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

[Sharky]

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

ebola is a BSL4 pathogen. Was the PPE and training used appropriate for a pathogen of this virulence?

I think we can pretty confidently say the training wasn't adequate, for the simple reason that there wasn't enough time to do it right.

My understanding is that using BSL4 PPE correctly requires not only very specific procedures, but also specific physical movements, and that it can take a considerable amount of repetition and time to get them right.

IIRC, MSF has their teams undergo "dress rehearsal" type training in a non-infectious area before they are deployed to the field. Given the timeline of the Dallas events, it seems highly improbable that the HCWs there had a similar level of training.

 

[GardenSpider]

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

Our healthcare workers are not expendable. Too many such incidents under the guise of expediency or economy will only result in people resigning en-masse from key posts, and we will swifly be in the same boat as West Africa.

When you add up the investment; the years and cost of training and how many more years it will take to replace each and every HCW including doctors (especially in Africa) that fall to Ebola, it adds up to a ballooning incalculable loss.

Spending as much in the way of time and resources as it takes to keep every HCW worker safe is not too much to ask. After all: They are on the front lines. Even if biohazard suites with their own air supply are needed. No expense should be spared. It boggles the mind that hospitals are under prepared to face off with an enemy as formable as Ebola. Every hospital should be getting up to speed right now and following the established protocol laid out by MSF as mentioned in the thread.

Playing the blame game does not further the conversation and does help anyone. I am disappointed in the news and headlines.

 

[Dani]

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

I think we can pretty confidently say the training wasn't adequate, for the simple reason that there wasn't enough time to do it right.

My understanding is that using BSL4 PPE correctly requires not only very specific procedures, but also specific physical movements, and that it can take a considerable amount of repetition and time to get them right.

IIRC, MSF has their teams undergo "dress rehearsal" type training in a non-infectious area before they are deployed to the field. Given the timeline of the Dallas events, it seems highly improbably that the HCWs there had a similar level of training.

In light of this, I hope they strongly consider transferring this new patient to a BSL4 level care unit. They apparently don't know what happened, therefore it can't be assumed it won't happen again.

 

[hawkeye]

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

In light of this, I hope they strongly consider transferring this new patient to a BSL4 level care unit. They apparently don't know what happened, therefore it can't be assumed it won't happen again.

Agreed and I'll add they need to stop underestimating this virus.

 

[Sharky]

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

In light of this, I hope they strongly consider transferring this new patient to a BSL4 level care unit. They apparently don't know what happened, therefore it can't be assumed it won't happen again.

It's stunning to me that Ebola in a test tube is considered to be a BSL4 pathogen, but when it's spread all over the street as vomit, or fomites in an apartment, or even in a hospital, it's treated relatively casually.

Dr Varga from the Dallas hospital said the PPE for the newly infected patient consisted of "barrier and droplet" protection: gown, gloves, mask and shield. That's a far cry from BSL4!

http://youtu.be/hpZEhUMHO2A?t=11m27s

 

[blacknail]

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

Our healthcare workers are not expendable

Managers only keep their jobs when the workers below them on the food chain are expendable. Companies always "take action" by firing a few people whenever something bad happens to save themselves. There is nothing new here, it is just that we are never going to get ahead of Ebola if we don't admit our vulnerabilities and work to close the gaps, and Ebola doesn't buy the rhetoric like most people do.

 

[Dani]

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

It's stunning to me that Ebola in a test tube is considered to be a BSL4 pathogen, but when it's spread all over the street as vomit, or fomites in an apartment, or even in a hospital, it's treated relatively casually.

Dr Varga from the Dallas hospital said the PPE for the newly infected patient consisted of "barrier and droplet" protection: gown, gloves, mask and shield. That's a far cry from BSL4!

http://youtu.be/hpZEhUMHO2A?t=11m27s

He also said it was what the CDC recommended. And hospitals have better gear than that, even if they don't have BSL4 suits. Did the CDC tell them not to use those, or what?

 

[Sharky]

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

He also said it was what the CDC recommended. And hospitals have better gear than that, even if they don't have BSL4 suits. Did the CDC tell them not to use those, or what?

There's clearly a disconnect somewhere, and it sure sounds like it's on the CDC side, not the hospital.

I suppose we should be reassured by the fact that the head of the CDC is "known for his aggressive and sometimes controversial efforts to limit smoking and consumption of trans fats."

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051500295.html

 

[Graupel]

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

The number of hospitals with BSL4 gear, let alone well-trained staff for BSL4 work has to be a handful at most.

Clearly if BSL4 is required, then there needs to be a serious Plan B with realistic and implementable plans. This is the issue with rapidly building treatment facilities in W Africa- it cannot be done. To create totally separated patient flow areas with gowning areas, and de-downing areas where everything can be soaked in bleach is not simple, or cheap, or rapid.

 

[Dani]

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

There's clearly a disconnect somewhere, and it sure sounds like it's on the CDC side, not the hospital.

