How can a nurse in an Ebola treatment ward become infected?

Watching a medic robing up before entering an Ebola treatment ward, it is hard to imagine how they could possibly end up being infected by the virus.

As the video above shows, the process takes nearly 20 minutes, and involves donning up to four different sets of gloves, overalls and masks, the idea being to leave absolutely no patch of skin uncovered. As an additional precaution, each set of clothing is bound with tape and ligaments to prevent it slipping loose, and before any medic enters the ward, a "buddy" medic checks over their uniform to ensure every seal is perfect.

Yet no amount of protection is a complete guarantee of safety, as has been proved by the case of the Spanish nurse who has become infected with the virus at a hospital at Madrid's La Paz-Carlos III hospital. The nurse, Maria Teresa Romero Ramos, was part of a 30-strong medical team that was treating two elderly Spanish missionaries who died of Ebola shortly after they were repatriated from Africa. All the staff were experienced medics who had had training for how to deal with the virus safely. So how could it have happened?

The answer may lie in the nature of Ms Romero's duties in the Ebola ward, which included disposing of the soiled medical nappies worn by her patient, who, like most Ebola carriers, would have been suffering near-constant vomiting and diarhhoea. This is potentially the most dangerous job in any Ebola ward, as faeces and vomit are two main conduits for the virus, and can infect anyone whose skin comes into contact with them.

The main risk, though, comes not during the ward rounds itself, but afterwards, when taking off clothing that may have become contaminated. At that point, the multiple layers of protective attire are supposed to act in a kind of Russian-doll fashion, ensuring that as the outer layers of clothing is disposed of, there is still some residual protection from inner layers. But medics say that even with a "buddy" watching over them once again, it is possible to become accidentally infected during the disrobing procedure, especially if the protective garb is heavily soiled.

Whichever way it happened, the Spanish nurse's case demonstrates that even the most stringent procedures are not entirely foolproof. Medicins Sans Frontieres, the main aid agency in the frontline of the fight against Ebola, used to pride itself on how none of its international staff had ever been infected while treating patients for the disease. Last month, however, that record came to an end when a medic tested positive while working at a clinic in Liberia.

Colin Freeman recently reported for The Telegraph on the Ebola outbreak in Liberia.

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