"Houston we have a problem" This just got very real

[Esme12]

And so it begins....

A health care worker who treated Thomas Eric Duncan, the first person in the U.S. diagnosed with Ebola who later died, has preliminarily tested positive for the deadly virus, the Texas Department of State Health Services said in a statement today.

The health care worker at Texas Health Presbyterian Hospital has been isolated since reporting a low-grade fever Friday, the department said. The Centers for Disease Control and Prevention will conduct further testing to confirm the diagnosis.

"We knew a second case could be a reality, and we've been preparing for this possibility," Dr. David Lakey, commissioner of the Texas Department of State Health Services said in the statement. "We are broadening our team in Dallas and working with extreme diligence to prevent further spread."

http://abcnews.go.com/Health/texas-health-care-worker-tests-positive-ebola/story?id=26135108

[doro8144]

I am angered that they are blaming the nurse. The hospital has not a shred of evidence that she broke infection control protocol. Why aren't they blaming the patient who lied to airport screeners about his contact with Ebola victims in order to board a plane to the U.S.?

Also, how can we be safe in flimsy yellow papaper gowns and gloves? All the videos from Africa show the workers in head-to-toe hazmat gear. We already know our infection control policies are inadequate as evidenced by the tens of thousands of patients who die annually from hospital-acquired MRSA and C-dif.

[LadyFree28, BSN, LPN, RN]

At this point, there should be a redesign of PPE.

[lpnflorida, LPN]

First off good morning, It's been along time since I have participated in All Nurse. I remember 30 plus years ago, We were taught and practiced double gloving. what goes into isolation never comes out of isolation. We always double bagged items that had to leave the room. By double bagging I mean, while we were still in our isolation gear, another staff person. would be at the doorway with their gloves on holding an open bag to receive the bag we had just tied up while in the isolation room. I still work, but I can tell you these are not practices we do any longer. When is the last time you saw anything double bagged? The food trays go in and out of these rooms. I guess disposable trays ,plates and the like went by the side of the road over the years. Admit it we all have gotten lax.. Ebola of course is a terrifying thing. I believe it will put us all back on our toes as to how to protect not only ourselves , our patients but our loved ones also. Anyone in the position to work with an Ebola patient needs to not only be mindful of protection but to remain in the moment. I have been guilty while taking gloves off or gown to without thinking brush that dang hair out of eyes. I know better but I was not in the moment, I was in what I refer to as automatic mode. The end of a long shift you are tired,, focusing on getting home getting some sleep, the moment of daydreaming. It only takes a split second of not being in the present( in the moment ) to put ourselves at risk..

No lecture mind you,, just reminding us all to be careful. We are all scared, Be reassuring to the public we do not want to help spread panic, even though we may internally feel panic ourselves.

[Esme12, ASN, BSN, RN]

Practice donning and doffing. It is so important. Know where the PPE equipment is and how to use it.

A once every year inservice on Haz Mat suits and dusty masks that have been sitting in cabinets for years makes it difficult to be 100% prepared. Someone from infection control should be making available all of the items needed for successful donning, teach about doffing, practice--and every single nurse needs to know how and where to find these items in a hurry.

Where the negative pressure room is and how to use it. And the cleaning service needs to be 100 % sure that they know how to properly terminally clean rooms, the bathrooms.

Hand hygiene always. But the availability and ease of use of the heavy duty hazmat items need to be more streamlined. And available. And used correctly.

The hospital personnel are not using HAZMAT suits from what I hear. But practice practice practice is key.

[Esme12, ASN, BSN, RN]

Welcome back!

First off good morning, It's been along time since I have participated in All Nurse. I remember 30 plus years ago, We were taught and practiced double gloving. what goes into isolation never comes out of isolation. We always double bagged items that had to leave the room. By double bagging I mean, while we were still in our isolation gear, another staff person. would be at the doorway with their gloves on holding an open bag to receive the bag we had just tied up while in the isolation room. I still work, but I can tell you these are not practices we do any longer. When is the last time you saw anything double bagged? The food trays go in and out of these rooms. I guess disposable trays ,plates and the like went by the side of the road over the years. Admit it we all have gotten lax.. Ebola of course is a terrifying thing. I believe it will put us all back on our toes as to how to protect not only ourselves , our patients but our loved ones also. Anyone in the position to work with an Ebola patient needs to not only be mindful of protection but to remain in the moment. I have been guilty while taking gloves off or gown to without thinking brush that dang hair out of eyes. I know better but I was not in the moment, I was in what I refer to as automatic mode. The end of a long shift you are tired,, focusing on getting home getting some sleep, the moment of daydreaming. It only takes a split second of not being in the present( in the moment ) to put ourselves at risk..

No lecture mind you,, just reminding us all to be careful. We are all scared, Be reassuring to the public we do not want to help spread panic, even though we may internally feel panic ourselves.

Here is the problem....double bagging went out of "evidence based practice" years ago...take special attention to the last line.

Double-bagging of items from isolation rooms is unnecessary as an infection control measure: a comparative study of surface contamination with single- and double-bagging.

Maki DG, Alvarado C, Hassemer C.

Abstract

In many hospitals, waste materials and used linens from the rooms of patients in isolation or the clinical laboratories are routinely double-bagged to reduce contamination of the external surface of the bag that could be transmitted to hospital personnel subsequently handling them. No studies have prospectively examined the value, if any, of double-bagging. We randomly assigned waste and linens from the rooms of 42 patients in contact isolation to be transported in single bags or double bags. Shortly after a single (or double) bag had been set outside the patient's room, the surface was cultured quantitatively in two locations near the knot; over 2 months, 209 bags were cultured. Surface contamination by Staphylococcus aureus (3% to 5%), enteric gram-negative bacilli (6% to 7%), or either (9% to 12%) was infrequent and comparable in both groups; moreover, quantitative levels of contamination in the two groups were almost identical (mean, 27 and 29 colony forming units [cfu] per bag). These data suggest that there is no advantage, as regards asepsis, to double-bagging potentially contaminated items from isolation rooms or clinical laboratories as compared with using a single bag. The use of a single-bag system with a heavy-duty bag, as compared with double-bagging, saved our hospital $9,400 in 1985.

