Second Ebola Case in Dallas

[Jean in Newcastle]

That's another one of the good reasons for the second pair of gloves.  You can get the first pair off without compromising the barrier, then removal of the second pair has much less chance of contaminating you.  (I learned this at Fermilab of all places--man, that was a lifetime ago.)

 

I thought of this when reading about the woman who made her own biohazard suit and treated her family.  She doubled everything.  Very smart and careful woman.

[Perry]

Food for one thing. The family reported that they weren't allowed to leave, but didn't have food for part of the time.

 

I agree, but I have to say, when I heard the family was quarantined, I didn't immediately wonder if they had enough food. I sort of assume (wrongly, obviously) that people have food in the house, since I know I could go for weeks living on what's in my cupboards.  Did the authorities know they didn't have food and ignore it?  Or did they not know? 

 

On the other hand, as  pet owner, the first thing I'd think of is how they are going to eat, since they are completely dependent on humans for that.

[Pen]

 N95 respirators. 

 

 

I have an "N95" on the label respirator for home repair activities. It seems to stop particulates like from sawing, but I can smell things right through it. I understand that if one can smell something it is because particles of the whatever it is containing the smell are reaching one's scent receptors in one's nose. And also that the inner nose has more direct entry to brain than for other senses, like touch, and so on.

 

Most of our senses are reacting to things that are relatively external to the body, but in the case of scents, there are actually molecules of the stuff smelled going to nose.

 

So I am a bit doubtful about N95. Or at least not any respirator with that on the label.

[Pen]

How many gloves are the medical workers in Nebraska using? I had heard it was 3 layers.

 

 

[momto10blessings]

My question is how/where is the dog going to the bathroom? Can't Ebola be spread via urine?

[Katy]

What I've never understood about double gloving is that when you're working with an HIV patient you're warned to NOT double glove, because the friction can increase the risk of glove tearing.  But when it's something really dangerous, you're instructed to double glove.

 

I have never found anyone who has been able to explain why to me.

[Katy]

My question is how/where is the dog going to the bathroom? Can't Ebola be spread via urine?

 

I can't recall where the dog has been taken to, but it's been removed from the apartment and taken to some sort of animal containment facility.

 

I hope the whole keep the dog alive thing wasn't a lie to make the media calm down, and they're actually planning on testing him to see if he's a carrier, not just putting him down quietly behind the scenes.

[momto10blessings]

I can't recall where the dog has been taken to, but it's been removed from the apartment and taken to some sort of animal containment facility.

 

I hope the whole keep the dog alive thing wasn't a lie to make the media calm down, and they're actually planning on testing him to see if he's a carrier, not just putting him down quietly behind the scenes.

Ok, last I heard the dog was being cared for in the apartment. At least I thought that's what I heard

[Laurie4b]

I agree, but I have to say, when I heard the family was quarantined, I didn't immediately wonder if they had enough food. I sort of assume (wrongly, obviously) that people have food in the house, since I know I could go for weeks living on what's in my cupboards.  Did the authorities know they didn't have food and ignore it?  Or did they not know? 

 

On the other hand, as  pet owner, the first thing I'd think of is how they are going to eat, since they are completely dependent on humans for that.

 

For poorer people, it's quite common to have little to no "reserve" on hand.  Reserve means that at one point, you could buy more food than you needed at that point in time. The poor often cannot do that. They can't stock up on a sale of say, Cheerios, if they also need milk that week. KWIM?  Some people have zero reserve on hand.It was the end of the month when he was admitted. People are often quite stretched at that time and any reserves they had earlier in the month are gone. All this is  common knowledge to people like social workers (I used to be one)  and I would think to public health workers--anyone who works with low income people. In other countries, it's common to go to market each day. Some people eat out every day. There could be many reasons that the family did not have food in the house.

 

I can't recall what I read precisely (so my memory could be wrong, and I'd have to go back searching through articles to be sure) but my recollection is that yes, the family said that they didn't have food and they went for most of a day before someone brought sandwiches for them. So it sounded like they had nothing in the house. I could be wrong though because I'm just going based on memory.

