Ebola outbreak - general thread #4

[jjenny]

Ok so now do people in that area of Lower Greenville in Dallas need to be concerned? Will they have to go now and trace all of HER contacts ? How does this work?
A new batch of people who have to be monitored for 21 days? Which reminds me, Wow and by the grace of God , no one that was in the Duncan apartment got sick, right?

Just googled the address and it's literally a block from someone I know. So that's curious. But nothing to worry about, right?

We don't know yet if nobody in Duncan's apartment got sick. Incubation period is up to 21 days.
It hasn't been 21 days yet.

 

[CARIIS]

No doubt, the other Emory pt is sole about confidentiality . For us, confidentiality was golden . And if you think about it how could, in psych, any trust be devolved if the pt did not know that whatever warts they want to reveal, are between the clinician and the pt only.

We reviewed it during assessment the the notion. IN our field way before Hippo it was in place and done. During marital therapy, after initial sessions , it was always good to have one individual with each individual.

Unless the partner signed a release nothing in that session could be discussed when joint sessions resumes. Husband tended to a much more difficult time with that notion! “Its my wife”. I always encouraged, a was able to, with few exceptions have the husband see its importance. The wives more readily signed the release! Are we together to foster secrets?

Witt the exception of treatment team, as colleagues, we could not speak with a pt prior clinician without consent. Only time that was breached , was duty to warn,, danger to others self etc.

The top four golden: sex with a pt, failure to warn, breach of confidentiality, and dual relationships (knowing someone socially and working with them,- having any kind of relationship with them ).

In public, if we passed a pt at the grocery store we were not allowed to acknowledge them unless the pt approached and interacted with us first. Think about it – a therapist says hi and the person they are with asks who was that.........

All of us found Hippa in pain , cause we had been doing it since Freud! As is typical the govt turned it into 484 pages!

For us a sentence worked! It is forbidden to discuss any treatment with anyone with a signed consent to do so.

See how nice, short, consist that principle is!! They turned it into everyone had to take Ceu's regarding it 3 hour trainings : For : It is forbidden to discuss any treatment with anyone without a signed consent to do so.

Only the govt!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

IMO, In this instance there might be some who might say it could impact me. How could not honoring a pt right to confidential impact another individuals chance of contracting Ebola. IMO. It cant, and IMO confidentiality in this instance, is not any different in tis sitution.

In actuality, with Ebola, and the way the media has presented the situation in all liklihood the release could put the pt in danger. I have no doubt, that shortly this going to explode,much like HIV, into hate, spray painting pt houses with we dont want you here etcetc etc. Mass hysteria,wiht IMO, no need for. IMO when all this starts the indivudulas should be prosecuted as commiting a hate crime.

The media might try to bring regarding the aforementioned statement – once again – its just the media doing what it does –educated the public, and in this situation, just like HIV , they impacted the ability to get what behaviors one must engage to increase/decrease livelihood of of contracting.

IMO,Fear always breeds panic................

 

[jjenny]

J.D. Miles ‏@jdmiles11 48s49 seconds ago
Should this 2nd #Ebola patient stay at Presbyterian hospital considering the disease spread there despite precautions?

It would be better for everybody (including the patient) if she was air lifted to one of the special hospitals designed for Ebola. They are more equipped there to treat Ebola patients. Do they have isolation pods that would fit in a helicopter?

 

[Sonya610]

When the CDC works with the ebola virus in the lab, they wear a "space suit" and have to go through a 7 minute decontamination shower before they take the suit off.

That is probably one of the reasons the CDC guys wear full water tight face covers. If you want to disinfect your suit with bleach then a cloth/paper mask isn't going to cut it (or flimsy eye protection), you don't want to get the disinfectant in your face or inhale strong bleach/disinfectant fumes for several minutes.

