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Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

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  • #31
    Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

    ..After learning of the situation a crisis cabinet chaired by Health Minister Ana Mato, was urgent meeting at the headquarters of his department. This contagion occurs 9 days after the death of Garc?a Viejo, who was repatriated to Sierra Leone on 21 September and died five days later after suffering a "deterioration" in the gravity and maintained, to be affected by a "significant dehydration "and hepato-renal involvement....

    Possible second case
    A nurse at the Hospital of La Paz being examined as a possible second case of Ebola infection, according to medical sources reported Europa Press.
    The patient reported 061 Monday to feel high fever and was taken to the Hospital of Peace, where he works. There has been subjected to the test of Ebola and is awaiting the results.
    Currently, it is unknown if the nurse of La Paz, which have not been offered more data might be in contact with infected patients.https://translate.google.com/transla...ola&edit-text=
    CSI:WORLD http://swineflumagazine.blogspot.com/

    treyfish2004@yahoo.com

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    • #32
      Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

      computertranslation

      Staff Carlos III complain costumes did not meet the rules

      The hospital responds that they have met the security measures for Ebola
      A health of Madrid, first Ebola contagion in Europe


      MIGUEL ANGEL MEDINA Madrid 6 OCT 2014 - 21:52 CEST


      Medical personnel who treated Miguel Pajares a suit with gloves subjects with duct tape.

      Medical personnel of Carlos III denounced this afternoon that the costumes that has treated the two Spanish priests infected by Ebola did not meet the necessary safety requirements . In his words, the normative case for a brand like this condition is necessary to use a clothing level 4, ie, fully waterproof and breathing apparatus. The clothing used to serve both as Miguel Pajares Manuel García Viejo was only level 2 Yolanda Fuentes, deputy director of the Hospital Carlos III - La Paz, has denied that any breach of its security measures. "The costumes are well matched to the protocol and the security measures required for this disease," he explained.

      As seen in the pictures supplied by staff of Carlos III, the suit used is not regulatory. Not vented and gloves are latex and are secured by adhesive tape. The complaint also risk has meant that the hospital has not been evicted to meet García Viejo, criticize and waste from the rooms of the two religious were expelled infected by the same elevator that used the rest of the staff.

      More: El Pais
      ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
      Richard Horton, Editor-in-Chief The Lancet

      ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

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      • #33
        Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

        Originally posted by Graupel View Post
        I see two possibilities:

        a) she had a major exposure (needle stick etc.), in which the health system failed on every conceivable level

        b) she had no obvious exposure and this has truly massive implications for containing the epidemic

        Either way, hospitals and public health systems in developed countries that have assumed they won't have any problems need to wholly reconsider everything about how they will respond
        I think it's the latter. The patient appears to be a nurse's assistant, who probably wouldn't even be administering injections or IV's. From what I can gather, she went in his room twice. Nurses' aides are, however, typically responsible for bathing, etc. so she would have had exposure to body fluids- though PPE should have prevented that mode of transmission, they appear to have been inadequate, level 2 PPEs. But why were they inadequate? Why can't one use level 2 PPE's with Ebola?

        The gear shown above may not be Level 4, but it should be adequate to prevent infection with a virus that is transmitted by bodily fluids.

        In any assessment of risk, there are two basic things one must know: what is the chance that something will happen, and what are the consequences if it does?

        I have always thought the Level 4 precautions were because this is a killer virus, not because it's easily spread. In other words, the chance is low, but the consequences are high, hence the extra vigilance with using level 4 labs and PPE. But if the Level 4 biosafety precautions are ALSO REQUIRED because it's easily spread, then that's a whole different kettle of fish, IMHO. However, that is certainly not what we're getting through the media. We're constantly told it's not easy to acquire. Then you see someone infected wearing the above outfit, and it does make one wonder.

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        • #34
          Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

          ...
          Some 30 health and the husband of the infected follow the protocol

          The husband of the nursing assistant Ebola infected and three health professionals who cared Summa yesterday following the protocol of prevention against the virus, the same applies to the 30 hospital workers that Carlos III de Madrid, as the patient attended religious died from the virus.