 

To me, it's a matter of planning. Once you won't let someone out of their home, what will you have to take to them? TP? food? baby diapers? etc. It doesn't sound to me like the *community* had a plan. There was no overall planning and coordination. Like I said, Dallas is apparently learning, and I hope that other community leaders are out there saying, "What would happen here? Are we prepared? Would the left hand know what the right hand was doing? Who would be in charge of what? Who would be "the general?" " etc.

[Pawz4me]

This WSJ article says the dog was moved to a safe location yesterday.

 

 

 

Dallas officials announced Monday that the dog of Nina Pham, the Dallas nurse, will remain in a safe place to await its owner’s recovery. The dog, a Cavalier King Charles spaniel named Bentley, was moved Monday afternoon, officials said.

[Perry]

What I've never understood about double gloving is that when you're working with an HIV patient you're warned to NOT double glove, because the friction can increase the risk of glove tearing.  But when it's something really dangerous, you're instructed to double glove.

 

I have never found anyone who has been able to explain why to me.

 

I've never in my life heard that.

 

Double gloving clearly improves protection. 

 

What Does Research Show?

A number of studies were designed to look at the efficacy of double gloving and other possible alternatives. Quebbeman has published a number of studies on exposure in the surgical environment and all recommend the practice of double gloving. His 1992 study reported a 51% hand contamination rate of those who single gloved versus a 7% contamination rate for those who double gloved.¹⁶ Korniewicz and Rabussay in their studies have stressed the high in-use failure rates of gloves.⁵ Albin reports that surgical gloves worn in double-glove fashion, tested every 15 minutes, had leaks 25% of the time while those worn singly had leaks 59% of the time.¹⁷ Chapman and Duff reported data on double gloving in obstetric surgical procedures. Of 67 sets of double gloves studied, 66 holes were found in the outer gloves and seven holes in the inner glove. Their summary found that the difference in the frequency of injury of inner and outer gloves to be highly significant. Their recommendations included routine double gloving to decrease the potential for patient fluid contact.¹⁸ In Infection Control and Hospital Epidemiology, Tokars found that hand contact with patient fluids were 72% lower for those surgeons who double gloved.¹⁹ A study by Greco and Garza supports the data stating that perioperative personnel's risk decreased by 70% in comparison with single glove use.²⁰ In the European Journal of Cardiothoracic Surgery, Hollaus, et. al. concluded, "The perforation rate of 78% lies in the highest range of reported perforation rates in different surgical specialties. Double gloving effectively prevented cutaneous blood exposure and thus should become a routine for the thoracic surgeon to prevent transmission of infectious diseases from the patient to the surgeon."²¹ In summary, the research data supports the practice of double gloving.

 

[Katy]

That's awesome.  I heard that over and over in nursing classes and hospital safety refreshers.

 

ETA: Apparently my quote thing didn't work.  Thanks Perry!

[Perry]

That's awesome.  I heard that over and over in nursing classes and hospital safety refreshers.

 

 

 

I wonder if that's a regional thing...

Anyone else ever been taught that?

[Pawz4me]

An article with good info about the dog

 

Quick summary of the article:  Bentley the dog is being quarantined at the Dallas Animal Services and Adoption Center.  Workers caring for him are wearing protective gear.  The dog is getting attention so he will maintain good mental health.  He won't be allowed to go outside while in quarantine. They plan on taking regular photos of Bentley and sending them to Pham so she'll know he's okay.

[BlsdMama]

There are reports the nurse's boyfriend has symptoms but I can only find links in rag news.

[Pawz4me]

There are reports the nurse's boyfriend has symptoms but I can only find links in rag news.

 

There's a news conference going on right now.  The spokesperson for the hospital says the boyfriend is symptom free but is being monitored.

 

[Supertechmom]

N95 respirators have to be Fit tested.  They put this big giant hat on your head with the respirator on.  Then they spray stuff in it. If you can smell it or taste it, then it doesn't fit.  They then keep adjusting it till it does. I would say in this case, IF i had to take care of any patient who required N95, I would get retested and make sure the fit was right before taking care of them.  Losing weight can affect the fit.

 

 

and this one is more like the one I did.

https://www.youtube.com/watch?v=eVgXTXKc5A8

 

[Colleen]

You know, I've observed that a lot -- people, especially on FB -- caring more about pet/animal issues than they do about human concerns.  It rather boggles my mind.

 

But there's a world of difference between this phenomenon and thinking that the Dallas health officials (collectively) care more about the dog than they did about Duncan's family.  

