"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

[Flatlander]

Sheri Fink, author of Five Days at Memorial (about tragic events at major hospital after Katrina), and herself a physician, was interviewed on NPR yesterday. She described in detail her first-hand observations of how containment of ebola is managed in West African clinics she visited. There are strict protocols at each successive level of entrance and movement of the patient through the facility, starting with the admission entrance, to observation, to treatment, extensive treatment, recovery, and discharge, or morgue. Each area is isolated from the one before and the one after. Patients progress in a straight line through one area to the next. It is all very logical and consistent. Each area has different requirements for protection and containment, from minimal to extreme.

http://www.pri.org/stories/2014-10-13/keeping-disease-and-people-separate-isnt-easy-even-ebola-treatment-centers

Did I read correctly that up to 50 medical personnel were exposed to Mr. Duncan at Texas Presbyterian? That's unbelievable, and seems like poor planning and unnecessarily risky.

It's the lack of information about what's really going on in the hospitals that scares me, not the virus itself. It seems like there are gaping holes and gaps in protocols and procedures for ebola treatment here. Please correct me if I'm wrong!

[lifelearningrn, BSN, RN]

More than a nurse: Who is Ebola patient Nina Pham? - CNN.com

An updated article. She sounds like a remarkable young woman.

[Spidey's mom, ADN, BSN, RN]

I heard today that in Africa, over 200 doctors and nurses have succumbed to Ebola. Here's an article about that from August 2014. It is worse today of course.

http://www.who.int/mediacentre/news/ebola/25-august-2014/en/

Flatlander - thanks for that post. Lots of good info.

Our government is messing up here . . . . and usually I'm a fan of the CDC but not today.

On Ebola, Obama Gets an F

[GadgetRN71, ASN, RN]

So, my hospital has been having so called "informative meetings". I went to one today. It consisted of 4, maybe 5 slides with info any of us could have gotten from the internet. We were told that regular PPE is just fine and when I asked about why CDC workers you see on the news wear Hazmat suits, it was a distinctly uncomfortable moment. I expressed concern about those flimsy face shields we have and about the fact that the man in Texas had projectile vomiting and diarrhea. That's when I started to get semi dirty looks from administration,lol. All in all, not a confidence inspiring event.

My facility is screwed.

[sofla98]

the more I read about this and the more "news" we have trickling toward us, I am affirmed in my decision that I will only care for an Ebola patient if I am availed the same equipment as the Hazmat team. I do not care what anyone says about proper PPE etc... have you heard of anyone from the CDC or Hazmat contracting Ebola? exactly! also I wouldn't mind a decontaminating bleach shower before and after patient care.... that is all....

THIS!!! My point EXACTLY!! They're not going to fit every nurse, PCA, RT, house keeper, etc. with those Haz-Mat suits that you see them wearing in Liberia, on the TV set! I guarantee that nurse didn't have one of those suits on and the CDC threw her under the bus! It makes me sick!

I for one WILL QUIT nursing if this becomes an epidemic. No way am I willing to risk it, especially if they're not going to ensure we have the same protective gear that the CDC people would wear! Sorry, not sorry....

[Sloan RN]

I'm disappointed in the lack of general research of some reading this thread. If healthcare professionals like us are getting their information on Ebola from the news, we're all screwed. Everybody should be reading reliable sources...UpToDate, CDC, WHO, journal articles, etc.

A word on Hazmat suits. Have you ever used one? Do you have any idea how to use one? My hospital has chosen not to use them if we were to get an Ebola patient because:

1. They open in the front. If you are taking care of a patient with Ebola, what part of you is most likely to become contaminated with infected bodily fluids? Yup, the front. How are you going to get out of a Hazmat suit with blood/diarrhea/vomit on the front without contaminating yourself? It's extraordinarily difficult. It's a little easier if you're standing in the middle of a field tent in Africa where they can just dump chlorine or bleach on your suit every time you want to take it off. That's not going to work in a hospital room.

2. Hospital workers aren't familiar with them. I've never touched a Hazmat suit, let alone worn one or taken one off. On the other hand, I've put on surgical gowns, gloves, N-95s and face shields hundreds of times. It's equipment I'm familiar with, therefore I'm more likely to don and doff it correctly.

