Nursing and the Ebola Virus

[RN., MSN, RN]

http://news.nurse.com/article/20141013/NATIONAL06/141013015?sf32476479=1#.VD8WgDe9KSN

Emory Nurses decreased their work hours from 12 hour shifts to 8 hour shifts with a 45 minute break and a shower after 4 hours. The physicians would cover for them while they were on break. The nurse would then return for the last 4 hours and go through 18 steps to apply full PPE.

Note that the comment about it being so claustrophobic wearing a HELMET AND A HOOD for that long......Hmmmmm. I wonder if the Texas nurses had that level of protection?

QUOTE: "Practicing what we had learned during training versus applying it in a real situation were quite different experiences," Hill said. "We had to adapt and customize along the way. We had trained for the nurses to work 12-hour shifts, but we realized that wearing the PPE [personal protective equipment] for that long was not going to work. It can get claustrophobic staying in one room wearing a white suit with a helmet and hood for so many hours."

[MassED, BSN, RN]

I am not understanding why the need to stay in a patient room for an extended period of time. Get in, get out, as little time in full PPE, the better and less chance for exposure from an extended time in the patient's room.

Even cleaning the room, drawing labs, obtaining vs are all things that can be done in much less time. Are they providing companionship or something? This seems ridiculous to me.

Edited Oct 16, 2014 by MassED

[calivianya, BSN, RN]

I am not understanding why the need to stay in a patient room for an extended period of time. Get in, get out, as little time in full PPE, the better and less chance for exposure from an extended time in the patient's room.

Even cleaning the room, drawing labs, obtaining vs are all things that can be done in much less time. Are they providing companionship or something? This seems ridiculous to me.

I think it's because they have more risk of exposure if they are taking off their PPE more often. Did you watch the video? That PPE is ridiculous - pretty much impenetrable. It's like a space suit. They are safe while they are in it, unless the patient stabs them with a syringe or something. It's when the PPE comes off that they get exposed. With Emory's plan, if they take off their PPE three times, they only risk exposure three times in twelve hours. If that nurse is doing things every hour, like hourly urine/lots of IVBP/etc., they'd risk exposure at least twelve times per shift if they only came in and out when they needed to.

Besides, they said it takes 20 minutes to put on and 20 minutes to take off... can you even imagine? That only leaves 20 minutes free every single hour to get patient care/charting/etc done if you are going in every hour and spending 40 minutes putting on/taking off PPE.

Would I care for an Ebola pt? yes. Ideally, only after training for level 4 bio safety/hazard training and was equipped w/airborne PPE and rubber. I have had the discussion with other RNs... It's been 50/50 yes/no. I think the decision is solely up to the RN and their decision should be respected.

And I DEFINITELY think the gov't is down playing the potential airborne and spread of this. ERs/Hospitals would not be able to sustain themselves w/the influx of pts who think they have Ebola w/flu like symptoms. Which in turn takes resources away from pts with other needs.

They also need to get there sh** together and start treating RNs like Golden Gods, we should be getting anything we ask for in terms of EVD, right now, like yesterday NOW. Bc if this thing really kicks off and RNs (i.e. me) don't feel 100% supported

and safe, the gov't leadership can have a field day cleaning Ebola diarrhea.

One. Time gov't. One time, just this once... Please don't screw this up!

Edited Oct 16, 2014 by Foreverinschool
Typo

Under the circumstances at Emory I would take care of an Ebola pt as well… at the Dallas Hospital? Well, not unless I was suicidal which I am not… Those poor staff have been denied basic equipment and safety precautions. It is criminal what that hospital did to those nurses!!!

[MissyWrite]

I am not understanding why the need to stay in a patient room for an extended period of time.

The biggest risk of contracting Ebola is during the removal of PPE (when your PPE is sufficient to begin with, otherwise the risk is just as great during patient care).

In addition, proper PPE takes time to put on and take off the right way. 10 to 20 minutes for each.

[MissyWrite]

The CDC has now admits their PPE guidelines were too lax. Finally! They have issued new guidelines 'based' on those used by MSF, but still not as stringent.

