Ebola: Personal Protection Equipment
I STRONGLY encourage people to acquire at least some PPE to protect them against a potential Ebola outbreak. I'm writting this on October 7th. I expect we will start seeing new Ebola cases popping up starting in about a week - this expectation is based on the Dallas patient's exposure to a large number of people and the incubation time Ebola requires. If I'm correct, large numbers of people will start buying masks, gloves, tyvek suits, and anything else they perceive as being needed to protect themselve, to such an extent that it may become diffucult if not imposible to acquire these items after the rush starts.
Many of these items are not that expensive and have many other uses besides Ebola protection. Please consider purchasing ASAP.
Doctors Without Borders created this list of gear to send home with families when they have an infected family member but there's no room at the local clinic for them. It's a good, basic starting point (click image for full size):
Some of these items are linked to further down, so keep reading.
Reusable or disposable PPE?
Modern hazmat PPE/BSI uses a lot of disposable supplies. This works great - until you run out of out of supplies and are forced to start improvising solutions, as has started to happen in Africa (and as has happened in times past). It appears that the roughly 5,000 cases in Africa may already be stretching the production capacity on some items. UNICEF recently reported “Securing availability of EVD PPE for high-risk settings is even more difficult. Suppliers have not experienced such a high demand previously, and production time is longer.”. DuPont has apparently tripled production of their tyvek coveralls in an attempt to keep up with demand.
Rather than fully and exclusively equip with traditional PPE (much of which is disposable) I think it preferable to start with at least some improvised equipment - but the best, reusable, improvised gear available. It may not be QUITE as good as the disposable gear, but should last longer than a supply of disposable - thus, in the long run it’s better.
The following list and information is based on my research - I’m not a doctor and I’ve been greatly hindered in my research by the fact that there’s really not a whole lot of hard data about Ebola. Lymes Disease, for comparison, is still very mysterious. But in the past I have been able to find far more hard data on Lymes that I was able to find recently on Ebola. As such, many of the items listed below are untested. If we have an outbreak in the USA it may become impossible to acquire the conventional gear and improvised will have to be used; this document is the result of my research with that eventuality in mind.
I Highly recomend this manual, created by the CDC and WHO, on dealing with Haemorrhagic Fevers in Africa:
Manual: Infection Control for Viral Haemorrhagic Fevers in Africa
Goggles and respirators serve two main functions:
1. To protect you from aerosolized droplets of saliva or mucus getting in your mouth and eyes (Ebola may not be “airborne” - but people still sneeze and the droplets of moisture they eject can contain Ebola)
2. To protect your eyes and mouth from inadvertent touching.
These are probably the most critical equipment to prevent an Ebola infection.
Reusable respirators are much more effective than disposable masks (they create a better seal, have better filtration, etc), but will probably need their filters disposed of after possible exposure to Ebola. The normal filter modules are too expensive to replace frequently. An alternative is to alter the filter system to accept other filter mediums. Specifically, some filter cartridges can have a housing added to allow the use of prefilters. Another option may be to rubber band a disposable mask (like the Gerson 2130) onto an Organic Vapor Cartridge. I will test this as soon as my Gerson masks arrive and report back.
3M makes a variety of respirators with disposible filters - I use the 7500 half masks quite a bit and find them comfortable and worth the extra few dollars over the cheaper models. You could go a little cheaper with some of their other masks, though.
Another option over goggles and respirators is to use full face respirators. These are more costly, but would seem to offer more comfort and safety than two separate items. Your entire face would be continuously covered and protected.
I would get the 3M 6800 full face respirator (that's for the medium size - other sizes also available); it will use the same filter cartridges that the half-face respirator I mentioned earlier uses, and is relatively inexpensive at about $90.
After goggles and masks, gloves are probably the next most critical safety gear. Current practice in treating Ebola patients is to wear two pairs of gloves; A lightweight sugical/exam glove with a heavy weight, reusable glove on top.
When you shop for reusable gloves be aware that some may not resist cleaning with vinegar or other disinfectants.
The conventional solution is to use Tyvek coveralls. Typically these are disposed of after a single use, though reuse may be possible provided the suit is still in good condition and can be disinfected.
Dupont makes a variety of Tyvek suits for different purposes - some are more robust or impermeable than others and are therefore recommended for Ebola. Dupont suggests using their Tychem C, Tychem QC and SL lines, though some of their other lines can be upgraded by taping the seams and making use of more robust “accessories” (aprons, arm protectors, etc).
Normal retail prices on appropriate coveralls range from $10-15 per unit, though cases of new/old stock can greatly reduce that. Searching ebay I was able to find a number of lots of cases of 25 for well below $100, though some of these were the cheaper, less durable/impermeable models. I actually found two cases (50 suits) of Tychem QC for about $80 shipped.
Another option if you can’t find any tyvek suits, or if they are out of your budget for the number you need, is to create reusable gear or buy ex-military NBC suits. The latter can be found for around $20, though these are also originally meant to be disposable - but they are far more robust than Tyvek suits and are meant to survive extended use in battlefield conditions. If they can be disinfected I think they could be reused many, many times.
If you want to make a reusable clean-suit it should be tough and very cleanable in addition to being impermeable. Ebola can be inactivated by chemical disinfection or via heating (for an hour at 60 C.) or boiling (5 min).Your suit should be able to survive this disinfecting process repeatedly - it will be essential to do this after every likely exposure to Ebola.
One option may be to waterproof existing clothing - silicone can be diluted in mineral spirits and be brushed on. This is allegedly highly effective at waterproofing the clothing. However, the silicone treatment will apparently be destroyed if you heat the article of clothing, as in a clothes dryer. Another treatment option is wax.
A more “pre-made” option may be to purchase heavy-duty rain suits.
There’s not a whole lot of information out there on reusable suit options, which is partly because there’s been very little scientific testing done on what’s necessary to disinfect and inactivate the Ebola virus. Ebola prevention and treatment is still somewhat a frontier, with little reliable information and
Another piece of gear which is vital if you are treating actual patients is a heavy-duty apron. It helps keep infectious fluids off your more easily damaged suit - and if you are trying to reuse your suit this will dramatically increase your ability to keep it unsoiled and damage free.
I’m working on a simple way to make a heavy-duty vinyl apron, but don’t have anything to post yet.
This particularly applies if you are walking around in an area known to be infected, like an isolation clinic. When you leave the area (or enter a safe area) you need to be able to disinfect your footwear or remove a disposable covering. Ideally, you do both. You wear gum boots, which will be disinfected, and they are then covered by disposable shoe covers. In my research I couldn’t find anything to indicate that for gum boots you need anything other than a strong, waterproof boot, and simple disposable shoe covers (or two layers of garbage bags).