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Friday
Sep012017

VHF - 2 Who Should Wear CPC/PPE?

Who should wear CPC/PPE? Does everyone on scene or at the incident site need it? How often ae changes needed? What type of respiratory protection are we talking about? Are there different ensembles’ for different work tasks? Your response must be prepared for all these questions and YOU have to have the answers ahead of time!

All health care professionals who provide direct patient care, all support staff that either cleans the isolation room, handles contaminated used or new supplies, laundry and waste disposal staff workers. Anyone in the lab who handles specimens of any type as well as those transferring these specimens to the lab facility if on site. If off site, proper exterior decontamination must take place before samples are handed off to transporters. Laboratory support staff that cleans lab equipment must also be properly dressed. Security Officers that are responsible for the confinement of exposed patients to the VHF in question. Burial Teams; or funeral facilities that will be handling the bodily remains. Finally, in a rural setting, family members who care for VHF patients.

As you can see this is a much longer list/decontamination needs than a normal hospital treatment plan for the ill. The primary reason is to eliminate the possibility of further “Outbreak” either within your facility or throughout the community.

The two Doctors and one nurse that were transported back to the U.S. were exposed through direct patient contact/fluids. See CNN.com/ebolaresponse2014.

Support Staff who takes part in laundry and waste disposal are at the same elevated risk. VHF can resist environmental conditions for periods of days and still be highly infectious. Their activities can be considered to be of even higher risk, as their equipment procedures may come into contact with totally unprotected individuals passing through the facility for unrelated cases.

Any personnel that work in the Lab or involved in Lab cleaning may be exposed to VHF samples sent for analysis. If your Hospital is a larger facility, with a BSL 4, have them handle the sample analysis they are equipped for this exact type of work.

Security Officers cannot be overlooked, when patients are in the early stages of VHF, their fear of impending death is enormous! They often run in sheer panic. This is exactly what you do not want!! This is how “Outbreaks” are spread throughout the community. Therefore ensembles’ of Level “B” Security Officers are the only ones that will be able to restrain or tackle the patient to return them to a restrained isolation area. Once the VHF becomes more severe, they will quickly become too weak to run or walk anywhere.

Burial Teams or funeral services depending on your situation, also risk heightened infection through VHF corpses and garments. So much so, the second phase of our series is devoted to Burial Teams. The discussion between incineration and burial cross contamination is ongoing, but burial has been used successfully.

Any family member that cares for a VHF patient must go through these procedures OR risk infection themselves; it’s a simple no-nonsense need without exceptions due to the viral, deadly consequence of VHF diseases.

Those who are on-scene or at facility, that are NOT in contact with ANY of the above do not require CPC/PPE. Appreciate, IF they do by accident, they are immediately quarantined and must be isolated for 21 to 30 days per protocol. Extra measures need to be taken to be assured that administration personnel do not become exposed.

CPC/PPE is generally considered “Best Practices” to only be used for periods of eight (8) hours before replacement. In this situation, it is highly unlikely a care giver can work in CPC/PPE for this length of time. This enters in either replacement or laundry systems for CPC/PPE.

Doctors and health care workers seen in the profile report on “Outbreak” in the Frontline examination demonstrate different levels of respiratory protection. While a full Level “B” CPC/PPE ensemble’ requires full SCBA (Self-Contained Breathing Apparatus), remember that the 29 CFR 1910.120 standards are by definition “ensembles’). This means that the work task function can adjust the “workability” of a Level of Protection to fit the needs of the work task at hand. Truly, since these practices are still held to the standards, work conditions in this type of a response restrict the operation from the use and replenishment of SCBA units and air refilling. With a true Level “B” ensemble’ health care workers would need SCBA units, a five stage cascade unit, and all the training and maintenance crew and equipment that entail a successful operation. As you can see, this would be next to impossible with the resources available in this scenario. Not to mention the extra energy expended of using this equipment by health care workers who are not used to working under fire suppression conditions like Fire Department personnel are. So, this leaves us with an actual modified Level “C” type response. The CPC is splash protective Level “B” wear coupled with Level “C” respiratory protection. This includes the use of filter masks or APR (Air Purifying Respirators). While Haz-Mat norms tell us this practice is risky, again the conditions of the overall work and capabilities ultimately dictate what the responders will have to adapt to. You will also note the lack in some cases of full face splash protection. This is not what we would recommend, but in an imperfect response world sometimes these compromises must be made for the work task at hand to be successful.

Also there are different ensembles’ for different types of work activities. This is normal but must be noted that these workers cannot engage in all work practices, just the ones in which they are outfitted for. The workers seen in the film that are decontaminating the homes of the admitted sick Ebola patients are exhibiting a different level of protection from the patient care workers. Note that their ensemble’ uses Level “C” paper Tyvek suits commonly seen for use when dealing with solid particulates. This is functional as these workers are NOT handling patients or contaminated materials. Their work task is strictly to spray contaminated surfaces with the 1/10 bleach solution and let sit. They are NOT involved in removal of contaminated materials or goods within the home. Since their actions greatly reduce and or eliminate physical contact with the contaminant this level of ensemble’ is appropriate.

Whatever situation your response is in or it takes, these considerations must be pre-planned into your capabilities, resources, manpower, transportation, and command structure. You cannot be prepared for all contingencies (unless you are a virtual army) but you can be prepared for your “Phase” of this type of hazardous material response. Have clear outlines and objectives your Team wants to accomplish before you begin your pre-plan. Then stick within those objectives. Knowing, that if these objectives expand past your “Phase” capabilities your pre-plan will become quickly overwhelmed. If your plan needs expansion, all the elements of cost, equipment, training, manpower, transportation, and other issues will also need to expand. Decide what and how much you can do before you do it.

                 Haz Mat Mike

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