Donning and doffing was the order of the day at the first staff training session on the personal protective equipment (PPE) required for health care workers when dealing with a patient suspected of having Ebola.

The session, held last week for emergency room staff at St. Paul’s Hospital – identified as the preferred location for adult Ebola care the in Saskatoon Health Region – focused on teaching staff what to wear, how to wear it, and more importantly, how to take it off.

“Doffing is a critical step,” explained Dr. Johnmark Opondo, deputy medical health officer with Saskatoon Health Region at the training session.

RR-2014-10-29-Ebola-training-session-2

Saskatoon Health Region employee Jenn Selkirk demonstrates how to don the knee-high booties that are part of the Personal Protective Equipment for staff when dealing with a possible Ebola patient.

From what has happened in Spain and Texas, it’s clear that staff need to be very present and in the moment, watching the steps of doffing very carefully to ensure they are not exposed to Ebola during that process.

In Texas and Spain, it was very small mistakes that led to staff contracting the disease, Opondo noted.

As Ebola patients become more and more symptomatic, as they have done in a health care environment, transmission becomes more and more likely, Opondo explained. This is why health care workers must be especially vigilant.

“Using your PPE properly is your best protection,” Opondo said

That’s why the Region is recommending staff wear PPE they are more familiar with than the Haz-Mat suits some agencies have opted for. The more complicated suits have not proved to be more effective, and there is more room for error when taking one off than protective gear like gowns and masks that the health care community is already familiar with.

The PPE as demonstrated in the training session covers a person from head to toe. There are knee-high booties, an impenetrable gown, two sets of longer gloves, head gear, a mask and even a face shield. All of it is designed to keep fluids from an Ebola patient from touching a health care worker anywhere. The Region is recommending that two people be involved in both the donning and doffing process – one who is actually going to be doing the care, and another support person for the staff member, there to make sure the PPE is on correctly, and is doffed correctly.

Hand-cleaning is another important step in the donning and doffing process. Hand hygiene is performed multiple times as layers of PPE are put on and most importantly, when they are taken off. It has been proved that the Ebola virus in small amounts can be killed with hand sanitizer applied in a timely manner.

A gown is tied at the back.

Saskatoon Health Region employees in Infection Control and Occupational Health and Safety, Jenn Selkirk (left) and Anne Marie Parker, demonstrate how to properly don the impenetrable gown which forms part of the personal protective equipment for staff dealing with possible Ebola patients.

The PPE training done for staff is building on what they already know, explained Shelly McFadden, director of Safety and Wellness with Saskatoon Health Region.

“The PPE for Ebola is currently a moving target,” McFadden said. “The basics are likely to stay the same, but the PPE used will likely be modified somewhat as planning gets more concrete. Staff will be educated about those changes as they occur…. Our source of truth is going to be what is decided at a Provincial level, where we have a seat at the table. That’s going to be guiding our principles.”

Plans for dealing with Ebola are shifting on a daily basis based on what is happening in the rest of the world.

“Every day, we observe what is happening globally,” said Opondo. “What is happening in those situations in Spain, New York, West Africa, Texas – will really influence what happens here.”

Though the risk of Ebola in Canada is very low, planning and preparations for dealing with any Ebola cases in Saskatchewan has been a priority for the health system. The Ministry of Health, along with health regions, and other provincial, national and international partners, have been working together to come up with a plan to keep patients and staff safe if such a case arises.

Also part of the training session was a drill scenario in the emergency department at St. Paul’s Hospital.

“This is an important test of our training and protocols,” Lori Frank, director of Enterprise Risk Management, told those assembled as participants and observers of the drill.  “We are looking for you to help improve our processes, training and education.”

The drill involved a “patient” presenting herself in the emergency department as feverish and recently returned from Liberia, where she underwent surgery in a hospital that also contained Ebola patients. Staff ran through the protocols from the admission process and risk assessment to donning PPE, consulting with the patient, and following appropriate protocols so the right departments in the health region were aware of the possibility of an Ebola case in Saskatoon.

“The drill was meant to ensure that the process being recommended meets our goals of safe, client/patient centred care, staff safety, containment, isolation and limiting exposure,” Frank stated. “This is how we improve – we test the process. We’ll learn from this.”

A debriefing after the drill provided information that will be used to improve the recommended processes and protocols before other training sessions and simulations are held around the Region.

Information for health-care providers about Ebola planning and preparedness is available at http://www.saskatoonhealthregion.ca/ebola.