Toward a Level 4 Protocol for Ebola

Nurses COVID

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I've looked over the Ebola safety protocol for health care workers and was a little shocked.

Anyone who might be working with treating a patient in the future might try putting some gloves on at home, dipping them within a centimeter of their edge in paint, and trying to remove them without getting a single speck of paint on their skin using any protocol - not easy to do.

Comparing the health care protocol with the level 4 biohazard safety protocol for lab techs working with Ebola http://en.wikipedia.org/wiki/Biosafety_level#Biosafety_level_4 shows rather large gaps. To be fair, it would obviously be impractical to construct level 4 containment facilities in all hospitals by tomorrow. It would be reasonably easy, on the other hand, to start implementing some of the level 4 standards. Starting with:

- Positive pressure safety suits with a segregated air supply for health care workers

- UV light treatment, vacuuming, and showering in disinfectant solutions before suits are removed. (This would be analogous to washing paint off a glove that went all the way up your arm before removing it - not a speck of paint would hit your skin.)

Has anyone discussed something like this with hospital management? Are your suits on their way? If I were a nurse I'd get my own level 4 PPE and tell the staff they either let me use it or "I'm not going in there" as a form of self preservation, determination to win a war with a case of the disease, and extremely reasonable civil disobedience.

I'll research this more this evening.

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Specializes in Operating Room.

I mentioned something like this at my hospital meeting and was basically ridiculed. I agree though- I may just purchase my own stuff and tell them this is the only way I'm going into that room.

My hospital is NOT prepared for this, either on a practical level or a psychological/ emotional level. They aren't great with new technologies, new ways of thinking.

We're doomed,lol.

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Nathan....as you are not a nurse.....out of curiosity, what is your interest? Given your familiarity with Level 4 safety equipment, do you work in sales of PPE by any chance? Do you sell to large facilities....or individuals?

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I am just a concerned citizen. There is some sense of mystery around the deaths that have already occurred and I just wonder if future deaths could be prevented with the better suits and disinfection procedures. While I'm not an expert myself, these ideas were gleaned from protocols with a proven track record and developed by experts.

Nurses should not be dying from this stuff in developed nations - if hospital staff meetings ridicule ideas like these, ask them to explain how two nurses have contracted the disease and then ask them to explain why higher level PPE and protocols are a bad idea. I bet they'd fall silent and then consider making some changes. I bet this would save lives.

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I am just a concerned citizen. There is some sense of mystery around the deaths that have already occurred and I just wonder if future deaths could be prevented with the better suits and disinfection procedures. While I'm not an expert myself, these ideas were gleaned from protocols with a proven track record and developed by experts.

Nurses should not be dying from this stuff in developed nations - if hospital staff meetings ridicule ideas like these, ask them to explain how two nurses have contracted the disease and then ask them to explain why higher level PPE and protocols are a bad idea. I bet they'd fall silent and then consider making some changes. I bet this would save lives.

The nurses followed the CDC protocol that is the very scary part. If you listen to the news the nurses are demanding better equipment and better staffing.

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You could probably split the cost of the equipment with some of your fellow staff and let whomever is assigned to care for a patient use it for their shift. The hospital should reimburse you guys at some point I'd think.

Everyone tends to reference the local experts, the authorities, and existing protocols in situations like this - almost as if they are afraid to try something new when they could hide behind something already legally acceptable. What is really needed is for the top experts at e.g. the CDC to sit down and think about this stuff from first principles, upgrade the protocols, make them legal, and implement them.

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Aha - the CDC is crowdsourcing solutions as we speak!!! Check it out: CDC - Blogs - CDC Director Blog – Guest Blog: Calling all Innovators to Help Fight Ebola

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Specializes in LTC Rehab Med/Surg.
You could probably split the cost of the equipment with some of your fellow staff and let whomever is assigned to care for a patient use it for their shift. The hospital should reimburse you guys at some point I'd think.

Everyone tends to reference the local experts, the authorities, and existing protocols in situations like this - almost as if they are afraid to try something new when they could hide behind something already legally acceptable. What is really needed is for the top experts at e.g. the CDC to sit down and think about this stuff from first principles, upgrade the protocols, make them legal, and implement them.

Don't the suits need hosed down with bleach between uses? How would that be accomplished in an isolation room?

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I am just a concerned citizen.

Thank you for answering the question about your interest, but this really doesn't tell us your interest and allow us to gauge our responses accordingly.

There's no personal gain for you in having this conversation with allnurses members?

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Specializes in Critical Care.

Even if you could buy your own suit it would still need to be cleaned and sterilized before you could use it again. Who would do that? How would they do that. If you didn't pass the TB test you would be given a respirator to wear over your head, but no one ever cleaned it. It just sat in a cabinet till it was used. That is pretty scary especially when you think about Ebola. The suits and respirators need to be cleaned properly between uses unless they are meant to be thrown away. I'm sure that would cost more money than any hospital would be willing to pay. I don't know of any hazmat suits wear I work. If we did would they have one that fit everybody? What about the plus size nurses out there would there be hazmat suits that fit them? A gown doesn't begin to provide adequate protection as far as I'm concerned.

The National Nurses United has been outspoken over safety concerns and missteps at the Dallas Hospital and lack of equipment and preparation across the country. They seem to be the only ones speaking out for the healthcare workers. Where would we be without an effective advocate like them? They have even sent a letter to President Obama asking for national guidance on adequate protection, equipment and preparedness. Who else has spoken up for the nurses? Not anyone else, that I'm aware of!

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Specializes in ICU.

Nurses are disposable, administration doesn't care. My hospital just got named as an Ebola treatment center in my state. I saw it on the news that they are building an isolation unit *inside of MY unit.* I found out from a friend (who doesn't work at my hospital, incidentally) reposting a NEWS WEBSITE on Facebook.

I wonder if we were supposed to find out that we were a designated Ebola treatment center and that my unit is where they'll go by getting an Ebola patient. You think that if they don't even care enough about us to tell us, that they'd actually buy us protective equipment? That's pretty funny. I'm also too broke to buy my own.

They also haven't mentioned if we're allowed to refuse to care for these patients or not. I'll have to decide if it's worth my job to refuse, should this situation occur. If all they give us is normal isolation gowns and an N-95, I'm not doing it. I'm sure that's probably what Nina Pham and this other nurse were wearing. I'm not terribly interested in risking my life. If they give us suits, sure - I think Ebola is interesting and I wouldn't mind helping up close, but otherwise, they can find somebody else or they can fire me.

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Specializes in RN CRRN.

How can scientists suit up in the hazmat suits in the level 4 biohazard/containment lab at the CDC in order to work with Ebola in a petri dish, but nurses were even allowed to go in with just a gown gloves and mask to treat a patient with diarrhea etc.?

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