Ebola Virus Disease (EVD) Information PPE FAQ


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As of October 20th, the Centers for Disease Control and Prevention advised that while working in PPE, healthcare workers caring for Ebola patients should have no skin exposedFor more information, please visit the CDC’s page on PPE Procedures, including donning and doffing, here.

Information on the Ebola Virus Disease (EVD) is readily available from a number of national and international health organisations, including the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the Public Health Agency of Canada (PHAC) or your local health authority.

The purpose of this page is to provide a summary of key information provided to the public from these authorities on EVD and our trusted suppliers, as well as guidance on suitable personal protective equipment (PPE) for preventing the transmission of EVD when working in an environment where EVD is present, or people infected with the virus may be present.

This page is not to be considered a substitute for detailed information about the disease or any related topics by these recognized national and international health authorities.

For the most up-to-date information and preventative actions, please regularly consult the following authorities:


Ebola virus disease (EVD) is a severe disease that causes haemorrhagic fever in humans and animals. Diseases that cause haemorrhagic fevers, such as Ebola, are often fatal as they affect the body’s vascular system (how blood moves through the body). This can lead to significant internal bleeding and organ failure.

The current outbreak of Ebola is in Central and West Africa. The first case of Ebola was diagnosed in the United States on September 30, 2014; in 2014, more than 7400 cases have been reported across the globe, with nearly half ending in death. There have not been any confirmed cases of Ebola in Canada.

The Ebola virus can spread through:

  • Contact with infected animals
  • Contact with blood, body fluids or tissues of infected persons
  • Contact with medical equipment, such as needles, contaminated with infected body fluids

Exposure can occur in health care settings when staff do not wear appropriate protective equipment, such as masks, gowns and gloves. Particular care must be taken not to allow exposure when removing protective equipment.

Personal Protective Equipment (PPE) Guidance

It is not always possible to identify patients with EVD early in the course of their illness because initial symptoms may be non-specific. For this reason, it is important that health care workers (HCWs) at all levels carefully apply standard precautions on a consistent basis, with all patients – regardless of their diagnosis – in all practices and at all times.

These include:

  • Hand hygiene
  • Use of disposable medical examination gloves before contact with body fluids, mucous membrane, non-intact skin and contaminated items, and
  • Gown and eye protection before procedures and patient-care activities likely to involve contact with or projection of blood or body fluids.

In addition, regular application of best practices for injection safety and safe handling and disposal of sharp instruments, safe cleaning and disinfection of the environment and of reusable equipment, and safe laundry and waste management should be a high priority in the health care field (HCF).

All HCWs (including aides and cleaners) and visitors should be trained / instructed to use personal protective equipment (PPE) and perform hand hygiene. Instructions should be displayed at the entry of the isolation room/area. Personal clothing should not be worn while working in the patient care areas. Scrub or medical suits should be worn.

Before entering care areas, don PPE according to the expected level of risk and following the steps recommended by WHO. The PPE include:

  • Correctly sized non-sterile examination gloves or surgical gloves;
  • Disposable, long-sleeve, impermeable gown to cover clothing and exposed skin;
  • Medical mask and eye protection (goggles or face shield);
  • Closed, puncture and fluid resistant shoes (e.g. rubber boots).

Additional PPE, depending on performed tasks and risk assessment, may include:

  • Waterproof apron, if gown is not impermeable;
  • Disposable overshoes and leg coverings, if boots are not available;
  • Heavy duty (rubber) gloves, when performing environmental cleaning or handling waste;
  • Particulate respirator (FFP2 or EN certified equivalent or US NIOSH-certified N95), when performing procedures that promote generation of aerosols.

Before exiting the isolation room/area, carefully remove and dispose of PPE (including boots) into waste containers and perform hand hygiene. When removing PPE, be careful to avoid any contact between the soiled items (e.g. gloves, gowns) and any area of the face (i.e. eyes, nose or mouth) or non-intact skin. Do not re-use disposable PPE.

Carefully clean and decontaminate reusable equipment. Adhere rigorously to using dedicated equipment (e.g. stethoscopes) on a single patient only. When this is not possible, decontaminate the items between each patient contact. All waste generated during this decontamination process should be treated as infectious waste. Items and equipment should not be moved between isolation rooms/areas and other areas of the HCF, unless they are appropriately discarded and disposed of.

Respiratory Protection

  • PAPRor N95 Respirator. If a NIOSH-certified PAPR and a NIOSH-certified fit-tested disposable N95 respirator is used in facility protocols, ensure compliance with all elements of the OSHA Respiratory Protection Standard, 29 CFR 1910.134, including fit testing, medical evaluation, and training of the healthcare worker.
    • PAPR: A PAPR with a full face shield, helmet, or headpiece. Any reusable helmet or headpiece must be covered with a single-use (disposable) hood that extends to the shoulders and fully covers the neck and is compatible with the selected PAPR. The facility should follow manufacturer’s instructions for decontamination of all reusable components and, based upon those instructions, develop facility protocols that include the designation of responsible personnel who assure that the equipment is appropriately reprocessed and that batteries are fully charged before reuse.
      • A PAPR with a self-contained filter and blower unit integrated inside the helmet is preferred.
      • A PAPR with external belt-mounted blower unit requires adjustment of the sequence for donning and doffing, as described below.
    • N95 Respirator: Single-use (disposable) N95 respirator in combination with single-use (disposable) surgical hood extending to shoulders and single-use (disposable) full face shield.** If N95 respirators are used instead of PAPRs, careful observation is required to ensure healthcare workers are not inadvertently touching their faces under the face shield during patient care.

