"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

[dnnc52]

The problem as nurses is that our BON is all about the protection of the patient and very little about us as nurses. I reported a bad working conditions a few years ago to the BON and was actually informed of this. When I asked the BON then who do I go to I was told that the BON does not get involved with personal matters between the nurse and employer. Now we can turn this around as to if you protect the nurse than indirectly your protecting the patient. But I don't know if this would work in the behalf of the nurse. I hate to think that if we are expected to take care of these patients and the facility did not provide what we feel is appropriate PPE that we have no where to go? With our concerns?

[Flatlander]

Thanks Sloan RN. Would you mind sharing the sources for information presented by Emory, etc?

Are you aware of studies showing that toilet flushing can cause aerosolization of contaminants? http://www.ncbi.nlm.nih.gov/pubmed/23040490 If those studies are borne out, that could be a problem.

Regarding contaminated surfaces, here is the quotation from the CDC website you cited, which to me sounds ambiguous (lab studies say one thing, no evidence substantiated from the field, but extra care recommended due to nature of ebolavirus and severity.)

From CDC website page cited by SloanRN.

QUOTE:

On August 1, 2014, CDC released guidance titled, "Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals(http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html).”

The role of the environment in transmission has not been established. [italics are mine.] Limited laboratory studies under favorable conditions indicate that Ebolavirus can remain viable on solid surfaces, with concentrations falling slowly over several days.^{1, 2} In the only study to assess contamination of the patient care environment during an outbreak, [again, italics are mine] virus was not detected in any of 33 samples collected from sites that were not visibly bloody. However, virus was detected on a blood-stained glove and bloody intravenous insertion site.³ There is no epidemiologic evidence of Ebolavirus transmission via either the environment or fomites that could become contaminated during patient care (e.g., bed rails, door knobs, laundry). However, given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity, higher levels of precaution are warranted to reduce the potential risk posed by contaminated surfaces in the patient care environment. END QUOTE

I don't think I'd want to base conclusions on only one study, when the CDC states the role of the environment is not yet established, and "higher levels of precaution are warranted."

Here is some more from the CDC page. Seems like this might be the reason patients homes were decontaminated...

QUOTE: from CDC.

Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.

Avoid contamination of reusable porous surfaces that cannot be made single use. Use only a mattress and pillow with plastic or other covering that fluids cannot get through. Do not place patients with suspected or confirmed Ebola virus infection in carpeted rooms and remove all upholstered furniture and decorative curtains from patient rooms before use.

To reduce exposure among staff to potentially contaminated textiles (cloth products) while laundering, discard all linens, non-fluid-impermeable pillows or mattresses, and textile privacy curtains into the waste stream and disposed of appropriately.

The Ebola virus is a classified as a Category A infectious substance by and regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180). Any item transported offsite for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, and used health care products (such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, used Personal Protection Equipment (gowns, masks, gloves, goggles, face shields, respirators, booties, etc.) or byproducts of cleaning) contaminated or suspected of being contaminated with a Category A infectious substance.^{6, 7} (see question 8).

It seems to me that decontamination is definitely recommended.

Your post contained some useful information. Interesting that contamination can occur due to using too many barriers. CDC's Frieden noted that some workers were triple gloving, apparently more dangerous than double-gloving due to difficulty of removing. Interesting stuff on hazmat pros and cons, too.

[missmollie, ADN, BSN, RN]

And a second healthcare worker has been diagnosed with Ebola:

Second Health Care Worker in Texas Tests Positive for Ebola, Authorities Say - ABC News

[Esme12, ASN, BSN, RN]

I am beyond angry ......NOW you think you should have done more CDC????

You lying piece of .......!!! NOW you're going to dispatch to dispatch a team? A few days ago you were blaming the nurse for a breach of protocol you lying sack of manure.

Give the US nurses what they need!

2nd Dallas worker tests positive for Ebola - CNN.com

[sissiesmama, ASN, RN]

I am beyond angry ......NOW you think you should have done more CDC???? You lying piece of feces!!! NOW you're going to dispatch to dispatch a team? A few days ago you were blaming the nurse for a breach of protocol you lying sack of manure. Give the US nurses what they need!

