Archive for Public Health

After the Storm, Pt. 2

The death toll from Hurricane Harvey has surpassed 60, Beaumont’s federal prisoners have gone a week without food and are drinking toilet water as I type this, and Irma has grown larger than Ohio on its collision course with Puerto Rico and Florida. If my calculations are right, 161,997.07 acres of California land are currently on fire, as are massive swaths of Montana and Oregon. This is America in 2017, and many more disasters are to come. Where will you be? What will you do? How will you be remembered?


If you’re reading this, you’re probably a professional laborer or an employer of laborers looking for great deals on high-quality safety equipment, and you’re in the right place to do so. Here at Enviro we have a large selection of products from several top-rated brands, engineered to serve all kinds of labor needs. But disaster cleanup is a significantly grimmer occasion to need our products than just another day at the factory. There’s a degree of solemnity that is appropriate for situations where the dead are multiplying and the dying are in dire straits.


What are we to do? Well, for us the solution is to keep doing what we do best: provide the market with top-tier products at unbeatable prices. If you read last week’s post, we covered the hazards of contamination by the fetid water and airborne debris. We’re still dealing with those same concerns, but your eyes are also at risk in this situation.


Proper eye protection for this job must seal out foreign matter and have anti-fog coating on the lenses to prevent perspiration distorting your vision. Ideally, they should also have side-shields to protect from impacts by flying objects. An airtight seal around the eye will do the trick to stay infection-free. Some goggles, like Pyramex’s chem splash (PYR304T-N) even have one-way air vents to allow some airflow without compromising the protection. 3M has a cheap and convenient option (AOS40661-00000-10) that can easily be bought in massive bulk and distributed to hundreds of rescuers.


Also necessary is protection for your hands, which will be your most essential tools in the field. Two great products come to mind. HexArmor’s Chrome Series 4036 is a waterproof heavy-duty work glove. Besides looking like something Tony Stark would make (HexArmor gloves are instantly recognizable), it feature level-5 cut protection, impact-resistant back-of-hand protection, and top-tier abrasion resistance on the palms. Combine all that with the waterproof H2X lining that fends off the bitterly wet and cold conditions you’ll be facing, and you have an excellent choice for the more extreme situations. In more predictable contexts, you can go with a disposable glove such as the Micromax N89. These are nitrile-coated medical-grade gloves designed for lab work, but what makes this particular product stand out is its long cuff. Even the best gloves are useless if water rushes into them, so this glove can serve a similar function to waders, except for the arms rather than legs.


Hurricane season is not over. America is facing devastating natural threats that we can do nothing to stop. But if we prepare in advance and go into recovery operations with a high level of organization, grit, and passion for the suffering, then we can come out of this stronger than ever before. Thanks for reading.

After the Storm

Few things are more devastating or confusing than to be in the path of a natural disaster, and hurricanes are among the worst. Last week, the most brutal storm to hit the United States in 12 years made landfall in Texas: Hurricane Harvey. By now you’ve seen more than enough images of devastation, rescue crews driving boats through flooded neighborhoods, and overcrowded shelters. It hasn’t been as deadly so far as Katrina or Sandy, thank God, but it’s far costlier than any other disaster in American history. The jaw-dropping combination of 132 mph winds and 19 trillion gallons of water, which AccuWeather hauntingly rendered as a gargantuan cube hovering over downtown Houston like the New Jersualem in the Revelation of John (the phrase “Biblical proportions” has been invoked numerous times in the media) have clobbered the region with an estimated $190 billion recovery cost.


Here at Enviro we have a track record of stepping up to provide rescue supplies in times of crisis, such as the Ebola outbreak in West Africa earlier in 2014. We’re committed to contributing similarly to the Harvey relief effort. It’s the least we can do as Americans and human beings to serve the heroes on the ground with the best of our equipment.


