I don’t know what kind of PPE (personal protective equipment) that she was wearing, but there is little that is easy or safe about taking off the stuff I have available to me. I have a flimsy one-size-fits-none gown that has ineffective ties and is open in the back.. I have fragile gloves that tear even when being put on. I have shoe covers that go up to the knee, and I have an N95 respirator mask (you can get these at Home Depot and Lowe’s, so they’re nothing terribly special). I have no pants other than the scrubs I wear.
So, here’s how I take the stuff off, toe to head: shoe covers off and into the trash. Next, I have to somehow get the gown off my neck without touching myself. I usually yank it and break the ties. Then I slide this off my shouders and down my arms, until I get to my wrists. (BTW, I make a thumbhole in my gown sleeve so that I can get my gloves over it easily. The hole is covered by my gloves. I do this because otherwise, the sleeves of the very thin gown material will slide up your arms if you don’t. I can’t tell you how many times I’ve seen nurses in isolation with their wrists exposed.). The really tricky part is getting off the gown and gloves without touching the exterior of either with your bare hands. I turn the gown sleeve inside-out over my hands, one at a time, and pull off my gloves, then wad it all up (while still only touching the inside of the gown), and put it in the trash. All the trash is open. There are no lids. After all that, I use alcohol foam on my hands to decontaminate them, and then I take off the mask.
Here’s the kicker – there is no special or protected space between patient rooms and the hallway. So, I have to take off all this contaminated stuff WHILE I’M IN THE PATIENT’S ROOM, because you CANNOT go out in the hallway with it.
Let’s pretend the patient coughs, now that the nurse is exposed. Droplets from coughs can travel 2 – 6 meters. The bigger the droplet, the farther it goes. I’m thinking when ebola patients cough up blood, those droplets probably get pretty frickin’ big. In the ER where I work, the head of the bed is a little over 2 m from the door (in our negative pressure room). In the inpatient rooms upstairs, the bed is quite a bit farther, maybe 6m. Either way, there’s no getting away from exposure.
My guess is that when this nurse first started caring for the ebola patient, she only had this basic crap to work with. Even if the CDC was there and provided her with some sort of suit under her gown, we still have the problem of disrobing within the contaminated environment.
The CDC acts like it’s just two nurses, but the fact of the matter is that there have been 10 healthcare workers (docs and nurses) in the World Health Organization who have died from ebola. You can bet they had the best possible protective gear in the world, but they still died.
So let’s not point any fingers or criticize on the nurse in Texas.