Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

[Nika]

Didnt they run all manner of tests on him the night he had a 103 and sent home? My money is on the phlebotomist if they ran bloods.

[Lizw]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

CNN is saying it was a nurse in PPE during the second visit. I've wondered myself why someone from his first visit hadn't turned up yet. He was possibly not sufficiently infectious yet.

[Nika]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

yep that must be it - a few days must have made a huge difference in the viral titer

[alert]

Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

CNN also reporting that a contact of this nurse is also in isolation. (WHY? Are they ill? Did they also have contact with Duncan? It is way too early to have caught Ebola from the nurse.)

The ER is also set on "diversion", meaning they are not taking new patients. (Again, why?)

[AnnaLisa]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Looking at the picture of PPE in the news thread, that gown does not appear to be resistant to liquids. She has no hood on. One pair of gloves is used. I didn't notice what was on her feet. I certainly hope we have our people equipped with Tyvek suits and all areas are covered, triple gloved etc. At this point I am wondering about some type of HEPA or SCBA?

If a nurse in PPE managed to acquire this, I am really at a loss that more people have not.

[alforddm]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

As MSF has repeatedly stated removing the ppe is a problem spot. In Spain the nurse used a glove covered finger to remove her face mask. Similar problem most likely here. More advanced ppe won't reduce infection of health care workers if they are not sufficiently trained and diligent in its use. It could in fact increase infection as complexity makes things more difficult to remove.

[hawkeye]

Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

CNN also reporting that a contact of this nurse is also in isolation. (WHY? Are they ill? Did they also have contact with Duncan? It is way too early to have caught Ebola from the nurse.)

The ER is also set on "diversion", meaning they are not taking new patients. (Again, why?)

Seems they have learned to respond quickly after the attention to Mr. Duncan's case. I have to assume that all of this was implemented prior this story getting out (at around 5:45am Eastern).

Mike Rawlings, the mayor of Dallas, addressed likely public fears brought about by the second case. He said: ?We heard about this around midnight and have been working throughout the morning to make sure the citizens of Dallas are safe when they wake up. I believe I can say they are.?

Rawlings detailed protective measures taken by the city, including the Dallas fire and rescue haz-mat team ?clearing up and decontaminating any of the open areas of an apartment complex? and ?standing by to make sure nobody enters that apartment complex?.

http://www.theguardian.com/world/2014/oct/12/texan-healthcare-worker-ebola-thomas-duncan-us

[Lizw]

Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

Regarding the ER diversion, this is fairly common in areas with multiple emergency departments, when one of them is beyond capacity, or there is some pressing reason not to admit new patients. I think this is just an over-abundance of caution, relating to perception of risk more than actual risk.

[Chicagogal]

Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

The ER is also set on "diversion", meaning they are not taking new patients. (Again, why?)

Look at the media frenzy that happened at Emory. They may be concerned really sick patients will not be able to reach the ER once the media descends.

[AnnaLisa]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

I agree that doffing PPE is a problem, that said, you need a fluid impermeable gown not cloth or paper. I would hope she was wearing a tyvek type suit and had her skin fully protected, googles, N95, 3 pairs of gloves and boot covers or something similar. As an RN, I'm familiar with donning and doffing for the more common conditions, but, honestly given what we do NOT know about Ebola, I think we need to err on the side of safety. I hope she also was using a buddy to don and doff.

I was expecting a case from the family or the unprotected people, not a case from the HCW who are using PPE.

I'm not going to be so quick to blame the HCW, when we just don't know enough about this.

Nurses have been 'blamed' 3 times for errors, I'm not buying it. (Nurse didn't relay information regarding Duncan to the doctor...Nurse in Spain touched her face....Nurse in US didn't doff properly.)

[TMI]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

I agree that doffing PPE is a problem, that said, you need a fluid impermeable gown not cloth or paper. I would hope she was wearing a tyvek type suit and had her skin fully protected, googles, N95, 3 pairs of gloves and boot covers or something similar. As an RN, I'm familiar with donning and doffing for the more common conditions, but, honestly given what we do NOT know about Ebola, I think we need to err on the side of safety. I hope she also was using a buddy to don and doff.

I was expecting a case from the family or the unprotected people, not a case from the HCW who are using PPE.

I'm not going to be so quick to blame the HCW, when we just don't know enough about this.

Nurses have been 'blamed' 3 times for errors, I'm not buying it. (Nurse didn't relay information regarding Duncan to the doctor...Nurse in Spain touched her face....Nurse in US didn't doff properly.)

Yes, it is quite surprising that a HCW who may have had exposure while removing her PPE tests positive, yet the family members that cared for him with absolutely no PPE have not? I understand they are still within the incubation period but this new development makes it all seem so random.

[Sollydog]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

This blog post by MSF doctor Benjamin Black paints a vivid picture of working in and removing PPE while working in Sierra Leone:

http://blogs.msf.org/en/staff/blogs/may-the-forceps-be-with-you/kailahun

It is a slow, meticulous process with multiple uses of chlorine solution at each step of removal.

[Chicagogal]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

It would be so interesting to know if they are looking at immune titers for non-symptomatic people in the circle of exposed individuals. Anyone know if blood work has been mentioned?

[hawkeye]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

I agree that doffing PPE is a problem, that said, you need a fluid impermeable gown not cloth or paper. I would hope she was wearing a tyvek type suit and had her skin fully protected, googles, N95, 3 pairs of gloves and boot covers or something similar. As an RN, I'm familiar with donning and doffing for the more common conditions, but, honestly given what we do NOT know about Ebola, I think we need to err on the side of safety. I hope she also was using a buddy to don and doff.

I was expecting a case from the family or the unprotected people, not a case from the HCW who are using PPE.

I'm not going to be so quick to blame the HCW, when we just don't know enough about this.

Nurses have been 'blamed' 3 times for errors, I'm not buying it. (Nurse didn't relay information regarding Duncan to the doctor...Nurse in Spain touched her face....Nurse in US didn't doff properly.)

I haven't see anything about disinfecting PPEs prior to removal. Seems using chlorinated water (at the proper PPM) would help reduce the risk?

[Nika]

Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Looking at the picture of PPE in the news thread, that gown does not appear to be resistant to liquids. She has no hood on. One pair of gloves is used. I didn't notice what was on her feet. I certainly hope we have our people equipped with Tyvek suits and all areas are covered, triple gloved etc. At this point I am wondering about some type of HEPA or SCBA?

If a nurse in PPE managed to acquire this, I am really at a loss that more people have not.

please note that pic is simply illustrative of droplet PPE - it is not a snapshot of the actual nurse in question here or even of anyone at this hospital.