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Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
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.
Later stages of the disease and corpses are known to be the most infectious. In Africa, many of the transmissions are/where at funerals. Where the custom of touching/kissing the dead are common.
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.
There is a photo on this page. Scroll about 1/2 way down the page (assuming this was the PPE used for protocol):
Attribution: Health care workers at Texas Health Presbyterian Hospital, where the Ebola patient Thomas Eric Duncan, 42, was treated. Credit Joe Raedle/Getty Images
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
I'm an ex-nuclear worker. Someone above said that more advanced PPE won't help if they don't use the PPE right. This is exactly true. That said, if water-impermeable materials are needed because there's a wet hazard, then they should be used.
There's also an issue about fit. If the anti-c's are too tight or too loose so that you have to fight them and can't get out of them safely, it's an issue. This has come up with the Spanish case (too short sleeves).
The number of layers is very, very important, because you need to be able to use your hands to get out of the clothing without contaminating yourself. There should be layers of clothing and layers of gloves and they need to be removed & decontaminated in stages. It's a standard in the nuclear industry to have a passageway within which you come out of the anti-c's. The higher the risk of contamination, the more stages there are. If a person takes them off, even in stages, in the same area, there will be contaminations. It's important to set up "stations" and progress through the stations, actually moving down the hall as you disrobe. If you, for instance, wash your boots in the same area as you take off your boots, it won't be long and people will be contaminated on their feet.
If the same area is used for dressing before going in and disrobing after coming out, it won't be long before there are contaminations going in and you won't be able to tell what's going on. It will get completely confusing. The "dress-out" areas and the "step-off "coming-out" areas must be in completely different locations, not in close proximity of one another. I mean they need to be completely different passageways entirely. Just a suggestion: Those long non-carpeted wide halls that many hospitals have might make very good "dress-out" and "step-off" areas. Just cordon them off with tape and rope and signs at the site, and blockade them 40 feet down (or something like according to the hazard) on the clean side so that people can't wander in accidentally. But if you are working on this, look around the real estate you have and see how you can set it up best.
The trash-bag case in Africa is interesting because that is the most basic case possible and yet she did it. This is a brilliant example of what the power of being deliberate and thoughtful about what you're doing as you do it can do. Mindfulness is essential. Going in and out of contaminated areas is not trivial. It's very important and there needs to be a helper on both the "going in" side and the "coming out" side. It's important that the system is set up before you ever see a patient. In each nuclear plant, there is a department specially dedicated to making sure that this is done correctly, and contaminated areas are kept clean to prevent the spread of contamination by people from this department who are highly trained in contamination control. In a hospital, this might mean that you have a small group of people (like doctors or grad nurses with a lot of experience or other very observant talented individuals) who work shifts to take care of this when a case is on site, and have the procurement power to find the right equipment and stock it for you.
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
This is what MSF does but the CDC messaging didn't seem to go to this level. I think we may well see the CDC respond to pressure to step up to this level.
Its a worthwhile effort. I know that the Hospital administrators and others will think its a bit much but perhaps this onward transmission event will help smooth the way.
If a nurse in PPE managed to acquire this, I am really at a loss that more people have not.
I'm not absolutely sure if we know that. The family who lived with the index have invoked HIPAA, acquired an attorney, and are at undisclosed location being cared for. Infections must be disclosed, but only to authorities, not to the public and media unless there is a threat to public health by not disclosing.
Louise Troh is very angry. Her rights in this matter are very complicated.
I suppose it's possible that Louise has some partial immunity, but I think it's unlikely that Youngor Jallah does, and Ms Jallah, if you remember, cared for him right before transport. The judge reported the apartment as "unsanitary", so the residence was rife with fomites.
I'm not an attorney or a physician, so please correct me if I'm wrong.
I really think that words, 'conspiracy' and 'paranoid', used against those who anticipated this situation, are less appropriate after hearing the news conferences today. It's like the statements the PTB have made recently never existed.
I've probably had more "exposure" to news conferences, since I'm in Dallas.
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
Why are they not videoing the application and removal of ppe? Wouldnt the ability to review footage make figuring out what went wrong easier than relying on memory?
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
There are actually all kinds of issues associated with that, alforddm. And such a strategy will tend to decrease mindfulness and logic on the part of the worker, who will "follow the rules" for liability reasons even in cases where something else is logically called for this early in the learning process about what works and what doesn't. Remember that there are a lot of people learning a lot of things really quickly. We don't want to get in the way of that. It's far more important that mindfulness, strict logical behavior, good communication and collaboration be the emphases at this point.
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
If it is this difficult to manage infection control in western hospitals, how difficult will this be for developing nations?
Is Dallas healthcare worker infection (and possibly Spain, it was reported she was on a vent) result of extreme measures taken by Western health care systems for late/end-stage Ebola?
Richard Bresser MD (acting director of the CDC during H1N1) ABC news correspondent said today on Twitter that only specialized hospitals and specially trained workers should be caring for Ebola patients. This is a contradiction of Frieden's "any hospital can manage with appropriate procedures" Again, what does this say about management capabilities in less developed health care systems in the rest of the world?
Why are they not videoing the application and removal of ppe? Wouldnt the ability to review footage make figuring out what went wrong easier than relying on memory?
I also thought about that - just like we follow exercise videos, except you'd need the ability to "pause". Between training, 2nd "watcher", and a video perhaps they could reduce the problems.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
If it is this difficult to manage infection control in western hospitals, how difficult will this be for developing nations?
Is Dallas healthcare worker infection (and possibly Spain, it was reported she was on a vent) result of extreme measures taken by Western health care systems for late/end-stage Ebola?
Richard Bresser MD (acting director of the CDC during H1N1) ABC news correspondent said today on Twitter that only specialized hospitals and specially trained workers should be caring for Ebola patients. This is a contradiction of Frieden's "any hospital can manage with appropriate procedures" Again, what does this say about management capabilities in less developed health care systems in the rest of the world?
I took issue with Tom Frieden's statement as well, not because I don't think that smaller hospitals are capable of managing isolation and sanitation procedures, but because of more mundane things like ventilator care, electrolyte and hydration management and other things that they routinely don't do well unless someone is watching. Not trying to start an argument about general quality of hospital care here, btw. Just being realistic.
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
While level of care is certainly an enormous factor, the patient's & HCW immune status is also a factor. Perhaps this nurse was tired from working long hours, or for whatever reason has an immune system that responds poorly to viral infections.
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"The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
Regardless of how or why - my thoughts are with the HCW.
She is one of the few that watched and cared for a very sick man that died from the disease she now has. I hope she stays positive and survives to tell her story.
Regardless of how or why - my thoughts are with the HCW.
She is one of the few that watched and cared for a very sick man that died from the disease she now has. I hope she stays positive and survives to tell her story.
I agree completely. She is as selfless as police and firefighters who risk injury and death to help others. I admire HCWs most because they are caring for some of the most helpless and suffering souls. God bless her and all HCWs and volunteers caring for ebola patients here and in West Africa.
"I know God will not give me anything I can't handle. I just wish that He didn't trust me so much." - Mother Teresa of Calcutta
I agree completely. She is as selfless as police and firefighters who risk injury and death to help others. I admire HCWs most because they are caring for some of the most helpless and suffering souls. God bless her and all HCWs and volunteers caring for ebola patients here and in West Africa.
+1
And to add, I can't believe, with all of the unknowns here, that they are blaming the nurse for her own infection. It's extremely cowardly.
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