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

[Lynda]

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

If a nurse in PPE managed to acquire this, I am really at a loss that more people have not.

I'm not absolutely sure if we know that. The family who lived with the index have invoked HIPAA, acquired an attorney, and are at undisclosed location being cared for. Infections must be disclosed, but only to authorities, not to the public and media unless there is a threat to public health by not disclosing.

Louise Troh is very angry. Her rights in this matter are very complicated.

I suppose it's possible that Louise has some partial immunity, but I think it's unlikely that Youngor Jallah does, and Ms Jallah, if you remember, cared for him right before transport. The judge reported the apartment as "unsanitary", so the residence was rife with fomites.

I'm not an attorney or a physician, so please correct me if I'm wrong.

I really think that words, 'conspiracy' and 'paranoid', used against those who anticipated this situation, are less appropriate after hearing the news conferences today. It's like the statements the PTB have made recently never existed.

I've probably had more "exposure" to news conferences, since I'm in Dallas.

 

[alforddm]

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

Why are they not videoing the application and removal of ppe? Wouldnt the ability to review footage make figuring out what went wrong easier than relying on memory?

 

[USALady]

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

There are actually all kinds of issues associated with that, alforddm. And such a strategy will tend to decrease mindfulness and logic on the part of the worker, who will "follow the rules" for liability reasons even in cases where something else is logically called for this early in the learning process about what works and what doesn't. Remember that there are a lot of people learning a lot of things really quickly. We don't want to get in the way of that. It's far more important that mindfulness, strict logical behavior, good communication and collaboration be the emphases at this point.

 

[Ray]

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

If it is this difficult to manage infection control in western hospitals, how difficult will this be for developing nations?

Is Dallas healthcare worker infection (and possibly Spain, it was reported she was on a vent) result of extreme measures taken by Western health care systems for late/end-stage Ebola?

Richard Bresser MD (acting director of the CDC during H1N1) ABC news correspondent said today on Twitter that only specialized hospitals and specially trained workers should be caring for Ebola patients. This is a contradiction of Frieden's "any hospital can manage with appropriate procedures" Again, what does this say about management capabilities in less developed health care systems in the rest of the world?

 

[AlaskaDenise]

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

Why are they not videoing the application and removal of ppe? Wouldnt the ability to review footage make figuring out what went wrong easier than relying on memory?

I also thought about that - just like we follow exercise videos, except you'd need the ability to "pause". Between training, 2nd "watcher", and a video perhaps they could reduce the problems.

.

 

[Lizw]

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

If it is this difficult to manage infection control in western hospitals, how difficult will this be for developing nations?

Is Dallas healthcare worker infection (and possibly Spain, it was reported she was on a vent) result of extreme measures taken by Western health care systems for late/end-stage Ebola?

Richard Bresser MD (acting director of the CDC during H1N1) ABC news correspondent said today on Twitter that only specialized hospitals and specially trained workers should be caring for Ebola patients. This is a contradiction of Frieden's "any hospital can manage with appropriate procedures" Again, what does this say about management capabilities in less developed health care systems in the rest of the world?

I took issue with Tom Frieden's statement as well, not because I don't think that smaller hospitals are capable of managing isolation and sanitation procedures, but because of more mundane things like ventilator care, electrolyte and hydration management and other things that they routinely don't do well unless someone is watching. Not trying to start an argument about general quality of hospital care here, btw. Just being realistic.

 

[AlaskaDenise]

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

While level of care is certainly an enormous factor, the patient's & HCW immune status is also a factor. Perhaps this nurse was tired from working long hours, or for whatever reason has an immune system that responds poorly to viral infections.

.

 

[curiosity]

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

Regardless of how or why - my thoughts are with the HCW.
She is one of the few that watched and cared for a very sick man that died from the disease she now has. I hope she stays positive and survives to tell her story.