In a full-scale cleanup after a disaster of this scale, contamination is the primary concern. The water has wreaked havoc on Texas’s urban infrastructure. The sewers have overflown and deadly parasites and molds are free to infest the environment, as well as toxins from industrial sites. You need protection from those hazards, and companies like DuPont have got your back with Tyvek coveralls. Their signature flashspun polyethylene fabric protects against particles as small as 1 micron, and its protective qualities are inherent to the fabric and therefore resist wear and abrasion. You’ll want serged seams on the wrists to keep water from rushing into the sleeves, but for your legs you’ll need full waders. If you’re feeling particularly cautious, you might want to get the variety that comes with a respirator-fit hood, which brings us to the next item.


Airborne contaminants are everywhere in a situation like this. The National Hurricane Center website has a helpful animation that shows the spectrum of damage that hurricane winds can cause to a house and to a stand of palm trees. If you adjust the wind speed approximately to where Harvey’s winds reached their zenith, half of the house is disintegrated and blowing in the wind, and the trees are stripped of their fronds. That’s a cloud of building material (possibly predating the asbestos ban) floating free in the air to be inhaled. You need a respirator that has the right balance of high-performance and portability. The N95 particulate respirators from 3M are a good family of products to explore, some of which feature a nifty exhalation valve that prevents it getting too hot in there. The punishing heat of Texas in summer combined with the oppressively wet conditions and the level of exertion involved in rescue work way well make it a necessity.


This won’t be the final word on Harvey in this space, since it only covers two categories of product that we carry at Enviro. There will probably be more posts about the relief effort after the weekend, so stay tuned and stay safe.

Introduction to Hearing Protection

The landscape of the safety industry is complex, with an abundance of variations on a core group of products and concepts that can be paralyzingly overwhelming to even look at, let alone navigate. How is the average everyman supposed to know what he needs when the market is glutted with options that all seem the same? There are dozens if not hundreds of blogs out there to help guide the consumer towards the purchasing choice that’s best for them, and it’s anyone’s guess if reviving this blog will contribute meaningfully to that conversation. But here at Enviro we try to make it a point to reach out to the consumer base and help them determine what they need. We’ve organized our site to sort products into the most prominent categories that the industry recognizes, and we partner with the finest brands in the industry so that you get only the best. One of our most popular categories is hearing protection, which has been receiving a lot more attention lately.

Hearing protection has gone underrecognized and underregulated for decades, and labor environments have only been getting louder. Multiple generations of workers have suffered permanent damage to their hearing systems that could have been avoided if protection were emphasized in their workplace. OSHA’s estimate is that 22 million workers are exposed to hazardous noise annually, and that $242 million goes toward hearing disability comp. That’s money down the drain! Thankfully, interest in the hazards of occupational noise exposure is increasing, and we’re seeing more proactivity towards conserving the hearing of the working class.

So at what point is noise dangerous? The medium that carries sound from its source to your ear is air (that’s why you can’t hear anything in outer space), and the volume of sound is measured in decibels, the difference in air pressure that is created when a sound wave is present. Every hearing protection product has a noise reduction rating (NRR) that approximates how many decibels are subtracted from the sound entering the ear when the product is being used correctly.

There are many brands out there that offer hearing protection, but 3M is the one that we carry that has the largest presence on the site and draws the most enthusiastic response. 3M is one of the titans of the research/development world, and the innovations that come out of their labs are second to none. A few months ago their E-A-R EasyTouch earplugs hit the market, which feature a winning combination of comfortable thermoplastic resin coating and polypropylene stem that allows the worker to push it into the ear and find the perfect fit, without worrying about contamination. If you prefer the classic model, we also carry standard roll-down earplugs in a wide array of styles and functionalities.

