CDC finally admits: most hospitals are NOT well prepared for Ebola.

[pnwmom]

http://www.bloomberg.com/news/2014-10-12/ebola-control-training-lags-with-gap-in-federal-oversight.html

Hospital staff need better training, more funding and sharper oversight to handle Ebola patients, nurses and doctors said today after a caregiver in Dallas was confirmed to have caught the deadly virus.

The unidentified worker, who cared for Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Hospital, was infected after a “breach in protocol,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention. It’s the first time someone has contracted Ebola inside U.S. borders.

Even as the CDC has hastened to reassure the public that the virus won’t spread in the U.S., the agency doesn’t monitor hospitals and has no authority to make sure they comply with official guidelines, according to Abbigail Tumpey, a CDC spokeswoman who is leading the education outreach to hospitals.

“There are 5,000 hospitals in the U.S. and I would say probably the number of them that have actually done drills or put plans in place is small,” she said.

SNIP

About 85 percent of nurses haven’t received interactive education on how to take care of Ebola patients, according to the association’s survey of 1,900 nurses in the past few weeks, and 76 percent of the nurses surveyed said their hospital hasn’t communicated any policy on potential admission of patients with Ebola.



SNIP

[uppityperson]

1. Did you read this part? I agree, funding in important areas has been slashed.

Funding is another obstacle, as budget cuts are hurting hospitals’ ability to hire experts and equipment, according to some physicians.

“Infection control budgets have been slashed,” said Judy Stone, an infectious disease expert who works at various hospitals in Philadelphia.

At one hospital she visited, she was alarmed that each room didn’t have its own stethoscope, which meant physicians could be carrying drug-resistant bacteria from room to room. When Stone protested, she was told there wasn’t enough funding to buy more stethoscopes.

It was interesting, watching the pbs half hour documentary on MSF field hospital in Sierra Leone. You need to be oc about what you touch, who you approach, how you dress when you are for people. And not having funding for basic infection control stuff? It has the potential of biting us in the butt. Not as bad as is happening in W Africa, but still, even 1 is too many.

[scarystuffyo]

4. Hospitals need to charge more?

really

[pnwmom]

6. For-profit hospitals may need to give up some profits or be replaced by non-profits,

who will put patients' well being ahead of the almighty dollar.

That's a start, though it won't solve all the problems.

[Louisiana1976]

9. Better yet, replace America's current for-profit medical system with single payer. With single payer

hospitals would pay more attention to basic hygiene than they do when they're trying for profits.

[uppityperson]

14. +++++++++++++++

[magical thyme]

21. I work at a nonprofit lab with a nonprofit hospital

nonprofit won't fix anything, ime. Somebody is lining their pockets, just not the workers.

They may put patients' well being ahead of the dollar, but that doesn't mean they put nurse or CNA or lab tech health or safety ahead of the almighty dollar.

Our lab switched from spring-loaded butterfly needles to manual; cheaper and riskier. The hospital I think stopped supplying the nurses with any butterflies, so our lab director started locking our supply closet so they couldn't "borrow" the crappy ones we have.

30 minutes to our south, one hospital stopped supplying any butterflies. Don't know how they expect to get blood cultures on anybody or anything other than heelsticks on neonates and babies.

We are chronically short-staffed since they cut one position that used to cover the late afternoon rush. I rarely take my legal 15 minute break; often don't take a full 30 minute lunch. There's times when I'm dying to pee and simply can't stop because the ED keeps sending criticals.

There's also a higher patient:nurse ratio than there was in the past.

[pnwmom]

22. Thanks for the info, magical thyme. This all has been eye-opening. nt

[Yo_Mama]

41. Compensation for patient care keeps getting cut

Nursing staff keeps getting cut.

Hospitals are getting more risky, not less. Doesn't matter whether you are non-profit or not, it is still very expensive to provide quality health care.

[AllyCat]

43. Non-profit is a myth. Time magazine article last year showed they are WORSE

Than for-profit. I work for one. They make nearly $50M a year in, uh, profit, I mean income, wait, uh, benefit? Overage? And we get our pay and benefits cut. Single-payer!!!

[kestrel91316]

29. Nope. Take the corporate profiteering out of healthcare, though, and we'll have

plenty of money to deal with this thing.

I happen to think that all hospitals and medical clinics should be completely non-profit. If you aren't a WORKER in healthcare or support services, you shouldn't be able to make a dime off its delivery.

