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

[Gemineye]

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

Curiosity, from what I've been able to find, CDC is kind of vague on what PPE should be used for EBV.

They recommend:

?All persons entering the patient room should wear at least:
◦Gloves
◦Gown (fluid resistant or impermeable)
◦Eye protection (goggles or face shield)
◦Facemask

?Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to:
◦Double gloving
◦Disposable shoe covers
◦Leg coverings

It's that "including but not limited to" phrase that inroduces the ambiguity. When should the full "spacesuit" with N95 face masks be used? I think when a person has a choice, they use the full gear. But if they do not have access to, or cannot aford the spacesuit, etc. they wear the minimum. The more I read on this topic, the more confused I get!

Here's the link:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

 

[FrenchieGirl]

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/abci-ebola-primer-contagio-espana-201410062017.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.

 

[FrenchieGirl]

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.

 

[Dani]

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

There is a photo of the PPE claimed to have been used in this post http://www.flutrackers.com/forum/showthread.php?p=549702#post549702

If this is truly what the nurse was wearing and she didn't have a high risk exposure such as a needle stick, then that is an alarming development.

I agree. I'm cross posting this post of mine from the other thread:

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.
​

 

[Dani]

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

Curiosity, from what I've been able to find, CDC is kind of vague on what PPE should be used for EBV.

They recommend:

•All persons entering the patient room should wear at least:
◦Gloves
◦Gown (fluid resistant or impermeable)
◦Eye protection (goggles or face shield)
◦Facemask

•Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to:
◦Double gloving
◦Disposable shoe covers
◦Leg coverings

It's that "including but not limited to" phrase that inroduces the ambiguity. When should the full "spacesuit" with N95 face masks be used? I think when a person has a choice, they use the full gear. But if they do not have access to, or cannot aford the spacesuit, etc. they wear the minimum. The more I read on this topic, the more confused I get!

Here's the link:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Exactly. You shouldn't have to be hermetically sealed to care for a patient with Ebola. What I would wear in the OR to operate on a patient with Hep. C or HIV doesn't even come close to a full spacesuit with an N95 mask. That's why this makes me suspicious. How are these HCWs getting this disease?

 

[FrenchieGirl]

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".

 

[Emily]

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

Don't forget that even the best equipment can be circumvented by simply taking it off in a way that contaminates the hands.

 

[Vibrant62]

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

As few as 10 virions are required for an ebola infection. See http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php

All these need to do is reach a mucous membrane, and this is most commonly achieved by hands touching an infected surface, and then hands touching face or eyes.....

So virions shed by an infected individual simply need to reach mouth, eyes, or nose to produce an infection. Hands would remain contaminated if they touched infected secretions until they were washed..

It used to be considered rude to touch your face (or so I was taught as a child, but it hasnt stopped me doing it). Perhaps this is a practice we need to re-introduce??

 

[Dani]

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

Don't forget that even the best equipment can be circumvented by simply taking it off in a way that contaminates the hands.

It's very possible that, she being a nurse's aid, she wasn't instructed on how to do that. In fact, it's kind of surprising that they allowed an aid or assistant in the room in the first place unless she were under the supervision of someone else. Taking care of a patient like this requires a certain level of skill that is either acquired by repetition (which they wouldn't have had time for) or education. Ideally, both.

 

[Emily]

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

Even if she were instructed, I think it takes working in pairs to remove ebola-contaminated PPE properly. Overwork, fatigue while wearing a respirator...these all jeopardize safety.

 

[AnnaLisa]

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

I am surprised they delegated his care to a nursing assistant as well. It seems to me, that licensed nurses and physicians are really the only personnel that needs to be in there. I don't know how they do radiology or other sophisticated testing, (I assume they don't). A nurse can do anything a nursing assistant can and more, so why expose the assistant? Plus, I would expect a higher level of knowledge and performance from the nurse. Then again, I don't know how they do things in Spain. Perhaps she went in with an RN, to assist with care, but it seems best to me, then to send in 2 RNs. Like so many times lately, I am just left wondering....