Where our inventory really shines, in my opinion, is in earmuffs and headsets. This is where you can see some of that overwhelming variety I mentioned before. The most important distinction to know, however, is that between active and passive hearing protection. Earplugs and most earmuffs are passive: they block out all sounds, including those you might want to hear, such as conversation. Active hearing protection has a sophisticated, hypersensitive inner system that measures how loud sounds in the area are and selectively mutes those that are above a certain decibel threshold. I’ll get more into the exciting particulars of these products in future posts.

California-Based Measles Outbreak Reported in 14 States

Throughout the month of January, approximately 84 individuals from 14 different states were reported to have contracted measles as part of a larger outbreak. A majority of these cases are part of a series that originated in the Disneyland theme park in Anaheim, California. The outbreak is still ongoing, with at least 50 of the measles cases in California linked to Disneyland, while at least 13 cases in other states are linked to the outbreak.

The measles outbreak surfaced among Disneyland visitors who came down with the virus after visiting the park between December 15 and December 20, and cases have continued to be reported since. The measles virus has affected at least five Disneyland employees. Dr. Gil Chavez, deputy director of the Center for Infectious Diseases in California, the state with the highest number of reported cases, has recommended that people who have never had a measles vaccination and children under 12 months do not visit the park while the outbreak is ongoing. Dr. Chavez also recommended that individuals in those categories stay away from places such as airports and shopping malls where large crowds are likely to be present.

The Centers for Disease Control and Prevention (CDC) have issued an official Health Advisory to notify public health departments and healthcare facilities about the outbreak and to provide guidance about treatment of the disease. Measles is a respiratory illness caused by an airborne virus similar to influenza. It is highly contagious and may be spread through bodily fluids or through the air when a carrier coughs or sneezes. Symptoms include fever, dry cough, runny nose, skin rash, red eyes, sore throat and little white spots inside the mouth. After the initial symptoms, comes an uncomfortable spot-like rash that covers much of the body. Complications from measles are relatively common, and are usually more severe in adults who catch the virus.

Measles is common around the world, with 20 million new cases reported yearly around the globe. In 2000, the United States declared that measles was eliminated from this country, but travelers with measles can continue to bring the disease to American shores. The United States experienced a record number of measles cases during 2014, with 644 cases from 27 states reported to the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). The majority of people who contract measles are unvaccinated. Health officials have stated that individuals who have been vaccinated are at little risk from the disease, and would in fact be safe visiting Disneyland in California, the outbreak’s epicenter. However, the disease is extremely contagious to those without immunization. The CDC reports that 90 percent of unvaccinated people in close proximity to an infected person will catch measles.

The current outbreak and the higher number of measles infections in recent years may be attributable to some people declining to have their children immunized. Some parents fear a link between immunization and autism in children, while medical experts have continually asserted that there is no evidence for any such link. According to the CDC, 79 percent of the people who opted out of the measles vaccine in 2013 did so because they did not believe in vaccinations. Amy Schuchat, assistant surgeon general for the United States Public Health Service and the NCIRD, noted that one out of every 12 children are not receiving their measles vaccines on time, rendering them vulnerable to catching and spreading the disease. Schuchat also urges adults who are not sure whether they have been vaccinated for measles to contact their doctor. “There’s no harm in getting another MMR vaccine if you’ve already been vaccinated,” Schuchat noted. Schuchat and other medical authorities state that anyone exhibiting measles-like symptoms, such as skin rash, should seek medical evaluation and treatment.

Flu Prevention in the Workplace

Hear that sniffling and sneezing around you? There is no doubt about it: flu season is upon us once again. This frigid time of year brings with it many workplace concerns, from winter weather driving to winter work safety, and flu prevention is a serious issue among them. A case of the flu can spread like wildfire around a workplace. No one likes getting sick, and, beyond that, when influenza puts several employees down for the count, it can significantly reduce workplace productivity over the long winter months. But there is good news! By following a few easy prevention tips, employers can gain the upper hand and significantly reduce the flu’s impact on workplaces this season.

