Every member of the Biocontainment Unit goes though hours of training detailing the types of protective equipment needed to work safely around highly infectious diseases. There are specific protocols for putting on (donning) and taking off (doffing) the gear they wear.
"We look at lots of different products. We do a lot of training in those products before we actually take care of the patient. We find little quirks sometimes. Maybe the glove doesn't fit quite right. Maybe we feel like that mask is leaking or not doing what it should do. Then we modify it to fit our needs and to fit what we think is the absolute safest equipment that we can wear to protect ourselves in the biocontainment unit."—Dr. Angela Hewlett, Medical Director, Nebraska Biocontainment Unit
Click on the protective gear below to place it on the doctor and learn more about it.
There are steps to take even before the personal protective equipment (PPE) goes on. Team members take off any jewelry, wash their hands and hydrate. Scrubs and washable footwear (such as Crocs) go on first.
"We decided we needed to develop strict policies, protocols on how to put on the PPE safely, meaning you were going to be completely covered and more importantly, you were going to get it off in a way that you didn't contaminate yourself."—Kate Boulter, Nurse Manager, Nebraska Biocontainment Unit
The type of suit warn can vary depending on the level of risk. The suit needs to be durable and fluid-proof. The fit of a suit is important not only for comfort but to avoid loose-fitting garments that could be difficult to seal off.
"You want to make sure you have everything covered that could transmit any kind of Ebola virus to you; any mucus membranes; eyes, nose, mouth, lungs when we breathe in. Anything that you would touch needs to be protected. The easiest way to mitigate that risk is to cover up everything."—Betsy Flood, RN
The boot covers provide an extra layer of protection over the footwear. The multiple layers can be uncomfortably hot.
"What we didn't think about was all that heat trapping (inside the suit). The fight or flight response is off the charts when you're in the room of an Ebola patient so your heart rate's up. You generate a lot more heat under those circumstances so the amount of sweat you produce was incredible. We actually had inches of sweat, up above our ankles, within our suit when we walked out of the room after the first procedure (with the Ebola patient)."—Dr. Dan Johnson, Critical Care Physician
Doctors and nurses wear three pairs of gloves when they’re in the biocontainment unit. They often wear different colors to remind them which layer is exposed.
"The first pair of gloves goes underneath our gown. That pair is helpful when you are taking off your equipment so nothing would brush across your clean hand. The second pair of gloves we talk about it as our “skin.” We never go below that level in the patient’s room. The third pair of gloves we call “patient care gloves.” Once you are finished, you take them off, wash your “skin” gloves with bleach and then put a fresh, third pair of gloves back on."—Betsy Flood, RN
The hood, along with a plastic shield protects the head and face from splashing fluids. It’s used in combination with respirators that filter the air before it is inhaled should be used for respiratory protection.
"We had a face mask that neither tuberculosis, nor influenza, SARS, or any other respiratory pathogen can get through. It's airtight. Then we had a face shield on that came down over our face, which was to prevent any kind of splatter that could potentially get into the eyes."—Dr. Dan Johnson, Critical Care Physician
Every place where skin exposure could take place is sealed with duct tape, especially wrists and ankles.
Removing the Gear
"When you leave the room it's incredibly important to remove that equipment in an extremely careful and meticulous manner. We do everything under supervision in the biocontainment unit. When we walk out of the room we basically stand, arms outstretched, and a person who's in front of us who's also fully protected telling us exactly what to do and the exact appropriate steps. There's no room for human error." —Dr. Angela Hewlett, Medical Director, Nebraska Biocontainment Unit