Second Ebola Case in Dallas

[BlsdMama]

If I remember correctly neither of the two health care workers who were brought here for treatment believe that any protocol was broken when they contracted it either.

 

The truth is I don't believe we understand enough about the disease. Period.  We may find some of the things we previously believed about ebola to be true is wrong.  It really affected a minute portion of the population and so I wonder how well we understand it at all.  Unfortunately in a global world we may be up to finding out more about it than we'd like.... :(

 

Praying without ceasing.  That's all I've got on this one.

 

 I tend towards anxiety.  However, it's not actually productive.  You can do what you can do and no more.  And worrying over it is not only against scripture (in my case - Matthew 6:27) but can paralyze you from being effective.  I'm *very* concerned by this -  a second person *and* a healthcare worker to boot - but what will my anxiety produce?  Activity or inactivity?  :(

[ddcrook]

Right now I am feeling deeply grateful for health care professionals who work weekends, holidays, and crazy shifts, and expose themselves to harm so they can help keep the rest of us well.  I know those of you who work in health care will say, "I'm just doing my job.  It's what I chose to do," etc.  I get that. But still, I am grateful.  

[lea1]

I have seen a RN in a top University research hospital touch another kid without changing gloves after checking one child and I had the unpleasant experience of insisting that she change gloves even though the kids involved were not my children.

 

What the laymen do not understand is that Ebola is an unknown disease with no known medication available as of today. If a droplet of body fluid remained in an "aerosol" state in the air for a few minutes, anyone who breathes the same air can be exposed according to medical information I googled a couple of weeks ago.

 

Unless the medical professional knows that the person already has Ebola, it is impossible to take the levels of precautions that Ebola requires. And medical professionals in the West have not encountered this largely unknown disease so far and hence may not approach this with the same awareness as in Africa.

 

That said, exposure to Ebola does not mean a full blown disease in the victim. Whether the virus develops severe symptom depends on the person's immunity, base health level etc. So, no 2 persons will react the same to the same virus.

 

This.  Plus I have also read that this virus can live on a dry surface for 2 weeks.

 

[TeenagerMom]

I work in a hospital. It is very easy to break Isolation protocol by not removing PPE in the correct order, absentmindedly touching your face, pushing your hair back out of your way, etc without even REALIZING you have broken protocol. If protocol is followed to a T, chances of transmission are very small for even much more contagious illnesses. I have countless patients with MRSA, C-Diff , Hepatitis, Necrotizing Fascitis, etc. And the ONLY illness I have contracted from my 4+ years of employment there is a Norovirus. I have seen many healthcare workers remove their mask before removing their gloves which means they just introduced pathogens to their face.

[Laurie4b]

Familiarize yourself with cognitive biases. Learn to identify when you might be employing one (or more). 

 

Just wanted to take a moment to say that is one of the clearest articles on cognitive biases I've read. Thanks for posting it.

[Laurie4b]

I have seen a RN in a top University research hospital touch another kid without changing gloves after checking one child and I had the unpleasant experience of insisting that she change gloves even though the kids involved were not my children.

 

What the laymen do not understand is that Ebola is an unknown disease with no known medication available as of today. If a droplet of body fluid remained in an "aerosol" state in the air for a few minutes, anyone who breathes the same air can be exposed according to medical information I googled a couple of weeks ago.

 

Unless the medical professional knows that the person already has Ebola, it is impossible to take the levels of precautions that Ebola requires. And medical professionals in the West have not encountered this largely unknown disease so far and hence may not approach this with the same awareness as in Africa.

 

That said, exposure to Ebola does not mean a full blown disease in the victim. Whether the virus develops severe symptom depends on the person's immunity, base health level etc. So, no 2 persons will react the same to the same virus.

 

I agree. I have had similar experiences with hand-washing, for instance. I hope that one positive thing that comes of this is that all workers tighten up on the known protocols. I can understand how people get sloppy when pressed for time or tired, but I think we could improve in general.

