Nursing and the Ebola Virus

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For those of us in unaffected countries, are you concerned about the ebola virus spreading? Would you care for ebola patients? I live in an area with a very high density of African immigrants and come into contact with these individuals regularly. We have a lot of African immigrants who bring back tuberculosis from their home countries and at my unit we end up caring for them. We take care of a lot of rare infectious diseases. I was reading an article and it dawned on me how plausible it would be for me to encounter this virus. And I admit, it's terrifying and I might refuse that assignment. Many healthcare workers in Africa are dying because of caring for the ill.

It's an unknown ebola patient, that is what scares me. People are leaving the area as quick as they can. That patient even lied, just to get out. And he KNEW he was exposed. He left because he was afraid.

As I mentioned in my earlier post, look no further than Andrew Speaker, the XDR-TB patient who knowingly traveled by airplane in order to reach the US.

The most at-risk nurses are the ones in the ED, by far... Especially the ones in triage.

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As I mentioned in my earlier post, look no further than Andrew Speaker, the XDR-TB patient who knowingly traveled by airplane in order to reach the US.

The most at-risk nurses are the ones in the ED, by far... Especially the ones in triage.

This seems like such a no brainer, but apparently (by virtue of the many threads/posts of nurses so upset that these two patients were brought in) it's not so obvious. TWO patients were brought into the country under EXTREMELY controlled conditions. Precautions were ridiculously overboard, and yet these TWO patients are going to signal the beginning of a horrific epidemic. Meanwhile, we have open borders with no way to ascertain whether or not a patient is lying about being symptomatic. But of course no one notices that this is a problem because they are otherwise engaged freaking out about two patients brought in under armed guard, with escorts dressed for a nuclear holocaust, to a unit specifically designed for such an occurrence. Triage nurses manning our ED departments nevertheless go about their business greeting patients in the ER without these Herculean precautions and there is very little concern...very very bizarre imo...

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Meanwhile, we have open borders with no way to ascertain whether or not a patient is lying about being symptomatic.
Shortly after the original SARS outbreak, I often traveled to Hong Kong. Before reaching passport control, passengers passed through a thermal imaging station to identify those who were febrile. Seems a wise course of action. Not sure what they did with those who read hot, though.

Triage nurses manning our ED departments nevertheless go about their business greeting patients in the ER without these Herculean precautions and there is very little concern.
Not so sure about that... Myself and my colleagues are quite concerned and aware that flu-like sx could signal an Ebola infection.

We're still doing our jobs but I wouldn't say that "there is very little concern" on behalf of the triage nurses or the nurses in the pods.

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Specializes in ER.
Okay, but where is the "case closed" coming from? That suggested to me that you were getting from your link that this disease is airborne, therefore "case closed." First of all "case closed" does not say to me that anything needs more studying, since it's clearly established. Second, I don't see why you linked that article, as it did not indicate to me AT ALL that airborne transmission has been established as a mode of transmission.

I'm all for caution, I'm not flippant, and I don't believe many are in the face of such a virulent infection. However, I believe strongly in looking to science and SOUND research methods. I take issue with anyone who follows a poorly backed up assertion with "case closed," regardless of which side of the argument they are taking.

Due to the possibility that it is airborne, that is the reason it is "case closed." The fact that there is more to this strain and that people being so confident in their assertion that "it is not airborne." There is much to be learned about this strain. I have provided many links in my previous posts regarding this topic.

It seems there is a great divider between those who believe Ebola is a threat and others who believe it is not.

I cannot understand this divide, but hope medical professionals will be cautious, educate themselves through many sources, and using common sense. Saving two at the potential cost of millions is worth the risk? It is a moot point now. Especially when they could have received the same healthcare there, brought to them.

Keep in mind, we don't know what we don't know. No one can be so sure about any of this, so why would you not be overly cautious? What's the worst that could happen by being cautious? Ridicule and protecting life? Or the other side of that, assisting the spread....

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Due to the possibility that it is airborne, that is the reason it is "case closed." The fact that there is more to this strain and that people being so confident in their assertion that "it is not airborne." There is much to be learned about this strain. I have provided many links in my previous posts regarding this topic.

It seems there is a great divider between those who believe Ebola is a threat and others who believe it is not.

I cannot understand this divide, but hope medical professionals will be cautious, educate themselves through many sources, and using common sense. Saving two at the potential cost of millions is worth the risk? It is a moot point now. Especially when they could have received the same healthcare there, brought to them.

Keep in mind, we don't know what we don't know. No one can be so sure about any of this, so why would you not be overly cautious? What's the worst that could happen by being cautious? Ridicule and protecting life? Or the other side of that, assisting the spread....

Who on this thread has said there is no need to be cautious? What many are saying is that the two patients in Atlanta are, in the big picture, pretty irrelevant in the light of the fact that we currently have open borders and with that, the more likely possibility that the infected patient you DON'T know about is the one who is going to cause the problem.

Secondly, I tried to read through this whole thread and I never saw any link you provided which gave legitimate legs to the idea that this virus is transmitted via airborne vs. droplet route. I may have missed something, but I'm not going to go back through 30 pages again.

