Personal Protective Equipment (PPE) for Ebola virus disease (EVD)
Frequently Asked Questions (FAQs) - Europe
Version dated 11th August 2014 - 3M has received a number of inquiries regarding the appropriate personal protective equipment for potential exposures to Ebola virus disease (EVD).
Following are responses to many of the most commonly asked questions. It is important to note this FAQ is not a substitute for the guidance of the United States Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), the European Centres for Disease Prevention and Control (ECDC) and your local health authority.
Please consult their websites frequently for the most current information and infection control procedures regarding EVD.
Ebola virus disease (also known as Ebola hemorrhagic fever) is a severe, often-fatal disease caused by infection with a species of Ebola virus. EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat.
This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
Outbreaks of Ebola have occurred sporadically in parts of Africa, South America, the Middle East and Eastern Europe. It is a severe, often fatal disease in humans with fatality rates ranging up to 90%.
How is it transmitted?
Ebola is spread through direct contact with blood or body fluids (such as saliva or urine) of an infected person or animal, or through contact with objects that have been contaminated with the blood or other body fluids of an infected person, dead or alive.
Transmission is believed to occur via contact with mucous membranes and non-intact skin (i.e., rashes, cuts, etc.). Risk of infection by inhalation of contaminated aerosols by healthcare workers has not been documented, but thought to be low at this time based on case history evidence.
Ebola virus is easily killed by soap, bleach, sunlight, or drying. Machine washing clothes that have been contaminated with fluids will destroy Ebola virus. Ebola virus survives only a short time on surfaces that are in the sun or have dried.1
What does the WHO recommend for personal protection equipment (PPE) against Ebola virus disease?
The prevention of Ebola virus infection includes measures to avoid contact with blood and body fluids of infected individuals and with objects contaminated with these fluids.
Barrier precautions are used to prevent skin or mucous membrane exposure of the eyes, nose, and mouth with blood, other body fluids, secretions (including respiratory droplets), or excretions. For those working to control the Ebola Virus Disease (EVD) outbreak and treat patients, the WHO recommends a basic suite of personal protective equipment for most activities which includes:
Eye and face protection
Fluid resistant mask or respirator
Some tasks require additional body protection. Certain tasks, including administering aerosol generating medical procedures, certain laboratory tasks and autopsies require respiratory protection.
Please see “Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola.” for the full guidance.
It is important that anyone involved in infection control for ebola virus disease (EVD) thoroughly read and understand that document.
PPE should be selected based primarily on the potential exposures and need for protection against infective fluids and agents. However work conditions, environmental conditions, tasks and accessibility to decontamination facilities should also be considered.
Hand hygiene is strongly emphasized and it is of the highest importance that hand hygiene be performed thoroughly and often including before and after donning and before and after doffing PPE.
Note, currently there is no established guidance that specifies performance criteria for personal protective equipment (clothing, gloves, foot coverings, etc.) specific to EVD. Emphasis should be on the prevention of infective materials from contacting mucous membranes (mouth, nose, and eyes) and non-intact skin.
PPE can help provide a barrier to infectious material however, it is very important that all local infection control protocols and manufacturer’s user instructions be followed when removing (doffing) the equipment to avoid contamination. Additionally, local infection control practices and manufacturer’s user instructions should be followed when cleaning any reusable PPE. The WHO guidance contains recommendations for donning, doffing and cleaning PPE.
A more complete summary of the WHO PPE recommendations as well as the US CDC, ECDC and United Kingdom’s PPE recommendations for EVD can be found here.
Eye protection provides a barrier to infectious materials from entering the eye and is often used in conjunction with other personal protective equipment (PPE) such as gloves, gowns, and masks or respirators. See Appendix 1.
Goggles are designed to fit snugly, but not necessarily seal around the wearer’s eyes. NIOSH states2: “appropriately fitted, indirectly-vented goggles* with a manufacturer’s anti-fog coating provide the most reliable practical eye protection from splashes, sprays, and respiratory droplets.
