The three hospital workers have entered the no-mistake zone.
They are wearing plastic face shields, white jumpsuits, blue knee-high booties, two pairs of gloves, and a hood with an air filtration system attached at the waist.
They are here, learning how to safely treat an Ebola patient at Brigham and Women’s Hospital, should such a patient ever show up, because they do not want Boston to be Dallas.
“The game changer,” said Dr. Eric Goralnick, the Brigham’s medical director of emergency preparedness, “was that second nurse being infected.”
That was Amber Vinson, one of two nurses who contracted Ebola from a patient they treated in Dallas. The other nurse, Nina Pham, was declared Ebola-free Friday. Meanwhile, a doctor is lying in a New York hospital with the illness after returning from Guinea, one of three West African nations at the epicenter of the deadliest Ebola outbreak in history.
At the Brigham this week, medical teams learned how to protect themselves from the virus, if it is ever in their midst.
The hospital plans to train about 120 nurses, physicians, respiratory therapists, and others to form an Ebola team that will be deployed if a high-risk case comes to the hospital.
As part of that training, the three workers in white jumpsuits peer through their plastic face shields at pinkish liquid puddling at their feet.
Patients with Ebola lose liter upon liter of body fluid. So nurse Maggie Holmes, infection control practitioner, squirts liquid onto the floor. It looks nasty but is benign, part of the four-hour training course in the hospital’s STRATUS Center for Medical Simulation.
Waste management is a critical part of caring for a patient with Ebola. When patients are at their sickest, the Ebola virus is highly concentrated in their bodily fluids.
Even a few drops of blood or sweat that make their way from a patient to a health care worker can cause illness. That can happen when health care workers rub their eyes, or when the virus penetrates a break in the skin.
But this crew is well-protected in their elaborate safety gear.
“I feel safe,” says Deb Buonopane, an Emergency Department nurse and one of dozens of people undergoing training.
Holmes hands each of her colleagues a squeeze bottle containing a substance called Premisorb. They apply the white powder in a circle around the puddle and then inside it. Instantly, the liquid turns solid.
With two pieces of cardboard, each trainee scoops up the former puddle, now just a crumbly slab, and dumps it in the trash.
That’s not the end of it, of course. Ebola cleanup, as with every aspect of Ebola care, requires a Zen-level mindfulness, slow, careful attention to every move you make. The medical workers learn to mop up any residue, dispose of the mop head, and wipe the mop handle with a disinfectant.
Next, they go into another room to practice on the realistic mannequins (they breathe, cough, speak, have a pulse) that are used for training.
They perform skills they know well — inserting an IV and a catheter, interacting with a patient, removing soiled linens — but that they have never done inside those bulky suits.
And then comes one of the trickiest tasks — safely removing the protective garb. It is believed that health care workers who became infected with Ebola most likely came in contact with the virus while removing contaminated gear.
That’s why everyone must have a monitor with a checklist.
“We want to be really focused, deliberate,” says Deborah Mulloy, associate chief nurse for quality in the hospital’s Center for Nursing Excellence.
The monitor, she says, wears protective garb but has not been in the patient’s room. The monitor helps to remove items and ensure that each step occurs correctly, with stops to swab with disinfectant wipes along the way.
The trick is to roll everything inside out so none of the suit’s outside comes in contact with the skin — right down to the last glove, grabbed by two deft, clean fingers reaching underneath the glove’s wrist and curling it over.
Final step: a shower.
When the Centers for Disease Control and Prevention issued new guidelines for Ebola preparedness Monday, the Brigham compared its protocols with the new rules, and found no gaps and nothing that needed adjustment, says Goralnick, the Brigham’s emergency preparedness medical director.
But the hospital is constantly updating its plans based on new knowledge and staff feedback.
For example, the hospital decided to use a hood with filtered air, not because Ebola is airborne, but because the other alternative — a specialized mask with a face shield — was causing problems.
Face shields were fogging up, and workers tended to touch their faces to adjust masks; plus, the hoods are more comfortable because the filtration system blows cool air. The only problem is that the plastic front squashes the nose.
Now, the hospital is looking into getting one-piece jumpsuits with feet, and new hoods that don’t compress the face so much.
In addition to the four-hour course at the simulation center, the Ebola response team will practice repeated drills.
The specialized team will come in only when a patient has been identified as high risk and been moved into an isolation room. Goralnick knows of only two patients who were put into isolation for suspected Ebola; in both cases, the disease was quickly ruled out.
Does he expect to see an Ebola patient? “It’s a pretty low likelihood, to be honest,” he says. “We are focused on this because we need to be perfect.”
And the training won’t be for naught even if Ebola never shows up at the Brigham, Goralnick says — it will come in handy for any other new infectious diseases the future may bring.