Ebola outbreak - general thread #5

[chipmunk]

No cause- effect relationship exists. However, unless you have been evaluated for epistaxis, you might consider a workup to rule out sinus or nasal problems soon.
I received my influenza vaccine 2 weeks ago. Had a mild febrile reaction which I did not treat, as treatment lowers the immune response.

Ah, thx for tip. Same thing with me but I just took Tylenol. Won't any more - unless becomes something worse.

 

[Muffet]

That hospital should have been saying "we are clueless" instead of "we are ready."

One of the things the CDC backtracked on the last couple days was its telling everyone that every US hospital with an isolation unit could handle an Ebola patient.

The CDC also chose to qualify these nurses to their "low risk" group.

I believe everyone there was arrogant and negligent, except the people on the front lines.

 

[chipmunk]

This is not a comment specific to your facility but I hope that any hospital which lacks supplies will step forward and say so now, not later like Dallas Presby. did.

I hope it's not a case of hoarding. I hope it's "just" not being able to manufacture them fast enough. If it's hoarding it might become necessary for the CDC or similar agencies in other countries to prioritize which facilities get how many items. If things get bad, and I doubt it will come to this, governments can order companies to make more. This issue will be another which favors designated ebola treatment hospitals for sure.

In the states and I think most of Europe during bad flu seasons the manufacturers had a good system to manage this. But flu vaccines and ebola gear are apples and oranges.

 

[SeekingJana]

I remember chuckling over a title of a book once that seemed extremely "Southern". It was the book " It Was On Fire When I Lay Down On It".

That's how I view the Presby. nurses who were assigned to care for Patient Zero in ICU without the proper isolation training and PPE.

The situation was already on fire when they entered the room for the first time.

 

[margarita25]

Poor Doggie

:beagle:

Dog of Dallas nurse with Ebola moved to air base
http://www.chron.com/news/texas/article/Dog-of-Dallas-nurse-with-Ebola-moved-to-air-base-5822759.php



Photo By Courtesy of Sana Syed/PIO, City of Dallas/AP This Oct. 13, 2014, photo released via Twitter by the City of Dallas Public Information Managing Director Sana Syed shows Bentley in Dallas, the one-year-old King Charles Spaniel belonging to Nina Pham, the nurse who contracted Ebola. Bentley has been taken from Pham's Dallas apartment and will be cared for at an undisclosed location.

 

[LaborDayRN]

Poor Doggie

:beagle:

Dog of Dallas nurse with Ebola moved to air base
http://www.chron.com/news/texas/article/Dog-of-Dallas-nurse-with-Ebola-moved-to-air-base-5822759.php


View attachment 61321
Photo By Courtesy of Sana Syed/PIO, City of Dallas/AP This Oct. 13, 2014, photo released via Twitter by the City of Dallas Public Information Managing Director Sana Syed shows Bentley in Dallas, the one-year-old King Charles Spaniel belonging to Nina Pham, the nurse who contracted Ebola. Bentley has been taken from Pham's Dallas apartment and will be cared for at an undisclosed location.


View attachment 61322

He looks so scared. I wish someone was cuddling him tonight......but I'm sure that's out of the question.

 

[Elley Mae]

I think the "fault" or "breach of protocol" lands at the feet of the CDC. They knew Mr. Duncan was there. They knew he had Ebola. Yes, the Hospital was/is at fault for at least not screaming "help" but I blame the CDC. I mean, aren't issues like this something that they are supposed to be on top of. They should have been first on the scene immediately after it was reported that Mr. Duncan had Ebola. They are the experts, they say. They know protocol, they say. So why weren't they on the ground at the Hospital running or overseeing everything?

I would like to think that people from the cdc would be doing fly byes/walk ins, to do checks on procedures and equipment and inspections. you know like the health department does on restaurants.
I still say that the cdc needs a new head. jmo idk

 

[Lato]

CNN saying that second healthcare worker is testing postive for ebola....yet no link yet.

 

[RabidBadger]

Second health care worker tests positive in Dallas.

http://www.nbcnews.com/storyline/eb...alth-care-worker-tests-positive-ebola-n226161

 

[Lato]

Dr. Elizabeth Cohen on line with CNN and also confirms as well as Fox News dot com in their breaking news.....

 

[lawstudent]

Yikes. I was wary of believing the nurse's union's statements in their entirety because that came across as an attorney preparing for a lawsuit and could be exaggerated. Not that I don't think they have a right to sue if certain things happened, but I just know how those things get hyped. But it does seem like there were some clear opportunities for infection if a second person has it. I can totally believe protocols were changing constantly, but I do believe that was meant to offer better protection has more information became available. Unfortunately it was kind of a crazy situation that probably was not organized due to the novelty of it. It doesn't necessarily mean anyone was just acting with total disregard of safety, but things were probably getting out of hand and people were frazzled and getting mixed instructions.

Are there other diseases which healthcare workers typically worry about contracting? I guess the major infectious diseases are often caught in childhood and so they are immune, or they have been vaccinated. And something like HIV is hard to transmit. But there must be other situations where a hospital faces something somewhat similar. I guess we've just been lucky that a lot of those diseases have been wiped out with vaccines so we don't have smallpox etc. anymore. If we ever had another plague, though, I guess healthcare workers would have to end up sacrificing themselves.