 

[shotgun09]

Watching CDC dude now, on Face the nation. What I can gather, ( obviously MO ) this Nurse may have been a Dialysis Nurse....just sayin.. He is clearly blaming the nurse for probable improper protocol in removing PPE, but with his comment about " looking into" Intubation and Hemodialysis" as potential breaches, this kind of narrows it down.

 

[faw720]

Ok so now do people in that area of Lower Greenville in Dallas need to be concerned? Will they have to go now and trace all of HER contacts ? How does this work?
A new batch of people who have to be monitored for 21 days? Which reminds me, Wow and by the grace of God , no one that was in the Duncan apartment got sick, right?

Just googled the address and it's literally a block from someone I know. So that's curious. But nothing to worry about, right?

If what was said in the press conference is true, the person you know should have already been notified. Officials said that all nearby residents were going to be personally notified as well as printed information given.

 

[Elley Mae]

I guess this case will show if she was contagious before she was symptomatic. If she took her temp 2 times a day and contacted them on seeing the spike in her temp then no one she was around should get it if it is only contagious after showing signs of it. jmo idk

 

[SStarr33]

I guess this case will show if she was contagious before she was symptomatic. If she took her temp 2 times a day and contacted them on seeing the spike in her temp then no one she was around should get it if it is only contagious after showing signs of it. jmo idk

Excellent point. We will learn lots from this patient. I sure hope they can keep her alive.

 

[jjenny]

Watching CDC dude now, on Face the nation. What I can gather, ( obviously MO ) this Nurse may have been a Dialysis Nurse....just sayin.. He is clearly blaming the nurse for probable improper protocol in removing PPE, but with his comment about " looking into" Intubation and Hemodialysis" as potential breaches, this kind of narrows it down.

Quite possible. They went all out for Duncan (despite what family claims) using ventilation and dialysis. While Duncan was full of Ebola virus. Have they spread it around in trying to treat Duncan?

 

[Brightbird]

Have you seen this very awkward video turned out by the Galveston Health Department on how to don and REMOVE a PPE suit after Ebola exposure?

This was done as an OFFICIAL instruction video for EMTs etc...and it is a joke, they do NOT sanitize the suit the wearer just struggles to get out of it while an unprotected "helper" fumbles with the bio-hazard bag holding the "contamination". And these are the "experts" that the rest of us are supposed to depend on?

Long video, removal starts at 7:30 mark.

[video=youtube;gUIAd8jdnT4]https://www.youtube.com/watch?v=gUIAd8jdnT4[/video]

Not confidence inspiring is it Looks like the EMT workers wear more protection than CDC minimum. But all the clips I've seen from West Africa show them decontaminating the suit and gloves first before removal. Wonder why Texas health/CDC doesn't think that's necessary.

 

[shotgun09]

Not confidence inspiring is it Looks like the EMT workers wear more protection than CDC minimum. But all the clips I've seen from West Africa show them decontaminating the suit and gloves first before removal. Wonder why Texas health/CDC doesn't think that's necessary.

$$$$$$$$

 

[jjenny]

The ER staff would not be the ones "treating" the new ebola patient. The patient would be on the isolation ward of the hospital which is never staffed by the ER workers at any time even when it does not involve ebola. The ER staff most likely did not quit work.....they are the 18 people now being monitored because of their contact with the new patient. If they are being monitored....they obviously can not continue to work or treat patients.
This type of thing multiplies exponentially. Every patient that this staff member treated in the ER should be monitored, if not isolated. Every room in the ER that this staff member worked in must be decontaminated, as must every restroom, every break room, etc. Taking 18 people out of work rotations in an ER would require shutting down until new staff could be transferred in, plus the time needed to sterilize every piece of equipment and item that had been exposed while that staff member was at work. The ER may be closed for days, if not weeks!

I think this nurse was part of Duncan's treating team and not in the ER.

 

[Sonya610]

Wonder why Texas health/CDC doesn't think that's necessary.

Because they never ACTUALLY thought about it? They just read basic instruction sheets without using common sense?

