"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

[chadrn65]

Watch the first video, very informative.

U.S. nurse with protective gear gets Ebola, but how? - CNN.com

Of the thousands of hospitals in the United States, only four have been training for years to deal with highly infectious diseases such as Ebola: Emory University Hospital in Atlanta, the Nebraska Medical Center in Omaha, the National Institutes of Health in Maryland and Rocky Mountain Laboratories in Montana.

"They have the management, the processes, the implementation in place that if an Ebola patient comes in, just right away they know what to do," said Gavin Macgregor-Skinner, who teaches public health preparedness at Penn State University.

But if someone with symptoms of Ebola shows up at any other hospital, as Duncan did, the hospital might not be ready.

"It may not be that every single hospital is in fact prepared for this," said David Sanders, associate professor of biology at Purdue University.

"We may have to think about regional centers that are best prepared to deal with Ebola patients."

[diosa78]

These hospitals are not ready. Again Ebola is a Level 4 Biosafety hazard and those who deal with it have specific training before handling it. Why are government officials denying the virulence of the virus? I will refuse to handle any patient that might even have Ebola because it is out of my scope of practice (I am not an infectious disease or public health nurse trained in Level 4 Biohazards) and I have not been adequately trained and therefore am putting the general public at risk of spreading the disease. However, if I am properly trained and provided with the resources that government and military workers in Level 4 labs are provided, I will care for these patients. Details from the NIH are provided below. How many of our employers provide this??

[h=2]Elements of Training[/h]Formal training in preparation for work in a BSL-4 laboratory should consist of 3 elements: didactic or classroom-style theoretical preparation, one-on-one practical training in the facility, and mentored on-the-job training (Figure). Theoretical training helps laboratory workers develop an understanding of the underpinnings of biocontainment operations and the laboratory systems that support these operations. Hands-on practical training includes a comprehensive orientation to the specific facility in which the person will work to include a complete review and documented understanding of all standard operating procedures; orientation to engineering aspects of the facility; overview of all safety procedures, including alarms and emergency operations; and an introduction to the care and use of a protective suit or glove box. The institutional biosafety officer and building engineer typically assist in providing this orientation, some of which may be augmented by training videos.

Figure

Framework for maximum containment laboratory training.

BSL-4 laboratory orientation training assumes that the person has already mastered all procedures for safe and secure handling of infectious agents at the BSL-2 and ideally BSL-3 levels. This training generally involves individualized orientation within the facility provided by an experienced staff member or dedicated training officer. It may begin while the laboratory is shut down for annual recertification and maintenance or while it is operational. Training would involve use of entrances simply designed to demonstrate how one enters and exits the suite, general orientation on the use of air hoses, working within biologic safety cabinets or glove boxes, storage and record keeping of pathogens, clean-up and decontamination following procedures or spills, solid and liquid waste management, use of autoclaves and other specialized equipment, communications with others inside and outside of the BSL-4 facility, and other general procedures.

Finally, the person under consideration is assigned a dedicated mentor and is introduced to working with live pathogens in the BSL-4 laboratory under the mentor’s close supervision. This stage of training is basically open ended; the length of time and number of entries into the facility will vary greatly depending upon the skills of the person and his or her ability to master all procedures necessary for independent work. Final decision of when a person is allowed independent access is subjective and based on an assessment by the mentor and laboratory director; it is usually discussed only after the person has had extensive experience working in the facility. The time required to gain full independent access may also vary depending upon the kind of work that person will be undertaking. For example, persons not likely to be directly handling infectious material, such as safety officers, building engineers, or maintenance staff, may be offered limited independent access sooner than a person who will be handling live pathogens routinely. Partial or limited access may also be granted to a person for independent access only during normal duty hours. Laboratory procedures that involve animals or sharp instruments (e.g., needles, syringes, postmortem procedures) represent the greatest risk and consequently require special training and experience; these procedures should be mastered at lower containment levels before a person is permitted to undertake these activities under BSL-4 conditions. Most standard operating procedures for animal manipulation require that at least 2 persons be present, regardless of their experience level. Some laboratories require a final oral or written examination before granting a person independent access, which may be administered by the safety officer. However, the ultimate decision as to who is allowed independent access to the BSL-4 laboratory is made by the BSL-4 laboratory director.

A typical mentor will be an experienced person who has earned full unrestricted access to the laboratory and has the clear confidence of the laboratory director. Although there are no set time or formal educational requirements to become a mentor, mentors should have extensive practical experience working under BSL-4 laboratory conditions.

All laboratories should have developed a process for reevaluation of all persons working in the BSL-4 laboratory to ensure that their knowledge and skills remain current. This process may be an annual refresher course or periodic formal or informal review and training and may be augmented by orientation sessions as new equipment is introduced into the facility. Ensuring that senior program staff members are regularly present in the laboratory is important for maintaining consistent safety, security, and scientific standards.

Go to:

[h=2]Need for Certification of Training[/h]The need to document that a person has completed appropriate training has been discussed extensively. It is evident that a tacit internal certification exists in BSL-4 facilities currently operating and this takes the form of approval to work independently. This certification may be more formally captured in a specific document or may be a checklist signed by the approval authority. A more broadly applicable documentation system could provide evidence of consistency in training, demonstrate recognized capabilities with certain tasks such as for animal handlers, and provide a mechanism to gauge the number of persons working in the field.

