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Texas Health Care Worker - Ms. Pham - Tests Positive for Ebola: Hospital - now virus free

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

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

So just to be clear - this (and I assume other staff) wore droplet precaution level PPE

such as:

15880-routinehighrisk.jpg


There is also ENHANCED droplet precaution PPE and procedures - here is a PDF reviewing this next level of safety:

http://www.wrha.mb.ca/extranet/ipc/files/manuals/acutecare/Rev1309-5.31.pdf

So it would be nice to know which sort was used in this case

Hopefully Dr. Edward Goodman, an epidemiologist at the Texas Health Presbyterian Hospital will confirm the exact PPE spec. Here's an excerpt from when Mr. Duncan was first isolated:

Goodman said. “We don’t have those problems. We’re perfectly capable of taking care of this patient with no risk to other people.”

Head-to-toe coverage for doctors treating the patient is not required, Goodman said. Doctors will be wearing two waterproof gowns, gloves, surgical masks, eye protection and shoe protection.

It does not require a highly specialized unit to care for someone with Ebola, Goodman said. But in the event that a negative pressure unit is required, the hospital has that capability.

http://thescoopblog.dallasnews.com/...t-hospital-continuing-normal-operations.html/

UPDATE:
Photo at this page shows a HCW in the background. Assuming this PPE is protocol...note the neckline. Is it exposed?

http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?_r=0
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

Does anyone have a link to a recording of this conference?
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

The real issue here- even if there was a 'protocol violation' so what? That implies the current required level of PPE is simply not implementable in many/most community hospitals in the US. People can and will make mistakes.

This reality needs to be part of the planning process. Every hospital in the US in not suddenly going to get to 6 Sigma ninja PPE-levels.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

Here's the full version:

http://www.youtube.com/watch?v=hpZEhUMHO2A

Residence is 5700 Block Marquita Ave which is about 15 minutes away from the hospital.

https://www.google.com/maps/place/5...2!3m1!1s0x864e9f405960a45f:0xc0dd641b4901f71f


Here's a photo of the apartment complex under police watch and what appears to be a yellow containment barrel on the left:
http://www.pressdemocrat.com/news/2966776-181/dallas-health-worker-tests-positive
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

City of Dallas (Twitter)

Sana Syed@dallaspiosana · 1 hr1 hour ago
@Mike_Rawlings is on site to reassure residents city and county are here to help. pic.twitter.com/tFX5VgSWjP
..


Sana Syed@dallaspiosana · 3 hrs3 hours ago
Per Presby, health care worker is in stable condition. Process of worker self-monitoring to isolation at hospital was 90 minutes.

Sana Syed@dallaspiosana · 3 hrs3 hours ago
@Mike_Rawlings: we have been working through the night to ensure citizens of Dallas are safe. pic.twitter.com/LFdHrGX6FV

Sana Syed@dallaspiosana · 3 hrs3 hours ago
@DallasPD is still at 5700 block of Marquita to answer questions from concerned residents.

Sana Syed@dallaspiosana · 3 hrs3 hours ago
@Mike_Rawlings:we knocked on every door on the block to explain what happened and what Ebola is so they won't be concerned w HazMat presence

Sana Syed@dallaspiosana · 6 hrs6 hours ago
@TexasDSHS: Texas health care worker tests positive for Ebola:
http://www.dshs.state.tx.us/news/releases/20141012.aspx


https://twitter.com/1500Marilla/with_replies
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

That's terrible for the case-patient. I can only hope this forces a serious reconsideration about exactly how 'sure' everyone is, especially if this patient wasn't even on the list of possible contacts.... 'tried and true" indeed. If they are on the list , perhaps....

"In this country, we have health care infection control and public health systems that are tried and true and will stop before there's any widespread transmission. The core of that, the way to stop Ebola in its tracks is contact tracing, and follow-up."

- Tom Frieden Oct 4.

http://www.cdc.gov/media/releases/2014/t1004-ebola-confirmed-case.html
I've mentioned the word "hubris" a couple of times in this forum.... I think it's applicable again here. We don't know a lot about how Ebola spreads in an urban, American environment. It's the unknown unknowns that get you in the end.