 

[JimO]

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

Regardless of how or why - my thoughts are with the HCW.
She is one of the few that watched and cared for a very sick man that died from the disease she now has. I hope she stays positive and survives to tell her story.

I agree completely. She is as selfless as police and firefighters who risk injury and death to help others. I admire HCWs most because they are caring for some of the most helpless and suffering souls. God bless her and all HCWs and volunteers caring for ebola patients here and in West Africa.

 

[Lynda]

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

I agree completely. She is as selfless as police and firefighters who risk injury and death to help others. I admire HCWs most because they are caring for some of the most helpless and suffering souls. God bless her and all HCWs and volunteers caring for ebola patients here and in West Africa.

+1

And to add, I can't believe, with all of the unknowns here, that they are blaming the nurse for her own infection. It's extremely cowardly.

 

[Dani]

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

I took issue with Tom Frieden's statement as well, not because I don't think that smaller hospitals are capable of managing isolation and sanitation procedures, but because of more mundane things like ventilator care, electrolyte and hydration management and other things that they routinely don't do well unless someone is watching. Not trying to start an argument about general quality of hospital care here, btw. Just being realistic.

This isn't a small hospital, though. It has 900 acute care beds! That's huge. There are whole states that don't have that many beds. And it's a private nonprofit hospital, which typically have absolutely anything anyone could want right at their fingertips, with well-trained staff. I believe it's ranked as one of the best facilities in Texas. So it's not an understaffed, overworked public hospital. That's what makes this so worrisome, these guys should have been able to handle it.

 

[Dani]

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

About Us
Welcome to Texas Health Dallas

Texas Health Presbyterian Hospital Dallas

Texas Health Presbyterian Hospital Dallas is an 898-bed acute-care hospital treating some of the most complicated cases in North Texas. The facility is committed to transforming health care in North Texas by investing in advanced technology — such as hybrid operating rooms that incorporate advanced imaging devices into the operating room — allowing physicians on the medical staff to perform leading-edge minimally invasive procedures. Texas Health Dallas is recognized as a Magnet-designated facility for excellence in nursing services by the American Nurses Credentialing Center, the nation's largest and leading nursing credentialing organization. (Edit: that is a very hard designation to earn, BTW)

Texas Health Dallas was recognized in 2007 as a U.S. News and World Report Best Hospital for Digestive Disorders, Neurology and Neurosurgery and Orthopedics specialties. From our Stereotactic Surgery Program for Parkinson's disease to our Gamma Knife for treating tumors, we are able to offer a wide range of services to care for complicated medical conditions.

Knowing that a helping hand or a caring smile can mean as much to a patient as advanced technology and services, we believe that "it's all in the way we treat you."

Our patients offer overwhelming praise for their care. In survey after survey, more than 90 percent of our patients rate their overall satisfaction with the hospital as "excellent" or "very good." We believe that personal attention and care go a long way toward aiding the journey to healing.

Texas Health Dallas received the Magnet Recognition Program Award for excellence in nursing services from the American Nurses Credentialing Center (ANCC), the nation's largest and leading nursing credentialing organization within the American Nurses Association (ANA).

Doctors on the medical staff practice independently and are not employees or agents of the hospital except resident doctors in the hospital's graduate medical education program.

 

[Lynda]

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

This is perhaps not relevant, but I've had 2 children and several illnesses at Presbyterian Dallas, and over the last 45 years I've had uncountable contacts with them, including family MI's, strokes, auto accidents, cancer treatments, surgeries, and several deaths.

I just want everyone to know how absolutely top-notch they are. Sorry, but I'm feeling very defensive for them right now.

 

[AnnaLisa]

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

This could have happened any where, and it probably will again.

 

[Roehl_JC]

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

I also was a patient at Dallas Presbyterian Hospital during the 1970s and this is one of the best hospitals available.
We should never seek to blame anyone for mistakes, errors and failures during the ebola crisis...especially the brave doctors, nurses, police and Fire Dept. EMTs....Bless them all for being there as our courageous First Responders.
Let's learn from errors in a team-positive cooperative setting.
I send my heartfelt sympathy and love to this nurse, her family and neighbors and the D/FW community. We are all in this together.