[Lisbeth]

It's okay to not know for a bit, Jinnah. It's okay to be ignorant while looking at all possible variables. Jumping to conclusions isn't effective, and is in fact counter-productive. You might try these tips to help keep any concerns under your control:

 

 

Do things to care for and develop your intellectual well being.

Put time and energy into continuous learning about the diversity of opinions and findings in the social sciences, especially, social psychology, general philosophy, adult learning, and marketing.

Stop taking things at face value . Always try and assess the value of evidence presented, regardless of their personal appeal and the appeal of their ideas.

Know how information has been gained, don't assume based on feelings of trust or peace of mind.

Familiarize yourself with the mechanics of influence and persuasion. Recognize the difference between fact and opinion, and how emotions are manipulated to blur this line.

Research epistemology - it explains how we conclude our knowledge is credible.

Resist the temptation to believe the easiest explanation is accurate.

Familiarize yourself with cognitive biases. Learn to identify when you might be employing one (or more).

That is just so condescending.

[DianeW88]

I work in a hospital. It is very easy to break Isolation protocol by not removing PPE in the correct order, absentmindedly touching your face, pushing your hair back out of your way, etc without even REALIZING you have broken protocol. If protocol is followed to a T, chances of transmission are very small for even much more contagious illnesses. I have countless patients with MRSA, C-Diff , Hepatitis, Necrotizing Fascitis, etc. And the ONLY illness I have contracted from my 4+ years of employment there is a Norovirus. I have seen many healthcare workers remove their mask before removing their gloves which means they just introduced pathogens to their face.

 

Yes.  This.  The breach most likely occurred when the healthcare worker was removing the PPE. You have to pay attention, and you have to do each step correctly.  I have no idea how prepared this hospital was for this type of illness.  Do they have decon showers?  Is someone there making sure you are performing each removal step in the right order?  Too many variables to know for sure, but it is VERY easy to do.

 

I expect a handful of cases to result from Mr. Duncan's illness, but I don't believe it will go beyond that. 

[Lisbeth]

I work in a hospital. It is very easy to break Isolation protocol by not removing PPE in the correct order, absentmindedly touching your face, pushing your hair back out of your way, etc without even REALIZING you have broken protocol. If protocol is followed to a T, chances of transmission are very small for even much more contagious illnesses. I have countless patients with MRSA, C-Diff , Hepatitis, Necrotizing Fascitis, etc. And the ONLY illness I have contracted from my 4+ years of employment there is a Norovirus. I have seen many healthcare workers remove their mask before removing their gloves which means they just introduced pathogens to their face.

Because it is so easy to make these mistakes, we should be taking measures to not put our healthcare workers in this position.

[LNC]

All I could think of was we used to live on her street (street name reported in article I read). A few houses away. The neighbors were reversed 911 called about the hazmat cleanup. Of course, I am very sorry for her and her family. She is a brave lady to care for that patient.

[songsparrow]

I expect a handful of cases to result from Mr. Duncan's illness, but I don't believe it will go beyond that. 

 

I hope that this single case will be the only one to result from Mr. Duncan's illness, and that no more than one case results from this person's illness, and so forth.

Because once you hit transmission to 2 people, you're at the start of an exponential growth curve.  

 

See "The Ominous Math of the Ebola Epidemic":  "Global health officials are looking closely at the 'reproduction number,' which estimates how many people, on average, will catch the virus from each person stricken with Ebola. The epidemic will begin to decline when that number falls below one. A recent analysis estimated the number [in West Africa at] 1.5 to two.  Ebola cases in West Africa have been doubling about every three weeks, and no data suggests a major change in that trend line."