The real issue here- even if there was a 'protocol violation' so what? That implies the current required level of PPE is simply not implementable in many/most community hospitals in the US. People can and will make mistakes.

This reality needs to be part of the planning process. Every hospital in the US in not suddenly going to get to 6 Sigma ninja PPE-levels.
Agreed. The number of HCWs infected in this epidemic has been alarming from the start. I know there is the temptation to blame it on poor protocols or lack of supplies, but that should have stopped the minute MSF workers became infected, and they have. This virus does not appear to behave quite like it did in the past- or perhaps it's just we didn't know as much about it as we thought because prior outbreaks were so small.

I do not want to hear one word of blaming the victim. It's time the CDC and WHO just admitted this is a dangerous and unpredictable virus, and we will just have to buck up and do the best we can. They've tried to instill a false sense of security, and all that does is increase mistrust because nothing ever works out 100% like you think it will.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

Not too happy with the messaging here: CDC: PROTOCOL BREACH IN TREATING EBOLA PATIENT

Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, says the Texas hospital worker had extensive contact with Thomas Eric Duncan before Duncan died Wednesday from Ebola.

Frieden says the worker has a low level of virus and is being monitored.

He says the diagnosis of the worker - who's not identified - clearly shows that there was a breach of protocol.

So, if she'd really been following protocol (even though she says she was) this wouldn't have happened? This No True Scotsman argument is starting to wear thin. Maybe it's time to recognize the virus is more wily than we thought.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

Texas nurse who had worn protective gear tests positive for Ebola

By Elizabeth Cohen, Steve Almasy and Joe Sutton, CNN
updated 12:02 PM EDT, Sun October 12, 2014
...
The nurse had "extensive contact" on "multiple occasions," said Dr. Tom Frieden, the director of the CDC.
...
"At some point, there was a breach in protocol, and that breach in protocol resulted in this infection," he said at a news conference Sunday.

"The (Ebola treatment) protocols work. ... But we know that even a single lapse or breach can result in infection."

Varga said someone who is a "close contact" of the nurse has been "proactively" placed in isolation.

The hazardous materials unit of the Dallas Fire Department has cleaned up and decontaminated the public areas of the health worker's apartment complex, Mayor Mike Rawlings said. Police are keeping people out of the area and are talking to residents nearby.
...
Hazardous materials units have also cleaned out the nurse's car and will work on her apartment Sunday.
...
David Sanders, associate professor of biological sciences at Purdue University, said he thinks the CDC testing will probably support the preliminary results.

"It sounds likely that it's positive, and it's going to stay positive."
...
The Texas health department said officials have interviewed the patient and are identifying any contacts or potential exposures.
...
http://www.cnn.com/2014/10/12/health/ebola/index.html
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

its entirely too early to know WHAT happened in this case.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

This is logical IF the protocol is the right protocol. However, since protocols are always man-made and not perfect--that's their nature--there is a problem with jumping to that conclusion automatically. In places like nuclear plants, where the protocol has been tested by decades of experience, you can get to this with a certain amount of investigation fairly quickly, but in this situation, there just is not that kind of experience to be had. A lot of people are learning new things really fast, and in the learning stage people make mistakes about what the hazards are and what protocol should be used, not to mention how to use the protocol in all of its stages, from planning and procurement to use and disposal. That's how we learn to perfect the protocol.

I agree that it's too early to come to conclusions about this case. Tom Frieden is trying to keep people from panicking. That's what this statement is designed for.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

How neighbors of Dallas Ebola patient No. 2 reacted to news of infection

Staff Reports
Published: 12 October 2014 12:06 PM
Updated: 12 October 2014 12:13 PM
...
Carleen Guerrero, 41, lives with her husband across the street from the apartment on Marquita.

She woke up to a knock on the door around 5 am. She said the officials continued to knock until she came to the door.

"They were very persistent because it was 5 am and I was asleep," she said. "I said 'Who is it?' And they said 'Dallas police.'"

Two police officers and a CDC representative told her a woman across the street had been diagnosed with Ebola, but the case was contained. They gave her papers about Ebola symptoms.

She said she's not concerned about her health.