[lpnflorida, LPN]

Esme,, thank you for the Evidence Based Practice. I would agree with that. but perhaps your hospital is using stronger bags than we have been using of late. No joke we bag and entirely too often the bag breaks apart, and this is occuring when not over filled.. Perhaps I need to bring to the attention of the system I work in that single bagging works as long stronger bags would be used.. I think the cost savings perhaps had more of an influence in our system at least....

[Esme12, ASN, BSN, RN]

Esme,, thank you for the Evidence Based Practice. I would agree with that. but perhaps your hospital is using stronger bags than we have been using of late. No joke we bag and entirely too often the bag breaks apart, and this is occuring when not over filled.. Perhaps I need to bring to the attention of the system I work in that single bagging works as long stronger bags would be used.. I think the cost savings perhaps had more of an influence in our system at least....

I'm a proponent of double baging. It still baffles me how the bags in the room aren't comtaninated...maybe that is why MRSA is so rampant.

Follow the green.

[Spangle Brown]

I have to read it again I just read it and it didn't say she was the ED nurseWell that clears it up that she wasn't wearing a space suit. I actually didn't see that earlier. Extensive contact on multiple occasions after isolation doesn't sound like the ED nurse.

Now....why aren't nurses wearing the space suits we see everywhere else?

THIS doesn't make sense "after he was placed in isolation and was wearing protective gear as prescribed by the CDC: gown, gloves, mask and shield, officials said."

Why would the CDC say such limited PPE would be ok, when they are using so much more in Africa?? Why isn't the space suits being used in isolation?

I wonder if there is some confusion on what is ok for use in the ED for general protection and what should be used in Isolation for confirmed cases

[idialyze, BSN, RN]

Since I am a Dialysis Nurse, I have thought about this a lot. I know I could not refuse to dialyze this man, but I Would request a HasMat

suit and invite the "Talking Heads" to join me in the room. Since administrators think they are doing enough to protect the staff, they shouldn't have a problem being in the room with me, right?

[edmia, BSN, RN]

First off good morning, It's been along time since I have participated in All Nurse. I remember 30 plus years ago, We were taught and practiced double gloving. what goes into isolation never comes out of isolation. We always double bagged items that had to leave the room. By double bagging I mean, while we were still in our isolation gear, another staff person. would be at the doorway with their gloves on holding an open bag to receive the bag we had just tied up while in the isolation room. I still work, but I can tell you these are not practices we do any longer. When is the last time you saw anything double bagged? The food trays go in and out of these rooms. I guess disposable trays ,plates and the like went by the side of the road over the years. Admit it we all have gotten lax.. Ebola of course is a terrifying thing. I believe it will put us all back on our toes as to how to protect not only ourselves , our patients but our loved ones also. Anyone in the position to work with an Ebola patient needs to not only be mindful of protection but to remain in the moment. I have been guilty while taking gloves off or gown to without thinking brush that dang hair out of eyes. I know better but I was not in the moment, I was in what I refer to as automatic mode. The end of a long shift you are tired,, focusing on getting home getting some sleep, the moment of daydreaming. It only takes a split second of not being in the present( in the moment ) to put ourselves at risk..

No lecture mind you,, just reminding us all to be careful. We are all scared, Be reassuring to the public we do not want to help spread panic, even though we may internally feel panic ourselves.

You are right on about our own vigilance with PPE. The nurse in Spain remembers one time when she brushed her gloved hand against her cheek. That was the transmission contact.

Let's be truthful now: how many times have you put on PPE to enter a contact room for say VRE in urine and because you "know" you're not touching urine, the gown is flopping open and you keep readjusting it, and you remove the PPE in whatever order gets you out of that hot mess as quickly as possible?

I see it everyday.

[edmia, BSN, RN]

THIS doesn't make sense "after he was placed in isolation and was wearing protective gear as prescribed by the CDC: gown, gloves, mask and shield, officials said."

Why would the CDC say such limited PPE would be ok, when they are using so much more in Africa?? Why isn't the space suits being used in isolation?

I wonder if there is some confusion on what is ok for use in the ED for general protection and what should be used in Isolation for confirmed cases

No, there's no confusion on the CDC's part. When the fluids become more copious or there are procedures where fluids might become aerosolized (ie: suctioning an intubated patient, dealing with high pressures such as dialysis...), the CDC does recommend further protection to include foot covers and N95 masks on top of eye protection and the regular contact and droplet precaution gear.

Go to the CDC site and read what they say. Print it out and give it to your management if you feel your place of work is not up to speed on recommendations. If you really feel your employer is not ready and you work in the ED or ICU or an urgent care facility where patients are likely to turn up, call OSHA and report unsafe working conditions.

http://www.cdc.gov/vhf/ebola/hcp/patient-management-us-hospitals.html?mobile=nocontent

[imintrouble, BSN, RN]

We don't have haz-mat suits. The only areas that stock face shields, is OR and ED. We are so non-compliant with PPE, it's amazing we've not all contracted something. We've definitely become lazy with precautions.

We're a small hospital, in the middle of nowhere. That's not going to protect us forever. As a nurse, I should be embarassed by my attitude about isolation.

I don't even remember what order to remove my PPE. I honestly forgot there WAS an order.

I'm the perfect example of why it's vital to mandate Ebola training for every single health care worker.