International Journal of Nursing Studies 51 (2014) 1693
Contents lists available at ScienceDirect
International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns
Letters
Response to ‘‘MacIntyre et al., 2014: Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations?’’ Jose M. Martin-Moreno a,b,*, Gilberto Llina´s a, Juan Martı´nez-Herna´ndez c a b c
University of Valencia Medical School, Valencia, Spain University Clinical Hospital, Valencia, Spain Hospital La Paz-Carlos III, Madrid, Spain
A R T I C L E I N F O
Article history: Received 22 September 2014 Accepted 7 October 2014
In response to the guest editorial recently published in your journal, ‘‘Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations?’’ (MacIntyre et al., 2014), I am writing to clarify an important point that the authors seem to have wilfully misunderstood when citing a letter that two colleagues and I recently published in The Lancet. In our original publication (Martin-Moreno et al., 2014), we pointed out that very conservative precautions (in the form of air tanks and pressurised suits) in routine contact with EVD patients were unnecessary, but never that healthcare workers should refrain from using masks, as suggested in the editorial. Indeed, we explicitly stated that face masks and goggles should be ‘‘systematically’’ applied. We also acknowledged that there were certain situations, such as dealing with massive haemorrhaging, when more conservative protections were appropriate. Our only qualification was that masks ‘‘may not’’ be necessary when speaking to a patient at a distance of 1–2 m. In short,
we recommended graded precautionary measures in line with the risk of a disease spread by direct contact. Obviously, we support the use of a risk analysis framework that prioritises the safety of healthcare workers. However, the use of full respiratory protection for all healthcare workers dealing with EVD has not been shown to be necessary. Moreover, it is simply unfeasible, not to mention uncomfortable, in healthcare settings lacking air conditioning and sometimes even electricity. These suits also undermine risk communication messaging—so crucial to control transmission outside of hospitals—by suggesting that the precautions recommended to local populations are inefficacious. References MacIntyre, C.R., Richards, G.A., Davidson, P.M., 2014. Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations? Int J Nurs Stud 51 (11), 1421–1426. Martin-Moreno, J.M., Llina´s, G., Martı´nez-Herna´ndez, J., 2014. Is respiratory protection appropriate in the Ebola response? Lancet 384 (9946), 856.
* Corresponding author at: Department of Preventive Medicine and ˜ ez 15, Public Health, University of Valencia Medical School, Av. Blasco Iban 46010 Valencia, Spain. E-mail address: [email protected] (J.M. Martin-Moreno). http://dx.doi.org/10.1016/j.ijnurstu.2014.10.005 0020-7489/ß 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/ licenses/by-nc-sa/3.0/).
Contents lists available at ScienceDirect
International Journal of Nursing Studies journal homepage: www.elsevier.com/ijns
Letters
Response to ‘‘MacIntyre et al., 2014: Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations?’’ Jose M. Martin-Moreno a,b,*, Gilberto Llina´s a, Juan Martı´nez-Herna´ndez c a b c
University of Valencia Medical School, Valencia, Spain University Clinical Hospital, Valencia, Spain Hospital La Paz-Carlos III, Madrid, Spain
A R T I C L E I N F O
Article history: Received 22 September 2014 Accepted 7 October 2014
In response to the guest editorial recently published in your journal, ‘‘Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations?’’ (MacIntyre et al., 2014), I am writing to clarify an important point that the authors seem to have wilfully misunderstood when citing a letter that two colleagues and I recently published in The Lancet. In our original publication (Martin-Moreno et al., 2014), we pointed out that very conservative precautions (in the form of air tanks and pressurised suits) in routine contact with EVD patients were unnecessary, but never that healthcare workers should refrain from using masks, as suggested in the editorial. Indeed, we explicitly stated that face masks and goggles should be ‘‘systematically’’ applied. We also acknowledged that there were certain situations, such as dealing with massive haemorrhaging, when more conservative protections were appropriate. Our only qualification was that masks ‘‘may not’’ be necessary when speaking to a patient at a distance of 1–2 m. In short,
we recommended graded precautionary measures in line with the risk of a disease spread by direct contact. Obviously, we support the use of a risk analysis framework that prioritises the safety of healthcare workers. However, the use of full respiratory protection for all healthcare workers dealing with EVD has not been shown to be necessary. Moreover, it is simply unfeasible, not to mention uncomfortable, in healthcare settings lacking air conditioning and sometimes even electricity. These suits also undermine risk communication messaging—so crucial to control transmission outside of hospitals—by suggesting that the precautions recommended to local populations are inefficacious. References MacIntyre, C.R., Richards, G.A., Davidson, P.M., 2014. Respiratory protection for healthcare workers treating Ebola virus disease (EVD): are facemasks sufficient to meet occupational health and safety obligations? Int J Nurs Stud 51 (11), 1421–1426. Martin-Moreno, J.M., Llina´s, G., Martı´nez-Herna´ndez, J., 2014. Is respiratory protection appropriate in the Ebola response? Lancet 384 (9946), 856.
* Corresponding author at: Department of Preventive Medicine and ˜ ez 15, Public Health, University of Valencia Medical School, Av. Blasco Iban 46010 Valencia, Spain. E-mail address: [email protected] (J.M. Martin-Moreno). http://dx.doi.org/10.1016/j.ijnurstu.2014.10.005 0020-7489/ß 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/ licenses/by-nc-sa/3.0/).
