Nursing and the Ebola Virus

[0.adamantite]

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.

[MassED, BSN, RN]

macawake said:

Regarding monoclonal antibodies. As I'm sure that most/all of you already know, anaphylaxis is a systemic hypersensitivity reaction mediated by interactions between immunoglobulin IgE and mast cells.

The first monoclonal antibodies were murine-derived and were highly immunogenic to

humans, i.e. had a very high risk of anaphylactic reactions. After that came chimeric monoclonal antibodies which consisted of approximately one third mouse proteins. Then came humanized monoclonal antibodies (~10% mouse protein) and fully human (protein) monoclonal antibodies (no mouse protein).

As far as I know, both chimeric, humanized and fully human mab's are in clinical use today, but it's not my area of expertize so take it with a grain of salt.

The risk of an anaphylactic reaction (by a human being) to a specific monoclonal antibody depends on how much mouse protein it contains.

I'm curious, what human virus can you name that has changed its' mode of transmission to airborne can you name?

Quite a few posters seem to worry about the Ebola virus changing its' mode of transmission.

Much more than a 100 million people have been infected by the Hepatitis C virus since it was discovered. Yet, today it is still transmitted the same way that it was when it was discovered in the 1980s'.

The Ebola virus doesn't attack or dwell in the respiratory system in human beings, it's partial to the liver. What would be this virus' evolutionary motivator to suddenly find a way to attach to cells and replicate in the airways?

I believe that it's understandable but misguided fear, and most definitely not scientific knowledge, that is the reason behind worry for possible future airborne transmission of the Ebola virus.

"Ebola is an RNA virus, which means it mutates once or twice every time it copies itself. This could change the way the virus operates when inside the human body."

"Ebola does share some of the characteristics of airborne viruses like influenza and we should not disregard the possibility of it evolving into something that could be transmitted in this way," added Sanders, whose work on Ebola led to his participation in the U.S. Defense Threat Reduction Agency's Biological Weapons Proliferation Prevention Program.

"I want the facts to be clear. It's important that we not get the idea that this can't happen," he added. "When people say that it is impossible for this virus to mutate, this is simply not true."

To pose a major threat in the U.S., the Ebola virus would have to mutate so that it could survive outside the body for a significant length of time like influenza can, Sanders said.

"This is not how the Ebola virus is currently known to spread, but there is evidence that it has some of the necessary components for respiratory transmission," he said.

Read Latest Breaking News from Newsmax.com Experts: Ebola Could Spread Like Cold or Flu

[Libitina]

MassED said:

Don't you think that a healthcare individual would take EXTRAORDINARY care in the placement and removal of their PPE??

I'm a theatre/OR nurse and said to my husband that people shown at Duncans apartment and in Africa weren't removing their PPE properly and having seen training footage of the extra steps being used for removal of PPE after contact with infected patients then yes, I can see contamination occuring.

I do feel the Spanish nurse was pushed into stating it was basically her own fault because she may have touched her face with a glove though.

[CrunchRN, ADN, RN]

Panic is as much or more of a danger...........................

[MassED, BSN, RN]

Libitina said:

I'm a theatre/OR nirse and said to my husband that people shown at Duncans apartment and in Africa weren't removing their PPE properly and having seen training footage of the extra steps being used for removal of PPE after contact with infected patients then yes, I can see contamination occuring.

I do feel the Spanish nurse was pushed into stating it was basically her own fault because she may have touched her face with a glovethough.

perhaps she touched something.... it's the unknown details that leads to some speculation. One cannot expect every person to be perfect in their donning and removal of PPE. This is precisely why these patients should be in a specific facility specially made to house these deadly diseases and their hosts.

[MassED, BSN, RN]

imintrouble said:

I'm sorry that this man has died. But I can't help but wonder if he might have lived, if he'd told the ER staff on the first visit, that he'd had close contact with a dying Ebola patient in Africa.

To me it reaffirms the importance of being completely honest with health care professionals.

That rarely happens. People are afraid of being stigmatized, or for whatever other reasons they choose not to divulge everything. This is why, as ER nurses, we know to believe little of what a person says and err on the side of caution and assume they're being dishonest. Acting with a certain criteria and an abundance of caution might catch those that are being dishonest. Vital signs and symptoms do not lie. Such as a heart rate of 60 and 10/10 reported pain.

[SandyB]

I'm a theatre/OR nurse and said to my husband that people shown at Duncans apartment and in Africa weren't removing their PPE properly and having seen training footage of the extra steps being used for removal of PPE after contact with infected patients then yes, I can see contamination occuring.

I do feel the Spanish nurse was pushed into stating it was basically her own fault because she may have touched her face with a glove though.

The problem is, the right PPE should have meant she couldn't easily touch her face with a glove.

BBC News - How not to catch Ebola

Are nurses as well protected as journalists?

[RNsRWe, ASN, RN]

SandyB said:

The problem is, the right PPE should have meant she couldn't easily touch her face with a glove.

BBC News - How not to catch Ebola

Are nurses as well protected as journalists?

C'mon, everyone knows nurses are much more expendable!

[Willow_RN]

I'm reading multiple reputable sources saying to wear head to toe gear but my hospital says it's just droplet isolation- wear a plastic gown, gloves and mask with face sheild. I do not believe this. I am truly afraid for my life should I be forced to care for an Ebola patient under these conditions. I'm also expected to go home (to my husband, small children and dog) in my scrubs and shoes that were not fully covered. We won't be hosed down with chlorine or have a buddy to help us remove our PPE under the current guidelines.

[Libitina]

So now one of the Sheriffs department ( who entered the apartment without any PPE) is possibly showing symptoms too apparently. He walked into a medical centre where they called an ambulance for him.

Yet more potential mistakes ...

[MassED, BSN, RN]

Willow_RN said:

I'm reading multiple reputable sources saying to wear head to toe gear but my hospital says it's just droplet isolation- wear a plastic gown, gloves and mask with face sheild. I do not believe this. I am truly afraid for my life should I be forced to care for an Ebola patient under these conditions. I'm also expected to go home (to my husband, small children and dog) in my scrubs and shoes that were not fully covered. We won't be hosed down with chlorine or have a buddy to help us remove our PPE under the current guidelines.

Amen to that. We don't have full body suits or any specific buddy system in place. No way to dispose of waste, no dry runs of what we do when an Ebola-suspected patient checks in.. We are also told negative pressure rooms are appropriate. We are not prepared. Period.

[MassED, BSN, RN]

I'm reading multiple reputable sources saying to wear head to toe gear but my hospital says it's just droplet isolation- wear a plastic gown, gloves and mask with face sheild. I do not believe this. I am truly afraid for my life should I be forced to care for an Ebola patient under these conditions. I'm also expected to go home (to my husband, small children and dog) in my scrubs and shoes that were not fully covered. We won't be hosed down with chlorine or have a buddy to help us remove our PPE under the current guidelines.

I don't believe one can be forced to care for a patient with Ebola if one doesn't believe there is appropriate and adequate PPE. Safety for staff is paramount. I'd take my chances with HR on that one.

[sistrmoon, BSN, RN]

Don't you think that a healthcare individual would take EXTRAORDINARY care in the placement and removal of their PPE??

I sure do. But here's the latest update:

http://www.washingtonpost.com/news/to-your-health/wp/2014/10/08/spanish-nurse-says-she-has-no-idea-how-she-got-ebola-as-her-family-fights-for-their-dogs-life/

Honestly, if it's that easy to contaminate during removal, I think the suit should be washed down before removal, a 2nd person should assist or the suit should be redesigned.