Increase Awareness

One of the foremost steps an employer should take to enact flu prevention in the workplace is to raise flu awareness among employees. It is, of course, common knowledge that this is flu season. Even so, reminding employees of this fact can be immensely helpful. Putting the flu toward the forefront of employees’ consciousness can increase the precautions they take. Employers should make an effort to educate workers on influenza signs and symptoms. For instance, employees should know that the flu typically comes on quickly and is different from a cold, although it shares many of the same symptoms, such as: cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue. In some cases, an individual who has contracted the flu will also have a fever, feverish chills, vomiting or diarrhea, but an individual may still have the flu in the absence of these particular symptoms. Employees who come down with flu-like symptoms should monitor their health and take extra preventative measures to avoid potentially spreading the virus in the workplace.

Encourage Vaccination

The Center for Disease Control and Prevention (CDC) recommends encouraging influenza vaccination among workers. According to the CDC, every individual over six months of age should be getting a flu vaccine every season. An annual flu vaccine is the most surefire way to prevent yourself from catching the flu and spreading it to others in the workplace. Vaccines are available in both traditional shot form and as a nasal spray, which is particularly convenient for those with a phobia of needles. A certain degree of misinformation and urban myths surround flu vaccines and vaccinations in general. It may be helpful to dispel myths in order to make employees more comfortable and confident in getting a flu vaccination as a prevention measure. For instance, it is important to emphasize that the flu vaccine cannot cause flu illness. Employees who are over 65, who are pregnant or who suffer from certain chronic medical conditions should be made aware that they are at increased risk of complications from flu that could lead to serious health problems. It is particularly important for such individuals and those in the workplace around them to consider getting vaccinated for the flu. Employers should encourage any such employees who contract flu should consult a physician and should take time off from work until they have fully recovered.

Start Small

Simple but crucial ways to prevent the spread of influenza in the workplace include proper hand and respiratory hygiene practices. Employees should wash their hands regularly with soap and hot water, particularly after using the restroom or shaking hands. In fact, it may be wise to advise employees to avoid shaking hands during flu season. Hand sanitizers are another useful tool, but they should be used in moderation, and are not a substitute for soap and water. Covering coughs and sneezes is not only common courtesy, but also helps prevent the spread of airborne flu pathogens. Posting signage throughout the workplace politely reminding employees to wash their hands thoroughly and cover their coughs can help to maintain workers’ flu mindfulness and safe practices. Email can also be useful to inform workers about safe practices in more detail. Surfaces can play a large, underestimated role in spreading influenza. Employers should frequently disinfect work surfaces such as telephones computers, and office equipment with sanitizing wipes. Flu prevention products, like healthcare masks, can also be helpful. A designated workplace health monitor can keep track of the above policies and see that they are maintained to ensure flu prevention.

Offer Work-From-Home Options

It is always a safe bet to establish a policy of sending employees with the flu or flu-like symptoms home. While employees may be inclined to be troopers and work through their illness, it is best for the workplace as a whole for them to stay at home in order to prevent the spread of the flu to others. Employers should consider expanding their work-from-home options and capabilities in order to maintain productivity throughout flu season and to encourage sick employees to stay home while still feeling like they have put in their fair share of work.

Practice these simple steps, and remember that the health and well-being of individual workers should always come first, and you should be able to effectively tough out and prevent the flu in your workplace this season.

Latest Ebola Virus News: 46 U.S. Hospitals Named Treatment Centers

America is now better prepared for the possibility of additional cases of the Ebola virus, as 46 U.S. hospitals are now designated Ebola treatment centers. The U.S. Department of Health and Human Services has responded to new concerns about Ebola by designating the 46 hospitals as part of a nationwide health system to treat infected patients and stem potential spread of the illness. The Centers for Disease Control and Prevention (CDC) announced the designation of the first 35 facilities in early December 2014 , and promised that more would be assigned in the following weeks. “We continue our efforts to strengthen domestic preparedness and hospital readiness,” Health and Human Services Secretary Sylvia Burwell said in the CDC news release.

