"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

[edmia, BSN, RN]

http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf

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.

[Rexjackiec]

Does anyone know what flavor of "Healthcare worker" this is? I have seen CNAs and other non-nurses do things in hospitals that have made my toes curl. There are many people working in hospitals who don't have the benefit of some of the classes that we get as nurses. Think about the microbiology class you took during your schooling. Did that change the way you look at the world?

A friend of mine who worked as a CNA before becoming an RN told me that she was never taught how to correctly put on and take off PPDs. Maybe that's the problem. Maybe the people taking care of ebola patients need intensive training in staying safe. Won't happen. Too expensive. But I think it's a good idea.

I have been a CNA for 17 years. I was taught extensively about proper handwashing and use of ppd/ppe. I am in the process of applying to nursing school for my bsn (just waiting for the letter!! Fingers crossed.) I have seen all walks of "MEDICAL PERSONEL" use horrible handwashing skills. Everyone is guilty of it from doctors down to Physical therapy to patients family... Maybe she just panicked trying to get out of that room or something.. It is sad but i have seen it happen.

[Rexjackiec]

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.

Very well said!

[Esme12, ASN, 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 confusion....nurses in the ED do not put on HAZMAT suits either. They are available for a HAZMAT situation but this is not being considered a HAZMAT situation by the facilities and CDC recommendations for healthcare personnel.

The question is why are nurses/hospital personnel NOT being given HAZMAT suits when everyone else wears them when in contact with this patient population. Are we that expendable?

[duskyjewel]

Are we that expendable?

Well, how many conversations have we seen about how oversaturated the nursing labor market is?

[Tracyelln]

Let's be honest here. First of all, the CDC said we are prepared to care for Ebola patients and there is almost no chance of it spreading here in the US. It's easy for these people to make decisions from an office. I would like to see these CDC people doing the care for these Ebola patients themselves.

Next, we were told by the president that if we stopped flights from these western African countries where Ebola is rampaging, it would only get worse for these countries. What about our country? I would have thought the government and CDC would have worried about us first. As for getting supplies and healthcare workers over there, we could use charter flights, etc. Look at all the countries that have banned flights from these African countries. Why not do the same here? Isn't it our governments job to protect us?

Now they are changing their story on how easy it is to transmit this disease. From the start, many of us nurses disagreed with the CDC. I don't think they knew enough about the disease and the strains to convince us that allowing Ebola patients into our country was a good idea.

As for this nurse who now has tested positive for Ebola, it is one person too many. For the hospital and CDC to throw her under the bus saying its her fault is crap. I think it's typical of the 'higher-ups'. It may not have been her to have breached the protocol but some other care giver touching a surface with contaminated gloves, etc.

As a nurse with 20 years of experience, I have see all kinds of breaches in protocol when it comes to isolation. The MD's are the worse! I also know that **** happens! Patients puke on staff, people get needle sticks, etc. There is also this thing called human error! We all have seen it if not experienced it ourselves.

Back in the day, they used to test us for MRSA. They stopped doing it because so many nurses tested positive for colonisation in the nares (if I remember correctly).

i have many years experience working in the ER. My heart goes out to those nurses and caregivers on the front line! Patients are not always honest with you and don't always listen to you either. Some don't even make the effort not to cough in your face, etc.

My thoughts and prayers go out to the nurses and staff members that are caring for these patients. I especially am praying for the nurses who have tested positive for Ebola. I pray these nurses recover quickly. This is one person too many!

[Esme12, ASN, BSN, RN]

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.

Safe Management of Patients with Ebola Virus Disease (EVD) in U.S. Hospitals | Ebola Hemorrhagic Fever | CDC

But the question remains...why is everyone else wearing HAZMAT suits when near these patients and contaminated materials?

IF the N95, gown, gloves, shoe covers, eye wear ok...why is no one else using that same protection?

What about out hair? What about projectile emesis or explosive stool that gets on your scrubs...we ALL know THAT has happened?

We see people being hosed down....suits washed off before removal...yet a simple disposable thin cheap plastic disposable gown, a pair of gloves, a plastic shield (and lets face it, it offers little protection) and some shoe covers sufficient for us?

Hummmmm.....

