merilynRN

There is a big question in my mind also, about whether the N95 is enough.

It originated from The Happy Hospitalist blog, The Happy Hospitalist and it is available on a tee shirt... Got Ebola? Blame the Nurse! Shirt | Zazzle There are some other funny "protocols" up on the site besides that one =]

I am glad Dr. Gary Weinstein spoke out. What he says only makes sense. But was he referring to the PAPR (Powered Air Purifying Respirator) as the "full respiratory mask" he speaks of, or something else? "I think that these two nurses took care of a critically-ill patient at a time when he was not in control of his body fluids, and at a time when the recommendations from the CDC that we were following did not include the full respiratory mask. I don't know that. But that's what one person thinks – that's me. That's not based in science, it's not based on anything I saw. It's just trying to be thoughtful and think about the risks that we now know."

binary, the link you provided currently is not working.

This is why I was so annoyed when the nurse Jennifer Joseph was interviewed on CNN stating that Nina was in "full Hazmat suit" without differentiating that she was given the a "full suit" only after the diagnosis was confirmed. I think it's likely the contact occurred during those first couple of days. No one in the media has been pointing this out. I didn't see the interview of the Texas hospital admin admitting Nina only had the (inadequate) standard gear when she first received Duncan (Sept 28 - 30 prior to positive result), but the LA Times had revealed this several days ago, before the National Nurses United statement came out. "Did you see the interview today where the Texas hospital admin admitted that Nina, the first nurse to contract ebola from the pt, was given the gown/gloves/mask when she first received him, then AFTER he got a positive dx she was given the full haz-mat CDC PPE to wear? She WASN'T GIVEN THE RIGHT GEAR yet they kept saying it was a breach in protocol, that she must have contaminated herself when removing her PPE! " further confusing all the misinformation.

This is a good article below about the hazmat suit and training that should be required for nurses and others treating ebola patients. In the media, and between different people interviewed including Texas Presbyterian nurses as well as friend and former coworker of Ms. Pham, I am hearing very different things about the PPE actually used by nurses caring for Duncan. Of course there was a difference between what was used before confirmation of diagnosis and after as well. But people are speaking who do not really know from start to finish, leaving confusion. Personally I believe the suit with respirator that Doctors Without Borders use in Africa, should be what is required for nurses and others (RT, CNA, etc.) involved in direct care with close contact. Even if viral particles are aerosolized for a short time due to projectile vomiting or toilet flushing (which also aerosolizes particles), that may be long enough to transmit in an airborne manner. We need the respirators. I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About Ebola by Abby Hoffman I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About EbolaÂ*|Â*Abby Norman

Thank you for posting. Excellent information from the Center for Infectious Disease Research and Policy. And to think this commentary was posted back on September 17th! One would think it should have been widely disseminated information by public health officials by now. COMMENTARY: Health workers need optimal respiratory protection for Ebola | CIDRAP

This below, is exactly what bothered me so much when they were calling it a "breach in protocol" when there WAS NO PROTOCOL before the diagnosis, when there should have been preemptive protocol based on Duncan's travel history, exposure history and clinical symptoms. I don't know if the CDC was involved yet before the positive results came in, but the hospital's medical personnel should have been so much more preemptive and proactive that this was indeed ebola they were dealing with. I wonder how many others were involved in direct care during Sept 28 - 30. Second Ebola nurse traveled on plane with low-grade fever Frieden called the first days of Duncan's diagnosis and isolation at the hospital the highest risk moments. He pinpointed those days between October 28 through October 30. "These two health care workers both worked on those days and both had extensive contact with the patient when the patient had extensive production of bodily fluids because of vomiting and diarrhea," he said.

It would be that 13% that do not present with a fever, that present a screening challenge.

