Nursing and the Ebola Virus

lee1 · Oct 14, 2014

and where is the head covering, neck covering,face covering, pant covering, shoe covering???? Did not see that in my hospital list either of what to wear.

allnurses Guide · Oct 14, 2014

Debra Burger - President of the California Nurses Association - on Ebola

Bengalcat · Oct 15, 2014

The U.S. needs to restrict air travel from the Ebola hot zone into this country. Needed medical and relief personnel can be transported by military transport and undergo the necessary isolation precautions when returning in country. If the U.S. led in this, other world leaders would follow suit. Twenty nations have already instituted travel restrictions.

The rationale given by the CDC, et al., for not implementing this very basic, public health precaution is ludicrous on every count. The government's reliance on airport personnel to effectively protect the public health by taking patient temperatures as they disembark in our nation's airport terminals is wantonly inadequate, if not negligently criminal. Our healthcare system is not sufficiently prepared to safely and effectively handle an Ebola outbreak in this country as reflected by the recent NNU survey. And I don't give a rat's backside about hypothetical ROT models which, in any case, are predominately based on fatality rates in remote locations, not densely populated, Western nations and, thus, because of this and other, unknown variables highly unreliable. Further, for me, there is no acceptable casualty rate. Any Ebola death in this country, be it a healthcare worker or patient, is unnecessary. Heck, even the family dogs and cat deserve better.

Two-thirds of the American public wants air travel restrictions imposed. As a nurse, my duty is to:

- Serve as an advocate on behalf of the public, patients, and coworkers

- Protect myself, my coworkers, my patients, and the public at large, including my family from harm or any potential harm

- Inform the public--not relieve public concerns with Pollyanna, false reassurances.

Nurses and firemen are accorded the greatest public trust. If our national leaders do not take responsible action--and immediately--I think nurses and their unions are ethically bound to consider calling a strike.

Sloan RN · Oct 15, 2014

Nurses are ethically bound to educate themselves using reliable sources and not media hype or misinformation.

Restricting travel would be extraordinarily difficult. Keep in mind you would be attempting to quarantine over 20 million people for a disease that has caused 8,400 cases. Allowing healthcare workers in and out via military planes is all well and good, but keep in mind those healthcare workers probably have MUCH more exposure to the virus than a typical civilian in those countries and PPE over there is not the best. Yet aid workers certainly would not be willing to go if they knew they couldn't get out.

What about other kinds of aid workers? Like those helping with malaria or AIDS? What about missionaries? How do you decide who is screwed and who gets to leave? It's just not feasible.

You simply cannot stop people from traveling. Would you build a huge fence around all the countries? Have guards stand shoulder to shoulder along the border? People would simply leave the country on foot or by car or whatever and take planes from non-quarantined countries.

The best way to control the situation is to send as much aid as we can to Africa to help stamp it out there. We are capable of controlling the virus here. Remember, Ebola has about a 50% fatality rate...in AFRICA. Where people are being treated in field tents without running water, where gloves are drying in the sun because healthcare workers have to re-use them. Where CBCs and BMPs cannot be run, let alone giving blood products and adequate IV electrolyte replacement. 50% of patients survive Ebola in those conditions. It's helpful to have some perspective. Ebola is no joke, but it's not the terrifying zombie virus the media is making it out to be.

APRN., DNP, RN, APRN, NP · Oct 15, 2014

The best way to control the situation is to send as much aid as we can to Africa to help stamp it out there. We are capable of controlling the virus here. Remember, Ebola has about a 50% fatality rate...in AFRICA. Where people are being treated in field tents without running water, where gloves are drying in the sun because healthcare workers have to re-use them. Where CBCs and BMPs cannot be run, let alone giving blood products and adequate IV electrolyte replacement. 50% of patients survive Ebola in those conditions. It's helpful to have some perspective. Ebola is no joke, but it's not the terrifying zombie virus the media is making it out to be.

I just heard that the WHO changed the fatality rate to 70% now.

dnnc52 · Oct 15, 2014

Seems like when it comes to the rationale to combat terrorist. They always say" we need to fight them over there before then can get here". So perhaps we should take the same advice with Ebola. "We need to fight it over there as well. But as soon as a high profile individual catches this infection then we will see more aggressive actions taken. I am also very concern that most of our PPEs are made outside the USA. So in the event of an all out plague that the US would just be a part of the market of supply and demand, and our demand will greater than the supply. We need to at least when it comes to medical supplies. Start manufacturing them here. We are already sleeping with the devil to get our gas needs covered!

Libitina · Oct 15, 2014

BBC News - Ebola outbreak: Second Texas health worker 'tests positive'

A second health worker in the US state of Texas has tested positive for Ebola, health officials say.

3fins · Oct 15, 2014

So now we have a second positive - as well as more info coming out about decrepit conditions under which Duncan was cared.

First off, Tom Frieden of the CDC should resign. The CDC wasn't monitoring hospital operations in any way, there were no protocols in place, healthcare workers received no hands on training.

Workers were using medical tape to rig up ill-fitting PPE. Also reports the trash in Duncan's room was piling up to the ceiling.