 

ETA:  The description of the protective garments being worn by this nurse and the nurse in Spain also made me think of this article that had been linked on a prior Ebola thread, but I'll link it here in case anyone hasn't seen it and is interested:  "COMMENTARY: Health workers need optimal respiratory protection for Ebola."  In the article, the authors argue the possibility that ebola could be transmitted through the inhalation of aerosol droplets of saliva or mucous that hang in the air after a patient coughs or sneezes, and urge that in order to adequately protect health care workers, "The minimum level of protection in high-risk settings should be a respirator with an assigned protection factor greater than 10."   As I understand it, neither of the nurses that contracted the disease were wearing respirators.  Of course, the nurse in Spain said that she touched her face with her gloves and that may be how she was exposed.  We'll have to wait and see what further facts come out about the TX nurse and whether she can remember any similar breaches in protocol.

[Halftime Hope]

http://www.nytimes.com/2014/10/08/us/as-anxiety-increases-agency-scrambles-to-address-concerns-of-health-workers.html?action=click&contentCollection=U.S.&region=Footer&module=TopNews&pgtype=article

 

I can't quote, but the last few paragraphs are worth reading.  They are about healthcare workers asking for better protection than simple face masks and glove, and how much effort it is taking to get those for them. And about some hospitals that are going beyond the CDC recommendations.

[Laurie4b]

http://www.bbc.com/news/world-us-canada-29590832  This BBC article says that the nurse does not recall any actions that were a breach of protocol, but since the breaches could occur unconsciously, that's not surprising.

 

What I am suprised at is the police guarding the nurse's apt. complex. On the one hand, it's great that they have already decontaminated the apartment. On the other hand, why does it need guarding? And if she was taking her temp 2x/day because she was a contact, and had just sprung a low-grade fever (no vomiting, etc. reported in initial stories), I wonder if this is a pendulum swing to the other side. In one of the news articles I read earlier today, they were looking for all her contacts, but if she had just gotten the fever, there shouldn't have been that many, right? What am I missing? 

[jelbe5]

Here is a link to a news segment from earlier today. Besser states his concern that while we do have specialized bio containment units at several hospitals the regular hospitals are simply not equipped in the same way.

 

http://www.wfaa.com/story/news/health/2014/10/12/ebola-dallas-besser/17148109/

[Mrs Mungo]

Once again, this is what worries me with our troops over in Africa. I know that they are being trained, but since so many health workers have gotten this, it means that there will be even more chance for those that are not used to those protocols... I'm praying for our men and women over there.

Most of our soldiers there are not directly working with sick patients. We have engineers building hospitals, soldiers (with a medical MOS who *have* been trained) training local care workers, providing security to NGOs (more care workers have been murdered than have died from Ebola), etc.

 

ETA: here is an article that talks about some of what the 101st will be doing:

http://www.usatoday.com/story/news/nation/2014/10/09/101st-soldiers-gear-up-to-fight-ebola-outbreak/17006711/

 

The other ebola thread, WOW, some of you are really showing your white privilege in an ugly way.

[Mrs Mungo]

Because it is so easy to make these mistakes, we should be taking measures to not put our healthcare workers in this position.

Such as? What does this mean, generally speaking?

[Perry]

Because it is so easy to make these mistakes, we should be taking measures to not put our healthcare workers in this position.

 

We already are.

 

 

CDC’s Role

Under 42 Code of Federal Regulations parts 70 and 71, CDC is authorized to detain, medically examine, and release persons arriving into the United States and traveling between states who are suspected of carrying these communicable diseases.

As part of its federal authority, CDC routinely monitors persons arriving at U.S. land border crossings and passengers and crew arriving at U.S. ports of entry for signs or symptoms of  communicable diseases.

When alerted about an ill passenger or crew  member by the pilot of a plane or captain of a ship, CDC may detain passengers and crew as  necessary to investigate whether the cause of the illness on board is a communicable disease.

 

 

But once they are here, we should take care of them, shouldn't we?