I suppose we should be reassured by the fact that the head of the CDC is "known for his aggressive and sometimes controversial efforts to limit smoking and consumption of trans fats."

http://www.washingtonpost.com/wp-dyn/content/article/2009/05/15/AR2009051500295.html

It's consistent with the CDC poster: CDC Ebola PPE
The url has "ebola" in the address, so that's what it's for. This is ordinary glove & gown protocol. No jumpsuit, or impermeable apron, even. A far cry from what they're wearing in MSF ebola facilities! There, they wear a jumpsuit, gown, impermeable apron, double gloves, hood & goggles, impermeable boots.

 

[nola_mnr]

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

http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?_r=0

[...]
On Sunday, National Nurses United, the country?s largest union and professional association of nurses, continued to sound the alarm and call for hazardous material suits at all hospitals.

?I?m angry about this,? said RoseAnn DeMoro, the executive director. ?We want the first line of defense to be the most prepared. Our hospitals are resisting us. The C.D.C. doesn?t say that we need hazmat suits. If this doesn?t change dramatically, we will picket every hospital in this country if we have to.?
[...]

 

[Dani]

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

The number of hospitals with BSL4 gear, let alone well-trained staff for BSL4 work has to be a handful at most.

Clearly if BSL4 is required, then there needs to be a serious Plan B with realistic and implementable plans. This is the issue with rapidly building treatment facilities in W Africa- it cannot be done. To create totally separated patient flow areas with gowning areas, and de-downing areas where everything can be soaked in bleach is not simple, or cheap, or rapid.

There are four, going on five facilities, probably with a handful of beds, each.

But, clearly it would help if the CDC would just dump their ordinary surgical gown & glove guidelines and recommend caregivers suit up as they do in MSF facilities. I just have no explanation for this. It boggles the mind that they're not even in jumpsuits.

 

[AnnaLisa]

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

I was thinking that hospital staff was wearing gear similar to if not identical to what MSF was wearing. I can't imagine wearing anything less.


http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

I found this. It indicates a fluid impermeable gown. What it describes is pretty much what MSF wears, isn't it?

 

[Dani]

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

I was thinking that hospital staff was wearing gear similar to if not identical to what MSF was wearing. I can't imagine wearing anything less.

They're not. Here's the full website for healthcare workers. CDC Ebola Infection and Prevention Recommendations I have to say, staff wear better gear in many different situations, such as with MRSA or a patient with leukopenia.

Interestingly, it also says to avoid intubating patients.

 

[Dani]

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

I was thinking that hospital staff was wearing gear similar to if not identical to what MSF was wearing. I can't imagine wearing anything less.


http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

I found this. It indicates a fluid impermeable gown. What it describes is pretty much what MSF wears, isn't it?

It indicates an impermeable or water resistant gown. The MSF wear a jumpsuit, gown and impermeable apron. Also no mention of hood or goggles, there would be exposed skin with a face shield. You'd have exposed surgical scrubs under your gown that which you'd then have to remove. Even the leg coverings and boots are optional, only for some situations. No jumpsuit.

No, it's just basic surgical gear. Nothing special. On the upside, everybody knows how to remove gear like that, it's pretty easy, so I don't think that would be where contamination would occur. What they need to do is put these folks in jumpsuits, hoods and goggles. True, they are harder to get off, but the protection is better.

 

[AnnaLisa]

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

Yep, you are correct...no hood. I forgot about that. I assumed they would have tyvek-like suits at minimum, with hoods and attached boots, with boots over those. I hope they are not using those paper over poly like gowns...basically paper with thin plastic liner under. I think the 'breach' is that we are not using a high enough level of PPE. Frankly, I think we need to step up to the PAPR units, with the filters and certainly Tyvek gowns.

 

[AnnaLisa]

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

Here is the doffing, level C, youtube. I am thinking this is where we should be at. There is also a donning video. Of course, this will raise the cost of care greatly. Perhaps we don't need the PAPR, but, at least the other gear, at minimum.

https://www.youtube.com/watch?v=ls69Tib1PjU

 

[Dani]

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

Here is the doffing, level C, youtube. I am thinking this is where we should be at. There is also a donning video. Of course, this will raise the cost of care greatly. Perhaps we don't need the PAPR, but, at least the other gear, at minimum.

https://www.youtube.com/watch?v=ls69Tib1PjU

That is a far cry from what the CDC guidelines are. I also liked the triple gloving, I think removal of headgear is the weak point in most other protocols. This leaves hands protected while head protection is removed. The gloves are the last thing to go.

 

[Graupel]

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

One of the (smaller? IIRC) MSF centers was going through 8K Euros ($10,500 USD) of PPE a day to do things the 'right' way.

How many hospitals a) have that much on hand and b) have management that will allocate those kinds of levels for more than a few days?

If the US has more than a few introductions, well....

 

[Dani]

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

One of the (smaller? IIRC) MSF centers was going through 8K Euros ($10,500 USD) of PPE a day to do things the 'right' way.

How many hospitals a) have that much on hand and b) have management that will allocate those kinds of levels for more than a few days?

If the US has more than a few introductions, well....

I don't think many have that kind of PPE on hand. But I do think that management will give them anything that is needed. $10,000 a day is small change in this situation.