However, to be efficacious, goggles must fit snugly, particularly from the corners of the eye across the brow. While highly effective as eye protection, goggles do not provide splash or spray protection for other parts of the face.”
* Directly-vented goggles may allow penetration by splashes or sprays; therefore, indirectly-vented or non-vented goggles are preferred for infection control.
Faceshields are designed to help shield portions of the wearer’s face. A best practice would be to wear a face shield in addition to goggles for infection control. While goggles help protect a wearer’s eyes from splashes, sprays, and droplets; a face shield can help reduce exposure to the eyes and provide protection to other facial areas.
Face shields should have crown and chin protection and wrap around the face to the point of the ear. This will help reduce the possibility of splash, sprays and droplets from going around the edges of the shield and reaching the eyes or other facial areas.
Safety glasses provide impact protection but do not provide the same level of splash or droplet protection as goggles and generally should not be used for infection control purposes.
Currently there is no established guidance that specifies performance criteria for protective clothing (coveralls, gloves, foot coverings, etc.) specific to EVD. Until such guidance is published, selection of personal protection ensembles should be based on a site-specific PPE hazard assessment. Performance criteria included in EN 14126:2006 - Performance Requirements and Test Methods for Protective Clothing Against Infective Agents should be considered. See Appendix 2. In general, protective clothing offering the highest level of protection from infective agents, such as the 3M™ Protective Coverall 4570, is also the least breathable and may introduce hazards related to heat stress and dehydration.
Breathable protective clothing offers less liquid or splash protection but may be desired for tasks in extremely hot conditions where the risk of contacting infective agents is low, where sufficient decontamination facilities are available at the completion of work tasks, and where the risk of harm from heat stress and dehydration is high.
Selection for EVD should be based primarily on the potential exposures and need for protection against infective fluids and agents. However work conditions, environmental conditions, tasks and accessibility to decontamination facilities should be considered.
Fluid resistant masks or respirators are another type of PPE recommended for those in contact with potential EVD cases. This document discusses the use of respiratory protection.
A respirator is a device designed to help provide the wearer with respiratory protection against inhalation of a hazardous atmosphere.
To help reduce nose, mouth and respiratory system exposures to particles that are potentially airborne (< 100 microns), particulate removing respirators are often recommended. Particulate respirators are available as:
a filtering half facepiece respirator, where the filter is the entire respirator
an elastomeric (reusable) half mask with a particulate filter
an elastomeric (reusable) full facemask with a particulate filter
a powered air purifying respirator (PAPR) that includes a particulate filter.
Particulate respirators are designed to help reduce the wearer’s exposure to certain airborne particles. Currently, health authorities have not documented EVD as being transmitted from infected individuals via expired airborne Ebola virus. However, droplets containing the Ebola virus that have become aerosolized (e.g. coughing, sneezing, vomiting, medical procedures, etc.) may have the potential to come into contact with a person’s mucous membranes in their nose or mouth or non-intact skin.
Therefore, respiratory protection may be helpful in providing a barrier to help prevent infectious materials from contacting a wearer’s mucous membranes. They may also help limit inadvertent touching of the nose, mouth and/or eyes (if a full-facepiece or powered-air respirator is used). See Appendix 3.
Those who will be exposed to individuals with known or suspected cases of EVD should wear PPE that provides a barrier to help prevent infectious material from contacting mucous membranes (mouth, nose, eyes) and non-intact skin (i.e., rashes, cuts, etc.).
Always ensure that PPE users are properly trained in the benefits and limitations of the equipment per all applicable guidance and regulations and the manufacturer’s user instructions. Please consult your occupational safety and health professional, the appropriate health authority and the PPE manufacturer with questions.
In the event you must travel to an area that is known to have EVD, you should avoid contact with blood and body fluids of infected individuals or objects contaminated with these fluids.