If the CDC's Ebola guidance and protocols for healthcare workers are

[kestrel91316]

so horribly flawed, where are all the other healthcare workers who also cared for Mr. Duncan?

I mean seriously, if the guidelines are a complete failure, EVERYONE who worked on him and relied on CDC's protocols should also have Ebola by now, right?

We're told it's completely impossible for the nurse to have broken technique, and that the mere suggestion of that is to insult her and the entire profession. She is the living embodiment of perfection, and so are all other nurses, Never once have any of them ever erred and caused a single pathogen to go where it shouldn't.

Do people even look at what they are typing anymore? Do they use their brains? WHERE are all the other victims of Dr. Frieden's evil CDC lies and misinformation and bad advice?



When supposed medical professionals need to be reminded endlessly to do something so basic as WASH THEIR HANDS, you know we've got a problem with people comprehending germ theory and owning up to their responsibilities in the workplace.

http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

CDC had to form a TASKFORCE on handwashing. Physicians and nurses have to be nagged endlessly about something this basic. It's grotesque.

[enlightenment]

1. Thanks for saying this.

It's been getting pretty weird around here lately.

[kestrel91316]

5. The government-hating here is on par with what you see on FR from teabaggers.

And always the hating on experts and specialists. By people with few, if any, credentials.

[LisaL]

14. CDC says they are rethinking their protocols.

Yet here you are arguing that protocols are perfect.
The protocols are less stringent than what is being done in Africa.

[Warpy]

36. Thank you, and they are

They know the blood and body fluid precautions that stopped HIV transmission are just not adequate for something as infectious as the Ebola virus.

Even with precautions like full suiting, rubber boots in Clorox washes on the way out of the units, and a Clorox decontamination shower before the suit is taken off, along with spotters who watch for any break in any of the barriers, health care personnel continue to contract the disease in west Africa, although the rate of spread declined with improved isolation suits and decontamination showers..

The precautions that stopped HIV won't stop Ebola-Zaire.

Ebola-Zaire is not that easy to catch unless you are in close contact with someone with full blown disease. That means nurses and family members are at highest risk. The risk is quite low for everyone else.

[Mojorabbit]

91. I have been on private physician boards discussing this today

Huge portion think cdc protocols not stringent enough for this particular disease. so it is not only us that are thinking it. They also think that the patients should have been transferred to hospitals set up for this. Many think that will bring down the hospital staff infections since those hospitals have the proper equipment and professional highly trained in this type of procedure. Might help cut down on health care worker becoming infected.

[LisaL]

101. One can look what doctors without borders wear, and what in CDC guidelines, to see

that CDC guidelines are less stringent.
And doctors without borders still reported 16 infections and 9 death among personnel.
So what would make anyone think that less stringent PPEs would be 100% effective?

[kestrel91316]

12. Oh you should see when there's an animal health issue. Then they all attack me.

Because, you know, if there's anyone who knows ZERO about animal health, it's a veterinarian with over 30 years of experience.

DU is full of people who took that "question authority" thing way too literally.

[enlightenment]

25. I'm not sure what's going on with all this.

I assume it's a symptom of fearfulness combined with mistrust.

I don't know much about medicine and don't pretend to - but I do listen and I do read. Given the number of healthcare workers infected in Liberia - and these folks are using protocols that are even more stringent than the CDC's (again, based on my reading of the CDC and WHO protocols, not any medical experience) - then I have to conclude that like most human beings, these healthcare workers are making mistakes.

Probably not big mistakes - probably very small ones - but this virus seems very able to optimize its own chances in pretty scary ways.

The young nurse in Dallas made a mistake. It isn't a crime - or a sin - and I sincerely hope that she recovers quickly and well. I refuse to turn this into some gigantic conspiracy.

Yesterday, I posted a link to an NPR interview with some healthcare workers who were being trained at a simulation center in Alabama, before heading to Africa. These are trained professionals who were gobsmacked at how easy it was to make a mistake, even with a buddy checking things out.

I don't understand why the CDC protocols have become this big bogieman . . .

[boston bean]

2. What you seem to be missing

Is that it could very well be flawed process or equipment or insufficient or direction and training. Blaming healthcare workers who are putting themselves at risk is repugnant.

[kestrel91316]

3. Blaming CDC for what is most likely an accidental oops by a nurse is repugnant.

[boston bean]

6. You so sure about that, eh?

CDC expects more Heath workers will get Ebola. And we see them revising the precautions to take. I know it takes common sense to come to such a conclusion, none the less it is the case.

[kestrel91316]

8. Well if they are the kind of people who have to be continually harangued about washing their

effing hands on the job so as not to kill their patients, there sure will be more. And it won't be the fault of the CDC's instructions for how to stay safe.

