How protective gear is removed poses risk.

• Position: Ebola Health Care

A team of American infectious disease and critical care specialists is alerting colleagues caring for Ebola patients that how they remove their personal protective gear can be just as crucial as wearing it to prevent exposure to the deadly virus.

In a commentary published in the Annals of Internal Medicine, the physician-specialists from Johns Hopkins University, Baltimore, Md., and the University of North Carolina, Chapel Hill, say rigorous steps exist---and must be taken--to avoid "inadvertent" contact of frontline caregivers' exposed skin and mucous membranes to infected body fluids.

Personal protective equipment (PPE)--including goggles or face shields, gloves, and gowns--effectively are decreasing West African caregivers' exposure to infected bodily fluids, but workers still are at risk "if removal of protective clothing that is contaminated with infectious bodily fluids is not done in a manner that prevents exposure," stress the authors, who include Trish M. Perl (senior epidemiologist for the Johns Hopkins Health System and a consultant to the Office of Critical Event Preparedness and Response) and Noreen Hynes (director of the Geographic Medicine Center in the Division of Infectious Diseases at the University of North Carolina School of Medicine).

"The physical exhaustion and emotional fatigue that come with caring for patients infected with Ebola may further increase the chance of an inadvertent exposure to bodily fluids on the outside of the personal protective equipment, leading to unwanted contact when the gear is removed," the authors indicate. 'The impulse to wipe away sweat in the ever-present hot, humid environment during personal protective equipment removal may lead to inadvertent inoculation of mucous membranes" in and on the nose, mouth, and eyes.

According to the World Health Organization, the unprecedented outbreak of Ebola in West Africa has resulted in a "high proportion of doctors, nurses, and other health care workers who have been infected." To date, WHO says more than 240 health...