2nd Dallas worker tests positive for Ebola - CNN.com

THIS!! And I could not believe it when they called her out on it - then retracted it. Guess they'll blame her dog next...

[Ginger's Mom, MSN, RN]

I am beyond angry ......NOW you think you should have done more CDC????

You lying piece of .......!!! NOW you're going to dispatch to dispatch a team? A few days ago you were blaming the nurse for a breach of protocol you lying sack of manure.

Give the US nurses what they need!

2nd Dallas worker tests positive for Ebola - CNN.com

i could not agree more

[Esme12, ASN, BSN, RN]

LOL. @Brendan1.

America isnt a white country. If ebola got out of hand, rest assured that my black butt would be hemorraghing, feverish and delirious...alongside you. LOL

I initially assumed it was bioterrorism. 1. Dude comes to Texas with it's huge poor immigrant pop. The state sends hlthcare workers to the borders for a reason. 2. The media drew special attn to the fact that hed been around kids. Kids are vectors.

I doubt...the guy came over here for reasons provided by the media. Doubt it.

...but im a psych nurse. Of course, Im going to second guess human motives. Thats what happens when you're up close and personal with the more negative aspects of human nature.

But, anyway, I questioned the nurse as well when id heard about it. I dont see the problem with that. Youd want to know if human error was a factor. Thats not throwing the nurse under the bus.

Blaming the nurse because patient zero got discharged with antibiotics...is. Yet, the media and that hospital were on mute once it came to be known that the nurse was likely one of the few who did their job. She probably told the provider and he blew her off. "Im the ... doctah!"

Some of these MDs are barriers to the care of their own pts.

PPE? Well...I try to place instructions beside the pts sink so that our aides know how to remove PPE the right way. Yeah - we were all taught but people do forget. Including me.

Facilities not being properly prepared? Yeah. At one of my PRNs, we were creating makeshift masks with briefs to enter a room. Ran out.

Most of my aides were afraid to go in and my resident wasnt being fed, I was told. One of the aides informed me. She actually went in the room without anything on her face to try to feed the woman! It wasnt my pt so I cant everything about her but i do know that she wasnt droplet precaution. Still, we were required to wear masks. So, i taped two sets of briefs together and we went in the room together.

...and im still not "scared" of Ebola. Fear is not a useful emotion. *shrug*

You shldnt be cowering in a corner; nurses shld be out raising hell about this matter (give us PPE, give us better instruction) since it will be us and our CNAs who are going to be on the front lines if this thing.

Fear isn't useful ...however with a second nurse....we need to be very worried

[Christy1019, ASN, RN]

I am beyond angry ......NOW you think you should have done more CDC????

You lying piece of .......!!! NOW you're going to dispatch to dispatch a team? A few days ago you were blaming the nurse for a breach of protocol you lying sack of manure.

Give the US nurses what they need!

2nd Dallas worker tests positive for Ebola - CNN.com

They couldn't even get her name correct in the article...

[lifelearningrn, BSN, RN]

SloanRN- I've read (and yes, I know how to do my research) that because of the virulent nature of Ebola, that it IS droplet precautions and can live on surfaces for up to 6 days. They say it is unlikely that it will, but it CAN. It is not like HIV in that it dies basically on contact with o2.

[Esme12, ASN, BSN, 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.

Well now they are "re-evaluating'" their recommendations....Nurse number 2 ill.

We are being advised by the village fools.

[lifelearningrn, BSN, RN]

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.

If the PPE we don for every day contact precautions was adequate, these health care workers wouldn't be getting sick.

I am not a in a panic or hyped up about this. I honestly don't think this country is going to see an epidemic because I KNOW it's not airborne. I am concerned about the health care workers not being given proper PPE for a disease from which THIS country has never dealt with.

[FLAlleycat]

. . . 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.

Completely agree with our last statement. However re PPE described (I'd also add surgical hat and shoe boots not just covers), have you seen the video demonstration by Dr. Gupta:

How can people in proper gear contract Ebola? | HLNtv.com

Doesn't do much to endorse the PPE we're given at the hospital.