Ebola virus disease, or Ebola hemorrhagic fever, is a potentially fatal disease that was first identified in 1976. Since then, outbreaks have happened every couple of years, mostly in sub-Saharan Africa. However, none of these outbreaks has been as serious as the current epidemic in West Africa. Until 2013, there had been a total of 1,716 cases. Although no one is sure of the precise numbers, since March 2014, the current outbreak has included more than 15,000 reported cases and has been responsible for nearly 6,000 deaths.
The deadliness of the current epidemic, as well as its potential to spread to other parts of the world, has spurred a large-scale response from governments and health organizations around the world. Companies in the specialty fabrics industry are also playing an important role. Manufacturers of personal protective equipment (PPE) that can be used to keep health workers safe from blood-borne pathogens are experiencing unprecedented demand.
In early November, Kappler Inc., a Guntersville, Ala.-based manufacturer of chemical and biohazard protective clothing, took as many orders in two days as it would normally take in two years. “If you ordered a case of ProVent coveralls today, we can ship them to you in May of 2015,” says technical director Philip Mann.
Kappler is running its machinery at capacity, making as many protective suits as possible to meet the surging demand. Other companies—DuPont, 3M, Kimberly-Clark, Lakeland Industries Inc. among them—are also responding to high demand for their medical protective products. These companies, however, declined to be interviewed for this article.
Personal protective garments for Ebola care are similar to many other types of full-body PPE, but they are constructed with protection against blood and viral penetration in particular. “There are two tests,” explains Jason Cole, Kappler’s director of research and development. “ASTM 1670 measures blood penetration, and 1671 is viral penetration. You want a fabric that you know is going to pass those, and then past that, it’s more about garment design.”
Cole says most companies use a single or double layer of nonwoven laminated with a film of some kind. Others use a nonwoven with a polymer coating. What’s important is that the fabric provides a total barrier against blood and viruses, but will still be breathable for the wearer.
“We have a fabric that uses what’s called a micro-porous film technology, so the film itself is designed to have small holes in it,” explains Cole. “The holes are large enough that water vapor can go through it, so if you sweat, your sweat can evaporate. But the holes are small enough that there’s still a good blood and viral barrier. You can do that with biological agents; it’s a lot harder to do that, usually, with chemical agents.”
Seam sealing is absolutely crucial, since needle holes are large enough to compromise the protective qualities of the fabric. “There are a lot of suits on the market that just have a sewn seam, and we certainly don’t recommend a sewn seam,” Cole says. “There are ways to seal up that seam. We use ultrasonic seams. A lot of people can use a taped seam, where you’ve got actually a tape that goes over the holes created by sewing. Either of those is a good way to block off some of the danger of having blood come through your seams.”
Stedfast Inc., Granby, Quebec, Canada, mainly makes surgical gowns rather than full-body PPE, but many of the concepts are the same. “We use an EPTFE breathable moisture barrier with all of our composites,” says senior account executive Mark Winter. “It’s breathable, so the body temperature is high enough and creates enough pressure where it’s pushing air out through the breathing channels. The channels that are in the PTFE membrane are too small for blood-borne pathogens or water droplets to pass through. These are also used for chemical protection against some of the less harsh chemicals.”
At Stedfast, seams are reinforced with seam tapes made of EPTFE membrane attached to a scrim, then cut into 7/8- or 1-inch seam tapes and applied with a seam sealer.
Manufacturing PPE for Ebola care is largely a matter of keeping abreast of CDC and World Health Organization recommendations, and providing gear that is comfortable enough to work in while being as protective as possible. But not all workers are caring for people in a hospital setting.
“When we talk to Doctors Without Borders, they describe a couple of different primary scenarios,” says Cole. “One is the clinical worker who’s actually dealing with live patients. Those suits are not that different from what we would sell to a hospital here in the U.S., because they’re doing basically the same job. It’s certainly a tougher environment, but they’re in a relatively controlled environment. But the other main job is, they’ve got people that are just dealing with dead bodies—carrying those around, getting them on a truck, or digging graves. And those suits really do have to be a bit more robust. It means more gear per person, says Mann.
“They’ll layer up,” he explains. “They’ll take a garment, and then they’ll put an apron over that, and additional sleeve protectors and an additional hood.”
The human factor
Designing a high-quality, protective garment for such a dangerous situation means taking human behavior into account. Jennifer Harris is an OSHA training expert at Lion Technology Inc., Lafayette, N.J., and she says people sometimes can be lazy, maybe they don’t want to put their gear on because it’s hot and uncomfortable, or they figure they’re only going to be doing something for a moment, and there’s no point in suiting up.
But the danger concerning the spread of Ebola inspires safer behavior than most hazardous work situations, Harris says. “They’re actually focused. A lot of times, people are like, ‘What are the odds that I’m going to actually get this? It’s probably not that big a deal.’ But when they hear the word Ebola, it gets their attention.”
The main risk is that to prevent contamination protective gear must be removed very slowly and methodically according to specific protocol. At a certain point in the day, workers are extremely tired, and may be tempted to rush or cut corners. Sometimes during a long shift, after being soaked with high volumes of body fluids, exhausted clinicians must replace their PPE because it has become too saturated to continue working properly.
Most PPEs for chemical protection are designed to be taken off with assistance from another worker, but Ebola gear is different in this regard. Doctors Without Borders doesn’t typically allow Ebola clinic workers to have a helper, because they don’t want to risk contaminating others with viral material.
“That’s really made us rethink how we’re designing these,” says Cole. “We’ve gone back to the drawing board, and we’ve been working with Doctors Without Borders to design a new suit that uses the same fabric that we’ve been using, but is more friendly to the way they have workers get in and out of the suit. One thing that we’re looking at doing is having a fabric that’s a different color on the inside than the outside, so that when they do start to remove the suit, they can have a visual cue of whether they’re working with the clean side or the dirty side.”
That will go a long way toward protecting workers who dare not make a single mistake in handling garments, gloves, masks, medical devices or laundry, for fear of contamination. The best PPE for the Ebola epidemic is not only made of the right fabric with the right construction, but is designed for maximum ease and consistency of use. This is the challenge that fabricators making PPEs have accepted.