N.B Applying Universal Safety precautions would save you. But this note is not about universal precautions.
Let's look at the bad habits that welcome Ebola:
Establishing rapport with your patient:
That handshake you are accustomed to giving can be skipped.
Now, the most important part of your rappor...t is asking how widely travelled the patient is, his west African experience, his guests, his visitation habits, his sick relatives, the loved ones he's buried, the travel behavior of his lovers etc.....all before you get down to the reason he came. That way you can establish your if ur population is at risk. If u have a waiting area, they can fill the compulsory questionnaire while awaiting their turn to see the doctor.
If feasible, the receiving nurse does this rapport at the nurses station while taking vitals. The earlier the patient is isolated, the better. This is important at this stage to help u quickly isolate the patient for further questioning and then allow your further kit up.
During examination, all that checking for pallor, temperature and axillary lymphadenopathy with bare hands should be left in the Pre-Ebola era.
If u use nylon gloves, this message is not for u. I don't know how to address your case. You are wicked to yourself.
That said if your normal wrist sized latex gloves are not protective enough please use your money and buy elbow length gloves..
Note that I'm not telling you to tell government to buy, or to tell your CMD or ur medical director in ur PP because it gets to a time you have to take charge of your life. No one would fill out your life assurance.....you would.
So you are done with examination and you go back to your table to document your findings postponing washing your hands till when the patient goes out....help yourself. A word is enough for the living. Wash those hands before you return to your seat.
And then splash some Jik on the faucet handle when you are done.
If your office is one of those that warrant your dipping hands into the drum to fetch water, please use your own money and buy a bucket with a tap that u can use. That N500 for buying it would save government the N5000 that would be given to your family for your effort.
When the patient leaves the examination bed, ensure the mackintosh that must have been placed there beforehand is doused with alcohol, bleach or original spirit....(not all those 'I dey kampe spirit'.....ofcourse if your bleach has been open for more than 30days, it belongs to the sewage tank). After the patient leaves the consulting room before the next patient, wash your hands again.
Now for the doctor managing the obviously ill patient, there is no time for sme sme. If you are in a designated Ebola ward, u would need an appropriate PPE that is impermeable to fluids, light enough to wear for long periods, permeable to air slightly, and should be worn over your boots. Do not tuck them into your boots, wear elbow length gloves over the PPE. Safety googles and head covers would be necessary. Before removal of this outfit, efforts to decontaminate the material should be made as removal may pose exposure to skin.
Spray the body with a medium pressure bleach solution, avoid using high pressure as this may aerosolise the organisms. As much as possible, these should not be reused. While in these outfits, business is strictly business, minimise contact with other staff.
Comport yourself as if sterile for a surgical procedure. You can't be giving a handshake to another kitted person when u r both loaded with the virus, you can't be leaning on a surface fully kitted in PPEs, you expose other staff.
By Likita Kent
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