State health officials have chosen the Ebola virus treatment centers in collaboration with local health authorities and the administrators of each designated hospital. The designated control centers have specially trained staff, appropriate Ebola personal protective equipment (PPE), from Ebola suits to the proper disposable gloves, and ample resources available to provide the particular kinds of treatments necessary to care for Ebola patients.

The designation of the Ebola treatment centers follows in the wake of concerns over whether most hospitals were prepared to care for patients potentially carrying the highly infectious disease. Almost half of hospitals responding to a recent survey conducted by Environmental Health & Engineering, a prominent environmental and engineering consulting service, reported that finding time to train staff to properly treat Ebola patients was a top challenge. Nurses’ groups have also expressed dissatisfaction with the level of training they’ve received in such crucial areas as the proper use of PPE. Nationwide nurses strikes over Ebola occurred in November.  The CDC asserts that the staff at the 46 designated treatment centers is trained and the facilities are optimized to minimize the risk health care workers face of contracting the disease while treating infected patients.

Individuals who believe they may have contracted the Ebola virus are encouraged to go to go to one of the designated centers for treatment. The centers are strategically placed to help ensure that they are within reach of those individuals who are most likely to need the resources they provide. The CDC has indicated that more than 80 percent of travelers returning to the United States from West African countries affected by Ebola live within 200 miles of one of the designated centers. The designated control centers will play an important supplementary role to the nation’s three bio containment facilities at Emory University Hospital, Nebraska Medical Center and the National Institutes of Health, which are the main care centers for patients who are medically evacuated from overseas, among others.

Current Ebola treatment entails isolation of the potential carrier, combined with active monitoring throughout the virus’ 21- day incubation period. During that time, state and local health authorities remain vigilantly attentive to the situation, communicating every day with the potentially exposed individuals to check for fever or other symptoms of the virus.

Ebola is a highly contagious disease transmitted through exposure to the bodily fluids of infected individuals. In West Africa, where the epidemic is centered, Ebola has killed more than 6,000 people, according to the World Health Organization. There have been eight cases on U.S. soil thus far, two of which were nurses who contracted the virus while treating an Ebola patient, fueling concern over the danger faced by health care workers. The designated Ebola treatment centers are prepared to reduce the danger of such risks. The CDC has released guidance for hospitals and state health officials to refer to when selecting more hospitals to be designated as Ebola treatment centers in the future, potentially further reducing the risks faced by non-designated hospitals. However, all hospitals still need to be prepared for potential Ebola patients.

Recent Outbreaks Highlight Need for Norovirus Prevention

From New Mexico to Minnesota, numerous cases of the highly contagious norovirus have been reported in recent weeks. Today, 30 people fell ill with the sickness at a Duluth, MN, restaurant, marking the latest outbreak. The incident follows a larger occurrence of norovirus that took place on board a New Zealand cruise ship and infected 200 passengers with the ailment commonly referred to as the stomach flu. The ship, the Dawn Princess, is owned by Princess Cruises, a division of Miami-based Carnival Corporation. Princess Cruises officials have encouraged affected passengers to remain in their cabins, and have enacted strict disinfectant protocols.

Previous Norovirus Outbreaks

In November, another norovirus outbreak aboard the Princess Cruises ship the Crown Princess infected at least 172 people, according to the U.S. Centers for Disease Control and Prevention (CDC). The Crown Princess had sailed from Los Angeles to Hawaii and Tahiti on a 28-day journey. The virus, which can spread more easily in closed quarters, is a frequent problem for cruise ships in particular. More than 150 passengers and crew from the Crown Princess were sickened with norovirus in April, and in January more than 600 people on cruise ships sailing the Caribbean fell ill with the virus.

