1 Piece Cool protective suit with hands off extrication/doffing and safe hands off disposal.
Typically simple solutions are the best. I believe a personal protective suit that is quick and easy to enter and simple, easy and safe to remove will eliminate the spread of Ebola to healthcare workers.
Current Personal Protective Equipment (PPE) recommended by the CDC and Doctors Without Borders requires 10 to 15 minutes to apply and 15 to 20 minutes to remove. And as we have seen, the system is not perfect. I believe the biggest problem is the complexity of the process.
Here is what I propose"
+ air pressure
Open in back top to bottom
Low crotch wide base
Loops on wrists, head, etc
System to ID fluid on PPE
System for remote removal of PPE
1. One Piece: It seems to me that the current system leaves many surfaces and interfaces where contagious bodily fluids can accumulate and hide. It also seems that the process of seperating one component from the other is a time when fluid could be briefly aerosolized and/or splashed onto exposed skin or mucuous membranes.
Front of PPE
Back of PPE
Hooking in for removal
Opening the PPE from a distance
Stepping out of PPE
Gloves are left on the PPE
Empty PPE ready to dispose.
The PPE should be 1 piece. Also it should be made of or coated with a material that resists the adhesion of bodily fluid or tissue.
2. Positive Airway Pressure: This will allow the suit to remain cooler than otherwise possible, keep lens fog free and prevent fluid or aerosol from entering the suit.
3. Opens in the back: Most splashing occurs in the front so the opening should be in the back.
4. Interlocking closure: The closure will be be secure enough to prevent opening due to positive airway pressure or movement but easy enough to open by a remote device via an attached hook or loop. Believe opening via zipper or hook/loop closure is too kinetic possibly causing aerosolization of any nearby bodily fluid. A plastic interlocking device seems best. Closure should be from top to bottom as any splashes are more likely to be lower down.
5. Low crotch with a wide base: I believe the crotch should be very llow to ensure that the caregiver can step out of the suit consistently with one step only. A potential problem with this is that the caregiver may need to shuffle about the room and would be unable to widen their base if needed for lifting, pushing or recovering from imbalance. For this reason the base should be extra wide in the lateral and anterior posterior sense.
6. Integrated shoe: This may or may not be necessary. Experimentation will be neceessary. The goal is that the caregiver can move about safely but at the same time be able to extricate their foot reliably with little to no movement of the suit.
7. Loops to aid removal: I think it is critical that the caregiver does not need to grab the suit or any attachments to it during removal. To do this there are small low profile plastic loops on various parts of the suit. It can work one of many ways and experimentation will be key.
a. Smalll loops that are low profile and face laterally. When ready to remove the caregiver grabs a small caribiner attached to the extraction rack and clips it through the loop.
b. Big loops that can be placed on or hooked into the extraction rack.
Caregiver first secures the feet. Then the body and head and finally the hands. The last hand is the toughest and the one where a larger loop may be necessary.
8. Systtem to identify bodily fluids on the suit.
a. One system could simply be some type of color change on the suit if there is fluid on it. Problem is that if the caregiver is in long enough the area could dry and this give a false negattive result.
b. Patient could have an inert flurescent mark administered in their IV fluids such that all bodily fluids subsequently expressed will fluoresce. Thus before the PPE is removed the caregiver could be scanned with a blacklight and areas of evident splash could be given extra decontamination.
c. An inert radiopharmaceuttical that distributes in all fluids is put in IV fluids. PPE is scanned with Geiger counter or other sensor.
d. Infrared vision goggles may be able to detect fluids on PPE that are at a higher temp than the ambient air. May not work if suit exterior heats up to match the caregivers body temp.
9. System for remote removal assistance: The "extraction rack" could be made in various ways. One possibility is to use PCP pipe with hooks that can meet up with the loops on the suite. It can be held on either end by assistants at a safe distance with a shield built into either side who can help pull or stabilize as the caregiver steps out of the suit.
A more complex system might use a room or enclosed box with a bar or set of bars or robotically controlled arms that secure the suit as the caregiver steps back onto a clean platform. The caregiver should never step upon ground they step on as they approached the removal site.
If robotic arms are used then they can be used to place the suit in a bag or box for removal.
10. Disposal system: The empty suit can then be put into a sealable bag or box and taken for incineration This box could be two parts. One side that has an active vacuum and the other that is open. Once the suit is inside and the lid approximated the two compartments could be joined causing an airtight vacuum closure.
Another possibility could be that the entire process be enclosed within 1 room. The suit can be moved by robot (bomb disposal robots could be repurposed for this) to an area or device that sterilizes via gas, heat/pressure, UV light, radiation or other method. Or a small incinerator could be within the room vented to the outside.
11. Robotic care: Integrate robots into the dirtiest jobs. Use robots to vacuum up bodily fluids from the ground, move contaminated containers or equipment. Definately have robots with UV steriiilization or other methods go about the room. Also integrate the above bodily fluid detection systems within the room. Cameras should be watching every move. Infrared detection system could detect aerosolization etc. If a healthcare work ever contracts Ebola the video footage should be watched meticulously to detect how the infection occurred. Never blame the caregiver. They work within a system. Creating the best system will hopefully eliminate spread of the disease.