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Saskia v. Popescu, PhD, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist. During her work as an infection preventionist, she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She holds a doctorate in Biodefense from George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control and has worked in both pediatric and adult acute care facilities.

Determining Ebola PPE: A Guide to Avoid Occupational Exposures

JUL 03, 2019 | SASKIA V. POPESCU
While the Democratic Republic of the Congo is in the midst of an Ebola outbreak that has spiraled to over  2300 cases, there is a growing international fear that the outbreak will spill over into surrounding countries. The risks for health care workers have been a continuous threat during this outbreak as there have been 129 cases confirmed in health care workers, representing 6% of total Ebola cases in this outbreak. 
 
For many of us in health care and infection prevention, this Ebola outbreak has stirred memories from the 2014/2016 Ebola outbreak that was all too real in the United States. Ebola virus disease was not something we anticipated would present in US hospitals and certainly not something we were equipped to manage. Through tireless efforts, US health systems acquired the necessary personal protective equipment (PPE) and educated and trained staff on how to manage such a situation.

Flashforward to today and many of us need a refresher in not only the Ebola-specific PPE, but also what hospital facilities truly need in terms of a stockpile. In order to reduce the risk of occupational Ebola exposure, researchers from the Occupational Safety and Health Administration (OSHA) have created a matrix of PPE recommendations for various job tasks in not only health care and laboratory settings, but also those who work in waste handling, janitorial services, and travel and transportation.

In the development of this matrix, OSHA worked with representatives across those sectors to understand their work and zero in on tasks that might not be discussed in the available literature. The matrix was broken down in several ways – workers without appreciable Ebola exposure, and then those with a variety of work activities with varying risks including laboratory tasks, waste/maintenance/cleaning tasks, and healthcare and death care. 

The researchers developed several matrices broken down into the type of work activity and type of interaction. For example, the matrix for environmental service tasks, includes recommendations for PPE use during normal tasks, PPE use during a high-risk situation and includes examples of workers who may perform tasks for which ensemble might be needed. Based off these classifications, the PPE ranges from dedicated clothing including double gloves, face mask, eye protection, fluid-resistant gown, fluid-resistant shoes, boot covers, but also acknowledges that situations that might require more equipment, like a powered air purifying respirator (PAPR) or impermeable head/neck cover. 

Ultimately this PPE matrix reflects the assumption that more PPE provides more protection, but also accounts for the kind of work being performed. “Using PPE as part of a comprehensive infection prevention program also enables workers to continue interacting with patients in healthcare settings, travelers requiring entry screening at borders, and other potentially infectious people without the use of certain engineering controls, like physical barriers, that can preclude direct patient care, body temperature checks, and other interactive tasks,” the authors write.

As the authors noted, there is little relevant literature regarding worker protection against infectious diseases, especially for those occupations outside health care and laboratory workers.

Their efforts to resolve this deficiency is extremely helpful and beneficial for hospitals working to improve their Ebola readiness. The PPE matrix provided within this research serves as an extremely helpful resource for several occupations and industries seeking to prepare and educate their staff on PPE for Ebola patient management. 
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