 

[Truscifi]

Most of our soldiers there are not directly working with sick patients. We have engineers building hospitals, soldiers (with a medical MOS who *have* been trained) training local care workers, providing security to NGOs (more care workers have been murdered than have died from Ebola), etc.

 

ETA: here is an article that talks about some of what the 101st will be doing:

http://www.usatoday.com/story/news/nation/2014/10/09/101st-soldiers-gear-up-to-fight-ebola-outbreak/17006711/

 

The other ebola thread, WOW, some of you are really showing your white privilege in an ugly way.

 

Thank you for the info. My cousin just deployed as part of the aid mission. On the one hand, I think it is good we are helping, on the other he has a wife and two girls and....

 

I worry about him no matter where he is deployed or what he is doing though. At least this time hopefully no one will shoot at him or try to blow him up.

[gardenmom5]

they probably don't call them a bunny suit - but when I see the hazmat suits that is what it makes me think of.  every picture I've seen from west Africa of those caring for/disposing of bodies show them in hazmat suits, heavy rubber gloves, rubber boots and goggles.

The "gown and mask" reference really concerned me, too.  I'm a nurse and have taken care of patients on full isolation in the past.  That typically involved shoe covers, mask, gown, and gloves.  I'd be curious to know what kind of precautions were being taken in Dallas.  I've never worn or seen the bunny suits in a hospital.    

 

[Mrs Mungo]

Thank you for the info. My cousin just deployed as part of the aid mission. On the one hand, I think it is good we are helping, on the other he has a wife and two girls and....

 

I worry about him no matter where he is deployed or what he is doing though. At least this time hopefully no one will shoot at him or try to blow him up.

I understand the worry, extremely first hand. But, it isn't a new thing for the US military to take on humanitarian missions.

[TeenagerMom]

We already are.

 

 

 

But once they are here, we should take care of them, shouldn't we?

Absolutely we should and it is up to the health care workers to follow protocol. Yes breaks happen but it is up to the healthcare workers to hold each other accountable & watch each other's backs. When removing PPE, I pull my gown, then gloves, wash hands, & then remove mask & goggles then wash AGAIN full up to the elbows. They need to watch each other in the rooms. Remind each other and constantly remind themselves not to touch their face, push up glasses, etc. AND use N95 respirators. We are required to be fit tested on a yearly basis and if we lose or gain a significant amount of weight.

[zoobie]

http://www.bbc.com/news/world-us-canada-29590832 This BBC article says that the nurse does not recall any actions that were a breach of protocol, but since the breaches could occur unconsciously, that's not surprising.

 

What I am suprised at is the police guarding the nurse's apt. complex. On the one hand, it's great that they have already decontaminated the apartment. On the other hand, why does it need guarding? And if she was taking her temp 2x/day because she was a contact, and had just sprung a low-grade fever (no vomiting, etc. reported in initial stories), I wonder if this is a pendulum swing to the other side. In one of the news articles I read earlier today, they were looking for all her contacts, but if she had just gotten the fever, there shouldn't have been that many, right? What am I missing?

I would wager that one reason for police presence is to keep away the media circus.

[mommymilkies]

I'm on my phone, but did anyone see this? http://www.dallasnews.com/ebola/headlines/20141010-lawsuit-may-be-coming-in-ebola-victim-s-death-family-friend-says.ece

 

I can't imagine they'd possibly win.

[Jean in Newcastle]

I don't find it surprising there is a second case, nor that it is a healthcare worker. It's expected there will be a few. I'm glad they have access to good healthcare.

Exactly.  

[Katy]

Every time I hear anything about this I flash back to this time that I had to call and cancel an interview because I'd come down with a bad case of norovirus. I'd been working for a nursing temp agency and had worked for several weeks at a nursing home where the virus was running rampant.  Three people in the one facility died of this virus, so when I got it, I couldn't just swallow some immodium and go to the interview anyway.  I called and explained how serious the bug was and that I shouldn't come in because I didn't want them to get this strain at their hospital (it was in a different state).  The director of nursing thanked me, and ended up hiring me anyway after postponing my interview for a week.

