The hype about Ebola is similar to that surrounding Aids in the early 1980s. People feared infection because of homophobia and ignorance about transmission of HIV. Pubs provided useless disposable toilet seat covers. Now Ebola is generating the same hysterical response.
A GP on RTÉ's Liveline described an implausible waiting-room scenario where an Ebola-infected patient touched a chair, then a child touched the same chair and got Ebola. News coverage shows healthcare workers in unnecessary hazardous materials protective clothing.
Liam Doran of the Irish Nurses and Midwives Organisation (INMO) said nurses needed training in how to “gown-up”: an unhelpful intervention designed to promote the union’s agenda, not to reassure the public.
Is he seriously suggesting that nurses who have had years of third-level education and on-the-job training are unable to don a gown properly? Gowning up for Ebola is the same as for other infectious disease. Sharing airspace with an Ebola-infected person is not a risk factor unless they vomit over you or worse.
Bodily fluids
According to the
World Health Organisation
, Ebola virus disease (EVD) spreads through “human-to-human transmission via direct contact (through broken skin or mucous membranes, eg eyes, nose and mouth) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (eg bedding, clothing) contaminated with these fluids”.
“People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery from illness.”
The disease is spreading rapidly in some African countries because the people and health infrastructure are poor.
Contrary to popular belief, caregivers of patients with EVD do not need to wear full-body hazardous-material suits. According to the US Centres for Disease Control and Prevention (CDC), contact and droplet precautions are sufficient. A single-use gown or coverall, gloves, single-use full-face shield, a surgical hood, and boot covers to mid-calf, will protect health care personnel from direct contact with blood or other body fluids. The CDC also recommends waterproof aprons if patients with EVD have vomiting or diarrhoea.
Paradoxically, exceeding the CDC recommendations may increase risk. The Health Protection Surveillance Centre has an article on its website, Ebola Fever: Reconciling Ebola Planning with Ebola Risk in US Hospitals, which should be compulsory reading for anyone worried about Ebola. "Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear. Using extra gear inflates patients' and caregivers' anxiety levels, increases costs, and wastes valuable resources. More insidiously, precautions that exceed the CDC's recommendations fan a culture of mistrust and cynicism [about the health system]."
Isolation rooms
Ireland’s acute hospitals have isolation rooms where patients with infectious diseases are treated. They have adequate protective clothing so they are ready to receive people with EVD.
According to a report from the Economic and Social Research Institute, Activity in Acute Public Hospitals in Ireland Annual Report 2012, 75,585 people were treated for infectious diseases that year, 589 of whom had TB.
Central Statistics Office figures for the same year show that 246 people died from infectious diseases including syphilis, herpes, hepatitis, chicken pox and Aids- related causes. These diseases need the same kind of precautions and protective clothing as Ebola.
Hand hygiene
More worrying than whether Ebola comes to Ireland is whether health
care workers follow infectious disease control protocols. The Health Information and Quality Authority (Hiqa) inspected 49 acute public hospitals between November 2012 and December 2013 and found that hand hygiene was the most commonly identified serious risk.
Only 69 per cent of hand hygiene opportunities were taken by staff and, of these, just 79 per cent were compliant with best practice. “Formal notifications of serious risk were issued to 13 of the 49 hospitals. The latest Hiqa report on Tallaght hospital shows that “the prevention and control of healthcare-associated infections was not being effectively managed”.
Why do we get so worked up about the negligible threat from Ebola and ignore real and present dangers, such as healthcare workers not washing their hands properly? The INMO does not seem bothered. Perhaps staff will be more careful about hand hygiene now that EVD has been added to the list of infectious diseases that will be treated in our hospitals. They may finally reach the 90 per cent compliance with best-practice hand washing target set by the HSE. Then we will all be safer. drjackyjones@gmail.com Dr Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.