"If somebody was going to have it in my neighborhood that's probably the best person because she's a health care professional and knew exactly what to do," she said. "If some lay person got it, they maybe would have blown it off and said 'I got the flu.'"
...
She said she is worried about the woman's dog and its safety. "I would like to know they are not going to make a snap decision and euthanize the dog," she said.

More...
http://www.dallasnews.com/ebola/hea...atient-no.-2-reacted-to-news-of-infection.ece
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

This is logical IF the protocol is the right protocol. However, since protocols are always man-made and not perfect--that's their nature--there is a problem with jumping to that conclusion automatically. In places like nuclear plants, where the protocol has been tested by decades of experience, you can get to this with a certain amount of investigation fairly quickly, but in this situation, there just is not that kind of experience to be had. A lot of people are learning new things really fast, and in the learning stage people make mistakes about what the hazards are and what protocol should be used, not to mention how to use the protocol in all of its stages, from planning and procurement to use and disposal. That's how we learn to perfect the protocol.

I agree that it's too early to come to conclusions about this case. Tom Frieden is trying to keep people from panicking. That's what this statement is designed for.

Yes, that's definitely what this statement is for. However, by attempting to calm the public, he's smearing the HCWs whose lives are on the line during this outbreak. That does not engender a great deal of trust between them and the CDC, trust that is essential in stopping this in its tracks. There are many other ways he could have phrased it, but he's been surprisingly black & white in many of his statements over the past month or so. Your point about learning from experience is very apt- we are inexperienced with this disease compared to nuclear (remember the radium & the watch dial painters?) and to think we know it all is folly, but Friedan appears to be unwilling to voice any uncertainty of outcome, which is both patronizing and likely to lead to doubt on the part of the public as things like this occur.

Also, it's not like this is a little hospital out in the middle of nowhere with inexperienced staff, or a public hospital where staff is overworked & underpaid, and I'm sure they had their very best nurses on this case. I have worked in many hospitals just like Texas Presbyterian, and they want for nothing. The highest tech, best of everything. If they can't handle it, few community hospitals can.

In the light of how things have gone in Texas and Spain, perhaps Mr. Friedan misjudged the ability of the developed world- in which case we need to reassess things such as a travel ban. These occurrences do change the risk/benefit calculation on that subject.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

http://www.cdc.gov/media/releases/2014/t1012-ebola-reponse-update.html

In Friedan's first response, close to the bottom:

"The two areas where we will be looking particularly closely is the performance of kidney dialysis and respiratory intubation. Both of those procedures may spread contaminated materials and are considered high risk procedures. They were undertaken on the index patient as a desperate measure to try to save his life."

So nurse possibly aided in dialysis and intubation?

Ban on visas should have already happened. We can get workers in/out other than commercial flights...
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

http://www.cdc.gov/media/releases/2014/t1012-ebola-reponse-update.html

In Friedan's first response, close to the bottom:

"The two areas where we will be looking particularly closely is the performance of kidney dialysis and respiratory intubation. Both of those procedures may spread contaminated materials and are considered high risk procedures. They were undertaken on the index patient as a desperate measure to try to save his life."

So nurse possibly aided in dialysis and intubation?

Ban on visas should have already happened. We can get workers in/out other than commercial flights...

A nurse would assist on almost every procedure. It may also be that ventilating Mr. Duncan was a very bad idea,and a nurse would be in there almost constantly with him in those final hours. Has artificial ventilation been done, ever before? One wonders what kind of filters are on the machines, and is mechanical aerosolization possible whereas normal human breathing doesn't cause that? As I said, Ebola in a first world county is unknown. We could conceivably make transmission more likely with all of our interventions, creating a large viral load that PPEs may not always be reliable against. There are a great many unanswered questions, so to skip straight to "The nurse messed up," does not seem warranted or fair.

Edit: Here's the answer to my question from a post of Chicagogal's on another thread:

Q. How common is it for people to be on dialysis or intubated during an Ebola infection?

A. [Freidan] I don't know the details of other patient care. Not familiar with any prior patient with Ebola who underwent either of these procedures. Certainly very unusual. I do want to clarify: the 48 people being monitored does include HCWs who had contact prior to 9/28, just not those after.

