Texas Presbyterian "has stopped accepting new ER patients."

[antigop]

http://www.huffingtonpost.com/2014/10/12/ebola-texas_n_5972246.html

Varga says the health care worker reported a fever Friday night as part of a self-monitoring regimen required by the Atlanta-based Centers for Disease Control and Prevention. He said another person also remains in isolation, and the hospital has stopped accepting new emergency room patients.

I don't know if the other articles posted this info.

[riverwalker]

1. CDC guidelines are NOT adequate

they say shoes covers not needed. And in Texas "worker wore a gown, gloves, mask and shield while they provided care" no mention of shoe covers.
No shoe covers, and no full respirator mask.
CDC and AHA still claiming cheap assed trash bag gowns and precautions are all that is needed.

[DanTex]

2. What is the significance of shoe covers?

[Baitball Blogger]

3. They collect splatters of bodily fluid.

They would come from vomiting or sneezing.

[DanTex]

4. Thanks. Makes a lot of sense.

[uppityperson]

43. And then removing them makes it so you don't track that stuff elsewhere.

[Barack_America]

5. ? Were ED personnel even fully gowned up when he arrived?

Even if so, I think it is the UNGOWNING process that is to blame.

[Raven]

6. What does the ungowning process involve?

How is it done?

[Barack_America]

9. It would depend on the type of equipment worn.

But the general idea would be that any covering of the face should be removed last and only with a clean layer of gloves that has touched nothing beforehand.

In OR's, for example, you double-glove. As soon as you come in, one pair of sterile gloves is put on, then the gown, then more gloves over top. The first layer of gloves comes off with the gown, and the clean layer underneath can be used to remove the facial protection. Two pairs of hands are necessary for some steps and scrub nurses watch people like hawks to make sure there is no contamination.

I have to imagine that following sterile technique would be sufficient against Ebola, but not all hospital workers know how to do it.

[SidDithers]

10. I think it's this exactly...

It's not enough to simply wear PPE, one has to be trained how to properly use PPE.

And it's not as simple as people think.

Sid

[intheflow]

7. No mention of shoe covers is not indicative of anything.

News reporting sucks nowadays, there is no due diligence to cover a story completely or accurately. Shoes covers could have been edited out for space, or not included because the reporter didn't think they were that important. You really don't know.

[LisaL]

8. Yes you do know.

You can read CDC guidelines, can't you?
Shoe covers aren't even included.

[intheflow]

14. Well, a link directing me to that information would be useful.

The post I responded to didn't include such a link so it was natural for me to assume they were referring to what was reported in the article. I notice that you didn't include a link, either, so I guess you're only into chastising, not educating. Thanks anyway!

[LisaL]

15. Just go to cdc website.

Shoe covers are suggested as additional PPE only in certain situations.

"Personal Protective Equipment (PPE) •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"




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

[SickOfTheOnePct]

16. Based on this

She should have been wearing shoe covers.

***edited to add: And she may well have been, I don't know that it's been reported either way. But the CDC guidelines obviously do call for shoe covers given the condition that Mr. Duncan was in.

[etherealtruth]

21. Shoe covers are included in the CDC link you provided in another thread

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

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

[LisaL]

22. As additional PPE only required in certain situations.

Not even included in required PPEs for all situations.

[etherealtruth]

23. Exactly

If there was no blood, vomit, feces or bodily fluids why would you need the shoe covers? Although, I will heartily admit that a nurse or other health care provider would want to wear them in the event that I was providing direct care.

It is clearly in the CDC guidelines.

The patient in Nebraska (cameraman) remains in isolation with protective measures but is eating and displaying no current symptoms (x48 hours) .... I would feel adequately protected.

If you read further at your link there are also environmental protocols (cleaning staff)

[LisaL]

25. How would you know what is and isn't on the floor before you enter the room?

[etherealtruth]

27. Just to compare our isolation experiences

if you have much more experience or more recent experience I would be very interested in what you have to say

my experience with infectious disease as an RN occurred largely in the mid and late 1980s (at the tail end of the hysteria then associated with AIDS) ... I worked largely with dying AIDS patients (admittedly AIDS is far less transmissible than ebola... but in 1984 that was not clear). The protocols have been somewhat tightened (I remember recapping needles and syringes) ...

I am surprised you asked about the floor when the CDC clearly describes environmental services and the cleaning up of such things as vomit.