[Yo_Mama]

42. Texas Presbyterian is a non-profit.

It's one of the Texas Health Resources group, which is non-profit:
http://texashealth.org/Facts

A lot of non-profit hospitals are either going under or selling out.

[pnwmom]

5. There were so many parts I wanted to quote. Thanks for highlighting that problem.

I'm sure there has been a lot more corner-cutting as they try to maintain their profits.

And you're right about the OCD aspect. These protocols seem incredibly difficult to maintain, and yet they're expecting nurses and other staff -- with no training -- to follow them perfectly.

[Downwinder]

2. They have trouble handling Staph much less Ebola.

[hobbit709]

3. More like not prepared period, much less well prepared.

[RobertEarl]

7. Send every ebola patient to one hospital

There are places that can handle ebola. They are set up to handle such things. Not every hospital should go through such expensive measures.

Surely, I am not the first to think of this?

[uppityperson]

8. And where in this huge country will it be? How will patients get there? Who will pay for the transp

transportation? It will have to include private medical jets, since Boston and Dallas, to take 2 places as an example, are quite far from each other or even from mid-way.

[RobertEarl]

10. you are kidding, right? n/t

[uppityperson]

11. No, I am serious. Where in the country would it be, how would people be transported there?

Not snark, or sarcasm, but serious quesitons.

[magical thyme]

26. there are already 4 set up to handle Ebola.

NIH in Bethesda MD, Emory in Atlanta GA, Nebraska Medical Center in Omaha NE, and St Patricks Hospital in Missoula MT. 19 beds total. There is one plane equipped to transport them.

They were set up more than a decade ago and their staffs have trained for 12 years in this. They already have the facilities.

Transporting the rare Ebola patient to one of those facilities would decrease the risk of transmission dramatically, and reduce the need for specialty training and equipment everywhere. That, in turn, would decrease the chances of needing to use 19 beds simultaneously.

Failing that, communities should designate one hospital to be the Ebola hospital, where there is special training and an isolation wing set up. Transport suspicious patients to that hospital.

[SheilaT]

27. 19 beds total. Which is a good start,

but what if 20 people come down with Ebola? More? I sincerely hope not a single new Ebola case happens in this country, but it could happen.

[AngryAmish]

12. You drive the ambulance.

Quarantine, throughout human history, is the only way to contain infection. Castro quarantined hiv patients, very little hiv in Cuba.

[dsc]

13. really you are siting Castro's quarentine of HIV patients as a good thing.

[pinto]

16. No it is not.

[RobertEarl]

17. CDC finally admits: most hospitals are NOT well prepared for Ebola

See that in the headline where it says MOST...?

So there are some that are equipped. Instead of endangering a multitude of hospitals that are not prepared, we should be sending ebola patients to those hospitals that ARE.

Yes, I would drive the ambulance, but I'm sure there are many ambulance drivers who would do so, and they are in place and ready to drive. I can't believe the CDC isn't already thinking about it; maybe they are?

If we have to use them, there is a group called 'The Military' that is quite capable of all the logistics.

[uppityperson]

18. Ah, you were using hyperbole when you said ONE hospital for all with ebola.

Not "some that are equipped" like now. Gotcha. Sorry for not recognizing it and accepting your words for what they said.

Harborview in Seattle has recently said they are ready to accept pts with ebola. If I had it, I'd rather be in a big place like that than my dinky small town hospital as they have more equipment and are better prepared to deal with more seriously ill people. Of course, if I have a heart attack or anything beyond something minor, I also want to go there.

[RobertEarl]

24. How many cases are you expecting in the US?

From your posts one might think you think there will be many.

I am thinking four or five, unless we see more hospital admissions like the one in Texas, which wasn't prepared. So yeah, one hospital should be all we need.

[uppityperson]

31. I have no idea how many cases. If only 1 hospital, how will you get the patients there?

Boston and Dallas are a long ways apart. So if you are saying only 1 hospital, where would you think it should be located, and how will the patients, even 4-5, get there?

[RobertEarl]

35. In our country we have airplanes

Helicopters, too.

And ambulances.

thinkaboutit.

[uppityperson]

36. You give hints, but do not answer. Yes, I know we have those. Are you saying use

commercial airplanes? Charter airplanes? Charter helicopters? Drive ambulances 1500 miles? You continue to hint, but do not answer. How would you move someone from Dallas to Boston, or in between? Where would you think it should be located?

Can you answer? Will you answer?

Stay tuned.

