While the Ebola outbreak has sparked fear across the nation, healthcare personnel have been routinely exposed to infectious pathogens well before that virus hit our shores—confronting risks that are unique to their profession. In response to the immediate danger of Ebola, the Centers for Disease Control and Prevention issued tightened guidance for personal protective equipment (PPE) and related protocols. Its guidance addresses the specific risks of a single pathogen, but is only one precautionary step in the larger context of infectious disease risks healthcare workers face on a daily basis.
While precaution protocols are already defined and in place, PPE is only required if contact with blood or body fluids can be “anticipated.” However, in the complex patient care environment, which now is further complicated by the globalization of the patient population, healthcare providers are still vulnerable because they cannot accurately anticipate and prepare for unexpected exposure situations. Many at-risk exposures occur under these “unanticipated” circumstances.
From the first moment a patient comes through a hospital's doors to the time that healthcare staff identify the need for exposure protection, a large window is left open—leaving a sizable gap in safety. As any healthcare worker can attest, body fluid splashes and splatters of blood, urine, vomit and so on can occur when least expected. These are not only unpleasant events; these body fluid splashes can carry pathogenic organisms.
Even when a patient's disease status is known, compliance with PPE requirements is inadequate. At this year's American Public Health Association annual conference the week of Nov. 15, experts presented data showing that healthcare personnel wear PPE less than half the time required by regulations and compliance with PPE use tends to be lower than compliance with hand hygiene, with ranges as low as 40% to only 2%.
There are steps that can be taken to better protect our healthcare personnel and narrow this safety gap:
Close the regulatory gap in safety standards. There is a gap in the regulatory landscape relative to infectious disease and healthcare worker safety. It is time for unanimous congressional support for promulgation of the Occupational Safety & Health Administration's long-awaited Infectious Disease Rule. This regulation is designed to protect employees in healthcare facilities from exposure to microorganisms that cause illness and infection. The rule narrows safety gaps by expanding the work that has already been done related to blood borne pathogens such as HIV and hepatitis B and C.
In the 1980s and 1990s, the global community responded to the AIDS epidemic by enacting strong protective standards as the adoption of standard or universal precautions, needle-stick safety and vaccinations and requiring controls for PPE. Now is the time for even stronger standards that take into consideration a broader range of infectious disease threats that confront the public's health and consequently, frontline healthcare workers.
Introduce and evaluate innovative technologies. Provide a higher level of barrier protection in healthcare workers' everyday non-protective garments such as scrubs and lab coats. Routine attire can be designed to repel fluids and inhibit growth of micro-organisms while maintaining comfort and breathability. This type of attire acts as an engineering control—a technological advance that removes a hazard, or places a barrier between a worker and a hazard, without changing any of the worker's established practices. Such “active barrier” garments would not replace PPE, but would provide automatic enhanced protection under the vulnerable circumstances when exposures are not anticipated.
Recruit, invest in and mentor new professionals. This is a critical time in global health. We have the opportunity to recruit, invest in and mentor new healthcare workers, safety and health professionals, public-health practitioners, manufacturers and engineers who are dedicated to the safety and protection of patients and the healthcare environment. The healthcare sector is growing quickly and the time is ripe to foster a generation dedicated to better healthcare safety.
A catalytic event like the Ebola outbreak can draw our attention to a longtime problem. If nothing else, the Ebola crisis has shown us that healthcare workers have not hesitated to care for patients under the most dire of circumstances—they have given their all to meet the responsibility of their profession. We owe it to them to provide them with all they need to protect themselves. They need our support. And after all, we can't live without them.
Dr. David Nash, founding dean, Jefferson School of Population Health, Thomas Jefferson University, Philadelphia
Janine Jagger, University of Virginia School of Medicine & International Healthcare Worker Safety Center, Charlottesville
Amber Hogan Mitchell, vice president of regulatory affairs, Vestagen Technical Textiles, Orlando, Fla.
Vestagen Technical Textiles is a maker of “active barrier” garments. Dr. David Nash is a member of the company's board of directors.