          Alemany has stated that both the doctor and emergency room technicians who attended yesterday's practicing them are epidemiological surveillance and take your temperature twice a day for 21 days. Meanwhile, her family environment is only monitoring the husband as they are beginning to know the details of their relationship to the case have confirmed a few hours ago...http://www.elconfidencial.com/espana...espana_229203/
          CSI:WORLD http://swineflumagazine.blogspot.com/

          treyfish2004@yahoo.com

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          • #35
            Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

            The patient, who went on vacation after the death of Garc?a Viejo, life has become normal in recent weeks and shows no more symptoms that "a little fever and fatigue," said the director of the primary care Madrid , Antonio Alemany. The patient has a fever, about 38,6? is stable and is awaiting assessment as officials from the Ministry of Health. "We are not aware of any other case," added Alemany. This has added yet unknown what could fail, if they have actually implemented all protocols to prevent contagion, "We do not know yet what could fail are investigating the mechanism of infection.".

            Minister Ana Mato, in an extraordinary appearance before reporters, said that the protocol was "immediately activated to assist the patient and ensure the safety of health workers who treats and citizens." "We are working to verify the source of infection," added the minister. Has begun the study of all the contacts you have had this woman, including those who have had with health professionals Hospital Alcorc?n.

            The woman is stable and has fever 38,6?

            ...This is the third case of Ebola fallecieron- treated in Spain-the first two and the first in which the patient is not repatriated from Africa or is treated in the hospital Carlos III de Madrid. The capital has already activated the protocol in September when a Brazilian disturbing symptoms presented in the Southern Bus Station.
            The patient was admitted in the morning with a high fever. So the hospital activated the protocol before a possible case of Ebola and is isolated in the emergency room. A total of 60 health professionals who have had contact with the affected are under surveillance, according to a spokesman for the Union of Nursing.She is a woman of 44, married and childless, of Galician origin but has been in the Carlos III over 15 years, according to other health center that consulted by this newspaper. These other colleagues who, as the affected, have been working in shifts to care of the missionaries, have expressed surprise at the spread as protective measures were "extreme". Health protection two monkeys wearing two pairs of gloves and goggles when treated patients.

            The primary care manager of the Community of Madrid, Antonio Alemany, explained at the press conference with the affected Mato entered at any time in the room with Garc?a Viejo "protective equipment" and that there is no evidence that there had been other contact. He also explained that the affected went on vacation the day after the death of this missionary. "We have already begun the study of all the contacts you have had this patient, including health professionals Hospital Alcorc?n who have served," added Alemany.

            The partners have also explained to the doors of the center, the hospital was not evacuated to attend the second missionary because the sixth floor (the infectious intended) was already sealed since he attended the first affected. To access this facility, the professionals have a specific card.

            We do not know what could fail we investigated the mechanism of infection..http://elpais.com/elpais/2014/10/06/...15_352524.html
            CSI:WORLD http://swineflumagazine.blogspot.com/

            treyfish2004@yahoo.com

            Comment


            • #36
              Re: Discussion: Spain confirms 1st ebola case outside of Africa - health care worker who cared for dead ebola patient in Spain

              According to http://www.abc.es/sociedad/20141006/...410062017.html:

              Approximate translation:

              The nurse had taken precise precautions in her close environment, having slept separately from her husband in the last few days.

              Her husband, a doctor, and 3 technicians who attended her on Sunday are under surveillance by a team of epidemiologists, with the same protocol which applies to the 30 workers of the Carlos II Hospital in Madrid, the latter who had assisted the priests who died of the virus. This team is collating a list with all possible contacts of the woman, in case there is a possibility that she has transmitted the illness.

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              • #37
                Re: Discussion: Spain confirms 1st ebola case outside of Africa - health care worker who cared for dead ebola patient in Spain

                Bruselas pide explicaciones sobre las circunstancias del contagio


                Approximate translation:

                Brussels [will] ask for explanations on the circumstances of the infection

                Brussels will not comment while the case is not officially confirmed, but if it were the case that it is, Spain will have to "explain" the circumstances of the infection, sources said, underlining that European hospitals must be "highly equipped" to protect its staff.