 

When I finally went in we had a long conversation about it, and about how the disease is technically considered only droplet protection (just like ebola), but how if you can smell vomit or diarrhea, the virus is in droplets in the air.  So it can settle in your eyes, you can breathe it in, you can literally do everything correctly, but unless they treat it like an airborne virus, you will be exposed to the virus.  You just will. And the longer you work with patients with the same virus, the higher your exposure is and the smaller the chance that your immune system can fight the virus before you get sick.

 

I was very relieved to hear the local hospital's press release that they were prepared to treat ebola as an airborne virus- ie: not just standard precautions, or just a plastic mask.

 

I'm disappointed that the Dallas hospital didn't do better.  In a myriad of ways.

 

eta: because I shouldn't trust Firefox's spell check.

[Trish]

Hm, I have now also read something to that effect. And no matter how susceptible someone is to a disease - I don't see how they could catch it in full protective gear?

 

Maybe they were susceptible to believing what the CDC claims are "sufficient precautions."

[PinkyandtheBrains.]

Because it is so easy to make these mistakes, we should be taking measures to not put our healthcare workers in this position.

 

Suggestions?

[kroe1]

Absolutely we should and it is up to the health care workers to follow protocol. Yes breaks happen but it is up to the healthcare workers to hold each other accountable & watch each other's backs. When removing PPE, I pull my gown, then gloves, wash hands, & then remove mask & goggles then wash AGAIN full up to the elbows. They need to watch each other in the rooms. Remind each other and constantly remind themselves not to touch their face, push up glasses, etc. AND use N95 respirators. We are required to be fit tested on a yearly basis and if we lose or gain a significant amount of weight.

Well, I am watching your back as another health care person. Your order of removal is wrong according to the CDC. The gloves come off first. Everything else gets touched from the back of you. In other words the goggles are then slid off by the stems and pushed forward. The gown is removed by reaching to the back, untying in the back and then pulling it forward and inside out. This is totally opposite of the way we get out of garb in the OR. Mask is last and grabbed from the back. This is all done in the patient room for all small hospitals which do not have decon rooms. We have practiced at our hospital several times and no one can get it done the CDC way without a lot of practice. It took me 5 times before I could do it without hitting the side of my face when I reached backwards to untie the gown. Practice, practice, practice. It is not as easy as it sounds.

[umsami]

I actually feel that all of the ebola cases should be going to one hospital for tx at this time.  Like I seem to remember when doctor guy got it, they took him to a special isolation ward at Emory…which is not too far from the CDC.  That makes sense.

 

The cameraman guy and I think another person went to Nebraska. (Not sure why.)

 

This guy was kept in Dallas.

 

While I realize transporting cases is expensive, it would seem that keeping the patients at a facility which is used to dealing with the pathogen would make sense.

 

JMHO.

 

My Dad has had MRSA and a whole host of other illnesses and been in isolation.  The amount of violations of protocol I saw every time I visited was shocking.  If they're used to those lackluster conditions, it wouldn't surprise me.

Not exactly the same…but….don't forget hospital transmitted infections are a big problem too.  Different protocol exists in different parts of the world.  For example, in the UK, physicians cannot wear ties or white coats anymore.  Here, you'll often see specialists dressed in ties doing rounds.  White coats are often required by hospital rules.

[Butter]

 

What I am suprised at is the police guarding the nurse's apt. complex. On the one hand, it's great that they have already decontaminated the apartment. On the other hand, why does it need guarding? And if she was taking her temp 2x/day because she was a contact, and had just sprung a low-grade fever (no vomiting, etc. reported in initial stories), I wonder if this is a pendulum swing to the other side. In one of the news articles I read earlier today, they were looking for all her contacts, but if she had just gotten the fever, there shouldn't have been that many, right? What am I missing? 

