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

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

Dani said:
He also said it was what the CDC recommended.....
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I'd say he made a rather LARGE point of that piece of information.

Also, we're assuming the "breach" is something the nurse-patient did, but perhaps it was otherwise, i.e., something someone else did which impacted her, or an experience-discovered fault in the CDC protocol that was issued to US hospitals. .
 
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Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

AlaskaDenise said:
I'd say he made a rather LARGE point of that piece of information.

Also, we're assuming the "breach" is something the nurse-patient did, but perhaps it was otherwise, i.e., something someone else did which impacted her, or an experience-discovered fault in the CDC protocol that was issued to US hospitals. Is the CDC protocol the same one exactly being used by MSF?

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I think AnnaLisa and I have figured out that is not the same. They differ on multiple points and the MSF suit seems much more protective.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

RE the video, just a quick scan:
Isn't that suit kind of tight? I think so. He's peeling him like a grape.
All that flappy stuff hanging off him, belt ends and poncho hem and all could be a problem, I think. You can't feel where that stuff is, and you can't control how it moves around when you're working.
When that white neckpiece is about ready to come off it's folded up smack onto the face even though it's one of the original outside layers, bad idea. In the nuke plant they use hoods with velcro under the chin, so you can undo it with a gloved hand, and lean back over a biohazard barrel and it falls off without touching the face or dragging it across the face.
Same kind of thing with that outer layer of gloves, to me, those seem to be making it out pretty far.

But you know, here's the disclaimer. It necessary to really view these things very carefully & analytically and think about what might contaminate a person in the setting you have, and how to use the equipment & surroundings that you have to prevent that. Think LAYERS.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Dani said:
Interestingly, it also says to avoid intubating patients.
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Yes. So, at least one obvious violation of CDC policy. Makes me wonder how many more.

If the infected nurse was involved with intubation, that could certainly explain how she was exposed.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

USALady said:
The suit is too tight.
When that white neckpiece is about ready to come off it's folded up smack onto the face even though it's one of the original outside layers, bad idea. In the nuke plant they use hoods with velcro under the chin, so you can undo it and lean back over a biohazard barrel and it falls off without touching the face or dragging it across the face.
Same kind of thing with that outer layer of gloves, those are making it out pretty far. Hands are the thing most likely to be contaminated.
Click to expand...

I wonder if it's because the suits are pressurized. They can't have too much air leaking out. But, as AnnaLisa pointed out, you wouldn't have to have that, so the hoods could be made to fit less tightly.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Dani said:
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.
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Hopefully they'll get what's needed - otherwise I could understand the staff refusing to work unless properly protected. Then there's the lawsuits....

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

Sharky said:
Yes. So, at least one obvious violation of CDC policy. Makes me wonder how many more.

If the infected nurse was involved with intubation, that could certainly explain how she was exposed.
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Well, it's not a contraindication- they just said to avoid it. Which means it had better be justified. But I agree that intubation will be regarded with more caution in the future.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Dani said:
Well, it's not a contraindication- they just said to avoid it. Which means it had better be justified.
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Not only justified, but it also means they better be following the additional recommendations for reducing the risk of exposure to HCWs.

Based on what we've heard so far, I'm skeptical about that. At the very least, it would make a noteworthy question for the hospital.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

AnnaLisa said:
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
Click to expand...

The people (Univ. Nebraska Medical Ctr) that made the video also has handouts:

Donning and Doffing PPE

Hospital Decontamination - Donning & Doffing PPE

Printed Materials
which includes:
- Biological response (appears part is under construction/revision) saying
Nebraska is home to the largest Biocontainment Unit in the United States. The ten bed Nebraska Biocontainment Unit (NBU) at the Nebraska Medical Center in Omaha.
Click to expand...
- Hospital Decontamination PPE

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

Sharky said:
Not only justified, but it also means they better be following the additional recommendations for reducing the risk of exposure to HCWs.

Based on what we've heard so far, I'm skeptical about that. At the very least, it would make a noteworthy question for the hospital.
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Well, it's the doctor making the decision for intubation, trying to save the patient's life. And the doc is at risk as well in this situation. What to wear for PPEs is not really going to be his call, except perhaps for his own personal attire, it's going to be on the advice of other specialists, in conjunction with the CDC. This is an entirely uncharted area, so things are bound not to go according to plan in such a complex situation. So in the end, there will be a discussion & dissection of these events down to the finest detail, I am sure.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

hcc said:
So far, I think it's safe to say that nothing has gone as planned, nothing has gone as promised, and almost nothing the CDC has told us is true.

In light of these developments, how are you guys feeling about the CDC's assurances that "We don't need a travel ban." Those of you who've defended the lack of a travel ban, here in this forum, are you still as confident as you were?
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At this point in time, I don't see the necessity. A ban would not have changed the PPE protocol used, it wouldn't have stopped the breach, and it wouldn't improve the most important CDC communication - that being to hospitals and all other HCW, responders, etc.

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

hcc said:
Also I'd like to know how many different sizes of those things they provide? ......
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Some come in sizes on Amazon. BTW, some sold on Amazon are now being relabeled as for Ebola. Don't know if they're BSL-4 compliant, but they might be ok for home use.

You could also check on Alibaba, if you know exactly what the terminology means.