As scary as this illness is due to its virulence and ease of transmission, if this disease were easily transmitted via the airborne route, it would be racing through the world like wildfire, with consequences only imagined in sci fi movies. IMO, we need to focus not on two patients in a very controlled environment, but on identifying potential carriers coming into our country, on strengthening our infrastructure so as to be able to care for patients in our hospitals, and on finding a vaccine or cure.

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Specializes in ER.
I agree and while I'm comforted by the many wonderful near death experiences of people who have died and been brought back that doesn't mean I'm ready to die! I think the truth is because of global travel healthcare workers in America will end up getting sick and some will probably die from caring for Ebola patients. It is only a matter of time!

The nurses at Emory are safer than the rest of us because of the special isolation wards, one of only 4 hospitals in the US. We don't have a hazmat suit where I work, they have one or two respirators for people that don't pass the TB mask test, but they aren't even regularly cleaned!

You can't even get hospitals to put in ceiling lifts to protect our backs, you think they are going to pay for special isolation protection for us? It took an Act of Congress to get safe needles in hospitals. You think they would pay for the special medicine that Samaritans Purse obtained for the Dr and nurse? They would probably say our life insurance is cheaper! Tell me if I'm wrong!

But those of us worried are simply overreacted and paranoid and don't know anything about microbiology etc? I don't think so!

:yes:

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Specializes in hospice.
Shortly after the original SARS outbreak I often traveled to Hong Kong. Before reaching passport control, passengers passed through a thermal imaging station to identify those who were febrile. Seems a wise course of action. [/quote']

And just how do we do that with people pouring across a poorly controlled border in the thousands, from nearly every country on Earth?

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Specializes in ER.
Who on this thread has said there is no need to be cautious? What many are saying is that the two patients in Atlanta are, in the big picture, pretty irrelevant in the light of the fact that we currently have open borders and with that, the more likely possibility that the infected patient you DON'T know about is the one who is going to cause the problem.

Secondly, I tried to read through this whole thread and I never saw any link you provided which gave legitimate legs to the idea that this virus is transmitted via airborne vs. droplet route. I may have missed something, but I'm not going to go back through 30 pages again.

As scary as this illness is due to its virulence and ease of transmission, if this disease was easily transmitted via the airborne route, it would be racing through the world like wildfire, with consequences only imagined in sci fi movies. IMO, we need to focus not on two patients in a very controlled environment, but on identifying potential carriers coming into our country, on strengthening our infrastructure so as to be able to care for patients in our hospitals, and on finding a vaccine or cure.

another Ebola thread... might've posted the links there, as they are paralleling each other.

https://allnurses.com/general-nursing-discussion/no-worries-usa-940124-page16.html

I never wrote that anyone on this board is not cautious. I am speaking to being abundantly cautious (the world) in reacting to this virus. I am speaking of BRINGING Ebola, within a human (where it hasn't been - ever - and in this strain) to the United States.

Bringing these two back to the US, actually is the relevant point. It is the issue that they could have controlled keeping them there, having more control over any spread (containment). That is precisely the point. I realize we have open borders, but some things are out of our control. This issue was not one of them.

Again, the "potential" for Ebola to be transmitted via the airborne route has been repeatedly made on this board.

Look how this map has morphed.

Outbreak Distribution Map: Guinea 2014 | Ebola Hemorrhagic Fever | CDC

It is spreading like a wild fire.

Anyone who feels like this is going to be like any other disease for our isolation or reverse precaution rooms are just kidding themselves. If only 4 places in the United States are able to handle Ebola patients, then what does that say about our ER's when someone checks in with worrisome s/s? Will you feel comfortable with your equipment and your facility?

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Specializes in ER.

PreventEbola.com - News

New website on Ebola, formed 8/3. Just starting to read, but worthy information.

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Specializes in ER.

Case Definition | Ebola Hemorrhagic Fever | CDC

see footnote at the bottom. "1 Casual contact is defined as a) being within approximately 3 feet (1 meter) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations); or b) having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations). At this time, brief interactions, such as walking by a person or moving through a hospital, do not constitute casual contact."

If they say being within 3 feet is a risk, then that would lead one to conclude airborne transmission is the possibility.

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As long as our borders are open, the Atlanta patients argument is a total strawman, imo.

To me, it's like walking into your home during a robbery; all five robbers have assault rifles, but fortunately, they were observed by a neighbor and the cops arrive. One of the robbers is caught, but all the others escape. The homeowner obsesses constantly that the robber will escape from prison and come back to kill him. Meanwhile, he leaves his back door unlocked every night.

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Case Definition | Ebola Hemorrhagic Fever | CDC

see footnote at the bottom. "1 Casual contact is defined as a) being within approximately 3 feet (1 meter) or within the room or care area for a prolonged period of time (e.g., healthcare personnel, household members) while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations); or b) having direct brief contact (e.g., shaking hands) with an EVD case while not wearing recommended personal protective equipment (i.e., droplet and contact precautions–see Infection Prevention and Control Recommendations). At this time, brief interactions, such as walking by a person or moving through a hospital, do not constitute casual contact."

If they say being within 3 feet is a risk, then that would lead one to conclude airborne transmission is the possibility.

No, it would lead one to conclude that DROPLET transmission is a possibility :arghh: :arghh: :arghh:

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