3 Suit
After the second nurse in Dallas was
diagnosed with Ebola, the North Shore
system upgraded their Level 3 suit by adding
an impermeable gown on top. The suit
shown above begins to approach the
standard of protection used by health care
workers in West Africa. The C.D.C. may soon
require full-body suits in the United States.





The Difficult Process of Removing Protective Gear

Removing the layers of protective clothing is difficult, and many health officials have identified this process as a likely cause of infection. The C.D.C. director, Dr. Thomas R. Frieden, said the most important way to protect health workers is for a site manager to oversee them as they put on and take off the gear; this system has been implemented in Texas.
1. Gloves

Original C.D.C. guidance The gloves come off first. The rest of the disrobing process can be done with bare hands. A bare hand can safely pull off a glove by slipping it under the wristband.
The hospitalsWorkers at some hospitals use two pairs of gloves so that the inner pair remains on during the disrobing process.

2. Face Shield

C.D.C. Goggles, safety glasses or face shields should be grasped from the band or ear pieces, which are considered “clean” and safe to touch with bare hands.
The hospitalsNebraska’s protocol calls for removing these only after the gown and second gloves are removed, and a third pair of sterile gloves are put on.

3. Gown

C.D.C. Bare hands untie knots in the back, which are not considered contaminated. A peeling motion is used to turn the gown inside out for disposal.
The hospitalsThe protocol at North Shore, like that in Nebraska, specifies that the gown be removed before the second pair of gloves are taken off.

4. Mask

C.D.C. Masks are removed last by grasping behind the ears without touching the front, which is considered contaminated.
The hospitalsHospitals specify using the second or third pair of gloves to remove masks.