At present, those working in BSL-4 laboratories in the United States need security clearance and approval to handle select agents, must have completed the extensive training program described above, must have medical examinations, and must be known by the program director. Each BSL-4 laboratory is, however, unique and every program director should demand that all persons entering their facility be well prepared and knowledgeable of all safety and security procedures required of that facility. Although standardized documentation of training does not formally exist, there would be merit in developing an internationally agreed-upon facility-specific, time-limited document to recognize the specific skills and experiences of a person. Such documentation would have the added benefit of facilitating collaborations and personnel exchanges among BSL-4 laboratories.

[kalevra, BSN, RN]

This whole ebola thing reminds of of when HIV/AIDS became the new emerging disease. Except in the case of ebola, death can occur in as little as a week once symptoms kick in.

My co-workers and I were just talking about how difficult it is to get compared to the flu. We talked about how with proper PPE it could not happen to an American healthcare worker in a modern hospital. Boy were we wrong, not a good idea to underestimate the problem.

[cmryan12]

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.....

My understanding regarding the HAZMAT suits (because I asked where ours were) was that the reason EMS and health care workers/first responders that have been dealing with the ill patients in Africa aren't trained in appropriate donning/doffing procedures. And they're likely caring for more than one patient with the disease. While I think I would feel more safe in a space suit should I be taking care of an Ebola patient, I wonder if that's because of things like the germ study with the gloves, or knowing that those paper gowns don't catch everything.

Disclaimer: this is what I have heard only, nothing that has been confirmed. Though honestly, I'm not really sure whom to believe at this point.

[Caffeine_IV]

I'm not satisfied with the CDC answer on why we don't need better PPE. ALL hospitals are not ready.

They say as long as you have a private room with a door, you can safely care for these patients. I don't buy that either.

[Cremebrulee, BSN, EMT-B]

What happens when an ebola patient who is confused or impulsive is being cared for? Being in a 1:1 with that patient would put someone in a very unfortunate position.

Could officials argue that the PPE that they have proposed would be sufficient then?

[imintrouble, BSN, RN]

We don't stock impermeable gowns. We have the yellow paper ones because they're cheaper.

Limited face shields.

Noncompliant staff.

We're toast.

[phlebitis]

I haven't posted for a couple years, but have been a lingerer on this site.....I work in the ED and have had some training on Ebola/MERS. Our triage note has a required field asking about recent travel in the past 21 days, if they answer yes, more questions pop up, we had training on donning/doffing PPE which includes hazmat suit with hood, N95, Plastic face shield, booties (if the hazmat suit is footless, there are two kinds) and double gloves taped on. It is very uncomfortable and I found myself pouring sweat and panic setting in, I felt like I couldn't breathe, I am sure I will pass out if I have to wear this. Other nurses felt the same claustrophobia. The patient will be assigned one nurse, doctor, and room monitor (PCT). The room monitor is required to sit outside the door and record names of everyone entering/exiting the room and to gown up and assist the nurse/doctor to remove the PPE. The will watch for any breaches. We were told to simply insert an IV if needed and administer medications if ordered and if they meet certain criteria, will be transported to a larger hospital prepared to admit them. We were told to not draw any blood as our lab is not equipped to handle it. Despite this training, I am terrified of removing the PPE. What if something goes wrong? I will have to really trust in the PCT to do it correctly for both of our safety. We all just did it once. I do not feel prepared and I am uncertain. I do feel better that we have the right equipment, I'm just not so sure that we are all confident and ready to use it correctly.

[Guttercat, ASN, RN]

........

[Wannabeeinscrubs, ADN, LPN, RN]

They threw the nurse under the bus to make the masses feel better. She (the nurse) screwed up with PPE and that is why she got it. I am not in danger.

[Here.I.Stand, BSN, RN]

I don't get why regular floor nurses are taking care of these patients? Seems like the CDC would have nurses who've had extensive training and the best equipment for these patients.

I'm assuming he was in the ICU since he was intubated, so likely he did have the most extensively trained RNs that he required for his physiologic status. An infection control RN is more trained in the infectious aspect, but not trained in the care of the critically ill, unstable pt (unless s/he has an ICU background.)

If my metro area has cases of ebola, they will likely be treated at my hospital. However, they stress that any hospital w/ ICU capabilities is able to treat an ebola pt.

[Brendan1]

I have to say I have been a lurker on these boards for years, but now I have something to add to this conversation.

I am saddened by the number of nurses who are of the opinion that this ‘un-named nurse’ must have broken protocol to become infected with ebola. Sure, we all get lazy at times with isolation precautions- but it is when there is no chance of it being something that can kill our families, pets and ourselves.

This nurse, in my opinion, is a hero. She was assigned to the patient that is our worst nightmare. She was given isolation gear, and told that it would protect her, that she would be safe. She did her best to provide care and comfort to another human being who was dying a terrible death. And I know, if it was me, she was terrified for her entire shift. Yet, she did her job, she was a professional. Now, the whole world is criticizing her, and saying she must have made a mistake.

No one is looking at the manufacturer of the isolation gear- does it really provide the protection it promises? Has anyone looked at the memo that was probably sent out about how to deal with ebola? There is no mention of training that was offered to her before she was assigned to that patient.

The CDC says any hospital should be able to manage a patient with ebola- and in theory, that might be right. In reality nurses are working short staffed, extra shifts and with minimal supplies. Having another nurse to observe you while in isolation!! There isn’t even another nurse to cover for a bathroom break.

Ebola is here. It is the new reality. Pointing fingers, and blaming each other is not how we will survive this crisis. We need to share compassion and respect with each other.