Overabundance of caution.  I think you hit the nail on the head that this is a pendulum swing to the other side.  As someone said earlier in the thread, two patients means we could hit exponential growth now.  I think they are simply trying to do everything possible to prevent that.  Plus they hopefully learned from bungling stuff with Duncan's family and are trying to help reverse some of the bad press they had from that.

[Perry]

 

 

The cameraman guy and I think another person went to Nebraska. (Not sure why.)

 

Nebraska is one of four high level biosecurity patient care units in the US. 

The three other high-level biocontainment facilities in the U.S. are at St. Patrick Hospital in Missoula, Mont., the National Institutes of Health in Maryland and Emory University Hospital in Atlanta, where two infected patients were treated this summer.

 

From NPR

[Sun]

Every time I hear anything about this I flash back to this time that I had to call and cancel an interview because I'd come down with a bad case of norovirus. I'd been working for a nursing temp agency and had worked for several weeks at a nursing home where the virus was running rampant.  Three people in the one facility died of this virus, so when I got it, I couldn't just swallow some immodium and go to the interview anyway.  I called and explained how serious the bug was and that I shouldn't come in because I didn't want them to get this strain at their hospital (it was in a different state).  The director of nursing thanked me, and ended up hiring me anyway after postponing my interview for a week.

 

When I finally went in we had a long conversation about it, and about how the disease is technically considered only droplet protection (just like ebola), but how if you can smell vomit or diarrhea, the virus is in droplets in the air.  So it can settle in your eyes, you can breathe it in, you can literally do everything correctly, but unless they treat it like an airborne virus, you will be exposed to the virus.  You just will. And the longer you work with patients with the same virus, the higher your exposure is and the smaller the chance that your immune system can fight the virus before you get sick.

 

I was very relieved to hear the local hospital's press release that they were prepared to treat ebola as an airborne virus- ie: not just standard precautions, or just a plastic mask.

 

I'm disappointed that the Dallas hospital didn't do better.  In a myriad of ways.

 

eta: because I shouldn't trust Firefox's spell check.

 

Yes. This.

 

The BBC article where the CDC director points the finger at the health worker who's ill shows someone dressed in a "protective Ebola suit." The thing is, that's not at all what the CDC recommends. The CDC's recommendations seem much less protective than that suit. Here are the CDC's personal protective equipment recommendations:

• All persons entering the patient room should wear at least:
  • Gloves
  • Gown (fluid resistant or impermeable)
  • Eye protection (goggles or face shield)
  • Facemask
• Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to:
  • Double gloving
  • Disposable shoe covers
  • Leg coverings

 

Why are the CDC's recommendations so minimal, and why is the director so quick to point fingers at someone on the front lines who got ill?

 

[Perry]

 

 

Why are the CDC's recommendations so minimal

 

 

I imagine that they are wearing those protective suits at the hgh level biosecurity facilities, but it is completely impractical for every community hospital in the US to have those.  Here is an article describing them. 

 

There is just no way that all the caregivers of an Ebola patient are going to be able to wear those for every interaction. 

[trulycrabby]

Every time I hear anything about this I flash back to this time that I had to call and cancel an interview because I'd come down with a bad case of norovirus. I'd been working for a nursing temp agency and had worked for several weeks at a nursing home where the virus was running rampant. Three people in the one facility died of this virus, so when I got it, I couldn't just swallow some immodium and go to the interview anyway. I called and explained how serious the bug was and that I shouldn't come in because I didn't want them to get this strain at their hospital (it was in a different state). The director of nursing thanked me, and ended up hiring me anyway after postponing my interview for a week.

 

When I finally went in we had a long conversation about it, and about how the disease is technically considered only droplet protection (just like ebola), but how if you can smell vomit or diarrhea, the virus is in droplets in the air. So it can settle in your eyes, you can breathe it in, you can literally do everything correctly, but unless they treat it like an airborne virus, you will be exposed to the virus. You just will. And the longer you work with patients with the same virus, the higher your exposure is and the smaller the chance that your immune system can fight the virus before you get sick.