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

hcc said:
But, to take the extreme case, if everything they do on this end to "stop it in its tracks" were doomed to failure, then wouldn't travel ban be our only shot at limiting the spread?
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Think of all the things the US imports everyday that is shipped by air - it's a lot!

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

AlaskaDenise said:
Think of all the things the US imports everyday that is shipped by air - it's a lot!

.
Click to expand...

Just to give you an idea: Anchorage, Alaska international airport has a large air cargo business - 5.5 billion pounds in 2012, with 2/3 in transit. Anchorage &Memphis flip-flop between1st & 2nd place for total landed cargo weights. The shortest route from Beijing to LA & other US cities goe through Anchorage. So just closing down Anchorage and Memphis would stop the flow of about 8 billion pounds of imports!

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

A travel ban- meaning not allowing someone from West Africa into the country- wouldn't stop the flow of any other people or products, nor would it keep supplies and designated HCWs from entering Liberia. It's also significant that people in Liberian communities within the US are strongly in favor of it.

I don't know that the US needs it, but Asia and India REALLY need it. It's frightening to think what could happen if Ebola got loose there.

But I just wanted to add that, after seeing how Drs. Fauci and Friedan have thrown Texas Presbyterian under the bus, any facility in the US would be foolish to take on another Ebola patient. I think that, in the future, we will find the hospitals requesting immediate transfer to one of the four or five BSL-4 inpatient units in this country. This is regrettable, as the skills needed to stop a really big outbreak will not be disseminated. But the public attitude of the CDC and NIH are extremely unhelpful and not at all conducive to collaboration. They're blaming the hospital & caregivers who have NEVER had to deal with this before, not supporting them. There's not sense of us all being in this together. Not at all.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Dani said:
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.
Click to expand...

Sorry I wasn't very clear. I was thinking more in terms of staff/mgmt being hesitant to 'pull out all the stops' given the PPE requirements and disposal issues. I can imagine someone getting a huge dressing down from supervisors for sounding the alarm for a 'questionable' case.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

Graupel said:
Sorry I wasn't very clear. I was thinking more in terms of staff/mgmt being hesitant to 'pull out all the stops' given the PPE requirements and disposal issues. I can imagine someone getting a huge dressing down from supervisors for sounding the alarm for a 'questionable' case.
Click to expand...

Well, as I said, above, if it were me making the choice as an administrator (which I'm not, but I am in the administrative loop, so to speak) after the way this has all gone down with the CDC I would pull out all the stops and if the patient wasn't Ebola positive, fine. If they were, I'd call the CDC to come and get them. That clearly would save a lot of money and more importantly, grief. But PPEs aren't expensive, really, in the big scheme of things. Sometimes it shocks me what we spend money on.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

http://online.wsj.com/articles/new-york-health-system-opts-for-who-ebola-protocol-1413145347

New York Health System Opts for WHO Ebola Protocol

[...]
?I don?t think [the CDC?s version] is inadequate. We still need to know what happened with the nurse in Texas. Based on our experience, we?ve decided to use the WHO version,? said Brian Koll, executive director of infection prevention for the Mount Sinai system, referring to a Texas health worker who the CDC confirmed has tested positive for the disease after caring for Thomas Eric Duncan, the Ebola patient who died last week in Dallas.

?What I like about the WHO version is, every time you take off a piece of PPE [personal protective gear], there?s a hand hygiene step built in.?
[...]
He said the Mass General staff has also been doing infectious-disease drills, emphasizing the ?donning and doffing? of protective gear, with observers watching.
 
Re: Discussion: Texas Health Care Worker Tests Positive for Ebola: Hospital

CDC head criticized for blaming 'protocol breach' as nurse gets Ebola

Great article, here is an interesting excerpt:

Sean Kaufman, president of Behavioral-Based Improvement Solutions in Atlanta, helped train healthcare staff at a special isolation unit at Atlanta's Emory University which treated U.S. aid workers Dr. Kent Brantly and Nancy Writebol, the first two Ebola patients to be treated on U.S. soil.

He would observe the nurses and doctors as they cared for patients and keep detailed notes when someone would accidentally touch their sleeve or mask with an infected glove.

He then helped coach them through the process of carefully removing their infected gear. Facilities caring for Ebola patients are encouraged to use a buddy system so that colleagues are watching each other to make sure they don't take risks.

"Doctors and nurses get lost in patient care. They do things that put themselves at risk because their lens is patient-driven," Kaufman said. In Dallas, "I suspect no one was watching to make sure the people who were taking care of the patients were taking care of themselves," he said.

CDC and Texas health officials said the nurse who became infected had been wearing the recommended personal protective gear for Ebola, which consists of gloves, a gown, a mask, and a shield to protect the eyes from possible splatters from the patient.

According to experts, that gear offers the minimum level of protection. When an Ebola patient enters the latter stages of the disease, as Duncan did, they become so-called fluid producers, Kaufman said.

"Towards of end of the illness, the virus is trying to live and thrive. It's trying to get out of the person's body. It's producing massive amounts of fluid," he said.

At that point, caregivers need to add more layers of protective gear, such as double gloves and a respirator or a full bodysuit. Those kinds of decisions need to be made by managers who are constantly assessing the risk to healthcare workers, Kaufman said.
 
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