To see photos of old vs new, and read more about the bumbling CDC, read http://www.nytimes.com/2014/10/16/us...-say.html?_r=0

Sean G. Kaufman, who oversaw infection control at Emory University Hospital while it treated Dr. Kent Brantly and Nancy Writebol, the first two American Ebola patients, called the earlier C.D.C. guidelines "absolutely irresponsible and dead wrong."

HOW could the CDC not have known this? It is mind-boggling to me, absolutely amazing and ridiculous. And I feel the new guidelines still fall short, although they are an improvement.

"Ebola kills 50% to 90% of people who become infected, which is much higher than any other infection we are used to dealing with. The 2009 influenza pandemic killed less than 0.01% of those infected, and SARS killed 15%.The price of getting it wrong with flu guidelines might be a week in bed, but for Ebola it is far more likely to be death."

[dnnc52]

So we are not stopping or restricting folks from these high risk regions. But some of the major airports are going to have increased screening. At which time they will place those who are suspicious in quarantine. Then if they develop Ebola they get transferred to a US Hospital, where they can receive the best treatment and care?. So if I am sick and I can get to the USA then I have a better chance of tx. As well as not being a financial burden to my Motherland. Time to close travel. . Seems to me that is a hard call. So just monitoring air-travel is not going to be the answer. We must restrict all travel from these high risk regions? We always hear about terrorism that if we don't defeat them over there we will be fighting them here. Well Ebola is the same concept lets defeat over there...

Edited Oct 16, 2014 by dnnc52

This morning, before we knew that the second RN had called the CDC before flying and told it was safe, was being defamed by the media and internet trolls when it dawned on me that the gov't refuses to ban flights from the three countries in Africa but counting on travelers to "self-report" and go through ineffective, lame airport temperature checks thereby very possibly allowing hundreds of infected people into the country and that's ok while this poor nurse, an American citizen yet, was being called a criminal and that she should go to jail!!!

Crazy!!!!!!

So I've been doing some digging. Trying to remain factual, but I'm not going to lie, my head can't help but to do the "what if" dance, every time I see someone from over there dying, who's traveled. I'll try to lay it all out without jumping all over the place, please bear with me.

9/16- Duncan's sister dies from Ebola

9/19- Duncan leaves Liberia, and goes to Brussels, then Washington, headed for Dallas

9/20- Duncan arrives in Dallas

9/26- Duncan goes to an ER and complains he's not feeling well and has come from Liberia (nurse fails to communicate) Duncan sent home

9/28- Duncan is picked up by ambulance and taken back to the same hospital he went to previously.

9/30- Is proven to have Ebola

So this guy was flying while infected. They say that because he was showing no symptoms he wasn't contagious, so people on the planes are fine. It's only the time from 9/26-9/28 that we need to worry about according to the news and CDC. They say there was about 18 people he came into contact with, and they're all being monitored. Schools have sent out letters to parents, schools are being wiped down and cleaned. Now some news sites are saying that United Airlines is trying to get in contact with people who flew on the same flights as this man because it is now released that he flew in from Brussels to Washington Dulles on his way to Dallas. Why are they trying to find the passengers who flew with him if he wasn't symptomatic? Just to make sure? That's great but they have repeatedly said it's not a droplet transmission and there's no risk until symptoms show. Weird.

There's absolutely 0 reason that we should be accepting flights from affected countries. The world is too mobile these days, and as such much smaller than it used to be. This sort of thing while we can possibly deal with in a correct and safe manner in trickles, does not lend itself well with the shape our hospitals are in when it comes to people being infected in droves. In my mind it's a recipe for disaster, and that's not being a sensationalist. There's 0 reason we should be risking the lives of the people here at home, and our already overworked medical professionals. While our level of care here is better than a third world country obviously, we're just not ready to take on the kind of numbers that something like this could possibly bring if it gets out. So why bother even testing the waters? They wanna bring back sick workers being monitored from Liberia to here and expecting them and knowing where they're going to put them and preparing for them beforehand? Fine. That I'm not crazy about, but I can handle that a whole lot better than the idea of every sick African who thinks the USA is now a magical place of ZMAPP cures and lollipops hopping a plane to our shores because they think their life is worth risking millions and our government agreeing with them.

I just don't understand.

According to CDC it's contagious if you're febrile!