 

I was very relieved to hear the local hospital's press release that they were prepared to treat ebola as an airborne virus- ie: not just standard precautions, or just a plastic mask.

 

I'm disappointed that the Dallas hospital didn't do better. In a myriad of ways.

 

eta: because I shouldn't trust Firefox's spell check.

What you just said is so very important! I think questions were also raised about the possibility that the ventilator and/or dialysis machine somehow aerosolized the virus.

[Katy]

Catholic Health Initiatives hospitals have provided hazmat suits and training for their nursing staff.  And they're for profit!

 

I don't know why it is impossible to provide the suits and training to everyone who needs them.  One suit and some bleach is not as expensive as the inpatient care they'd have to pay for one staffer who got ebola on the job.  Not to mention, not providing them when many hospitals are might be considered criminal negligence and open them up to serious workman's comp issues that hospitals are typically exempt from.

[Guest]

I can't remember if someone asked this already... wouldn't it be better to send Ebola patients to a hospital that is actually prepared to treat Ebola (and has a good track-record)?  Like Emory?  

[Sun]

I can't remember if someone asked this already... wouldn't it be better to send Ebola patients to a hospital that is actually prepared to treat Ebola (and has a good track-record)?  Like Emory?  

 

I've been wondering that too. If there end up being lots of cases, I realize it might not be feasible, but with so few at the moment, it would.

 

There are two facilities that currently have Ebola patients but that have not had any workers get sick--Emory and Nebraska. I wonder if that's because those places have higher-level containment procedures to protect hospital staff.

[jelbe5]

I've been wondering that too. If there end up being lots of cases, I realize it might not be feasible, but with so few at the moment, it would.

 

There are two facilities that currently have Ebola patients but that have not had any workers get sick--Emory and Nebraska. I wonder if that's because those places have higher-level containment procedures to protect hospital staff.

Yes, my understanding is that both Emory and Nebraska have the bio containment units. My guess is they have the facilities AND the specialized training (including how to remove the protective suits, etc.). The hospital in Dallas was basically thrown into a bio containment situation. There may have been training but it would be nowhere near what Emory and Nebraska have because that is not their specialty.

 

I believe it is possible for local hospitals to be prepared for Ebola, but it is going to require training and practice, practice, practice. Until that happens perhaps it would be better for those who test possible to be transferred to one of these units. The question is, how many patients can they handle?

[Seasider]

Yes. This. The breach most likely occurred when the healthcare worker was removing the PPE. You have to pay attention, and you have to do each step correctly. I have no idea how prepared this hospital was for this type of illness. Do they have decon showers? Is someone there making sure you are performing each removal step in the right order? Too many variables to know for sure, but it is VERY easy to do.

 

I expect a handful of cases to result from Mr. Duncan's illness, but I don't believe it will go beyond that.

I wondered about decontamination showers.

 

There was a feature on our evening news, a nurses' organization calling for hospital administrations to institute buddy systems for proper donning and doffing PPE.

[Guest]

I wondered about decontamination showers.

 

There was a feature on our evening news, a nurses' organization calling for hospital administrations to institute buddy systems for proper donning and doffing PPE.

 

I thought they were wearing hazmat suits and decontaminating with spray methods after... I was very surprised to find out they were not.  

[Trish]

The CDC has been just full of surprises.

 

Wonder what's going on with the family, haven't heard too much about the Duncan clan lately. I hope nobody forgets they need our prayers!

[Katy]

The CDC has been just full of surprises.

 

Wonder what's going on with the family, haven't heard too much about the Duncan clan lately. I hope nobody forgets they need our prayers!

 

I read an article that mentioned they were seriously considering a lawsuit.  I hope they move forward with it; I generally trust bad PR and lawsuits to change corporate policies faster than hospital management.