 

Yes, I've observed the same phenomenon.  My comments aren't directed at Dallas health officials collectively, rather an observation re the general public.

[Perry]

I have an "N95" on the label respirator for home repair activities. It seems to stop particulates like from sawing, but I can smell things right through it. I understand that if one can smell something it is because particles of the whatever it is containing the smell are reaching one's scent receptors in one's nose. And also that the inner nose has more direct entry to brain than for other senses, like touch, and so on.

 

Most of our senses are reacting to things that are relatively external to the body, but in the case of scents, there are actually molecules of the stuff smelled going to nose.

 

So I am a bit doubtful about N95. Or at least not any respirator with that on the label.

 

N95 respirators are designed to block 95% of particulates over a certain size.  They don't do very well at blocking very small viruses, under about 80 nm.  Ebola is right around 80 nm in diameter. It has been thought that the virus itself isn't airborne, but travels in droplets, which are much larger than that. N95 respirators are best at blocking particulates like droplets (sneezing, coughing, etc) and blood.

 

Odors are molecules that travel through air.  Viruses are made of hundreds of thousands of molecules, and although tiny, they are vastly larger than an odor molecule.  You don't want the respirator to block molecules, or you wouldn't be able to breathe oxygen.

 

So smell isn't a very good indicator of whether a respirator is blocking a virus. 

[mathnerd]

CDC is getting more efficient and going about Ebola control in a more systematic way now, it seems. It totally makes sense to send the experts to Dallas where there is a possibility of more ebola cases amongst the caregivers of Mr Duncan.

 

http://www.forbes.com/sites/davidkroll/2014/10/14/emory-nurses-traveling-to-dallas-to-provide-ppe-infection-control-training/

 

[Laurie4b]

CDC is getting more efficient and going about Ebola control in a more systematic way now, it seems. It totally makes sense to send the experts to Dallas where there is a possibility of more ebola cases amongst the caregivers of Mr Duncan.

 

http://www.forbes.com/sites/davidkroll/2014/10/14/emory-nurses-traveling-to-dallas-to-provide-ppe-infection-control-training/

 

There was a little more in this article: http://www.foxnews.com/health/2014/10/14/cdc-lays-out-new-battle-plan-to-stop-spread-ebola-in-us/

CDC will, in the future, send rapid response teams to any hospital with an ebola patient, including an experienced, on-site manager to oversee PPE. I'm glad that the Nina Pham and Texas Presbyterian are getting the benefit of nurses with expertise.

 

I see the the open admission of mistakes and plans like this for the future to be positive and a sign that things are moving in the right direction.

 

ETA: left word out

[BlsdMama]

There's a news conference going on right now. The spokesperson for the hospital says the boyfriend is symptom free but is being monitored.

 

SO glad!

[Halftime Hope]

The CIDRAP article had a lot of great explanation about droplet size and travel, air currents, etc.  They were recommending a higher level of protection than N95, if I remember correctly.

[Pen]

Not sure if this was linked yet--

 

http://www.huffingtonpost.com/2014/10/14/nurse-ebola-protection_n_5980214.html

 

 

Title something like Nurses Say US Hospitals Aren't Adequately Prepared for Ebola

[Pen]

The CIDRAP article had a lot of great explanation about droplet size and travel, air currents, etc.  They were recommending a higher level of protection than N95, if I remember correctly.

 

 

On a search, I found that, with regard to flu virus not ebola, N95s were found, not perfect, but better than regular surgical masks, but needed to be sealed ... how to seal them was not made clear.

[BigMamaBird]

I understand their need and right to privacy, but have we heard any more about the Duncan family?  I've been thinking about them a lot lately and am hoping that no news is good news.  Since this nurse was exposed later than all the 80 something contacts they identified for Mr. Duncan, I hope that means they're all doing well, especially those kids that were exposed!

[HomeschoolMamaOfTwo]

Well, this might explain how she got it.  I can't even believe some of these things in this video.  I really hope it isn't true.

 

http://www.cnn.com/2014/10/14/health/texas-ebola-nurses-union-claims/

[momto10blessings]

Well, this might explain how she got it. I can't even believe some of these things in this video. I really hope it isn't true.

