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Why BSL-4 standards for researchers but not health care workers?

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  • Why BSL-4 standards for researchers but not health care workers?

    I still don't understand the reasoning. Does anyone else? Is it the cost of the equipment, or is it just too cumbersome in a hospital environment? I think the security workers had their own air supply and may have been at or close to BSL-4 protection in the video from the recent airliner scare.

    http://www.usamriid.army.mil/biosafety/
    — Biological Safety at USAMRIID —

    Established in 1969, USAMRIID has decades of experience operating containment laboratories and has provided extensive training and consultation to other agencies setting up their own facilities. We consider safety—of our employees, our neighbors, and the surrounding community—our number one priority.

    There are four levels of biological containment, ranging from Biosafety Level (BSL)-1, the lowest, to BSL-4, the highest. BSL-1 would be comparable to an open bench laboratory found in a school classroom—no special precautions would be needed. At BSL-2, USAMRIID employees wear laboratory coats and observe other basic precautions. For BSL-3 work, we require our personnel to change into scrub suits before entering the laboratory and take a complete shower before exiting. Other personal protective equipment may be required as well, depending on the tasks to be performed. BSL-4 is the highest level of containment, and employees wear positive-pressure suits commonly called "space suits" and breathe filtered air as they work.
    Yet CDC's recommendations for HCW's are much less stringent.

    http://www.cdc.gov/vhf/ebola/hcp/inf...endations.html

    Why? Researchers warned in 1995 that modern hospital workers might have increased risk, rather than less risk than HCW's in more primitive facilities in ebola endemic areas.

    http://www.ncbi.nlm.nih.gov/pmc/arti...00004-0007.pdf
    Int J Exp Pathol. Aug 1995; 76(4): 227–236.
    PMCID: PMC1997182
    Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus.
    E. Johnson, N. Jaax, J. White, and P. Jahrling

    ...

    Our experiments were conducted at
    240C and < 40&#37; RH, conditions which are known to
    favour the aerosol stability of at least two other African
    haemorrhagic fever viruses, Rift Valley fever and Lassa
    (Stephenson et a/. 1984; Anderson et a/. 1991). If the
    same holds true for filoviruses, aerosol transmission is
    a greater threat in modern hospital or laboratory
    settings than it is in the natural climatic ranges of
    viruses.

    ...

    Regardless, we have shown that Ebola virus (Zaire
    strain) can be transmitted by aerosol in an experimental
    primate model. In light of the pathogenicity of human
    filovirus infections, health care personnel at risk of
    exposure should use precautions to minimize the risk
    of aerosol exposure while managing acutely ill haemorrhagic
    fever cases of unknown or filoviral aetiology.
    The risk can be markedly reduced by adhering to sound
    and practical infectious disease management procedures.
    This requires curtailing aerosol generating procedures;
    using protective clothing, including gloves and
    masks; adequately decontaminating potentially infectious
    material; and conducting virus diagnostic procedures
    in regional containment facilities capable of safely
    handling highly hazardous infectious agents (Comperts
    et a/. 1978; CDC 1988).
    And even in that warning, I still don't see why BSL-4 standards were not recommended. Also, I'm not sure why they ruled out simultaneous ocular infection in the monkeys since I don't see that their eyes were protected in the head exposure chambers.

    It would be comforting to know that this experiment that involved considerable animal suffering had resulted in protection of modern hospital workers, but I don't see that result so far.
    Last edited by Emily; October 14, 2014, 02:36 PM. Reason: Added link.
    _____________________________________________

    Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

    i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

    "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

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  • #2
    Re: Why BSL-4 standards for researchers but not health care workers?

    Perhaps the media can pose this question to the CDC.

    ,
    "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

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    • #3
      Re: Why BSL-4 standards for researchers but not health care workers?

      Good question.

      Comment


      • #4
        Re: Why BSL-4 standards for researchers but not health care workers?

        The simple reality that there are only handful of BSL4 beds in the entire country- it is just a total and complete impossibility.

        I think the MSF systems in W Africa would be something like BSL3+.

        Comment


        • #5
          Re: Why BSL-4 standards for researchers but not health care workers?

          I dont personally think its a question of 'beds', its a question of the protection afforded to health workers whilst giving care. Negative pressure rooms are not needed - just spaces where good isolation and good healthcare can be provided.

          We could have patients treated in nursing homes or isolation centers, but the HCWs would still need level 3+ or 4 PPE, complete with assistants. That means that they all need training in its appropriate use, and if that is too difficult, perhaps we need designated teams within the general hospital staff who are willing to provide care and are subject to additional training, who can provide care if and when an ebola patient is confirmed.

          Comment


          • #6
            Re: Why BSL-4 standards for researchers but not health care workers?

            I was thinking of the suits, too, Vibrant. Someone who used to work at Harborview in Seattle some time ago thought they had moon suits available, but they certainly do not now, if they ever did.

            http://www.kirotv.com/news/news/ebol...rotocol/ngwWF/
            Updated: 11:48 a.m. Wednesday, Aug. 6, 2014 | Posted: 7:05 p.m. Tuesday, Aug. 5, 2014
            By Graham Johnson
            Ebola outbreak changes hospital protocol

            ...