[edmia, BSN, RN]

Esme, here is the CDC's response to that question about hazmat suits:

Why do responders in Africa wear so much personal protective equipment (that can include full body suits) for this Ebola outbreak when CDC says hospitals here could safely manage the care of an Ebola patient without a full body suit?

There are important differences between providing care or performing public health tasks in Africa versus in a U.S. hospital.

In field medical settings, additional PPE may be necessary to protect healthcare workers. In some places in Africa, workers may not have the ability to prepare for potential exposures. For example, in some places, care may be provided in clinics with limited resources (e.g., no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different PPE than what is used when providing care for infected patients in a hospital.

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

[imintrouble, BSN, RN]

Well, how many conversations have we seen about how oversaturated the nursing labor market is?

If I were a conspiracy theorist, I might suspect that's exactly why the nurse job market was promoted to over saturation.

[Tina, RN]

I never, ever buy into the hype the media feeds us about health issues... But, this is the first time that I am truly concerned. I agree with the title of this thread: This just got very real.

[Esme12, ASN, BSN, RN]

Esme, here is the CDC's response to that question about hazmat suits:

Why do responders in Africa wear so much personal protective equipment (that can include full body suits) for this Ebola outbreak when CDC says hospitals here could safely manage the care of an Ebola patient without a full body suit?

There are important differences between providing care or performing public health tasks in Africa versus in a U.S. hospital.

In field medical settings, additional PPE may be necessary to protect healthcare workers. In some places in Africa, workers may not have the ability to prepare for potential exposures. For example, in some places, care may be provided in clinics with limited resources (e.g., no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different PPE than what is used when providing care for infected patients in a hospital.

Source: Safe Management of Patients with Ebola Virus Disease (EVD) in U.S. Hospitals | Ebola Hemorrhagic Fever | CDC

Ebola's spread is 'unprecedented' says CDC chief Dr Tom Frieden

Oh so that is why the don full gear to transport the patient here in the US when they arrived and those patients were placed in the special containment units.

The new thoughts for the CDC and Ebola....the new PPe calls for foot and leg protection. Period

The health worker wore protective gear while having extensive contact with Thomas Eric Duncan, the Liberian man who died Wednesday of Ebola at Texas Health Presbyterian Hospital.

Officials said she has not been able to pinpoint any breach in infection control protocols, although there apparently was a breach, they say.

Experience shows that health workers can safely care for Ebola patients, ‘‘but we also know that it’s hard and that even a single breach can result in contamination,’’ Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention, said Sunday on CBS’s ‘‘Face the Nation.’’

The situation also raises fresh concerns about whether any US hospital can safely handle Ebola patients.

Dallas case focuses new attention on safety procedures - Nation - The Boston Globe

IN which they added

New data suggest that even tiny droplets of a patient’s body fluids can contain the virus, Maki said.

In addition to more training, the CDC recommends that hospitals minimize the number of people caring for an Ebola patient, perform only procedures essential to support the patient’s care, and name a full-time infection control supervisor while any Ebola patient is being cared for.

He has now said....

Frieden said everyone who treated Duncan was now considered to be potentially exposed and other cases of Ebola were possible.

“We’re deeply concerned about this new development,” he said on the talk show.

Texas health worker tests positive for Ebola - Nation - The Boston Globe

[Esme12, ASN, BSN, RN]

http://www.nytimes.com/2014/10/13/us/texas-health-worker-tests-positive-for-ebola.html?_r=0

"I'm angry about this," said RoseAnn DeMoro, executive director of National Nurses United. "We want the first line of defense to be the most prepared. Our hospitals are resisting us. The CDC doesn't say that we need hazmat suits. If this doesn't change dramatically, we will picket every hospital in this country if we have to."

The uproar over hazmat suits is merely the latest clash between Nurses United and the CDC. Bonnie Castillo, a National Nurses United disaster relief expert, blasted CDC Director Dr. Tom Frieden for blaming the second Ebola victim in the U.S.--an unnamed nurse who helped the Liberian man who brought Ebola to America--on a "protocol breach" that led to her contracting the deadly virus.

"You don't scapegoat and blame when you have a disease outbreak," said Castillo. "We have a system failure. That is what we have to correct."