 

http://www.cnn.com/2014/10/14/health/texas-ebola-nurses-union-claims/

That's terrible

[Laurie4b]

Well, this might explain how she got it.  I can't even believe some of these things in this video.  I really hope it isn't true.

 

http://www.cnn.com/2014/10/14/health/texas-ebola-nurses-union-claims/

 

Speechless. If true, this is a level of incompetency from the powers that be that I cannot even comprehend. The administrators weren't in danger--just allowing others to be. It's amazing that there is only one case if this is how things were handled. Medical tape around the neck?

 

I pray that the nurse recovers.

[HomeschoolMamaOfTwo]

Yes all of it was horrible, but the waste up to the ceiling is what made my mouth drop open. :-/

[VeteranMom]

Well, this might explain how she got it.  I can't even believe some of these things in this video.  I really hope it isn't true.

 

http://www.cnn.com/2014/10/14/health/texas-ebola-nurses-union-claims/

Her pants were likely exposed to contamination, too.  If something splattered on them, that could be another explanation of how she got the virus.  I have to wonder if she was taking care of more than 1 patient when working in the ICU.  If something was on her clothing and she brushed up against another patient, did someone else get exposed?  It's not unusual for nurses to help each other out- turning patients, cleaning patients, etc.  Was she in other patient rooms while she was at work?               

[Halftime Hope]

You know, I know this hospital.  I have a really, really hard time believing some of the specifics of that report.  http://health.usnews.com/best-hospitals/area/dallas-fort-worth-tx  

[HomeschoolMamaOfTwo]

I am really, really hoping that the claims are not true!

[VeteranMom]

You know, I know this hospital.  I have a really, really hard time believing some of the specifics of that report.  http://health.usnews.com/best-hospitals/area/dallas-fort-worth-tx  

I worked at the hospital ranked #20 in Texas.  I have no problem believing the CNN report and would bet it's all true.  I still have bad flashbacks about some of the situations I was put in when I worked at that hospital.  Texas is not known for protecting their nurses.    

[texasmama]

I am very concerned for Nina Pham.  I have prayed for her health and recovery quite consistently since learning she was ill. 

 

My best friend from childhood/adolescence is a nurse manager at a different hospital within this system.  I would like to ask her what her perspective is on the safety and the protocols, as she should have an accurate one.

[Seasider]

Her pants were likely exposed to contamination, too. If something splattered on them, that could be another explanation of how she got the virus. I have to wonder if she was taking care of more than 1 patient when working in the ICU. If something was on her clothing and she brushed up against another patient, did someone else get exposed? It's not unusual for nurses to help each other out- turning patients, cleaning patients, etc. Was she in other patient rooms while she was at work?

I think I remember hearing that the 28 bed ICU was cleared of all other patients. But sorry, I don't have a link for that. Anyone?

[Katy]

I worked at "the best" hospital in a major metropolitan area and I have no problem believing that story.  I've seen things so terrible I couldn't believe anyone could keep their license, and when I took it to the administration I was blamed for not training the rest of the staff (who all had seniority over me).

 

There are certain states I do not want to be hospitalized in, ever.

[Katy]

This is interesting: http://en.ird.fr/the-media-centre/scientific-newssheets/337-possible-natural-immunity-to-ebola

 

Apparently some people who have never had the virus, and live in an area where no one has ever been known to be ill, have antibodies to Ebola,  so it's possible there are harmless strains of the virus that give you immunity to the worst strains.  If we could find them it could lead to a quick vaccine.

[mathnerd]

I am very concerned for Nina Pham.  I have prayed for her health and recovery quite consistently since learning she was ill. 

 

My best friend from childhood/adolescence is a nurse manager at a different hospital within this system.  I would like to ask her what her perspective is on the safety and the protocols, as she should have an accurate one.

This news story says how the nurses cared for Mr Duncan who had projectile vomiting and explosive diarrhea without proper protective gear. So very sad to read it :( Apparently, these poor nurses were facing conditions worse than those in Africa.

http://www.washingtonpost.com/national/health-science/dallas-nurses-cite-sloppy-conditions-in-ebola-care/2014/10/15/1f0b9876-5423-11e4-b86d-184ac281388d_story.html

[Ausmumof3]

This is interesting: http://en.ird.fr/the-media-centre/scientific-newssheets/337-possible-natural-immunity-to-ebola

 

Apparently some people who have never had the virus, and live in an area where no one has ever been known to be ill, have antibodies to Ebola, so it's possible there are harmless strains of the virus that give you immunity to the worst strains. If we could find them it could lead to a quick vaccine.