You have seen Hazmat suits on the news because:

1. In Africa: In many places there is no disposable PPE that can be changed between patients available, so Hazmat suits are safer. Also, it's super hot there. It's been found that if you're sweating like crazy in hospital-style PPE, you're tempted to reach up and wipe your brow...thereby contaminating yourself. Hazmat suits circulate cool air to help with this. Also, stuff like goggles can be difficult in hot environments due to sweat and fog.

2. For EMS: The people at Emory spoke to this...ambulances are tight quarters and often hot as well. EMS guys in drills were seen wiping their brows from sweating in hospital-style PPE. Therefore Hazmat suits were better for them.

3. For people cleaning patients' apartments, etc: Overkill. The virus doesn't live long on surfaces (various surfaces have been swabbed in patients' rooms in both Africa and Emory, and no Ebola has been found anywhere except on a visibly bloody glove and one other visibly bloody article). It's probably not even necessary to decontaminate these peoples' houses at all, since Ebola has only been shown to live for significant periods of time when dried in tissue culture media in the dark at 4 degrees Celsius. Nonetheless, I imagine these people are suiting up because they're not sure what bodily fluids might be found where and don't want to be surprised by any splashes while cleaning, and because the public would probably freak out if they wore less. It's really just an abundance of caution.

We need to remember that Ebola is spread by CONTACT. It is not droplet and it is not airborne. It is not magic. To get it, you have to get the bodily fluids (blood, emesis and stool are the most infectious ones) of a symptomatic infected patient into your mucous membranes or through a cut in your skin somehow. There is no reason hospital-style PPE should not be adequate. My facility is recommending booties, a surgical gown (b/c they are waterproof and have the wrist cuffs), an N-95 (b/c suctioning and intubating can cause temporary aerosolization), a face shield and double-gloving. There is no reason that should not protect you. The trick is in getting it off, and I suspect that's how the nurse in Dallas was infected: some breach that led to her infecting herself while taking PPE off. THAT is why wearing unfamiliar PPE like a Hazmat suit is a bad idea.

Please, please do your research guys. Don't fall victim to media hype and hysteria. We are better than that.

[Ginger's Mom, MSN, RN]

Sloan,

I did my research and the cdc site is awful, I am appalled by the cdc response. the ppe provided by most hospitals do not cover 100percent.

[Sloan RN]

What exactly is awful about the CDC site? I assume you mean the one for healthcare professionals:

Information for Health Care Workers | Ebola Hemorrhagic Fever | CDC

Have you read the UpToDate articles? There are two, and they are free to the public now. They contain a lot of good and interesting information, and have very long source lists at the end for extra reading material if you're interested.

What are you concerned about not being covered if you're wearing booties, a surgical gown, an N-95, a face shield and double gloves? That PPE is provided by most hospitals and I don't see why it isn't adequate.

[BeachsideRN, ASN]

Not sure if this was posted already. It's a little (bad) humor.

Who To Blame When You Get Ebola: A CDC Guide For Healthcare Workers

[BeachsideRN, ASN]

I have a serious question though ... as a brand new nursing student (start clinical in January) how will all this Ebola affect how students are taught? Especially in ER circumstances. Do students typically participate in triage? Are they given N95 masks? I have an N95 respirator from my first job in HazMat - should I keep it my bag? I am sincerely concerned, although I probably should not be. An 18 year old me was all gung ho about infectious disease and wanting to work at USAMRIID/CDC .... now the 35 year old, married, mother of a toddler me is terrified to be starting nursing school with a potential pandemic looming.

[Sloan RN]

Probably won't affect how students are taught too much. As far as triage goes, everyone is being told to ask every patient whether they've had a fever and where they've been traveling in the past month. If the patient has a fever AND has been traveling to any of the affected countries (Guinea, Sierra Leone, Liberia) then they are immediately placed in a private room and the ID specialists are paged.

Your risk of contracting the disease as a triage nurse is pretty slim, as most Ebola patients present with fever and abdominal pain. Unless they vomit directly on you while you're triaging them and then you somehow get that emesis in your eyes/nose/mouth/a cut on your skin, you should be good. That being said, anyone who's known to be exposed to an Ebola patient is supposed to take their temperature twice a day to monitor for fever.

There should be N-95s available wherever you have clinicals, regardless of whether Ebola is out there or not.

[vintagemother, BSN, CNA, LVN, 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

Our CDC is not even recommending the types of safety precautions these nurses are taking. So sad.