According to this LA Times article, it appears that health care personnel taking care of Mr. Duncan were not in full protective gear until results came in positive for ebola on Sept. 30 -- two days after admission. So there seems to have been a two-day period where they were caring for him in standard isolation gear (non-protective) while he was having "explosive diarrhea and projectile vomiting". Maybe this is why they are expecting more cases. The timeline: Texas healthcare worker tests positive for Ebola - LA Times — On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics. — His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m. — Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees. — On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper. — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach. — On Oct. 8, Duncan died.

According to this article it looks like the nurses taking care of Mr. Duncan were in standard isolation garb before the positive blood test came back. "Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach." No wonder they are expecting more health care workers to test positive. Projectile vomiting. Explosive diarrhea. Yet no hazmat suits until after the results came in. Texas healthcare worker tests positive for Ebola - LA Times — On Sept. 25, Duncan came to the ER complaining of a headache and abdominal pain. At one point, he registered a fever of 103 and told the hospital he had been in West Africa. He was sent home with a prescription for antibiotics. Texas Health Presbyterian Hospital Dallas, where Ebola patient Thomas Eric Duncan was treated, is shown. A healthcare worker who participated in his care has been diagnosed with the virus. (LM Otero / Associated Press) — His condition worsened dramatically, and on Sept. 28, he returned to the hospital in an ambulance shortly after 10 a.m. — Doctors admitted him and put him in isolation. By evening, he was projectile vomiting, having explosive diarrhea and running a temperature of 103.1 degrees. — On Sept. 29, as his condition worsened, Duncan asked the nurse to put him in a diaper. — On Sept. 30, tests results confirmed Duncan had Ebola. Only then did staff treating Duncan trade their gowns and scrubs for hazmat suits, and the room was cleaned with bleach. — On Oct. 8, Duncan died.

http://www.latimes.com/nation/la-na-1012-ebola-fever-20141012-story.html#page=1 ​

More today, from the New York Times: (emphasis mine) "On Sept. 25, Mr. Duncan began complaining to Ms. Troh about chills, and she drove him to Texas Health Presbyterian Hospital, not far from her apartment. He arrived in the emergency room with a mild fever of 100.1 degrees and reported having abdominal pain for two days, a sharp headache and decreased urination, according to the hospital. When a nurse took his history, the hospital has reported, he said he had not been around anyone ill but had recently been in Africa. The nurse noted this, but doctors apparently failed to consider the possibility of Ebola for reasons that remain unclear. Mr. Duncan was sent home with antibiotics that were powerless to halt the progression of his virus" http://www.nytimes.com/2014/10/06/us/ebola-victim-went-from-liberian-war-to-a-fight-for-life.html

Hi, I had worked GYN and also Peds (Sloane Hospital for Women, and Babies Hospital) and got to know the managers & supervisors over time, including the L&D manager, sharing with her my interest in L&D. It was a foot in the door to work in associated areas first. Later on when a position came up I was hired and worked L&D for 5 years before eventually moving. You can try getting onto a GYN unit, and as time goes on get known and express your interest to those in Maternal/Child Health. Or, if in a smaller hospital, "clean" GYN surgical cases recover on the postpartum unit, and nurses are cross-trained to nursery, L&D and postpartum / GYN. Pursue your dream! I moved on into other areas of nursing later on, but it was wonderful having experienced what was then, my dream job. But I think the key is getting to know people internally and letting it be known that you are very interested in working in L&D.

well, well, well ... Presbyterian officials initially suggested that a nurse may have been at fault for failing to tell the emergency room doctor that Duncan had recently been in Liberia. Then hospital officials late Thursday blamed the miscommunication on a “flaw” in the hospital’s electronic records system. Friday, the hospital backtracked, saying that “there was no flaw” in its electronic health records system and that the ER doctor did have access to Duncan’s travel history. Hospital spokesman Wendell Watson said Saturday that the hospital was “looking into the entire chain of events,” but he declined to elaborate. quoted from article: Dallas hospital under fire as accounts of Ebola patient’s initial release change http://www.dallasnews.com/news/metro/20141004-dallas-hospital-under-fire-as-accounts-of-ebola-patients-initial-release-change.ece