                Comment


                • #38
                  Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                  I think we may need to compare and contrast with MSF protocols here. MSF has previously identified that one of the greatest times of risk for HCWs is the removal of PPE correctly, so they have in effect a 'dresser and undresser' second, who guides the HCW on donning and removal of PPE to reduce risks.

                  Perhaps these protocols need to be adopted in full in developed nations hospitals?

                  Comment


                  • #39
                    Re: Discussion: Spain confirms 1st ebola case outside of Africa - health care worker who cared for dead ebola patient in Spain

                    La enfermera con ébola mostró los primeros síntomas el pasado 30 de septiembre

                    At the end of the article, there is the following (approximate translation):

                    Health bodies demand explanations

                    The president of the General Nursing Council , Máximo González Jurado, has requested explanations from the Ministry of Health on the spread of Ebola and announced that it will launch criminal proceedings, if necessary, to demand accountability on these facts.

                    Meanwhile, the CSIF union and Optional association Specialists Madrid (Afem) request clarifications on how the nurse caught Ebola.

                    In the same vein, the spokesman for Association of Physicians Specialists of Madrid (Afem), Marta Hernández, has demanded the resignation of Health Minister Ana Mato, for what he described as a "very grave fact" and " third-world-its" in reference to the infection by Ebola of the nursing assistant.

                    The president of the doctors' union AMYTS, Daniel Bernabeu, has expressed "a mixture of dismay and outrage" at learning of the infection of the nurse after attending the religious Manuel García Viejo.

                    The general secretary of union nursing SATSE, Calvo José Manuel Freire, recalled that they had already warned that the Carlos III did not meet the "sufficient conditions" to handle this type of patients and infection demonstrates that "something is wrong".

                    Meanwhile, the Federation of Associations for the Defence of Public Health (FADSP) has accused the government of acting "irresponsibly".

                    Comment


                    • #40
                      Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                      Originally posted by curiosity View Post
                      I hope they will share any information immediately that would support a likely cause - like a documented lapse in PPE or a reported needle stick - anything that will create a justified reason vs. an unknown and panic inducing cause for transmission.
                      There had better not be a documented lapse in PPE as it appears she hasn't been followed up for 21 days!

                      Comment


                      • #41
                        Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                        Originally posted by Graupel View Post
                        I see two possibilities:

                        a) she had a major exposure (needle stick etc.), in which the health system failed on every conceivable level

                        b) she had no obvious exposure and this has truly massive implications for containing the epidemic
                        From Sharon's initial post above:
                        "Sources have told center 20minutes until just two days ago most of the staff was unaware of the need to apply in these cases protocol. For example, workers cleaning and disinfection, for example, were unaware of the rules. Regarding the isolation room where she met the woman, is adjacent to the Emergency Hospital Alcorc?n and near the area used to deposit the waste generated in the health center. So far, it has asked the workers who do not pass through this area."

                        Cleaning up without knowledge of the risks is a system failure. I hope there has been some training by now. This article read alongside the thread containing the anonymous Spanish nurse's letter is most upsetting.

                        Comment


                        • #42
                          Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                          Auxiliar de enfermer?a contagiada de ?bola ya ha ingresado en el Carlos III
                          07-10-2014 / 1:00: h EFE

                          La auxiliar de enfermer?a contagiada por ?bola ha llegado a las 00,40 horas de esta madrugada al Hospital Carlos III de Madrid, donde ser? tratada de la enfermedad que contrajo en este centro cuando atend?a a los misioneros Manuel Garc?a Viejo y Miguel Pajares, repatriados a causa del virus.

                          Approximate translation

                          The assistant nurse who is infected with Ebola has arrived at 00:40 am at the Carlos III Hospital in Madrid, where she will be treated for the illness she contracted in this same center when she cared for the missionaries Manual Garc?a Viejo and Miguel Pajares, who had been repatriated because of the virus.

