"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

[GadgetRN71, ASN, RN]

Here's a scenario for all of you: You work at a large urban hospital, let's say CCC/ICU day shift. You come on and get your report for the day. One of your patients discharges to a step-down unit at 10:00 am. Suddenly, the charge nurse approaches you and tells you, I need to place a patient with Ebola like symptoms in the room occupied by the former patient and I need you to take care of him. The patient has recently flown to your city from Liberia. He's a 55 year old African male, married, in apparent respiratory distress, temp = 103.5 and climbing, vomiting, diarrhea, low sodium, low K, dehydrated, etc. All you are offered for PPE are the flimsy yellow gowns, N95 gowns, latex gloves. You complain to you charge nurse about lack of proper PPE and the nurse dismisses you and states you have no choice, you HAVE to take this patient. How many of you would say, "**** this" and walk off the floor, realizing you've probably lost your job?

I would. I can get another job or take up another line of work. I cannot do so with my life.

[annie.rn]

I worked last night in a community hospital somewhere in TX, USA in a large city about four hours from Dallas. There was a rumor floating up from the ER that there might be an Ebola infected pt. who was going to be admitted to our general Med/Surg unit. Well, that sure got us quickly discussing who would get this pt. No one was volunteering. Not b/c we are heartless nurses but b/c we have had no training whatsoever. The hospital has no plan in place for isolating such a pt. We have no special PPE. All we've been told about the Ebola "plan" is to ask people if they've travelled outside of the U.S., esp. to W. Africa and if they say "yes", let a manager know. Granted, they haven't changed the admission hx. to include this question so you'd better hope everyone remembers to ask. It's very scary. I would take care of an Ebola infected pt. in a heartbeat but give me proper training first, proper PPE and let that be my only pt. for the day so I can focus. Last night we were all at five pt.s w/ no PCA's. To imagine being assigned an Ebola infected pt. on top of already being stretched thin is suicide for all involved. Patient, nurse and all other pt.s on the unit.

They are more concerned w/ getting the unit spiffed up and having cram sessions for the upcoming JHACO inspection (sorry if acronym is wrong) than they are w/ getting us prepared for the threat of Ebola.

I, for one, do not feel ready for this. I am not a martyr. I'm a nurse w/ young kids who need me to be around for a while longer.

[bearscrubs75]

Annie, your children come first. They need their mother. You're right, no one is prepared for this. Let's face it: you wouldn't be given proper PPE for the suspected Ebola patient and you would have to juggle his/her needs in addition to your other 4 pts w/o the help of a PCA. My butt would be out the door so fast my charge nurse would think she saw a ghost!

[ktwlpn, LPN]

QUOTE>>> Duncan's family did not have one good thing to say about the nurses>>>UNQUOTE

They may not be big fans of the nursing staff who endangered their lives at Duncan's bedside but I know they are big fans of the Rev Jessie Jackson. It's just sickening to me, the staff were provided with the same PPE we use every day, not the suits they wear in the field.The staff were probably scared to death to care for this guy (justifiably so) and this family is going to make his illness a race issue and accuse the staff of providing substandard care ....Crap

[Esme12, ASN, BSN, RN]

Dallas nurse with Ebola identified as Nina Pham | Local News - WCVB Home

[Brendan1]

well, he was in west Africa, got exposed, knew there was no chance for treatment where he was so he lied on the questionairre and came to the US for treatment. His family is 'dissatisfied' with his care- personally- I am pretty ****** off that he endangered all of us. Maybe its reverse discrimination...and he was trying to do us all in! ( One for the conspiracy theorists out there..;-) )

[diosa78]

I just read this article and it's obvious the nurses working in Africa have had significant training on how to put on and remove PPE. The Australian nurse describes how it takes 5 minutes to remove PPE after being sprayed down. I don't think this was happening at Texas Presbyterian, but who knows.

‘A teenage girl bled to death over two days': Ebola nurses describe life and death on the frontline | World news | The Guardian

[sistrmoon, BSN, RN]

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?

Exactly. I had a patient this past weekend who was confused and was piling his own feces on his bedside table. Can you imagine that scenario with Ebola?

[Esme12, ASN, BSN, RN]

I just read this article and it's obvious the nurses working in Africa have had significant training on how to put on and remove PPE. The Australian nurse describes how it takes 5 minutes to remove PPE after being sprayed down. I don't think this was happening at Texas Presbyterian, but who knows.

‘A teenage girl bled to death over two days': Ebola nurses describe life and death on the frontline | World news | The Guardian

They are not.

The stories the nurses tell are riveting...

[h=2]Sue Ellen Kovack, 56

Australian Red Cross nurse, Kenema, Sierra Leone[/h] At the start of the day, I check my hands for any cuts or scrapes that will bar me from donning PPE. Entering the centre, I must wash my hands in a 0.05% chlorine solution. I balance on one foot as someone sprays the bottoms of my shoes with 0.5% chlorine before being allowed entry to the low-risk area.

I search for a pair of cold wet boots in my size, which have been soaking in chlorine for the night, and I change into my scrubs. I go straight to the whiteboard to see who has passed away during the night; today, it’s one of three nurses who became infected at work. One is on his way to good health, the other is still hanging on.

