Ebola outbreak - general thread #4

[Isabelle]

I think patients with Ebola need to be 2 nurses to one patient care because of the extreme precautions that need to be taken. Nurses need meal and bathroom breaks. The more a caregiver has to get in and out of protective gear the higher the risk of a breach.

If Charity Hospital in New Orleans reopened to care for Ebola patients I would come out of retirement to be on the front line to provide care. The camaraderie and support caregivers gave each other to provide the highest level of care is not matched anywhere in the world!

 

[popsicle]

I read that on average, an ebola patient infects 3 or 4 people before dying. But keep in mind that the vast majority of the cases occurred in a few countries with certain conditions. In his end stages, Mr. Duncan was in a hospital. Most patients are going to be cared for by family, and their body will be prepared by the family. The odds of infection in Mr. Duncan's case would seem to be much lower - the majority of the time he was contagious, people were taking precautions.

It is entirely possible the staff was trained, but people mess up. Everyone makes a mistake at work every so often and can't believe how they could have done such a silly thing, no matter how diligent, even if only once a year. If you are a doctor or a pilot or a soldier, that one off day has horrible consequences. I've said this before, but look at how many doctors have scientists have died as a result of sticking themselves with a needle or dropping something radioactive. They may be very bright, responsible people, but it only takes a second of distraction when it is something they are comfortable with because they do it so often.

I don't think a slip up is the case here, simply because they are expecting more cases of Ebola. jmo

 

[SStarr33]

It was interesting that Duncan was the first patient in the US who was dialized and tubed. Wonder if any future ebola patient will get either of those.

 

[okiedokietoo]

I read that on average, an ebola patient infects 3 or 4 people before dying. But keep in mind that the vast majority of the cases occurred in a few countries with certain conditions. In his end stages, Mr. Duncan was in a hospital. Most patients are going to be cared for by family, and their body will be prepared by the family. The odds of infection in Mr. Duncan's case would seem to be much lower - the majority of the time he was contagious, people were taking precautions.

It is entirely possible the staff was trained, but people mess up. Everyone makes a mistake at work every so often and can't believe how they could have done such a silly thing, no matter how diligent, even if only once a year. If you are a doctor or a pilot or a soldier, that one off day has horrible consequences. I've said this before, but look at how many doctors have scientists have died as a result of sticking themselves with a needle or dropping something radioactive. They may be very bright, responsible people, but it only takes a second of distraction when it is something they are comfortable with because they do it so often.

Thank you for your response. I think Mr. Duncan was home approx. 4 or 5 days with symptoms, according to this timeline: http://abcnews.go.com/Health/wireStory/timeline-case-ebola-diagnosed-us-26125457

 

[SStarr33]

Disclosure and communicable diseases

(45 CFR 164.512 (b)(1)(iv))

http://www.law.cornell.edu/cfr/text/45/164.512

 

[lawstudent]

I don't think a slip up is the case here, simply because they are expecting more cases of Ebola. jmo

If it is not a slipup, I assume you mean it must be airborne? If they'd jumped to that conclusion, I'd imagine a lot of other people would already have it, and we'd be seeing it take over the countries with outbreaks. I think they are more indicating that they can't find the slip up, so it's possible that others made similar mistakes or that this nurse could have infected them over the last few days.

 

[SStarr33]

They decontaminated her apartment. I wonder if they took all of her stuff. Can you imagine?

 

[nightwatch]

The facility I currently work at ( I am an RN ), gave us a " Mandatory Education" on EBOLA. (via the internet of the facility), which was a three page read with illustrated instructions. Took me 3 minutes to complete, and of coarse sign...( covers their buts). No additional hands on training or available q & a experience was offered. This is BS!

Its been said before and I agree there needs to be a central medical facility to transport all Ebola patients to. Now our little hospital that serves 75000 county residents claims they are ready for Ebola. REALLY? Just seems there needs to be one place where all the controls are easy to monitor. Jmo

ciao

 

[lawstudent]

Thank you for your response. I think Mr. Duncan was home approx. 4 or 5 days with symptoms, according to this timeline: http://abcnews.go.com/Health/wireStory/timeline-case-ebola-diagnosed-us-26125457

Right - I'm not denying he could have infected someone at home, but the statistics of infection are over the course of the illness, and I imagine chances of infection increase as the symptoms do because of the presence of bodily fluids and the person's inability to care for him or herself. So the average ebola patient may be cared for by family for a few weeks, and over that time, 3 or 4 get infected. His family members may just not have been infected while he was home - just as people can have sexual contact with someone with HIV many times without contracting it. It's not a guarantee that one will get it, but the longer it goes on, the chances increase. If a healthcare worker messed up with a needle, that would be a way greater chance of infection, but obviously they haven't identified such a breach.

 

[Lyra500]

If it is not a slipup, I assume you mean it must be airborne? If they'd jumped to that conclusion, I'd imagine a lot of other people would already have it, and we'd be seeing it take over the countries with outbreaks. I think they are more indicating that they can't find the slip up, so it's possible that others made similar mistakes or that this nurse could have infected them over the last few days.

I wonder whether this means the CDC has identified a significant flaw in the procedures which the hospital was using and therefore suspect that other staff members who followed protocol would also be at risk.

