Sanitizing After PPE Doffing, Dealing With Potential HCID Exposure

We are continuing our new series, Media Day, where we spotlight individual medical institutions and their infectious disease (ID) programs. This episode profiles Emory Healthcare.

In the previous episode, Jill Morgan, RN, BSN, site manager, Serious Communicable Diseases Unit (SCDU), Emory University Hospital, provided an overview of donning (putting on PPE) and doffing (taking off) PPE when caring for patients with high-consequence infectious disease.

In this episode, Morgan discusses how providers sanitize themselves after doffing, and how they handle if a healthcare worker has a potential pathogen exposure.

Here is an edited transcript of her explanation.

Contagion: What is the procedure or process for ensuring that a healthcare worker is sanitized after they have doffed their PPE?

Morgan: When someone finishes removing all of their PPE, the very first thing we tell them—something that’s built directly into our protocol—is: don’t touch your face. If you’ve been wearing a baseball cap, headband, or anything similar and you’ve gotten warm, the natural instinct is to brush hair out of your eyes or adjust your glasses. Because that impulse is so automatic, the first reminder we give is “don’t touch your face,” and we immediately direct people to handwashing.

We have them wash their hands with soap and water up to their elbows. For our team, because we’ve been working in a known biocontainment room, we then do what we call a comfort shower. It’s not a decontamination shower, because I’ve been completely covered. I don’t feel that I was ever exposed to Ebola or Marburg virus while caring for patients, because I felt safe and fully protected by my PPE.

That said, it’s hot. Even with a powered respirator, you’re still wearing a suit that traps heat. Most people, especially post-COVID, are familiar with how uncomfortable it can be to wear a mask or respirator for long periods of time. Even though air is flowing, you’re still retaining a lot of heat. If you’ve been in the room for four hours, the first thing you want to do is take a shower. For us, that’s why it’s a comfort shower.

If someone felt they had a potential exposure, that would be a completely different process. But we want to be able to trust our PPE. That’s why building a foundation of the right equipment, the right processes, and training to a level of competency is so critical. You have to have all three pieces in place for this to work. Buying equipment alone doesn’t guarantee anyone knows how to use it. Even buying it, sourcing it, and creating protocols doesn’t mean your team is competent with it—and this is a high-stakes environment.

For us, the risk is high and the margin for error is low. We want to make sure people are completely comfortable doing what they need to do: wearing the equipment, delivering excellent patient care, and exiting safely.

Contagion: If you have somebody who has concerns that they have been exposed to a HCID, can you talk about the protocols for that?

Morgan: First of all, whether we’ve had a known exposure or not, we’ve been inside this space. Anyone who has been this far into our biocontainment unit here at Emory is required to undergo monitoring. That includes twice-daily temperature checks for 21 days, along with symptom monitoring, all of which must be reported.

I laugh when I say that, because many of us would forget—until the phone rings. It’s a reminder that you didn’t submit your temperature or take your reading, because it really is that important. We closely monitor staff for the entire period, just as public health would monitor anyone with a similar or potential exposure.

The monitoring period is typically 21 days, depending on the pathogen, and staff are followed for the full duration. If someone does experience an exposure, we involve occupational health and our infectious disease physicians right away. Fortunately, for some pathogens, we now also have additional protective options. For example, we’re able to offer our team an Ebola vaccine, which wasn’t possible just a few years ago.

While that vaccine has only been shown to be protective against one strain of Ebola among several, it happens to be the strain responsible for many of the outbreaks we’ve seen. So we’re very grateful to have that option available to our team.

This concludes the Emory series. To watch past episodes from the series, go here.