 

[Pathfinder]

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

Tech10/12/2014 @ 5:57PM


Statistics Lessons: Why Blaming Health Care Workers Who Get Ebola Is Wrong

John Villasenor Contributor
...
In an interview later that day, CDC head Dr. Thomas Frieden said, ?clearly there was a breach in protocol,? implying that the health worker or the hospital were somehow at fault for the transmission.

But blaming health workers who contract Ebola sidesteps the statistical elephant in the room: The protocol appears to have been designed under the unrealistic assumption that everyone who uses protective gear will navigate the complex process of donning, using, and removing it perfectly every time. And it appears not to recognize the probabilities involved as the number of contacts between health workers and Ebola patients continues to grow.

This is because if you do something once that has a very low probability of a very negative consequence, your risks of harm are low. But if you repeat that activity many times, the laws of probability?or more specifically, a formula called the ?binomial distribution??will eventually catch up with you. For example, consider an activity that, each time you do it, has a 1% chance of exposing you to a highly dangerous chemical. If you do it once, you have a 1% chance of exposure. If you do it twice, your chances of at least one exposure are slightly under 2%. After 20 times, you are at an 18% chance of at least one exposure. After 250 times, the odds of exposure are about 92%. And the exposure odds top 99% after about 460 times.
...
http://www.forbes.com/sites/johnvil...g-health-care-workers-who-get-ebola-is-wrong/

 

[AnnaLisa]

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

Newscasts are just rife with 'Breach in Protocol' headlines. Is this supposed to make the public feel better? It's got me agitated enough to turn it off. In reality, no one knows how she contracted Ebola yet, what is wrong with the truth?

 

[Dani]

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

Excellent find, Pathfinder.
Your screen name is quite appropriate.

 

[Dani]

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

Newscasts are just rife with 'Breach in Protocol' headlines. Is this supposed to make the public feel better? It's got me agitated enough to turn it off. In reality, no one knows how she contracted Ebola yet, what is wrong with the truth?

It seems the authorities have watched A Few Good Men one too many times. They think we can't handle the truth.

Unfortunately, most reasonably intelligent people, even without a medical background, can put two and two together. So when the facts on the ground and/or their actions don't match their words, people stop having faith in the government in general and the CDC in particular. Those of us with a medical background become highly suspicious of the CDC when they actually blame the HCW when nosocomial infections occur. And this is what they have done since the beginning, when it was HCWs overseas getting infected- blaming poor protocol and saying it would never happen here (even though those were American trained doctors, and/or members of MSF). Now it has occurred here, and they're still blaming poor protocol.

It's like saying the only good pilots are F-16 fighter pilots, and all the rest are inadequate, instead of saying it is just really hard to fly an F-16. And sometimes you crash.

 

[Vibrant62]

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

Questions to be asked before apportioning blame in any direction.

1. What PPE was used?
2. What training was given? - ebola is a BSL4 pathogen. Was the PPE and training used appropriate for a pathogen of this virulence?

It is a dangerous game that the CDC are playing here... if additional infections are acquired amongst HCWs (as is entirely possible and even probable) then where does the onus of safety lie?? Who ultimately is responsible?

Are HCWs provided with a partner to help them dress/ undress as per MSF protocols? Is there sufficient emphasis on decontamination at each stage of undressing? Do protocols match the requirements being followed for PPE right now in west africa by MSF and other frontline staff, and if not, why not??

If similar protocols for west africa are not being followed, then the failure does not lie with the nurses, doctors or other staff - it is with the protocols, as the duty of care lies with the healthcare system to ensure the safety of its staff. Also, policymakers need to remember that without them, we have nothing to defend ourselves against ebola.

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.