Of course, norovirus also affects many people on land. San Mateo County health officials have confirmed that at least 60 guests and employees at the luxury Hotel Sofitel in Redwood City, California contracted the virus sometime after October 28. In response to the norovirus outbreak, San Mateo County’s Environmental Health Services inspected the hotel’s food operations and found no violations that could have led to food-borne illness. After disinfecting and training staff, the hotel’s food services reopened. Officials have noted that most of the individuals who contracted the virus were temporary guests of the hotel who are no longer in the area.

How Is Norovirus Spread?

Norovirus spreads after contact with infected people or contaminated food or water, making it highly infectious. Symptoms include stomach pain, nausea and diarrhea. The gastrointestinal illness typically lasts one to three days. Each year, the norovirus causes 19-21 million cases of acute gastroenteritis (inflammation of the stomach or intestines or both) and contributes to about 56,000-71,000 hospitalizations and 570-800 deaths, mostly among young children and the elderly.

Norovirus is the leading cause of illness and outbreaks from contaminated food in the United States: about 50 percent of all outbreaks of food-related illness are caused by norovirus. Foods most commonly involved in outbreaks of norovirus illness include: leafy green, such as lettuce; fresh fruits; and shellfish, such as oysters. In addition to cruise ships, the most common norovirus outbreak settings are restaurants, catered events, healthcare facilities, schools and other institutional settings.

Norovirus Outbreak Prevention

The best means of norovirus prevention begins with proper hand hygiene. Wash your hands thoroughly with soap and water, particularly after using the toilet or changing diapers. Norovirus can be found in your stool even before you start feeling sick, and can remain for two weeks or more after you feel better, so it is important that you wash your hands often. In a pinch, you can use alcohol-based hand sanitizers as a safety measure, but they should not be used as a substitute for soap and water when looking to avoid contracting norovirus. Individuals working in the food service industry should be particularly vigilant about hand-washing, and anyone who has contracted the virus should not prepare food for others until at least 48 hours after the symptoms stop. When preparing food, rinse fruits and vegetables carefully and cook shellfish thoroughly. Be extra cautious when it comes to norovirus disinfection as these germs are fairly resistant and can survive temperatures as high as 140 degrees Fahrenheit. Individuals can also contract the virus from contaminated surfaces, so be sure to thoroughly clean and disinfect any such surfaces. Wear rubber or disposable gloves when handling any potentially soiled clothes or linens and wash at the maximum available cycle.

Health officials at the CDC note that it is currently the cold and flu season, when stomach flu circulates more widely on land. For your own sake and for the sake of those around you, be sure to take these norovirus precautions to stay germ-free during any potential outbreaks.

WHO Revises Ebola-Specific Standards for PPE

The World Health Organization (WHO) has released revised technical specifications for personal protective equipment (PPE) selection, in order to reflect the latest Ebola news updates. According to the International Safety Equipment Association (ISEA), the revisions are “a step in the right direction,” as they make an important addition by including performance standards in the PPE selection guidelines. The update, released October 31, encompasses information on effective test methodologies for ensuring that PPE can protect healthcare workers from transmitting Ebola.

Ebola is very much a global concern, with recent cases occurring in the United States and Europe, in addition to the outbreak in West Africa. The WHO’s new guidelines are meant to help establish standards to assist healthcare workers the world over in protecting themselves from Ebola transmission, in the hope of ultimately stymying the virus’ spread. An international panel developed the new guidelines after consulting with leading infection control experts as well as healthcare workers with field experience caring for Ebola patients. The panel’s findings emphasize the importance of thorough hazard analysis in selecting PPE. The panel’s specifications highlight that medical organizations must properly select and use protective clothing and equipment based on product safety standards to most effectively protect against biological hazards.