            "Over a month ago we would have been laughing (at the idea of) Ebola coming in with patients at Harborview, but now we take it very seriously," said Dr. John Lynch, Harborview's Medical Director of Infection Control.
            ...
            More relevant is a separated waste stream from the room, and protocols for medical personnel to wear and dispose of protective clothing.

            Those coverings are not as dramatic as 'moon-suits' that have been used in Africa or during the transportation of two American patients to Atlanta for treatment.

            Lynch says those suits have been worn in non-controlled areas and are not needed in American hospitals.

            "These are basic blood and body fluid precautions that we can easily take in any hospital in the country," Lynch said....
            Bet he's not saying that anymore.
            _____________________________________________

            Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

            i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

            "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

            (My posts are not intended as advice or professional assessments of any kind.)
            Never forget Excalibur.

            Comment


            • #7
              Re: Why BSL-4 standards for researchers but not health care workers?

              And seriously, if Harborview has limited capacity and is scrambling to address these issues?

              Comment


              • #8
                Re: Why BSL-4 standards for researchers but not health care workers?

                On the bright side, its good that these issues are coming to light NOW so that there is time for them to be addressed and for hospitals (not just in the US) to prepare properly.

                A tradgedy for the nurses who have been infected though...

                Comment


                • #9
                  Re: Why BSL-4 standards for researchers but not health care workers?

                  It was shocking to read that about Harborview. I've been thinking it won't happen here because we have Harborview. They have time to prepare, yet is it possible to care safely for a dying Ebola patient? The success stories in terms of no HCW infections in the US all involved caring for patients who did not get sick enough to die.

                  I just don't think standard hospitals have the philosophical bent to deal with this. Their lifesaving mission will not allow them to stand back when they should.
                  _____________________________________________

                  Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

                  i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

                  "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

                  (My posts are not intended as advice or professional assessments of any kind.)
                  Never forget Excalibur.

                  Comment


                  • #10
                    Re: Why BSL-4 standards for researchers but not health care workers?

                    Originally posted by Emily View Post
                    It was shocking to read that about Harborview. I've been thinking it won't happen here because we have Harborview. They have time to prepare, yet is it possible to care safely for a dying Ebola patient? The success stories in terms of no HCW infections in the US all involved caring for patients who did not get sick enough to die.

                    I just don't think standard hospitals have the philosophical bent to deal with this. Their lifesaving mission will not allow them to stand back when they should.
                    I think you nailed it. In Texas, they did everything possible, and now it may be that doing everything that's possible is exactly the wrong thing to do. It may be that standard protocol for Ebola in 2015 is no intubation, no ventilation. But it isn't in 2014. Choosing between the staff and the patient is not something we have had to do in this country, not in my lifetime. This is for academicians and ethicists.

                    Comment


                    • #11
                      Re: Why BSL-4 standards for researchers but not health care workers?

                      http://www.foxnews.com/politics/2014...mericans-have/
                      Fauci tries to calm US after missteps on Ebola, amid concerns Americans have lost faith
                      Published October 19, 2014
                      FoxNews.com
                      ...
                      Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told ?Fox News Sunday? that the adopted World Health Organization protocol for handling an Ebola patient was better suited for field work than confined hospital care....
                      _____________________________________________

                      Ask Congress to Investigate COVID Origins and Government Response to Pandemic.

                      i love myself. the quietest. simplest. most powerful. revolution ever. ---- nayyirah waheed

                      "...there’s an obvious contest that’s happening between different sectors of the colonial ruling class in this country. And they would, if they could, lump us into their beef, their struggle." ---- Omali Yeshitela, African People’s Socialist Party

                      (My posts are not intended as advice or professional assessments of any kind.)
                      Never forget Excalibur.

                      Comment


                      • #12
                        Re: Why BSL-4 standards for researchers but not health care workers?

                        Accepted that some aspects may need adaptation to a hospital space, but I fail to understand why MSF protocols cannot be applied in a hospital setting.

                        It may require some reconfiguration of space. The critical part of PPE seems to be PPE that covers all parts of the body and a buddy system and disinfection at each stage of doffing.

                        Whilst case numbers are low, having regional centers for transfer once patients are identified would seem sensible, where staff can have had additional training, along the same lines as MSF teams.

                        Can someone please explain to me why this is not possible?

                        Comment


                        • #13
                          Re: Why BSL-4 standards for researchers but not health care workers?

                          In Quebec we have each a pediatric and adult hospital designated to treat eventual Ebola cases. These designated hospitals were announced early September- before the Texas case. By having designated centres, only the ER staff needed extra training and designated negative pressure isolation room off the ER before a transfer could take place. This allows for resources to be allocated in an efficient manner to those on the front line and care education to happen at the targeted hospitals.

                          Comment


                          • #14
                            Re: Why BSL-4 standards for researchers but not health care workers?

                            Originally posted by Vibrant62 View Post
                            Accepted that some aspects may need adaptation to a hospital space, but I fail to understand why MSF protocols cannot be applied in a hospital setting.....
                            I agree about the differences in protocol application - in fact I would expect the opposite.

                            .
                            "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

                            Comment


                            • #15
                              Re: Why BSL-4 standards for researchers but not health care workers?

                              Please see:

                              CDC - Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) - October 20, 2014

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