ETA: I still don't view this as a massive scandal or outbreak, though. Hopefully, they were being closely monitored and quickly diagnosed, and haven't spread it to anyone else. While of course I hope that no one catches it, the test is more about keeping it controlled to those immediately in contact by necessity. I hope that the healthcare workers are successfully treated and no other victims arise. And hopefully they learned from these last few weeks how to avoid further nurse infection.

 

[Sonya610]

A nursing supervisor faced resistance from hospital authorities when the supervisor demanded that Duncan be moved to an isolation unit, the nurses said, according to the union.

Sounds like that hospital and possibly MANY others have a serious professional culture problem.

Perhaps the superiors are OFFENDED when their underlings make suggestions? Because they are smarter and better educated so if they didn't think of it first then it isn't a good idea? And/or they take all suggestions/ideas from lower staff members as a lack of respect for their position and are insulted?

Not sure if I am explaining clearly, but hopefully some know what I mean.

 

[Lato]

http://www.cnn.com/2014/10/15/health/texas-ebola-outbreak/index.html?hpt=hp_t1

2nd Healthcare Worker Tests Positive for Ebola in Dallas.....expanded article.....from 5:14 am today

 

[Lato]

Has anyone asked the question as to whether a healthcare worker caring for an ebola patient may also be assigned to other hospital patients during the 21 day period when the healthcare worker is being monitored?

 

[musicaljoke]

Second health care worker tests positive in Dallas.

http://www.nbcnews.com/storyline/eb...alth-care-worker-tests-positive-ebola-n226161

It doesn't sound as though she was isolated after her contact with Duncan, rather, she was "monitored". Had she been isolated earlier, there would be no need to track all the people with whom she came in contact. Early isolation is what brought the deadly SARS outbreak to an end in Toronto. At one time, there were more than 10,000 people in isolation in Toronto.

Does anyone remember long, long ago, when a home would be quarantined because of a terribly contagious disease: measles, hepatitis, scarlet fever...? The Public Health Nurse would tape a sign to the front door to warn away would-be callers until the quarantine period was over.

 

[musicaljoke]

Has anyone asked the question as to whether a healthcare worker caring for an ebola patient may also be assigned to other hospital patients during the 21 day period when the healthcare worker is being monitored?

No, that normally wouldn't happen. Nurses who work in the isolation ward, do not treat any other patients. Upthread somewhere, an isolation nurse explains this. Isolation of contagious diseases is certainly nothing new, so hospitals ought to have this well established long before now.

 

[Sonya610]

Did you see the one where they made them wrap tape around their necks to protect it???

I thought most bandage/medical tape wasn't even waterproof. What good would porous tape do to protect against infected body fluids?

 

[Sonya610]

Has anyone asked the question as to whether a healthcare worker caring for an ebola patient may also be assigned to other hospital patients during the 21 day period when the healthcare worker is being monitored?

Well in the TX case they estimate 70 healthcare workers at the hospital could have been exposed and we know the first nurse WAS working until shortly before she became ill. They didn't take ANY of them off the job for the 21 day monitoring period so it seems obvious that those 70 workers were treating a LOT of other patients.

 

[nrdsb4]

Couple of points:


One of the only positive things we have learned from this situation in Dallas is that it is pretty likely that this disease is not very contagious in its early stage. We have yet to have any of Duncan's contacts show up with the disease, even those who were around him after he became symptomatic. The fact that these nurses were monitoring their temps makes it also unlikely that any of THEIR contacts are going to get sick. Clearly once the illness takes hold and we start seeing the massive amount of fluids being secreted, this becomes a huge risk. These nurses were infected rather quickly after beginning care of the extremely ill Duncan, while Duncan's personal contacts remain asymptomatic at day 17. Additionally, the folks who interacted with an early symptomatic Duncan in the ER also remain asymptomatic as far as we know. That is something we can be hopeful about with respect to the contacts of the health care workers. If I were a nurse who took care of Duncan and was currently asymptomatic, I would err on the safe side and self isolate. I wouldn't be at all surprised to hear that many of them are doing exactly that.

About the "70 people involved in Duncan's care:" That does not mean that 70 different people actually came into contact with him. That could be the pharmacists who are mixing his drugs, the pharmacy tech who drops it off to the unit, the consulting physicians, the lab techs, etc. As usual, the people most often in direct contact with a patient are nurses. We are the ones who implement the care and I'm not believing they had 70 nurses working on this one patient.

That said, as soon as one nurse became infected, it was clear that she would not likely be the only one. I think that understandably, they are going to see resistance to getting other nurses to get increasingly involved, particularly if there is no confidence in the support structure and safety.

In order to nip this in the bud, they may have to consider transporting every nurse who cared for Duncan to one of the four specialty centers and shutting down ebola care at Presby. Now whether or not that is feasible I have no idea.

I think "lab contamination" is a very very remote possibility as universal precautions are always followed. It's not like they are flinging blood everywhere and mixing up samples. That makes no sense.

 

[nrdsb4]

Well in the TX case they estimate 70 healthcare workers at the hospital could have been exposed and we know the first nurse WAS working until shortly before she became ill. They didn't take ANY of them off the job for the 21 day monitoring period so it seems obvious that those 70 workers were treating a LOT of other patients.

BBM. We absolutely do not know that is the case. We also need to remember that the one thing the CDC and WHO seems to be right about is that the disease is not easily spread until the patient is well into their symptoms. It's not coincidence that the two people who are now infected were people who did not interface with Duncan until he was extremely ill.