Sent from my iPhone using allnurses

Someone responded perfectly around page 10 or so. Typical archaic, forceful, threatening attitude that I have encountered far too often in my career...so happy I haven't become that way

[RN., MSN, RN]

Thank You Brimfield Police Department! Very Well Said!

https://m.facebook.com/story.php?story_fbid=930447536984290&id=124800457549006

[dnnc52]

darn I was on pg 10 hope it was not me. But sounds like.

[1KoolRN]

2 words: SAFE HARBOR !!

]IAFF Calls for Safety Stand Down for Ebola Preparedness

http://www.sconfire.com/2014/10/16/iaff-calls-safety-stand-ebola-preparedness/

[dnnc52]

I am wondering while these nurse are wearing the Extreme(but necessary ) PPE. Seems that charting would be very difficult. Are they able to use a dictation device or something?. I could not imagine wearing that PPE for 4 hrs. I know I would be claustrophobic and would feel very surreal. I would not be on top of my game. Just being honest and no need to worry because I am retired. But still in the corner praying and doing what I can to support our family of Health Care Workers..

[Karou]

I am wondering while these nurse are wearing the Extreme(but necessary ) PPE. Seems that charting would be very difficult. Are they able to use a dictation device or something?. I could not imagine wearing that PPE for 4 hrs. I know I would be claustrophobic and would feel very surreal. I would not be on top of my game. Just being honest and no need to worry because I am retired. But still in the corner praying and doing what I can to support our family of Health Care Workers..

I imagine that they have computers in the room to chart on, so they do not have to leave to chart. If they are spending four hours in the room to reduce the frequency of removing/applying PPE then they probably have some down time to chart. I know not all hospitals have computers in the rooms but in this situation that is just how I envisioned it. Sorry if this was already addressed/answered, I didn't read all the pages of replies.

I couldn't imagine wearing PPE for that long either. Same reason why I couldn't be in the OR. Masks for too long make me nauseated even with fresh breath and peppermint oil.

So we are not stopping or restricting folks from these high risk regions. But some of the major airports are going to have increased screening. At which time they will place those who are suspicious in quarantine. Then if they develop Ebola they get transferred to a US Hospital, where they can receive the best treatment and care?. So if I am sick and I can get to the USA then I have a better chance of tx. As well as not being a financial burden to my Motherland. Time to close travel. . Seems to me that is a hard call. So just monitoring air-travel is not going to be the answer. We must restrict all travel from these high risk regions? We always hear about terrorism that if we don't defeat them over there we will be fighting them here. Well Ebola is the same concept lets defeat over there...

There are no direct flights to the US from any of the affected African countries. People there fly to some other part of the world (typically Europe) and switch planes to come here. So, are we going to shut down all flights from Europe?? We would have to basically close the US to all air traffic entirely to accomplish what you are calling for. Maybe you think that makes sense and is a workable solution, but it doesn't seem v. promising to me.

[MassED, BSN, RN]

The biggest risk of contracting Ebola is during the removal of PPE (when your PPE is sufficient to begin with, otherwise the risk is just as great during patient care).

In addition, proper PPE takes time to put on and take off the right way. 10 to 20 minutes for each.

which has nothing to do with staying in a room for an EXTENDED period of time. Initially, these patients are not very sick outwardly. I think that if they could be trained to take their temperatures every hour and show the staff through a window, as well as spiking new bags of IVF (which a monkey could be trained to do), then that would eliminate going into the rooms as much. What else are you doing in a room? Beyond labs, IVF, vital signs.... I can't imagine why one would need to be in a room all shift long. So you don/doff 20 minutes at a time and not go back in for hours, but visualize the patient from a window/video area, that seems reasonable to me.

Also, what about the nurse having to void? drink water? It would be impossible not to sweat and become dehydrated, and when you urinate every hour, what are you going to do?

There are no direct flights to the US from any of the affected African countries. People there fly to some other part of the world (typically Europe) and switch planes to come here. So, are we going to shut down all flights from Europe?? We would have to basically close the US to all air traffic entirely to accomplish what you are calling for. Maybe you think that makes sense and is a workable solution, but it doesn't seem v. promising to me.

Passengers on all incoming, international flights are required to present their passports/visas before entering the country. It is irrelevant that there are no direct flights arriving in the U.S. from Sierra Leone, Guinea, and Liberia.

That said, it is certainly possible that a relative few could circumvent a travel band, if they had a second passport.