RedWeasel

They have downgraded our precautions saying a paper gown and paper mask is enough. (See link in previous post). I don’t know what I would do. It is under the FAQ for HCPs on CDC site today. But they also say they dont know how longnit lives on surfaces they also may expect us to clean rooms etc ...

They now want us to use paper gowns and masks With this: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/infection-prevention-control-faq.html

If they tried to make me use droplet precautions...then yes. Give me every kind of PPE within reason and no problem!

I honestly think the cdc with their recommendations to use droplet precautions are at fault. Hospital - and most others in the country had stocked paper gowns masks and face shields for an ebola response. This could have happened anywhere. Just so happened to be in Dallas. How they couldn't have planned better I don't know...but really? Droplet?

I believe an excellent interim czar (or interim head of CDC if Tom Frieden steps down) or even an advisor to the czar would be Dr Brantly. He is still getting his strength back though I am sure. He would be such a great resource on this...knowing ebola, treating it, surviving it...

It isn't Droplet Precautions that is for sure. No skin is exposed. They wear a positive pressure suit. Google the words "Biocontainment level 4." A CDC link will come up (among others - ignore those) in your search. They explain precautions for the 4 different levels of pathogen biosafety, or see link at bottom (if it is allowed). See? Droplet precautions is NOT enough, and that comes directly from the CDC website itself (but isn't mentioned in their dedicated Ebola section)! We can do this! The nurses in Dallas didn't work with ebola in a controlled environment like a lab. It sounds like it was much more 'active' so better PPE is crucial, yes? I think it is up to us to speak up and stop the whole "Droplet PPE is enough." Wish the scientists with CDC would speak up for us too, they know what they wear. We should have the same - or at least hazmat and respirator, and no exposed skin. A shower even. We need this to be airborne precautions (I know it isn't airborne and probably won't ever be). The CDC could even call it "Level 4 Precautions" if anything, since it isn't technically airborne, but it is virulent. I still hear hospitals are going with the CDC Droplet Precautions because that is how it is spread, and we keep hearing those golden words, but... "those are the current CDC recommendations for a droplet transmission pathogen." Sure, but it is a level 4 pathogen, that makes CDC scientists use Airborne precautions. Virulency is a factor, more than route of transmission with Ebola. Google it and share with your coworkers ("biocontainment level 4). We have to be our own advocates. The CDC sure hasn't been... http://www.cdc.gov/TRAINING/QUICKLEARNS/BIOSAFETY/

Please everyone, refuse to go into or work with a patient with suspected ebola unless protected in better PPE. PPE to the level of Biosafety Level 4 scientists. Please insist we are all protected at least in a respirator with NO SKIN exposed. We deserve it as much as the CDC scientists deserve it who work in a Biosafety LEVEL 4 lab. They work with ebola in a petri dish. We may have it coming at us in a projectile manner. Refuse the just the gown mask and face shield." It is NOT enough to protect us. Refuse to be put at risk, your families at risk. No skin exposed. Shower available. The different levels of protection/PPE used in Biosafety labs. Short and informative. On the CDC site. Very informative! CDC LC Quick Learn: Recognize the four Biosafety Levels See what they wear and in what environment they work in on a biosafety level 4 pathogen. Check out the suit. They change clothes going in, shower coming out, wear a positive pressure suit (a suit-not a room). All work by them with the Safety equipment All work with the microbe must be performed within an appropriate Class III BSC , or by wearing a full body, air-supplied, positive pressure suit. "Class III BSC" which is defined as: Class III BSC A gas-tight sealed container that is designed to allow for the manipulation of objects, hazardous substances, or infectious disease agents. Class III BSCs have a HEPA filtered air supply and double HEPA filtered exhaust. They provide the ultimate protection for personnel, product, and the environment. also http://www.cdc.gov/biosafety/publications/bmbl5/BMLB5sectIV.pdf hope these links to CDC are allowed here...if not please delete and sorry! Otherwise please share the links with your ICU and ER staff...give them the links to educate themselves. We can't just trust others to know what is best for us, what PPE is best for us. Where are these scientists who work with this? Shouldn't they be advocating for better PPE for us? I am sure they don't want us to be spreading this around their grocery stores or public restrooms where they can pick it up. How do we prevent an outbreak when we aren't fully protected - according to the CDC?

Scientists in a level 4 biohazard (research the 4 different levels - you will be surprised) containment labe wear airborne precautions due to it's virulence. That is just so they can work with it in a quiet little petri dish. We are expected to work with diarrhea and projectile emesis, using droplet precautions (the originally recommended PPE for ebola for HVWs). That is your breach in protocol. From the top. CDC.

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.?

Oops I meant NO they don't have it right. At All. CDC Director should step down.

NO - because in a different NY Times article they compare even current, as opposed to last week's, CDC guidelines used by some of the U.S.'s four biocontainment unit hospitals like Nebraska Medical Center and North Shore in New Jersey. CDC still recommends removing gloves, then face shield and mask then gown. This makes one bring your possibly wet gown with gunk on it to your face risking germs being flicked onto your skin or eyes etc. There is quite a bit of info in the article and photos. Here is the order the CDC recommends in removal of PPE, compared to what the biocontainment hospitals do. There are differences. Quote from NY times piece 'Changes to Ebola Protection Worn by U.S. Hospital Workers: 1) Gloves Original CDC Guidance: The gloves come off first. The rest of the disrobing process can be done with bare hands. A bare hand can safely pull off a glove by slipping it under the wristband (I assume they mean slipping a finger and peeling). The Hospitals: Workers at some hospitals use two pairs of gloves so that the inner pair remains on during the disrobing process. 2) Face Shield CDC: Goggles, Safety Glasses or Face Shields should be grasped from the band or ear pieces, which are considered 'clean' and safe to touch with bare hands" The Hospitals: Nebraska's protocol calls for removing these only after the gown and second gloves are removed, and a third pair of sterile/clean gloves are put on. 3) Gown The CDC: Bare hands untie knots in back which are not considered contaminated. A peeling motion is used to turn the gown inside out for disposal The Hospitals: Protocol at North Shore, like that in Nebraska, specifies that the gown be removed before the second pair of gloves are taken off. 4) Mask CDC: Masks are removed last by grasping behind the ears without touching the front which is considered contaminated The Hospitals: Hospitals specify using the second or third pair of gloves to remove masks.

NBC is reporting she may have been more symptomatic on the flight than previously reported. Another source said her illness was more progressed than Pham when diagnosed. Could she have been symptomatic gastrointestinally when she called the CDC and they said fly back anyway? Who knows but this is scary. The plane flew to Atlanta and Fort Lauderdale before airline was notified of the ebola diagnosis. After cleaning it twice the plane is back in service. Ig uess we will never ban flights (from wherever) with passengers from West Africa if we can't even keep a plane that transported an ebola patient out of service for a day.

Exactly. I just think it is the CDCs job for it to be on the radar...twenty years ago. They needed plans in place. Ten plus 'teams' ready to fly out to whatever hospital gets the index patient to take over care of that patient. Do not leave it up to the staff. They were the experts. Their job is to plan for this stuff and they just haven't at every turn. I just think to myself, if I was watching all this at a movie theater, I would walk out half way through the movie. It would just seem too unrealistic. I would think to myself, "No one could be this stupid. The Govt, the CDC, the hospital administrators. They would have suspended flights, or at least quarantined anyone whose passport had those countries listed, or was in contact with someone with ebola here in the states." No one could be this stupid and stay in charge. Tom Frieden needs to step down, yesterday.

I can't believe the CDC has a poster to doff PPE by removing gloves, then reach up to your face wearing a dirty gown to remove face shield and mask, then remove dirty gown -after you have reached up to your head/face with soiled isolation gown sleeves right near your face in order to remove face mask/shield. Any microscopic wet gunk could flip off into an eye etc if on your sleeve. That isn't too far to travel for a droplet (sleeve to an eye). The first page of the attachment (which I tried to delete-I just wanted to show the one example) is how to don PPE, the next two pages are two separate examples on how to doff PPE. The first example on doffing is ridiculous. The second one is what I see most RNs/staff do. And this is the CDC. ppe-poster.pdf

Aren't all of her possessions being incinerated? She will need all new? All new scrubs? Everything? I am not sure of course but they took out barrels of biohazard 'things.' I don't think the hospital will pay for any of that?

I think our hospital rooms are pretty confined spaces as well. I think I could stand sweating in a suit vs a paper or plastic gown with neck exposed, gloves that rip easily and someone vomiting on you, as well as possibly having the virus aerolize in the air by suctioning etc... Killing Super Bugs with a Robot - The Nebraska Medical Center Killing Super Bugs with a Robot - The Nebraska Medical Center

The rooms at Emory and Omaha use Ultraviolet light to kill germs I do believe, other places have UV robots, so no some places may have limited amount of residual ebola on surfaces. The fact is, she got ebola wearing a gown, gloves, mask and face shield...

They sure didn't blame the Drs that got it now did they?

Exactly. It is ridiculous. Funny how the media isn't in the hospital to see how little the RNs had to work with.

I posted this somewhere else but on the CDC website under the Ebola info there is a section for healthcare workers. If you dig in there you will find a PDF on Donning and Doffing PPE. There is one example (with pictures) on donning. There are Two Examples (with pictures) for Doffing. The First Doffing Example has you 1) Remove Gloves, wash hands then 2) Remove Face Shield and Mask, (i.e. reaching up towards your face with dirty possibly wet gown sleeves) then 3) Remove Gown. That means you are reaching up to remove a mask and shield with dirty sleeves of your iso gown. Who wants to flick some Ebola into their eyes? Not Me. T he Second Doffing Example has us 1) Remove Gown and Gloves at the same time by peeling them off inside out (see PDF pictures) wash hands, then 2) Remove Face Shield and Mask. No reaching up to face with droplets of who knows what on your sleeves I don't know about you but they need to get rid of the first example if they do not want more Ebola cases of HCWs.

Okay. So if you go to the CDC site and dig through the healthcare section on Ebola, you will find a link on how to Don and Doff PPE. Now, there is one example on donning. Cool. There are TWO for Doffing. The First Doffing Example has you remove Gloves, wash hands, THEN Mask and Face Shield THEN Gown. I don't know about you but I do not want to bring my dirty gown sleeves towards my face to remove mask and shield (*at least when it comes to Ebola). Could this be how she did it? Any little bit could flick off her into her eye. The Second Doffing Example has us remove Gown and Gloves at the same time, wash hands THEN the Mask and Face Shield---eliminating the need to bring a dirty gown sleeve towards your face. They need to get rid of the first doffing example if they do not want more ebola HCW cases! Does anyone agree?

I would hope if dialysis and intubation would (down the road) help this RN then I think it is worth the risk Mr CDC Frieden. She put her life on the line for him! Does he think any other RN will want to walk into an Ebola pts room after seeing how this one has been hung out to dry by the head of the CDC (apologies from him are too late. He showed NO compassion for her)? Any backtracking and apologies he makes about it here on out are moot to me at this point. Too bad he couldn't at least visit her in the hospital and Apologize. Show us how safe your protocols are Dr Frieden. I know that is too much of a risk to let in non-essential personnel though. One more person to monitor so no, he can't visit. Still...

Exactly!

We cant. Not when they use full body suits, duct taped up around seams an reapirators just to clean her home...and yet the rN deals with projectile bloody vomit and diarrhea. That poor girl. ANA needs to step up for her rights!

Yeah we are to wear a surg mask gown and gloves whereas these guys have someone checking them, sealing em with duct tape, and respirators. See video of the plane evacuation of the guy who sneezed then yelled/joked he had ebola this week. The big respirator suits came on and pulled him off (was on a plane from usa that landed in another country...)