This is really encouraging.

[Katy]

This is really encouraging.

 

I think it's both encouraging and discouraging.  Because if a higher percentage of people in Africa have immunity, it might mean that this particular deadly strain is a lot more contagious than previously thought and/or CIDRAP's position that aerosolized transmission is possible is more likely.  Of course, only one infection so far, out of 100 possible in the general public and another 60 hospital workers, would indicate that the CDC is correct and it's not highly contagious.

 

I really hope those nurses reports are correct and they just didn't have the correct equipment to keep the nurses safe, or the intubation and dialysis aerosolized the virus in some way that the broader public wasn't exposed to.

[Katy]

A second health care worker has tested positive for ebola in Dallas.

[Ausmumof3]

Liberia's infection rate is 2 for every 1 case so at this point I guess US is the same. Though I guess it wasn't known that it was Ebola at first so it's slightly different.

[Twolittleboys]

One health care worker infected could still be attributed to human error but with now two cases it does seem that the hospital's procedures were completely inadequate. I really don't understand how this could have been so bungled - they must have realized the media attention this would garner and I would have thought that they would have erred on the side of caution. At this point I am kind of hoping that they will transport the new patient(s) to another hospital that is more able to take care of them (though I assume the CDC is now running the ebola care there now?)

[Pawz4me]

One health care worker infected could still be attributed to human error but with now two cases it does seem that the hospital's procedures were completely inadequate. I really don't understand how this could have been so bungled - they must have realized the media attention this would garner and I would have thought that they would have erred on the side of caution. At this point I am kind of hoping that they will transport the new patient(s) to another hospital that is more able to take care of them (though I assume the CDC is now running the ebola care there now?)

 

I read that two of the Emory University nurses who are experts on caring for Ebola patients are there.  One of them wrote Emory's protocols for nursing care of Ebola patients.  But since both cases are in Texas (not an interstate issue), I believe the extent of the CDC involvement is limited to what the hospital allows.  You'd think at this point they'd be glad to step back and let someone else take over, but who knows?

[Twolittleboys]

I read that two of the Emory University nurses who are experts on caring for Ebola patients are there.  One of them wrote Emory's protocols for nursing care of Ebola patients.  But since both cases are in Texas (not an interstate issue), I believe the extent of the CDC involvement is limited to what the hospital allows.  You'd think at this point they'd be glad to step back and let someone else take over, but who knows?

 

Honestly, I think that hospital is done. I am not really blaming anyone as apparently they were just completely unprepared but I honestly can't imagine that after this disaster anyone who has a choice going there for any treatment (no matter for what). This is probably unfair as they might do a great job with "regular" stuff but going into a hospital takes a lot of trust on the patient's side and I doubt many would still trust them.

[Lisbeth]

I still can't believe we are sending thousands of our troops into the heart of this "plague." What a disaster in the making.

[Twolittleboys]

I still can't believe we are sending thousands of our troops into the heart of this "plague." What a disaster in the making.

 

Well, first of all my understanding is that the troops would help with infrastructure etc., NOT with treating patients in the final stages of the disease so their risk of infection should be much lower. And while I hope and pray that not a single soldier will get ebola I do think that being a part of the military entails mortal danger. After all, armed conflicts/war by definition endanger lives. And while I personally am all for a humanitarian mission a case can also be made that stopping ebola in Africa is vital to keep Americans (or anyone really) safe.

[Bambam]

Interesting article from CIDRAP

http://www.breitbart.com/Big-Government/2014/10/14/CIDRAP-Confirms-Ebola-Transmittable-by-Air

[Halftime Hope]

OK, based on what several of you who have worked in hospitals have said, maybe it is possible, or perhaps you worked in hospitals like others I've seen?  I *would* believe that kind of bad decision-making about the hospital in my suburb and the one two suburbs over, based on what I have personally seen in those two hospitals from family members admitted.

 

As far as our soldiers, I heard on the news yesterday that one soldier was part of a mission delivering supplies to Sierra Leone has been tested and is being watched for ebola.  I pray it is something else!