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Disinfect prior to disrobing.

When removing protective clothing, cross contamination is a common occurrence. It would be prudent to double up on gloves and possibly add a cotton liner as first layer. This is done extensively in the nuclear industry. It would also be prudent to use an appropriate disinfectant prior to removal of protective layer and "kill" any living virus. These steps will add defense in depth to address this common failure mode.

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Photo of Edward (E. Barry) Skolnick, M.S.

David, note the Medicin Sans Frontieres' standard practice of spray-disinfection of PPE before removal, according to its illustrative poster available at URL: "", as linked to the OpenIDEO's "Fighting Ebola Challenge" Brief at URL: "".

Regarding your mention of an "appropriate disinfectant", please see my OpenIDEO "Research" phase contribution at URL: "". An acid-neutralized ("amended" or "pH-adjusted" chlorine bleach) formulation would have much higher concentration of the germicidal hydrochlorous acid (HClO) molecule near neutral pH, than does the typically water-diluted and alkaline (pH>11) bleach, so would be predicted to deactivate Ebola virus much more rapidly (perhaps in seconds) under spray treatment of PPE before doffing it, than does the conventionally water-diluted alkaline bleach.

Also (notionally), because the "enveloped" Ebola filovirus is regarded as being highly susceptible to inactivation by disinfectants (i.e., very low on the "Spaulding hierarchy") substantially more-dilute bleach solutions could be used for reliable Ebola virocidal disinfection than may be needed with alkaline bleach, thereby both improving Ebola disinfection cost-effectiveness, and reducing risks to healthcare workers from handling larger quantities of toxic chlorine in more concentrated alkaline bleach solutions. The innovation of pH-adjusted bleach as an improved sporicidal disinfectant has long been adopted by US EPA (but without the higher dilution) for anthrax-spore bioterrorism response preparedness, but needs some R&D to adapt it optimally, safely, and effectively, to global public health virocidal needs, like for reliable Ebola disinfection. -- ebskolnick

Photo of Bettina Fliegel

Hi David. Why is it necessary to add a cotton liner? Why do they use it in the nuclear industry? What type of PPE do they use in the nuclear industry?

Photo of David Fitzwater

It acts as another barrier when taking off rubber gloves. There are various combinations used depending on the nature of the hazard. For loose surface contamination, as a minimum; cotton liners, rubber gloves, plastic shoe covers, rubber shoe covers, cotton anti contamination jump suit, cotton head cover, and tape for seams. There are an assortment of respirators for airborne particulates. More layers are added as contamination levels increase. Sometimes it's doubling up. Some occasions require complete encapsulation and engineering controls.

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