So the breach in protocol was not the nurse 'doing it wrong' but the hospital devising an in house procedure which was not in line with CDC guidance - thus meaning that any staff working to the procedure may also be at risk.

Just a thought.

This CDC table with guidance on EVD mentions procedures which could produce aerosols (Aerosol Generating Procedures) - to be avoided if at all possible.

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

 

[okiedokietoo]

Disclosure and communicable diseases

(45 CFR 164.512 (b)(1)(iv))

http://www.law.cornell.edu/cfr/text/45/164.512

I'm reading through this but can't find the part where it says it needs to be disclosed to the public - only to people exposed.

(b) Standard: uses and disclosures for public health activities—
(1) Permitted disclosures. A covered entity may disclose protected health information for the public health activities and purposes described in this paragraph to:

(iv) A person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or investigation; or

 

[Muffet]

If it is not a slipup, I assume you mean it must be airborne? If they'd jumped to that conclusion, I'd imagine a lot of other people would already have it, and we'd be seeing it take over the countries with outbreaks. I think they are more indicating that they can't find the slip up, so it's possible that others made similar mistakes or that this nurse could have infected them over the last few days.

BBM
It isn't "airborne", but it doesn't need to be to show that the current assurances and protocols to be inadequate.

 

[SStarr33]

I'm reading through this but can't find the part where it says it needs to be disclosed to the public - only to people exposed.

Who may have been exposed

 

[okiedokietoo]

Who may have been exposed

Sorry, not understanding your point

 

[Muffet]

I wonder whether this means the CDC has identified a significant flaw in the procedures which the hospital was using and therefore suspect that other staff members who followed protocol would also be at risk.

So the breach in protocol was not the nurse 'doing it wrong' but the hospital devising an in house procedure which was not in line with CDC guidance - thus meaning that any staff working to the procedure may also be at risk.

Just a thought.

This CDC table with guidance on EVD mentions procedures which could produce aerosols (Aerosol Generating Procedures) - to be avoided if at all possible.

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

The CDC protocols for sufficient PPE is inadequate.

IMO

 

[Sonya610]

CDC does treat it as level 4 for researchers in CDC labs. But when it comes to health care professionals taking care of patients, all of the sudden it's not level 4 anymore.
What gives?

The health care professionals are drinking the CDC Kool-Aid (the CDC aren't drinking it themselves, they know better!).

 

[SStarr33]

Sorry, not understanding your point

Anyone who may have been exposed gets notified.

 

[SweetT]

It was interesting that Duncan was the first patient in the US who was dialized and tubed. Wonder if any future ebola patient will get either of those.

Sorry I guess I'm missing the point.. Did he not need those things?

 

[okiedokietoo]

Anyone who may have been exposed gets notified.

Right but does not include informing the public

 

[trex]

It does not indicate that Ebola is airborne though, which I think was the argument being put forward.

Okay, perhaps my verbiage was incorrect in saying "airborne"... What I meant by airborne was the term "Aerosol Transmission". According to the CDC doc regarding Biosafety Levels here - http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf - Ebola being a BSL-4 level disease and the definition of Biosafety Level 4 per the CDC -

Biosafety Level 4 is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections and life-threatening disease that is frequently fatal, for which there are no vaccines or treatments, or a related agent with unknown risk of transmission.

(previously in the states here we have not had any interaction with Ebola outside of a laboratory and I do understand it says laboratory infections, but now it is host-infections via human contact as it has officially escaped laboratory interactions in the US now.)

According to the definition of aerosol-transmitted: (aerosol transmission) a cloud or mist of solid or liquid particles containing pathogenic microorganisms, released by sneezing or coughing.

I googled: ebola aerosol transmission cdc, and opened this document from CDC: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Which states -

Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola virus disease (EVD). Note that this guidance outlines only those measures that are specific for EVD; additional infection control measures might be warranted if an EVD patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.).

Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures.

I was curious to exactly what was meant by: "aerosols generated during certain medical procedures." Further down in the document from the CDC it states - Avoid AGPs (aerosol generating procedures) for patients with EVD (Ebola virus disease) & If performing AGPs, use a combination of measures to reduce exposures from aerosol-generating procedures when performed on Ebola HF patients.

According to the medical definition of Aerosol Generating Procedures: Aerosol-generating procedures (AGP) are procedures that stimulate coughing and promote the generation of aerosols. Additional infection prevention and control precautions are required for some AGP where an increased risk of infection has been identified.

So... in my opinion, if the CDC warns health care professionals against doing procedures that generate aerosol droplets, which are defined as procedures that could cause the patient to cough (producing aerosol droplets)... There has to be some reason why they warn against promoting a patient to cough and release those aerosol droplets into the air - as in, they maybe are not sure if Ebola is in fact transmitted via aerosol. To me this means they don't want to take their chances so they must not really know, for sure, and won't gamble on it.

Health care peeps in this forum - please please correct me if I am wrong about any of the medical items/terms here. I tried to Google as carefully as possible and triple check definitions and meanings. But that doc from the CDC is pretty clear they have some sort of concern about a patient coughing and spreading Ebola. Just my opinion of course.