We need to synchronise putting the PPE on with other team members, because if one is slower than the rest we end up waiting and baking in the sun. We have a dresser to make sure we are completely covered, or we work in pairs and check each other. First on are gloves and a jumpsuit. Then a second pair of gloves, a thick duckbill mask, a hood, and an apron that is tied by the dresser so we can untie it with one pull. Then on go the goggles with a generous drizzle of antifogging spray, a final check in the mirror and a final check with each other. The checking does not stop there, as we must ensure during our time in the high-risk area that we are still covered, that a mask has not slipped, or that a piece of skin has not been exposed. If that happens, we leave the area immediately. We check the time – 45 minutes to one hour is the maximum allowed in the PPE.

She goes on to say...

We clean and care for as many as we can, but if we need to leave the area because of heat exhaustion or feeling unwell, the priority is to get out. You are a danger to your colleagues if you go down in your PPE.

After our nursing team goes in, the hygiene team suits up for their rounds. They clean up the vomit, diarrhoea and urine spills, the garbage and the nappies. Their task is monumental and they can be at most risk.

A minimum of five minutes is needed to undress. We have two tents, where the undressers and sprayers need to be on the ball. The urge to just pull the suit off is strong, but we wait. First, the chlorine spray to the hands. Then, feet apart, arms in the air, we are sprayed from head to toe, first the front, then the back. We wash our hands in 0.5% chlorine. Off come the first set of gloves.

We wash our hands again. Off comes the apron and hopefully it was tied perfectly, as we have to blindly reach around to release the knot; we pull it over our heads. Into the chlorine soak it goes. We wash our hands.

Next go the goggles. We bend over, close our eyes and gently remove them, dunk them three times in the strong chlorine-filled bucket, and then place them in water. We wash our hands.

The hood comes off next. Once again, we bend over, closing our eyes to avoid contamination and dispose of the hood in the garbage. We wash our hands.

Next, the removal of our heavy PPE. Moving slowly – we do everything slowly here – we carefully expose the zipper, hidden under a taped-down flap. We wash our hands. Blindly, we have to find the zipper, as our undressers and sprayers guide us. We wash our hands.

As we shimmy out of our PPE, we are soaked to the bone in sweat, but it feels great. This is the hardest part: to ease off the jumpsuit while kicking your legs back, at the same time standing on it so it doesn’t fly away from you. It’s a balancing act. The sprayer sprays the entire jumpsuit with a stronger chlorine solution and we put it in the garbage. We wash our hands.

Our heavy-duty filtration mask is next. I close my eyes and hope it doesn’t catch in my ponytail. We wash our hands.

The last pair of gloves comes off. Our boots are sprayed from all angles and we have to balance on one foot to cross the line from high risk to low risk. We wash our hands and we are done, stripped down to our scrubs, soaked with sweat.

I don't think this is being done in Texas.

I understand that the general conditions aren't good there...but Wow....I think we need to step up our precautions. Still this author talks of a nurse dying.

ALL of the stories are riveting.

‘A teenage girl bled to death over two days': Ebola nurses describe life and death on the frontline | World news | The Guardian

[FLAlleycat]

To be fair, I'm far more concerned with the expected projectile vomiting and diarrhea associated with Ebola. Most of your standard PPE isn't designed to deal with this. 6 feet of droplet worries pales in comparison imho. I say this having done my time being 'Christened.'

Completely agree. Projectile vomiting is a monster on its own. I was addressing some concerns about CDC constantly "changing" protocols.

[chadrn65]

I just read this article and it's obvious the nurses working in Africa have had significant training on how to put on and remove PPE. The Australian nurse describes how it takes 5 minutes to remove PPE after being sprayed down. I don't think this was happening at Texas Presbyterian, but who knows.

‘A teenage girl bled to death over two days': Ebola nurses describe life and death on the frontline | World news | The Guardian

Yes, I read the same info. They just reported on the evening news tonight that a specialist from one of the 4 hospitals I mentioned earlier in a post is already at the Dallas Hospital for proper training and assistance. So hopefully, whatever occurred with this poor nurse; won't happen again to someone else. I also read that this nurse's dog is in quarantine, and that they don't expect to destroy the dog as they did with the woman's dog in Spain.

[chadrn65]

Ebola: Five ways the CDC got it wrong - CNN.com

5. The CDC put too much trust in protective gear.

Once Duncan was diagnosed, health authorities started making daily visits to 48 of his contacts.

But that didn't include several dozen workers at Presbyterian who took care of Duncan after he was diagnosed. They weren't followed because they were wearing protective gear when they had contact with Duncan. Instead, they monitored themselves.

Public health experts said that was a misstep, as the CDC should have realized that putting on and taking off protective gear is often done imperfectly and one of the workers might get an infection.

Ebola outbreak: Health care workers become patients - CNN.com

CDC chief blames protocol breach

As authorities confirmed that the Dallas nurse had contracted Ebola, the Centers for Disease Control and Prevention's top official was quick to point to a breach in protocol.

The nurse was identified by CNN affiliate WFAA as Nina Pham. She had cared for Thomas Eric Duncan, who contracted Ebola in Liberiaand died of the illness at the hospital.

Dr. Tom Frieden, director of the CDC, told reporters that it's still unknown how the infection occurred, only that a "breach in protocol" for treating a patient happened.