The panel’s findings reinforce the crucial role PPE plays in preventing Ebola transmission. Healthcare workers not only save lives, but they are our first and best defense against the virus’ spread. Those who treat Ebola patients directly are at the highest risk of contracting the disease, leading to some popular paranoia regarding healthcare professionals in the United States and abroad. In response to cases of Ebola transmission by healthcare workers in the United States, some nurses’ organizations have demanded better PPE, including hazmat coverall suits, as well as more thorough instruction in the proper methods of wearing and safely removing PPE. Some of these demands were met after a series of Ebola strikes were enacted across the country in mid-November.

The WHO’s guideline updates for Ebola PPE selection based on hazard analysis form an important addition to the WHO’s essential recommendations for the types of PPE that are essential for healthcare workers. The experts on the WHO panel agreed that it is most important to have gear that protects the mucosae — the mouth, nose, and eyes — from contaminated droplets and fluids. This would include fluid-resistant medical masks, paired with safety goggles. Proper hand hygiene and gloves are also essential. The WHO also recommends that healthcare workers wear a gown/coverall and protective footwear; the Center for Disease Control and Prevention (CDC) and other similar organizations provide guidelines concurrent with those of the WHO.

The ISEA believes that, by linking PPE selection guidelines with product performance standards, the WHO has taken important action to guide healthcare providers to choose the right safety products to best protect healthcare workers. The ISEA draws on its member companies’ deep knowledge of protective product performance standards, and has been working with the CDC to develop effective gear and methodologies to keep healthcare workers safe. They report that demand for PPE has acutely increased in response to Ebola, and that manufacturers are working hard to supply protective clothing and equipment.

Update on Ebola Virus Precautions: Training Hospitals’ Top Concern

The latest news on hospitals Ebola virus preparedness shows that they are most concerned about issues surrounding the proper training of staff and Hazmat shipment, according to a recent study by Environmental Health & Engineering (EH&E).

In late October 2014, EH&E, a prominent environmental and engineering consulting service, surveyed hospital environmental health and safety managers (EHS), risk managers and facilities managers in U.S. hospitals to gain an update on Ebola virus precautions and procedures. The results reveal how hospitals have responded to the threat of Ebola and areas of particular concern to those professionals responsible for ensuring hospital safety. Potential vulnerabilities in hospital preparedness may lie in the lack of available time patient care staff members have to participate in training, and uncertainties about the proper certification of staff to ship infectious substances.

Almost half (48 percent) of hospitals participating in the survey identified ‘available time for patient care staff’ to participate in training as their top challenge to hospital safety. Another 20 percent indicated money or a lack of qualified staff and internal resources to support training as their main limitation. Such limitations prompted widespread strikes amongst nurses across the nation this month. Hospitals believe it is essential to provide direct, hands-on, Ebola-specific training to clinical staff, particularly to those who may treat such patients directly. EH&E indicates that it is particularly important for hospitals to train staff in the correct way to put on and remove Ebola personal protective equipment (PPE). While it may not seem significant to the lay observer, it is crucial for staff to don and doff protective equipment, such as Ebola suits, boots and double sets of disposable nitrile gloves, in the correct order, and to follow proper safety procedure. Experts have identified failure to follow PPE removal protocol as a potential source of Ebola infection among medical staff.

In response to hospitals’ concerns, EH&E recommends that a select number of staff, ranging from physicians and nurses to respiratory therapists and environmental safety staff, receive a high level of Ebola virus training. Since there may not be time to train all staff in effective precautions, members of the select Ebola-trained staff will be available to be called upon to deal with any such patients who may arrive. Bryan Connors, MS, CIH, Senior Scientist and Healthcare Division Practice Leader with EH&E, has added that it is also critical that hospitals train staff to play the role of safety monitor. The safety monitor will observe other staff to ensure that they follow proper Ebola protocol when treating patients at close range. “It works like a buddy system, assuring front line critical staff don and doff PPE appropriately and any safety issues are addressed in real time,” Connors said.