[RobertEarl]

38. You may have missed this reply to you upthread?

http://www.democraticunderground.com/10025657582#post26

[uppityperson]

39. I guess the answer is no. You can not or will not answer. Have a good evening. eom

[pinto]

15. The CDC doesn't monitor hospitals. The comments from Ms. Tumpey is a good heads up though.

All hospital staff, iirc, are schooled in the basics of infection control. This one presents a new challenge and the need for scrupulous procedures. I like the "buddy" concept on gowning and disgowning. I've heard mention of a designated infection control position whose primary role would be to see that established protocols are understood among all staff and that supplies for that are on hand.

[HereSince1628]

19. at least information spreads faster than ebola

there's at least an outside chance that interactive training can get to most of those 85% of nurses before an ebola patient shows up in front of them.

[LisaL]

20. I didn't need CDC to tell me that.

[nc4bo]

23. I agree with you. nt

[Warren DeMontague]

25. "we're ready".. we must be, I mean they've been telling us for MONTHS how completely and totally

ready we are.

Nothin' to worry about, folks!

[kestrel91316]

28. You can lead a horse to water but you can't make him drink.

Hell, CDC brings the water to the horse and lifts the bucket to his lips.

[pnwmom]

33. From what I read, all the CDC does is send them some links.

No one's helping train them or otherwise prepare them.

[kestrel91316]

34. It undoubtedly also sends each hospital (and for all we know, each physician),

paper copies via snail mail.

CDC is not their mother. Medical professionals need to accept responsibility for maintaining current levels of expertise/proficiency. We are ALL part of public health - veterinarians, physicians, dentists, nurses - none of us have the luxury of ignoring that sacred duty to look out for the community.

I don't know about physicians, but out role in veterinary AND HUMAN public health is part of the Veterinarian's Oath which we take upon graduation.

[pnwmom]

44. The CDC shouldn't have been holding press conferences saying how well prepared hospitals

were to handle Ebola cases, when it was just wishful thinking. They really had no idea whether hospitals were prepared or not.

[SheilaT]

30. I worked for four and a half years at our local

hospital, until I retired in April. The first nine months doing patient registration, the last part on the information desk.

Every year I was required to do some on the computer training. It was semi-interesting. But one of the units I had to do was about handling catastrophic events, and it said rather clearly that the hospital was supposed to hold regular drills. In four and a half years I was never aware of any drill. Maybe the happened always to occur when I wasn't there, and because I was not a direct patient care person, there was no need to even let me know that they were happening. But one of the things in that unit said every employee needed to know exactly what to do and where to go in case of a lock-down, a fire, and some other genuine emergency things. No one ever bothered to inform me of these things. Again, doing patient registration and the information desk are not exactly mission-critical kinds of jobs, but in the event of an emergency, every single employee really ought to have more than a vague idea what to do.

I'd have to drop by and talk to some former co-workers, but I wouldn't be surprised if little or no training relevant to Ebola has been done there. Granted, this is Santa Fe, NM, and we're off the beaten track so far as people who travel to and from Africa are concerned. Still, a little training wouldn't be so bad.

[jwirr]

32. I have noticed that most of the patients are in private hospitals. Is there a reason for that? I

wonder how many of our rural hospitals which are usually small would even have the equipment to be ready. I assume they are in that 5000 number.

[George II]

37. Two numbers to ponder - 320 million people, 1 case.

[pnwmom]

40. Here's another number to ponder: April 2014, Liberia: 1 case. n/t

[Yo_Mama]

45. And unless we control it, that means nothing

Liberia:


From CDC:
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6303a1.htm?s_cid=su6303a1_w

Actual history checked against model:


Here's their projection, with and without meaningful intervention:


After the press conference today, it is clear that CDC's first priority is containment, and every time you transfer patients there are more possible exposures. I believe there is one and only one properly equipped plane. I don't think they will go for the central hospital concept just because of the risks and their projections.

Also, they have to focus on getting hospitals prepared to deal with potential admissions, because if the hospitals think they can just hand it on with a phone call, they are not going to get containment. A hospital without proper procedures could generate additional cases in four hours easily, and realistically it's a day or two before transfers could possibly happen even if we kept having one case at a time.

Thus, for CDC's containment plan to function, each hospital has to have serious plans in place. The central hospital plan might generate more collateral cases if control measures at original intaking hospitals were not sufficient.

[George II]

46. My point is that six months ago about 99.99% of the population never even heard the word....

..."Ebola", now everyone is up in arms because every hospital and doctor and nurse in the country isn't fully trained to handle it already, even though the first and only case was only discovered a few weeks ago.