 

[hockeymom]

Watching CDC dude now, on Face the nation. What I can gather, ( obviously MO ) this Nurse may have been a Dialysis Nurse....just sayin.. He is clearly blaming the nurse for probable improper protocol in removing PPE, but with his comment about " looking into" Intubation and Hemodialysis" as potential breaches, this kind of narrows it down.

I feel like they have to blame the nurse because otherwise they have no other way to explain how she contracted it. Can you imagine if they just said we are clueless at this point?!! Nobody wants to hear that.

 

[Lyra500]

Have you seen this very awkward video turned out by the Galveston Health Department on how to don and REMOVE a PPE suit after Ebola exposure?

This was done as an OFFICIAL instruction video for EMTs etc...and it is a joke, they do NOT sanitize the suit the wearer just struggles to get out of it while an unprotected "helper" fumbles with the bio-hazard bag holding the "contamination". And these are the "experts" that the rest of us are supposed to depend on?

Long video, removal starts at 7:30 mark.

[video=youtube;gUIAd8jdnT4]https://www.youtube.com/watch?v=gUIAd8jdnT4[/video]

It does seem awkward and a tad shambolic in places.

Even with the triple gloving, it looked to me as if the lady who was demonstrating had possibly touched the outside (contaminated!) of the suit as she tried to roll it down and step out of the lower leg/foot part. I am sure some part of her blue inner glove touched the outside of the foot of the suit. If anything had splashed on there (imagine a severely ill patient in the midst of the projectile vomiting/explosive diarrhoea stage) then all it would take was for her to touch the back of her glove to her nose and there you go.

I suppose at least she was getting dressed into a full suit. The only PPE guidance for Ebola I could find on the CDC website was here:

http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

•

All persons entering the patient room should wear at least: ◦Gloves
◦Gown (fluid resistant or impermeable)
◦Eye protection (goggles or face shield)
◦Facemask

•Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to: ◦Double gloving
◦Disposable shoe covers
◦Leg coverings

With a poster showing donning and removal techniques

www.cdc.gov/HAI/pdfs/ppe/ppeposter8511.pdf

I would have thought that this was a time for definitive guidance rather than slightly woolly guidance using phrases like 'at least'. I am not convinced the 'at least' recommendations do actually provide the minimum protection required.

 

[Elley Mae]

The last think any hospital wants or needs right now is for the health care workers/nurses/Dr's to think that the protective gear is not protecting them.

 

[WichitaFalls]

For over 40 years this hospital has been my families hospital of choice. That being said, if I was the nurse (God be with her) that has tested positive, I would beg/borrow/steal to be transferred to Emory. No way would I want to be treated there at Presby. No way.

My heart is so heavy for this woman and our community.

 

[jjenny]

I feel like they have to blame the nurse because otherwise they have no other way to explain how she contracted it. Can you imagine if they just said we are clueless at this point?!! Nobody wants to hear that.

Just like in Spain. I don't think the nurse in Spain actually even remembers that she touched her face, but it sounds like they pestered her until she said she did.

 

[jjenny]

For over 40 years this hospital has been my families hospital of choice. That being said, if I was the nurse (God be with her) that has tested positive, I would beg/borrow/steal to be transferred to Emory. No way would I want to be treated there at Presby. No way.

My heart is so heavy for this woman and our community.

ITA. Best for everybody if she is send to a specialized hospital, where they are ready for Ebola patients. Since Dr. Sacra left Nebraska, it's available.

 

[trigger]

"I think the fact that we don't know of a breach in protocol is concerning, because clearly there was a breach in protocol." Frieden said. "We have the ability to prevent the spread of Ebola by caring safely for patients ... We'll conduct a full investigation of what happens before health workers go in, what happens when they're there, and what happens in the taking out, taking off their protective equipment because infections only occur when there's a breach in protocol."

Yup they are blaming the hcw