page_title: Western African Ebola virus epidemic
section_title: Protective clothing
hierarchical_section_title: Western African Ebola virus epidemic / Treatment / Healthcare settings / Protective clothing
caption_attribution_description: A Médecins Sans Frontières/Doctors Without Borders (MSF) staff member adjusts Dr. Joel Montgomery, Team Lead for CDC’s Ebola Response Team in Liberia, goggles before Dr. Montgomery enters the Ebola treatment unit (ETU), ELWA 3. MSF operates the ELWA 3 ETU, which opened on August 17. Photographer: Athalia Christie For more information on Ebola and what CDC is doing, please visit: www.cdc.gov/vhf/ebola/
context_page_description: The Western African Ebola virus epidemic was the most widespread outbreak of Ebola virus disease in history—causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and Sierra Leone. The first cases were recorded in Guinea in December 2013; later, the disease spread to neighbouring Liberia and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with the case fatality rate reported which was initially considerable, while the rate among hospitalised patients was 57–59%, the final numbers 28,616 people, including 11,310 deaths, for a case-fatality rate of 40%. Small outbreaks occurred in Nigeria and Mali, and secondary infections of medical workers occurred in the United States and Spain. In addition, isolated cases were recorded in Senegal, the United Kingdom and Italy. The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources.
context_section_description: The Ebola epidemic caused an increasing demand for protective clothing. A full set of protective clothing includes a suit, goggles, a mask, socks and boots, and an apron. Boots and aprons can be disinfected and reused, but everything else must be destroyed after use. Health workers change garments frequently, discarding gear that has barely been used. This not only takes a great deal of time but also exposes them to the virus because, for those wearing protective clothing, one of the most dangerous moments for contracting Ebola is while suits are being removed.
  The protective clothing sets that MSF uses cost about $75 apiece. Staff who have returned from deployments to Western Africa say the clothing is so heavy that it can be worn for only about 40 minutes at a stretch. A physician working in Sierra Leone has said: "After about 30 or 40 minutes, your goggles have fogged up; your socks are completely drenched in sweat. You're just walking in water in your boots. And at that point, you have to exit for your own safety ... Here it takes 20–25 minutes to take off a protective suit and must be done with two trained supervisors who watch every step in a military manner to ensure no mistakes are made, because a slip up can easily occur and of course can be fatal."  By October, there were reports that protective outfits were beginning to be in short supply and manufacturers began to increase their production, but the need to find better types of suits has also been raised.
  USAID published an open competitive bidding for proposals that address the challenge of developing "... new practical and cost-effective solutions to improve infection treatment and control that can be rapidly deployed; 1) to help health care workers provide better care and 2) transform our ability to combat Ebola". On 12 December 2014, USAID announced the result of the first selection in a press release.
  On 17 December 2014, a team at Johns Hopkins University developed a prototype breakaway hazmat suit, and was awarded a grant from the USAID to develop it. The prototype has a small, battery-powered cooling pack on the worker's belt. "You'll have air blowing out that is room temperature but it's 0% humidity ... the Ebola worker is going to feel cold and will be able to function inside the suit without having to change the suit so frequently", said one source. In March, Google developed a tablet that could be cleaned with chlorine; it is charged wirelessly and can transmit information to servers outside the working area.
  The WHO recommends the use of 2 pairs of gloves, with the outer pair worn over the gown. Using 2 pairs may reduce the risk of sharp injuries; however, there is no evidence that using more than the recommended will give additional protection. WHO also recommends the use of a coverall, which is generally appraised in terms of its resistance to non-enveloped DNA virus. When a gown (or coverall) is worn, it should continue beyond the shoe covers. According to guidelines released by the CDC in August 2015, updates were put in place to improve the PAPR doffing method to make the steps easier, and affirm the importance of cleaning the floor where doffing has been done. Additionally, a designated doffing assistant was recommended to help in this process. The order in which boot covers are removed, by these guidelines, indicates their removal after the coverall or gown. Finally, a trained observer is to read to the healthcare worker each step in donning and doffing, but must not physically assist therein.
caption: CDC staff preparing to enter ETU in Liberia
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