As an ICU nurse I have to ask, WHY DIDN'T THE ICU STAFF REPORT *** WAS GOING ON, WHEN IT WAS GOING ON??? WERE THEY THAT CLUELESS ABOUT THE RISKS??? An anonymous phone call to a news organization is all it would've taken.

You do have the right to refuse an assignment, especially when conditions are unsafe. While I sympathize with the victims, there is an element of stupidity and ignorance here that cannot be denied.

I can steadfastly say even before Duncan showed up I would have refused an Ebola assignment on the grounds I do not have the training to care for such a patient. It was something I had considered and even discussed with coworkers. Central lines, intubation, dialysis, diarrhea. blood draws, etc. There's a tremendous amount of bodily fluids you're going to be dealing with, much more than aid workers are being exposed to in Africa.

I work at one of the most prominent, well respected hospitals in the country. We still have not received any training in regards to handling Ebola. You can bet if a suspected case rolls into the ICU I'll be walking the other way, guiltless.

MissyWrite · Oct 15, 2014

Nurses from the hospital in Dallas have come forward to report on the deplorable conditions they had to work under while caring for Mr. Duncan.

"Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for the patient"

"hazardous waste was allowed to pile up to the ceiling"

"Nurses treating Mr Duncan were also caring for other patients in the hospital"

"they had to “interact with Mr Duncan with whatever protective equipment was available,” even as he produced “a lot of contagious fluids”

And so much more: Nurses allege staff worked with ebola patient 'without proper protective gear' | BreakingNews.ie

This hospital made one error after the next. So far, two nurses are infected. Why are they still permitted to care for Ebola patients? The administrators should be brought up on criminal charges, and the nurses should sue the heck out of them. The whole thing is totally outrageous.

MissyWrite · Oct 15, 2014

3fins, I agree with you. I too would be walking the other way, guiltless. They should have let the negligent administrators provide the care.

I wonder how many more nurses (and possibly other staff) will develop Ebola from this deplorable situation? What a nightmare -- a real nightmare.

What I don't understand is how the CDC recommendations differ so much for healthcare workers and workers in research labs working with Ebola, under very controlled conditions. Mr. Duncan was having explosive diarrhea and projectile vomiting, at a highly contagious time in his illness. These are totally uncontrolled conditions filled with highly concentrated sources of the virus.

Here are their recommendations for workers in BioHazard Safety Level 4 Labs:

"The microbes in a BSL-4 lab are dangerous and exotic, posing a high risk of aerosol-transmitted infections. Infections caused by these microbes are frequently fatal and without treatment or vaccines. Two examples of microbes worked with in a BSL-4 laboratory include Ebola and Marburg viruses.

BSL-4 laboratories have the following containment requirements: Laboratory practices

Change clothing before entering.
Shower upon exiting.
Decontaminate all materials before exiting.

Safety equipment

All work with the microbe must be performed...wearing a full body, air-supplied, positive pressure suit.

Facility construction

The laboratory is in a separate building or in an isolated and restricted zone of the building.
The laboratory has dedicated supply and exhaust air, as well as vacuum lines and decontamination systems."

CDC LC Quick Learn: Recognize the four Biosafety Levels

Here's a provocative article by a man who "work for many years under a few of the most renowned infectious disease experts (microbiologists, immunologists, and epidemiologists) on the planet." It's a must-read. He says that the garb we see aid workers wearing in Africa -- Tyvek suits, Tyvek hoods, paper face masks, goggles or a face shield that is open at the bottom, heavy rubber gloves and boots -- IS NOT ENOUGH.

Read more at Is protective gear inadequate to stop Ebola?

3fins · Oct 15, 2014

This hospital made one error after the next. So far, two nurses are infected. Why are they still permitted to care for Ebola patients? The administrators should be brought up on criminal charges, and the nurses should sue the heck out of them. The whole thing is totally outrageous.

Any lawsuit will fall flat. Medical waste piled to the ceiling? Cmon, people - call a spade a spade. RN and other staff knows better than to care for a patient under such conditions. You do have a right, even a responsibility, to refuse an assignment.

The CDC was nowhere to be found at the hospital and administration was on their own attempting to manage the problem. Hate to say it, but it looks like everyone involved in care, including the RNs can be labeled "at fault."

I'm expecting Tom Frieden's resignation sometime today.

MissyWrite · Oct 15, 2014

I'm expecting his resignation, too. And if he doesn't resign, he needs to be fired. What an ineffective and incompetent nitwit.

Here are some of the measures taken at Emory and Nebraska to contain the virus and protect staff:

"The team uses full-body protection because its nurses may be in the room with a patient for three to four hours a day and they are dealing with patients with a lot of vomit and diarrhea. They’ve created a lab within their unit so that no Ebola-contaminated specimens could spill and cause a contamination “disaster.” All of their waste, garments, sheets, etc, are autoclaved on site—a process that uses a pressure chamber to sterilize equipment. Nebraska has a similar set-up. They also autoclave their waste, use a hospital-grade disinfectant that’s poured into the toilet for 10 minutes prior to flushing..."

Emory and Nebraska Doctors Give Ebola Care Advice

And the REASON medical-grade disinfectant is used 10 minutes prior to flushing is that waste becomes AEROSOLIZED when flushed, providing another avenue for infection.