Hospitals are also concerned about providing adequate Hazmat shipment training. More than half (55 percent) of hospitals indicated that they do not have or do not know whether they have staff trained to ship Category A infectious substances. Specimens from patients who have or may have Ebola are considered Category A infectious substances, and so must be shipped in accordance with a rigorous safety protocol to prevent any potential infection. Such training can take upwards of eight hours to complete and requires attendant documentation. Hospitals simply cannot rely on ad hoc training.

On the plus side, a majority (64 percent) of hospitals indicate that they have been actively conducting Ebola training, including courses specifically on the proper use of PPE. Only 5 percent reported having conducted no Ebola training to date. Meanwhile, 21 percent reported having some preparedness, either through training for other infectious diseases, or on Ebola specifically, but without PPE training. Awareness of safety precautions has likely increased across all categories since the survey was taken, but adequate staff training, Hazmat shipment, and PPE preparedness remain areas of concern at hospitals nationwide.

Nurses’ Dissatisfaction with Ebola Safety Standards Heightens; Strikes Enacted

Nurses are making their dissatisfaction with hospitals’ Ebola safety measures heard. On November 11, approximately 18,000 nurses employed by Kaiser Permanente-owned hospitals and clinics in Northern California went on strike. Another 800 nurses employed by other Northern California hospitals also went on strike, and 400 nurses at a Washington, D.C. hospital will also went on strike on November 12, Global Ebola Awareness Day. Efforts were successful for California nurses, who have since won the enactment of regulations requiring hospitals within the state to provide better Ebola safety training and gear for workers. The striking nurses are members of National Nurses United (NNU), a 190,000-strong labor union that has been outspoken about their desire for better safety equipment and training for nurses in preparation for dealing with the virus.

Concern for nurses’ safety increased last month when news broke that two Dallas nurses, Nina Pham and Amber Vinson, contracted the virus after treating Thomas Eric Duncan, the first person to die from Ebola in the United States. After treatment, both nurses are now Ebola-free. The spread of the infectious disease to the nurses highlighted the importance of proper medical safety gear and safety procedures. An official with direct knowledge of the case stated that there were “inconsistencies” in the type of personal protective gear Nurse Pham wore and with the procedure she followed when putting on and removing the gear. However, NNU President Deborah Unger has identified the Dallas hospital’s failure to establish a set of safety rules and standard procedures for dealing with Duncan as a potential cause of the infections.

Members of the NNU have criticized what they see as efforts to blame nurses for such instances of the virus’ spread. They hold hospitals accountable for failing to provide nurses with appropriate gear and adequate training on how to use it. Those staging the strike are calling for powered air-filtration masks and full-body hazmat suits to be available at all of the nation’s hospitals and at the ready to be put to use should an Ebola patient arrive to seek treatment. Putting on and removing medical gear must be performed in a particular order to minimize the risk of infection, with, for example, pant legs needing to be tucked into boots. Full-body suits would potentially minimize the number of steps nurses would be required to follow, thus minimizing the opportunities for risk-causing errors. Nurses are also upset about the lack of preparation they have been provided with. The striking NNU nurses have stated that the Kaiser-Permanente hospitals have failed to address these and other related concerns they have raised.

Since the first cases of Ebola were reported in the United States, much fear and paranoia has surrounded nurses and other medical professionals who work directly with infected patients. For instance, Doctors Without Borders nurse Kaci Hickox has created controversy by riding her bike outside in defiance of New Jersey’s mandatory 21-day quarantine order, despite the fact that she has tested negative for Ebola and is no threat to others. Given the climate of fear, nurses want to ensure not only that they are safe, but also that they are not stigmatized. As Ebola can only be transmitted through the blood and bodily fluids of those who carry it, medical professionals who directly care for such patients are at the highest risk of contracting the virus. The nurses’ strikes join an expanding group of voices calling for the government to lay out federal standards for hospitals to follow in response to Ebola. The NNU argues that such standards should entail better training and Ebola safety products for nurses to minimize the risk they face.