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                          • #43
                            Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                            Originally posted by Treyfish View Post
                            The patient has a fever, about 38,6º is stable and is awaiting assessment as officials from the Ministry of Health.
                            So we now have:
                            a) infection after very limited exposures to a patient
                            b) multiple failures in the health system
                            c) a mostly asymptomatic index case

                            Even if the PPE was not standard, we're in a heap of trouble- how many hospitals below national-referral level can even consider Lvl 4 PPE?

                            Comment


                            • #44
                              Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                              WASHINGTON (AP) ? Raising fresh concern around the world, a nurse in Spain on Monday became the first person known to catch Ebola outside the outbreak zone in West Africa. In the U.S., President Barack Obama said the government was considering ordering more careful screening of airline passengers arriving from the region.

                              In dealing with potential Ebola cases, Obama said, "we don't have a lot of margin for error."

                              Already hospitalized in the U.S., a critically ill Liberian man, Thomas Duncan, began receiving an experimental drug in Dallas. But there were encouraging signs for an American video journalist who returned from Liberia for treatment. Ashoka Mukpo, 33, was able to walk off the plane before being loaded on a stretcher and taken to an ambulance, and his father said his symptoms of fever and nausea appeared mild.

                              "It was really wonderful to see his face," said Dr. Mitchell Levy, who talked to his son over a video chat system at Nebraska Medical Center.

                              In Spain, the stricken nurse had been part of a team that treated two missionaries flown home to Spain after becoming infected with Ebola in West Africa. The nurse's only symptom was a fever, but the infection was confirmed by two tests, Spanish health officials said. She was being treated in isolation, while authorities drew up a list of people she had had contact with.

                              Medical workers in Texas were among Americans waiting to find out whether they had been infected by Duncan, the African traveler.

                              ...

                              People leaving the outbreak zone are checked for fevers before they're allowed to board airplanes, but the disease's incubation period is 21 days and symptoms could arise later.

                              Airline crews and border agents already watch for obviously sick passengers, and in a high-level meeting at the White House, officials discussed potential options for screening passengers when they arrive in the U.S. as well.

                              Nancy Castles, a spokeswoman for Los Angeles International Airport, said the Centers for Disease Control and Prevention has had employees on site at more than a dozen major international airports in the U.S. like LAX for many years. Screening of passengers starts with Customs and Border Protection agents, who work with CDC when they have a case they are concerned about.

                              Obama said the U.S. will be "working on protocols to do additional passenger screening both at the source and here in the United States." He did not outline any details or offer a timeline for when new measures might begin.

                              Additional screening would not have caught Duncan because he wasn't exhibiting any Ebola symptoms when he arrived in the U.S.

                              ...

                              About 350 U.S. troops are already in Liberia, the Pentagon said, to begin building a 25-bed field hospital for medical workers infected with Ebola. A torrential rain delayed the start of the job on Monday.

                              ...

                              Southwest Airlines CEO Gary Kelly said he saw no need for additional screening at airports and noted that airlines already carefully clean planes.

                              ...

                              http://bigstory.ap.org/article/a360b...a-ebola-clinic
                              "We are in this breathing space before it happens. We do not know how long that breathing space is going to be. But, if we are not all organizing ourselves to get ready and to take action to prepare for a pandemic, then we are squandering an opportunity for our human security"- Dr. David Nabarro

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                              • #45
                                Re: Spain: Spanish Nurse Who Treated Ebola Victim in Madrid Tests Positive For Disease - 2nd confirming test confirms nosocomial transmission

                                Husband of Spanish nurse with Ebola under quarantine

                                Source: Reuters - Tue, 7 Oct 2014 09:06 GMT

                                MADRID, Oct 7 (Reuters) - The husband of the Spanish nurse infected with Ebola is now in quarantine in hospital, the head of Spain's public health service Mercedes Vinuesa told parliament on Tuesday.
                                ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
                                Richard Horton, Editor-in-Chief The Lancet

                                ~~~~ Twitter:@GertvanderHoek ~~~ GertvanderHoek@gmail.com ~~~

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