Tuesday, November 11, 2014

donning and doffing madness

So we are finally donning and doffing at my hospital.  We are training with all the stuff we would wear when caring for an ebola patient.

Putting it on isn't hard. Its about covering everything and having someone check to see that you have.
Taking it off is a whole other ballgame.  After taking it off, I can't believe that 75% of the people caring for those with ebola haven't got it.

To say there are a lot of steps is to understate it. At my hospital there are 8 parts of the gear:

hospital scrubs
face shield
mask shoe and leg covers
two pairs of gloves

Here are the steps to take it off:

1) you and buddy go to dirty area
2) clean hands (foam)
3) look for any obviously nasty stuff on garments and clean them off
4) foam hands
5) take off shoe/leg covers
6) foam hands
7) take off apron
8) foam hands
9) look for any nasty stuff on garments and clean them off
10) foam hands
11) take off face shield
12) foam hands
13) take off hood
14) foam hands
15) take off outer gloves
16) foam hands
17) take off gown
18) foam hands
19) use wipe to clean shoes
20) foam hands
21) take off inner gloves
22) foam hands
23) put on new gloves
24) foam hands
25) take off mask
26) foam hands
27) take off gloves
28) take shower

Takes 15 to 20 minutes to doff. Most likely place to make a mistake: taking gloves off, in my opinion.

The idea is that there will be two nurses caring for the patient. One in the room who doesn't leave except for breaks. The other is a runner, who gets what the nurse needs.

The nurse in the room will have on all the gear and an N95 mask for hours on end. Not sure how thats possible.

The people working at the centers that have been designated for caring for highly contagious patients in such places as Nebraska and Atlanta wear different gear. Theirs come in less pieces.. They wear an actual respirator. There are nurses around the country who think this what is needed.


Hllbillygirl G said...

uh, that would be 'no.' here at podunk hospital, our 'ebola training' consisted of 15 minutes donning and doffing the very same paper scrubs we use for Cdiff and MRSA, with the addition of shoe covers and a little plastic thingie on a mask that fogs up your glasses. No hood, no respirator, no impervious garb. Just Kabuki theater so some administrator can check a box and say we're 'trained,' and the lawyers can say we were 'trained' after one of us gets Ebola. Blame the nurse. It worked so well in Texas.

Anonymous said...

Since the patient would be transfering to one of the 4 designated centers in your area- I highly doubt the nurse would be in there for "hours except for breaks"

Anonymous said...

Anonymous- I am an ED RN at a small community hospital outside Atlanta. Even with Emory Biohazard Unit 25 miles away I can totally see being in the PPE for at least 4 hours at a stretch. Say a patient comes in through the front door with a positive travel history and symptoms. Off they go to isolation and on goes the PPE. We assume Ebola. Our hospital has the rapid Ebola blood test. Takes about 90 minutes. So under the best of circumstances, all the powers that be are notified, a nurse dons the gear and gets a blood sample within an hour of the patient's arrival (I think that time frame is unlikely, it will probably take longer because of all the moving parts involved in being ready to get the sample and then test the sample.) 90 minutes later we get a positive. Its now been 2 and a half hours since arrival. Now we've got to notify everyone and their brother, get Emory to accept the patient and arrange transport. Again, best case scenario 2-3 hours before the patient leaves the ED. That's very confident that everything moves without a hitch and nothing ever moves without a hitch. So now you are at 4 and a half to 6 hours that the patient has been in the ED. Our facility policy is 4 hours in the gear and then you come out and someone else takes your place. So that's two nurses each in the gear for 4 hours each. And there are no breaks during that 4 hours. So for the nurse that is in the gear they will be in the room gowned up for hours on end but WITHOUT breaks.