With appropriate training and practice (I think this is often missed and is a critical part) and supervision I would feel relatively safe using the CDC protocols .... the virus has (up until this point) only been transmitted when these protocols were breached or in the case of the epidemic areas not used).

I would be curious what your experience has brought you ... what realistic changes would you like to see?

I don't blame the health care workers .... I blame the health centers .... in my mind I have no doubt that they are not providing adequate training, oversight .... and may not have folk working in teams or pairs

[LiberalArkie]

11. I think that the CDC makes the stupid assumption that US hospitals know basic

disease prevention and protection. When it was just a couple of years ago that doctors and nurses were mandated to clean their hands before seeing a patient. I think it runs about 10% of the time I see them washing up before touching me.

These people know how to do it.

[etherealtruth]

24. I do agree with you on this

the CDC is assuming that staff has received adequate training, has appropriate equipment and is adequately overseen .... in the world of today's for profit health care centers ... this has proven to not necessarily be true.

[Yo_Mama]

12. There's been discussion of CDC guidelines

and prior to this case, there were questions if they were sufficient.

The CDC is still saying that they are sufficient. I think the healthcare workers are coming to the conclusion they are not. They had questioned the CDC guidelines before this happened, which is why the CDC had the question up on their FAQ.

If you can't totally disinfect before removing the clothing layers, there will be contamination. Not always, but it only needs to happen a few times before health care workers demand the higher level of protection or don't go in the rooms to take care of the patient. CDC needs to wake up pronto.

Here's the link again:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Most ventilation procedures are aerosol-generating, and it's obvious that much higher levels of protection need to be used as soon as these patients are intubated or ventilated. To me, anyway.

We need to stop blaming the workers. They are not going to be willingly careless in these situations, and we are telling our health care workers to use lower levels of precaution than are being implemented in fully equipped African Ebola wards.

Adding AGP link, so you can know I am not making this up.
http://www.hpsc.ie/A-Z/Respiratory/Influenza/SeasonalInfluenza/Infectioncontroladvice/File,3625,en.pdf

You also need practice.

[kestrel91316]

13. Translation: We've got more ebola than we want to deal with and

don't want to deal with workplace safety and liability issues, so we're going to bail on our obligation to help keep the community safe.

[RB TexLa]

18. They are obligated to operate an emergency room?

How so?

They aren't even obligated to operate a hospital, they could close the entire thing tomorrow and they have "bailed" on no obligation.

[kestrel91316]

26. Leave it to a Texan to support hospital corporations who abandon the community they are supposed to

serve.

No wonder this mess is taking place in YOUR fair state.

[RB TexLa]

31. I just don't see what obligaion you think they have to operate an emergancy room

or to provide those services.

[Warren DeMontague]

17. And yet Anyone who suggests we adopt travel restrictions to avoid importing more cases

Is "mean" and, of course, some kind of bigot.

Because "we can deal with ebola" and we have to expect additional importations of cases, which wont be a big deal, "we are prepared" and yeah so if a few hospitals, schools, etc get shut down it's the price we have to pay for not being "mean" to recreational visa-holders from one of the 3 main countries.

Also it is an insurmountable logistical challenge to check visas or otherwise have any sort of information about what countries an international traveler with a passport and a plane ticket has come from so we should not bother.

And now that there have been cases in other places, distinguishing those limited importations from the areas where this thing is rampantly out of control (3 specific countries) is hypocritical and, again, MEAN!

YOU JUST WANT TO SEAL THE BORDERS and YOU MIGHT AS WELL JUST LOCK YOURSELF IN YOUR HOUSE LOL LOL

See, there is simply no way to prevent the 150 or so travelers who come from Liberia, Sierra Leone or Guinea from entering is country on a daily basis, and if we were to do so until this situation is brought under control, it would devastate the economies of those countries- if those 150 people couldnt vacation in the US- hear that? ...DEVASTATE!!!!!

Oh, and anyone who expresses any concern at all about this massively lethal communicable disease is an ill informed panic ninny, I mean thousands of people slip and fall in the bathroom every year and WHERE ARE THE PANIC THREADS ABOUT SLIPPERY BATHROOMS HUH GUY?



...did I miss anything?