Respirator classifications vary by local standard and clarification should be sought from the manufacturer to verify the classification of the chosen respirator aligns with the WHO and US CDC guidance. Disposable particulate respirators (N95, N99, etc) are a wise choice in certain instances as they do not require disinfection and will not be reused.

Fit Testing

ebola-fit-testingOccupational Safety and Health Administration (OSHA) and Canadian Standards Association (CSA) fit-testing requirements specify that all respirators, including N95s, that rely on a mask-to-face seal need to be checked with either quantitative (QNFT) or qualitative (QLFT) methods to determine whether the mask provides an acceptable fit to a wearer. This includes all types of N95, air purifying, air-supplied, positive pressure, powered air-purifying respirators, and SCBA.

Levitt-Safety’s fit testers are specifically trained and ready to visit your site to provide fit testing for your employees. CSA also requires employers to conduct fit testing with their employees. Levitt-Safety can prepare you for this very task. Our fit testers are also qualified to provide train-the-trainer sessions which will prepare your employees for conducting future in-house fit testing. Learn more about our fit testing services here.


Non-vented, anti-fog (AF) coated goggles can be worn to help prevent exposure to infection. This type of goggle is designed for complete coverage and sealing, while the AF will help eliminate the need to remove goggles during potential exposure work. Be sure the goggles are tightly sealed to the face. Goggles exposed to EVD should be disposed of properly once removed.

While goggles help prevent splashes to the eyes, they do not protect other mucous membranes (nose, mouth) that could be exposed; nor do they protect skin. To help prevent splash on these areas, use a faceshield designed for splash protection, such as a polycarbonate visor. DO NOT use a mesh visor as these do not provide splash protection. Faceshields do not take the place of respirators and goggles. Be sure to wear an appropriate respirator and goggles under any faceshield. Faceshields exposed to EVD should be disposed of properly once removed.

Hand Hygiene

Perform hand hygiene with an alcohol-based hand-rub solution (20-30 seconds) or soap, running water and single-use towels (40-60 seconds), applying the correct technique recommended by

  • Before donning gloves and wearing PPE on entry to the isolation room/area;
  • Before any clean/aseptic procedures being performed on a patient;
  • After any exposure risk or actual exposure to the patient’s blood and body fluids;
  • After touching (even potentially) contaminated surfaces/items/equipment;
  • After removal of PPE, upon leaving the care area.

Always perform hand hygiene with soap and water when hands are visibly soiled. Alcohol-based hand rubs should be made available at every point of care.

Protective Clothing

Ebola Protective Clothing

We’ve receive a number of inquiries from our customers regarding the appropriate protective clothing for potential exposures to EVD. The prevention of Ebola virus infection includes measures to avoid contact with blood and body fluids of infected individuals and with objects contaminated with these fluids. Barrier precautions are used to prevent skin or mucous membrane exposure of the eyes, nose and mouth.

Your protective clothing should be selected based primarily on the potential exposures and need for protection against infective fluids and agents. However work conditions, environmental conditions, tasks and accessibility to decontamination should also be considered.

Public Health Ontario recently released a selection guide for PPE as it relates to EVD. In it, they reference CSA Z314.10.1 and AAMI PB70:2012. The challenge is that CSA Z314.10.1 and AAMI PB70:2012 are specifically standards for use of gowns, drapes, and wrappers in health care facilities, but typically PPE manufactures will reference testing to a more comprehensive or specific standard like “ISO” (in this case fluid resistance ISO16603 or ISO16604) which is part of a bigger European standard EN 14126 which defines performance requirements for clothing materials to protect against infective agents.

In North America we are more likely to simply reference the test method used such as ASTM 1670 or ASTM 1671 without referencing the AAMI or CSA standard. Protective clothing that meets ASTM for fluid resistance has been tested for resistance to a synthetic blood challenge. All materials that pass ASTM test 1671 have also passed ASTM 1670. A product that has passed ASTM 1671 (which includes any gown that is level 4 based on AAMI/CSA) is therefore one of the most desirable protective clothing for circumstances where there is high probability for blood and body fluid exposure where infectious agents are present.

Endeavour to ensure that the clothing you select as part of a complete PPE solution is in compliance with the standards outlined above.

Management of Sharps

Dispose of syringes, needles, scalpel blades and other sharp objects in puncture-resistant containers.They should be placed close to the “point of use” and remain upright at all times. Ensure that the containers are securely sealed with a lid and replaced when ¾ full.

Environmental Cleaning, Waste, and Linen Management

Cleaners should wear rubber gloves, impermeable gown and boots and in addition, facial protection when undertaking activities with increased risk of splashes or in which contact with blood and body fluids is anticipated, including handling of linen. Contaminated environmental surfaces or objects should be cleaned and then disinfected as soon as possible using standard hospital detergents/disinfectants (e.g. a 0.5% chlorine solution).

Safety with Laboratory Samples

Laboratory personnel handling potential EVD clinical specimens should wear full PPE (see above) and use particulate respirators (e.g., US NIOSH-certified N95), or powered air purifying respirators (PAPR) when aliquotting, performing centrifugation or undertaking any other procedure that may generate aerosols.

announcements from our suppliers in regards to ppe selection for evb can be found below: