Sloan RN

If the patient threw up, Clipboard Guy would only get it if he touched the emesis and then touched his eyes/nose/mouth. Or maybe if the patient ripped her Hazmat suit off and then threw up directly on his face. I get Ebola is scary for everyone, but it's not magic. I'm just having a hard time understanding what the mode of transmission would be in this particular scenario.

Which one is the patient? The guy in yellow? I watched a documentary about Ebola in Africa the other day and the Doctors Without Borders people don't wear PPE if they are outside the infectious zone of the hospital...more than 6 feet away from the patient seems to be the threshold of when you need PPE. Passing the clipboard back and forth is dumb, but other than that, what is the concern here? I'm not asking to be a troll, I'm really interested. How do we think the man with the clipboard would become infected if he remains 6 feet away from the patient at all times, the patient appears to be dressed in some kind of extensive PPE, and Clipboard Guy doesn't touch any of the caregivers? What would be the mode of transmission there?

16 Doctors Without Borders staff have contracted Ebola during the current outbreak, and that info is coming from the organization itself. There have been 404 cases of Ebola in healthcare workers, and 232 have died. TWO of them contracted it in the United States, and neither are dead. I get that we should be concerned and make sure we all understand proper precautions, but we should also be basing our opinions on actual facts and evidence.

So here are a few studies about Ebola and similar viruses on surfaces: Sagripanti JL, Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces. Arch Virol2010; 155:2035-203 Sagripanti JL, Lytle DC. Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Arch Virol 2011; 156:489-49 Bausch DG et al. Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. J Infect Dis 2007; 196:S142-7 Piercy, T.J., Smither, S.J., Steward, J.A., Eastaugh, L., Lever, M.S. (2010) The survival of filoviruses in liquids, on solid substrates and in a dynamic aerosol. J Appl Microbiol. 109(5): 1531-9. The information from Emory I was told by the head of Infection Control at my hospital during an Ebola training session; I don't have a source in writing yet, but I'm hoping when the transcript of the CDC's COCA webinar on Ebola (it was yesterday) is posted, it will contain some of that information. When it's posted it can be found here: http://www.bt.cdc.gov/coca/calls/2014/callinfo_101414.asp

Just read the statement from NNU on behalf of the Texas nurses ( Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United | National Nurses United ) and it's pretty clear what the breach was.... "For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own. " That is in zero way part of any protocol put out by the CDC or anyone else, and if such tape were to get contaminated it would be virtually impossible to take it off without a very high risk of contaminating yourself. This is an example of hospitals not communicating clear protocols, and leaving staff to make up their own, which makes them even more at risk. Some hospitals may be ready for Ebola (I do think my hospital has done a pretty good job but could do much better), but it's obvious that this particular hospital was not. To be fair, Duncan was an index case....Ebola being initially diagnosed in the US wasn't really on anyone's radar until he got here. In that way he kinda did us a favor...he's forcing us to get prepared.

I think my individual responsibility as a nurse in this Ebola situation is to a) be familiar with my hospital's plans for handling Ebola and b) be well-informed about the disease itself so I can help educate people who ask me about it. I've been pretty disappointed in the general lack of knowledge, or in the buying into media hype and misinformation, I've seen from other nurses. We are supposed to be better than that. We are supposed to know how to evaluate evidence and how to recognize reliable sources. Instead I've seen fellow nurses regurgitating information from random news outlets that's sensationalized or flat-out incorrect, or opining about vague government or political conspiracies. Give me a break! People in the public trust us. It is our responsibility to educate ourselves so that we don't inadvertently mislead them. We need to be prepared with accurate information that can be backed up with reliable sources.

Probably won't affect how students are taught too much. As far as triage goes, everyone is being told to ask every patient whether they've had a fever and where they've been traveling in the past month. If the patient has a fever AND has been traveling to any of the affected countries (Guinea, Sierra Leone, Liberia) then they are immediately placed in a private room and the ID specialists are paged. Your risk of contracting the disease as a triage nurse is pretty slim, as most Ebola patients present with fever and abdominal pain. Unless they vomit directly on you while you're triaging them and then you somehow get that emesis in your eyes/nose/mouth/a cut on your skin, you should be good. That being said, anyone who's known to be exposed to an Ebola patient is supposed to take their temperature twice a day to monitor for fever. There should be N-95s available wherever you have clinicals, regardless of whether Ebola is out there or not.

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.

I'll just cut and paste what I put in another thread: A word on Hazmat suits. Have you ever used one? Do you have any idea how to use one? My hospital has chosen not to use them if we were to get an Ebola patient because: 1. They open in the front. If you are taking care of a patient with Ebola, what part of you is most likely to become contaminated with infected bodily fluids? Yup, the front. How are you going to get out of a Hazmat suit with blood/diarrhea/vomit on the front without contaminating yourself? It's extraordinarily difficult. It's a little easier if you're standing in the middle of a field tent in Africa where they can just dump chlorine or bleach on your suit every time you want to take it off. That's not going to work in a hospital room. 2. Hospital workers aren't familiar with them. I've never touched a Hazmat suit, let alone worn one or taken one off. On the other hand, I've put on surgical gowns, gloves, N-95s and face shields hundreds of times. It's equipment I'm familiar with, therefore I'm more likely to don and doff it correctly. You have seen Hazmat suits on the news because: 1. In Africa: In many places there is no disposable PPE that can be changed between patients available, so Hazmat suits are safer. Also, it's super hot there. It's been found that if you're sweating like crazy in hospital-style PPE, you're tempted to reach up and wipe your brow...thereby contaminating yourself. Hazmat suits circulate cool air to help with this. Also, stuff like goggles can be difficult in hot environments due to sweat and fog. 2. For EMS: The people at Emory spoke to this...ambulances are tight quarters and often hot as well. EMS guys in drills were seen wiping their brows from sweating in hospital-style PPE. Therefore Hazmat suits were better for them. 3. For people cleaning patients' apartments, etc: Overkill. The virus doesn't live long on surfaces (various surfaces have been swabbed in patients' rooms in both Africa and Emory, and no Ebola has been found anywhere except on a visibly bloody glove and one other visibly bloody article). It's probably not even necessary to decontaminate these peoples' houses at all, since Ebola has only been shown to live for significant periods of time when dried in tissue culture media in the dark at 4 degrees Celsius. Nonetheless, I imagine these people are suiting up because they're not sure what bodily fluids might be found where and don't want to be surprised by any splashes while cleaning, and because the public would probably freak out if they wore less. It's really just an abundance of caution. We need to remember that Ebola is spread by CONTACT. It is not droplet and it is not airborne. It is not magic. To get it, you have to get the bodily fluids (blood, emesis and stool are the most infectious ones) of a symptomatic infected patient into your mucous membranes or through a cut in your skin somehow. There is no reason hospital-style PPE should not be adequate. My facility is recommending booties, a surgical gown (b/c they are waterproof and have the wrist cuffs), an N-95 (b/c suctioning and intubating can cause temporary aerosolization), a face shield and double-gloving. There is no reason that should not protect you. The trick is in getting it off, and I suspect that's how the nurse in Dallas was infected: some breach that led to her infecting herself while taking PPE off. THAT is why wearing unfamiliar PPE like a Hazmat suit is a bad idea.

What exactly is awful about the CDC site? I assume you mean the one for healthcare professionals: Information for Health Care Workers | Ebola Hemorrhagic Fever | CDC Have you read the UpToDate articles? There are two, and they are free to the public now. They contain a lot of good and interesting information, and have very long source lists at the end for extra reading material if you're interested. What are you concerned about not being covered if you're wearing booties, a surgical gown, an N-95, a face shield and double gloves? That PPE is provided by most hospitals and I don't see why it isn't adequate.

I'm disappointed in the lack of general research of some reading this thread. If healthcare professionals like us are getting their information on Ebola from the news, we're all screwed. Everybody should be reading reliable sources...UpToDate, CDC, WHO, journal articles, etc. A word on Hazmat suits. Have you ever used one? Do you have any idea how to use one? My hospital has chosen not to use them if we were to get an Ebola patient because: 1. They open in the front. If you are taking care of a patient with Ebola, what part of you is most likely to become contaminated with infected bodily fluids? Yup, the front. How are you going to get out of a Hazmat suit with blood/diarrhea/vomit on the front without contaminating yourself? It's extraordinarily difficult. It's a little easier if you're standing in the middle of a field tent in Africa where they can just dump chlorine or bleach on your suit every time you want to take it off. That's not going to work in a hospital room. 2. Hospital workers aren't familiar with them. I've never touched a Hazmat suit, let alone worn one or taken one off. On the other hand, I've put on surgical gowns, gloves, N-95s and face shields hundreds of times. It's equipment I'm familiar with, therefore I'm more likely to don and doff it correctly. You have seen Hazmat suits on the news because: 1. In Africa: In many places there is no disposable PPE that can be changed between patients available, so Hazmat suits are safer. Also, it's super hot there. It's been found that if you're sweating like crazy in hospital-style PPE, you're tempted to reach up and wipe your brow...thereby contaminating yourself. Hazmat suits circulate cool air to help with this. Also, stuff like goggles can be difficult in hot environments due to sweat and fog. 2. For EMS: The people at Emory spoke to this...ambulances are tight quarters and often hot as well. EMS guys in drills were seen wiping their brows from sweating in hospital-style PPE. Therefore Hazmat suits were better for them. 3. For people cleaning patients' apartments, etc: Overkill. The virus doesn't live long on surfaces (various surfaces have been swabbed in patients' rooms in both Africa and Emory, and no Ebola has been found anywhere except on a visibly bloody glove and one other visibly bloody article). It's probably not even necessary to decontaminate these peoples' houses at all, since Ebola has only been shown to live for significant periods of time when dried in tissue culture media in the dark at 4 degrees Celsius. Nonetheless, I imagine these people are suiting up because they're not sure what bodily fluids might be found where and don't want to be surprised by any splashes while cleaning, and because the public would probably freak out if they wore less. It's really just an abundance of caution. We need to remember that Ebola is spread by CONTACT. It is not droplet and it is not airborne. It is not magic. To get it, you have to get the bodily fluids (blood, emesis and stool are the most infectious ones) of a symptomatic infected patient into your mucous membranes or through a cut in your skin somehow. There is no reason hospital-style PPE should not be adequate. My facility is recommending booties, a surgical gown (b/c they are waterproof and have the wrist cuffs), an N-95 (b/c suctioning and intubating can cause temporary aerosolization), a face shield and double-gloving. There is no reason that should not protect you. The trick is in getting it off, and I suspect that's how the nurse in Dallas was infected: some breach that led to her infecting herself while taking PPE off. THAT is why wearing unfamiliar PPE like a Hazmat suit is a bad idea. Please, please do your research guys. Don't fall victim to media hype and hysteria. We are better than that.

I think you need to do some more research. If you listened to or read transcripts from the CDC's conference call for healthcare professionals where they had doctors from both Nebraska and Emory (the two hospitals with special biocontainment units who have taken Ebola patients so far), they touched on why some people wear Hazmat suits. It basically depends on the situation. They said the EMS providers in the ambulance wore Hazmat suits because the ambulance is a very contained space, can be very hot, and it was found that workers wearing hospital-type PPE would end up sweating a ton and reaching up to wipe sweat from their brow. The Hazmat suits circulate cool air inside to help with that. It's the same situation in Africa...that and the fact that they don't have disposable PPE in a lot of places there, so Hazmat suits are safer. My hospital has chosen not to use Hazmat suits because it was found that it was too difficult for healthcare workers to take them off correctly without contaminating themselves, and it was safer to use equipment we are more familiar with (like surgical gowns) that do the job just as well. The Hazmat suits for people going into the patients' homes really isn't necessary; Ebola doesn't live long on surfaces at all...they couldn't find any virus on surfaces in patients' rooms in both Emory and Africa, except for a bloody glove. I think people are wearing that stuff in the patients' homes out of an abundance of caution since they don't know what bodily fluids could be where when they go in there. Personally I think it would be fine to just not let anyone in the apartment for a week or so and leave it at that, but the public would probably freak out that not enough was being done. It's important to know the research behind all this to better educate yourself.

Thanks for taking the time to take notes and post them here! So interesting. I'll be interested to see specifically what they say about dialysis and intubation...I realize those are high-risk procedures, but it seems unethical to withhold them from a patient who wants them and has by definition a reversible disease process. I've heard some talk about making these patients DNI which seems ridiculous!

Take notes and post back here, I'll be at work and unable to listen but would love to know what is said. One of the most interesting things out of Emory is that they tested various surfaces in Ebola patients' rooms and found NO Ebola anywhere. This is consistent with a 2010 study I read where researchers were unable to recover Ebola from experimentally contaminated surfaces, unless the Ebola was dried in tissue culture media and kept in the dark at 4 degrees Celsius (obviously not real-world conditions). Seems to indicate that Ebola can't survive long at all outside a host, which is contrary to what most people believe.

Ebola is spread by contact, like RSV. The reason you see stuff like Hazmat suits on the news is due to an abundance of caution. At my hospital the recommendation is booties, a surgical gown (they're waterproof unlike our typical isolation gowns), an N95 (apparently due to concern that procedures like suctioning and intubation could somehow aerosolize the virus although I haven't seen any literature supporting that), a face shield to prevent direct splashes, and double-gloving. Any Ebola patient is supposed to have two nurses, so we can take turns in the room and help each other take off PPE without infecting ourselves. They're also putting Ebola patients in a negative-pressure room, which isn't really necessary, except for the aforementioned concern that some procedures may aerosolize the virus temporarily. Apparently in Emory, as the patients got better and were moving around the room themselves, PPE was scaled back accordingly (i.e. a regular surgical mask instead of N95s, no booties, etc). It's important that healthcare workers educate themselves about Ebola using reliable resources. I've been a little disappointed to see fellow nurses either knowing nothing about it or believing some ridiculousness they've seen on the news. UpToDate has made their articles on Ebola free to the public, and the CDC has good information as well. Ebola is no joke, but I don't think it's quite as terrifying as the media is making it out to be. P.S. As far as Hazmat suits in hospitals, it's my understanding that they are very difficult to take off without infecting yourself, and that some healthcare providers in Africa wear them because they don't have the luxury of disposable PPE that can be changed between patient encounters.