[Lakey] Obviously a trying day. Need to make sure the hospital has the appropriate infection control measures in place, and the expertise to prevent any other individual from being exposed. Appreciate the HCW coming in as quickly as possible and doing what she was supposed to do.

[Frieden] Confirmatory testing later today at CDC. Additional contacts traced today, with active monitoring in place. Thorough investigation. Ramp up infection control. Finally, our thoughts go out to the family. We understand how difficult a time it is for them, and for other HCWs who may have anxiety about exposure. This is how we break the links of transmission. It is possible we will see additional infections.
 
Last edited:
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

From: "Media@cdc.gov (CDC)" <sohco@CDC.GOV>
To: MMWR-MEDIA@LISTSERV.CDC.GOV
Subject: CDC Statement: CDC Confirms Healthcare Worker Who Provided Care for First Patient Positive for Ebola
Date: Oct 12, 2014 3:58 PM



For Immediate Release
Sunday , October 12, 2014

Contact: Media Relations
(404) 639-3286


CDC Confirms Healthcare Worker Who Provided Care for First Patient Positive for Ebola

Patient isolated and public health investigation ongoing

Today, the Centers for Disease Control and Prevention (CDC) confirmed test results reported late last night by the Texas Department of State Health Services? public health laboratory showing that a healthcare worker at Texas Presbyterian Hospital is positive for Ebola. The health care worker, who provided care for the Dallas index patient, was isolated soon after symptoms started and remains so now.

On Friday, October 10, the healthcare worker reported a low-grade fever overnight and was referred for testing. The health care worker had been self-monitoring for fever and symptoms. As a precaution, after identification of fever, the healthcare worker was isolated and CDC staff interviewed the patient to determine additional contacts or potential exposures. At this time, one close contact has been identified and is being monitored.

The hospital and patient were notified of the preliminary and confirmatory test results. Treatment decisions will be made by the patient and hospital.

This development is understandably disturbing news for the patient, the patient?s family and colleagues and the greater Dallas community. The CDC and the Texas Department of State Health Services remain confident that wider spread in the community can be prevented with proper public health measures, including ongoing contact tracing, health monitoring among those known to have been in contact with the index patient, and immediate isolations if symptoms develop.

Careful monitoring of all health care workers who had interaction with the index patient and this second patient is warranted, including those who cared for the index patient between the time he was isolated in the hospital September 28 through the time of his death on October 8, and they will now be considered patient contacts for follow-up monitoring.

Ebola is spread through direct contact with body fluids of a sick person or the remains of someone who has died of Ebola, or exposure to objects such as needles that have been contaminated. The illness has an average 8-10 day incubation period (although it could be from 2 to 21 days), and therefore CDC recommends monitoring exposed people for symptoms a complete 21 days. People are not contagious before symptoms such as fever develop.


###

U.S. Department of Health and Human Services

CDC works 24/7 saving lives and protecting people from health threats to have a more secure nation. Whether these threats are chronic or acute, manmade or natural, human error or deliberate attack, global or domestic, CDC is the U.S. health protection agency.
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

Wasnt this an issue with the SARS outbreak? (Referring to issues using vents on patients)
 
Re: Texas Health Care Worker Tests Positive for Ebola: Hospital

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

Cross posting, just to highlight the fact that this is a very large, very good hospital, which makes me quite concerned that the problems with this outbreak are not due to poor facilities or inexperienced personnel:

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: This is not an easy 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.



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

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

Unlike in Spain, Dallas Ebola patient's dog will be saved

Rick Jervis, USA TODAY 5:55 p.m. EDT October 12, 2014

DALLAS -- The health worker who tested positive for Ebola has a dog, but the mayor of Dallas says unlike in a recent Spanish case, the dog will be kept safe for eventual reunion with its owner.

Mayor Mike Rawlings told USA TODAY that the dog remained in the health worker's apartment when she was hospitalized and will soon be sent to a new location to await its owner's recovery.

There are no plans to euthanize the dog, he said.

"This was a new twist," Rawlings said. "The dog's very important to the patient and we want it to be safe."
...
http://www.usatoday.com/story/news/2...-dog/17159727/
 
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