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Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
- Thread starter Nika
- Start date
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
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?)
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?)
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.
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.
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.
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.
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
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).
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
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).
Lizw
Well-known member
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
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.
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
Well-known member
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
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.
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital
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.
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 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.)
Re: 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.
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.
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.
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
Well-known member
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?
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?
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
I haven't see anything about disinfecting PPEs prior to removal. Seems using chlorinated water (at the proper PPM) would help reduce the risk?
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
Well-known member
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
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.
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.
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital
There is a photo on this page. Scroll about 1/2 way down the page (assuming this was the PPE used for protocol):
http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?_r=1
Attribution:
Health care workers at Texas Health Presbyterian Hospital, where the Ebola patient Thomas Eric Duncan, 42, was treated. Credit Joe Raedle/Getty Images
There is a photo on this page. Scroll about 1/2 way down the page (assuming this was the PPE used for protocol):
http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?_r=1
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
For reference - in Africa a woman uses trash bags as Makeshift PPE to treat 3 infected family members:
http://www.flutrackers.com/forum/showthread.php?t=228137
For reference - in Africa a woman uses trash bags as Makeshift PPE to treat 3 infected family members:
http://www.flutrackers.com/forum/showthread.php?t=228137
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.
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.
Nika
Well-known member
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.
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.