[Laurie4b]

This article from CNNhttp://www.cnn.com/2014/10/13/health/ebola-nurse-how-could-this-happen/index.html?hpt=hp_t1  brings up several good points.

 

In a survey of 2000 nurses belonging to National Nurses United:   "76% said their hospitals hasn't communicated any policy about how to admit Ebola-infected patients. And 85% said their hospitals haven't provided education on Ebola where the nurses can interact and ask questions."

 

The article discusses the possible wisdom of sending people to the big 4 hospitals prepared to deal with this. (And I wonder who would transport and who would take care of the patient in the meantime. )

 

The CDC says that their protocols "work" but apparently they only work under certain conditions (my opinion) such as when the workers  have practiced until they can perform them without error (maybe have the muscle memory to perform them without error?) .  It appears from the two workers (one in Spain and one in the US) that there is a significant risk of an untrained health care worker making a mistake even under conditions in a Western hospital. We had speculated before that the health care workers who contracted it in Africa were perhaps working under conditions that made an error more likely, such as inadequate facilities or extreme fatigue. 

 

I remember a health worker in another thread saying hospitals are prepared to deal with all kinds of contagious diseases.

 

What do those of you who work in hospitals think as more info comes forward about the medical workers?

[Katy]

If this is being treated with just CDC recommended precautions the nurse could have done EVERYTHING correctly and still gotten sick.  If her hospital didn't require shoe coverings, there would have been virus on her shoes, and she could have transferred it to her face when she took her clothes off at the end of the shift. If she could smell the body fluids as she was cleaning them up, she could have breathed in the virus. Not to mention it's not as if nurses have access to the showers and locker rooms at hospitals that doctors have.  Most of the time they drive home in the scrubs they wear all shift.

 

The only lapse here IMO is not treating this as seriously as it deserves. Sounds as if the hospital administration's poor judgment is resolving itself though; so many workers are refusing to go in at this point the hospital's emergency room is closed.

[BigMamaBird]

The likely point of error is in removal of the PPE. The glove removal procedure is an area of particular concern apparently.

 

Another error is that people feel compelled to scratch their nose, adjust goggles and etc. This was discussed on NPR between 6:45 and 8 am if you are interested in learning more. Suspect it would be Morning Edition.

 

I recently had to wear goggles and a face mask to do some paint stripping.  It's ridiculous how much I  "NEEDED" to scratch my face once it wasn't possible to.  I can't imagine being beneath all those layers and the fact that a harmless scratch could turn into a life and death issue.

[jelbe5]

I can't find any sources which confirm this. Do you have a source?

There was a press conference yesterday where it was explained that the ER was on "diversion" due to "limitations in staff capacity." There was no elaboration on why there are limitations. I thought that perhaps the staff are receiving specialized training and many are unavailable because of that, but that is just speculation.

 

http://www.wfaa.com/story/news/health/2014/10/12/presbyterian-hospital-worker-ebola/17147507/

[zoobie]

There was a press conference yesterday where it was explained that the ER was on "diversion" due to "limitations in staff capacity." There was no elaboration on why there are limitations. I thought that perhaps the staff are receiving specialized training and many are unavailable because of that, but that is just speculation.

 

http://www.wfaa.com/story/news/health/2014/10/12/presbyterian-hospital-worker-ebola/17147507/

Aren't many of the ER staff quarantined?

[jelbe5]

Aren't many of the ER staff quarantined?

That was not confirmed in the press conference I watched but I would think this could certainly be a possibility.

[Seasider]

That was not confirmed in the press conference I watched but I would think this could certainly be a possibility.

If they're not, they should be.

[jelbe5]

If they're not, they should be.

I agree. I also noticed that one of the speakers at the press conference was Judge Clay Jenkins who transported the members of the household where Duncan was staying to a secure location. I was thinking that it might be wise for him to isolate himself "just in case".