[MerryBlooms]

20. Settle down, Captain Happy.

[Warren DeMontague]

33. Cap'm Happy ****** Mc****leknuckles

Last edited Sun Oct 12, 2014, 09:02 PM - Edit history (1)

That's what they used to call me on the Jai Alai team.

[MerryBlooms]

47. lol

In all seriousness though, the nurse contracting the ebola virus is worrisome. I'm very concerned for the caregivers.

[Warren DeMontague]

48. Agreed.

It seems they don't appreciate Frieden reflexively blaming "a breach in protocol"... not that there's any actual evidence for such a thing, but you know, the protocol couldn't possibly be insufficient itself...

"You don't scapegoat and blame when you have a disease outbreak," said Bonnie Castillo, a registered nurse and a disaster relief expert at National Nurses United, which serves as both a union and a professional association for U.S. nurses. "We have a system failure. That is what we have to correct."

And I can't says I blame em.

http://www.reuters.com/article/2014/10/13/us-health-ebola-usa-nurse-idUSKCN0I206820141013

[MerryBlooms]

50. CDC came off as CYA. I agree with RN Castillo. n/t

[Babel_17]

37. The hide .gif

It's hard to interpret the level of irony here. I didn't even notice the .gif on the hidden post, it sort of blends in with the avatar. Was that post meant ironically as well?

I ask because sometimes what's spoken in jest is meant to impart some real feeling. Sorry if I'm being naive.

[Warren DeMontague]

40. I didn't take it as intended seriously.

Frankly I'm flabbergasted that it got hidden.

[Babel_17]

41. That GIF of hiding behind a wall doesn't really register like the popcorn one (nt)

[MerryBlooms]

49. I was just teasing.

Warren is pretty well known around here for his wacky sense of humor, and I didn't worry about him taking offense.

I'm surprised the other post was hidden. 'Nice post Hitler', is a DU staple. Bad hide imo.

[Babel_17]

51. Ah, it was new to me

It was new to me as an inside joke here at DU. It's also a real insult that sometimes gets used on other forums, so I saw it in that light. I regret that the irony sailed over my head. Live and learn. I think it sailed over other heads as well. As I mentioned, that GIF, when next to some avatars, isn't that noticeable. At least not to my eyes when scanning the thread.

I voted to hide, as part of the jury. I now would vote to leave it alone but I'd post that irony is easily lost on the internet.

[MerryBlooms]

52. The vast majority of us do our best to be good

jurists, but things will slip by us-- happens all the time, don't sweat it.

[Babel_17]

53. Thanks! (nt)

[cherokeeprogressive]

30. You forgot that "by your reasoning" travel FROM the US should be restricted because... well, FLU!

It kills tens of thousands of perfectly healthy people, and is WAY more infectious.

Or something.

[pnwmom]

32. But flu is way less fatal; and there is a vaccine that increases immunity, and anti-viral treatment.

So the comparison doesn't hold.

[Warren DeMontague]

34. I think that was the point they were making, too.

[Warren DeMontague]

35. This is kind of OT, but you know what is always funny on DU?

People who respond "so what you're saying is..." followed by something you're not saying.

I can set my watch by it.

[pnwmom]

36. To me it's not always funny. It's always annoying.

Which is why they do it, I think.

[Warren DeMontague]

39. So what you're saying is there's a conspiracy of paid posters who are out to get you?

I kid, I kid.

[cherokeeprogressive]

42. Now THAT was funny. n/t

[uppityperson]

44. I am guilty of that, mean to mean "is what you are saying?" and I'll try and remember to use that

wording instead as the question seeking clarification. And yes, I am serious.

[Warren DeMontague]

45. I think I've done it, too.

I probably never realized it until I had it done enough times to me to get my attention. ...it's way simpler for people (myself included) to argue with some straw position than it often is to engage with whatever the other person is actually saying.

[pnwmom]

46. It's probably a good idea for everyone to try to remember that.

It's a mistake that's all too easy to make.

[TexasTowelie]

28. One question being discussed is about the air pressure flow.

See video at link:

http://www.dallasnews.com/ebola/headlines/20141012-yasmin-key-questions-for-dallas-hospital-on-ebola-patient-where-was-the-air-flow.ece

[LisaL]

29. Since we are told that Ebola isn't airborne.

Negative pressure flow isn't required in treatment of Ebola patients.

[840high]

38. I don't believe everything we're

being told.