Millions of people die every year around the world of HOSPITAL-ACQUIRED INFECTIONS. At least 100k of those are in the US. And failure to maintain basic hand hygiene is still a huge factor in those deaths.

If you can't wash your hands correctly and keep them washed, maybe you don't belong on the isolation ward or even in a hospital. Let alone working an Ebola case.

[Aerows]

23. Kestrel runs a veterinary hospital

She's neither an idiot nor a shit-stirrer.

[LisaL]

24. But can she count?

Up to 21.
Because that's how long incubation period can be.
Since Mr. Duncan's demise.
Which was five days ago.
Up until 21 days passes, she can't claim that only one nurse got infected.
70 people took care of Mr. Duncan.
We don't know how many got infected YET!
Until 21 days passes since Mr. Duncan's body was removed from the hospital, and all his bodily fluids were removed, and his room disinfected.

[Aerows]

26. I will refrain from

offering the opinion I would like to say given this venomous post.

This was an ugly post.

[LisaL]

30. Don't you think she knows full well that it's way premature to claim nobody else got infected?

And yet there is her OP.

[Aerows]

31. I don't think her OP

stated anything. Let alone that nobody else got infected.

She's level-headed and offering her opinion, as everyone else does.

[boston bean]

27. I called no one an idiot or shit stirrer

I do think the opinion that NURSES don't know how to wash hands and arguing with that is arguing with idiocy. Not going to bother thanks. Please try to st least give an accurate summary of my posts if you insist on giving a summary.

[Warpy]

38. The disease is terrifying

No nurse in the vicinity has to be reminded to wash his or her hands.

[Mojorabbit]

95. Thank you. I was getting pissed of at some comments. nt

[Mojorabbit]

94. She is also not a nurse who has worked in a hospital with a severely ill ebola patient. nt

[Aerows]

22. I'm so beffuddled by the way this has been handled

I can't begin to state it. I have no doubt that you run a veterinary clinic more sanitary and sound that this.

[uppityperson]

82. There is a difference between making a mistake, touching your nose, and having to be constantly

harangued to wash your fing hands. Saying a nurse got ebola because she did not wash her hands is rather insulting.

Blaming the CDC for improper isolation technique, or for making that error, is also wrong.

But insulting nurses working isolation? bah

[hedgehog]

118. I think part of the problem is that there is a difference between knowing proper procedure and

following proper procedure - not to mention having the facilities to follow proper procedure.

On my last visit to an ER, I saw a staff member walk by with a bed pan in hand, set it down on a file cabinet, go off to fetch a test tube, pour the urine sample into the tube, then seal the sample in a biohazard bag.

Another staff member walked into my cubicle looking for an empty sharps container for the used hypodermic he was carrying.

Something as simple as placing a catheter can be deadly if strict protocols aren't followed to ensure sterile conditions. This is where check lists and standard procedures save lives.

[etherealtruth]

19. I am going to take issue with "accidental oops by the nurse"

(that may or may not be true) I would like to know what kind of training (ongoing training/ with competency verification) she received, I would like to know why someone was not monitoring her (it does not appear that there was anyone) as she donned her PPE and removed the PPE ... I would like to know if environmental service protocols were followed (especially) in the area where PPE was removed ....

This poor nurse may have reflexively scratched her nose, brushed hair from her eyes, removed PPE in an inappropriate order .... but an equally likely scenario is that her training and monitoring by the hospital were sub par

[Aerows]

51. I think it comes down to exactly what you are saying

she didn't have enough back up.

[kestrel91316]

67. And that ALSO is not the CDC's fault. It could very well be profiteering hospital bean

counters at fault with training deficiencies.

My money is on human error. Because humans err quite often, and quite catastrophically, in hospitals.

[etherealtruth]

98. No, not all

[hedgehog]

108. I am wondering the same thing - it's not possible to follow the CDC protocols

unless there is a strong back-up team. As it is, why were 70 different people exposed? I think with some careful planning, far fewer people would have been in direct contact.

[kestrel91316]

4. If it is any of those things, why do we only have the ONE nurse with Ebola????

Everybody else used the same equipment and followed the same guidelines. They should all have Ebola if it's the equipment and protocols.

[boston bean]

7. Take it up with Frieden.

He says it is likely and should be expected.

[kestrel91316]

9. He knows nurses don't know hygiene. He's just being realistic.

But again, how many do we have right now??? ONE.

[boston bean]

18. Wow.

[LisaL]

21. Well, if the nurses don't know hygiene, how do you expect them to take care of Ebola patient?

[uppityperson]

83. Nurses don't know hygiene? Not "a nurse made an error" but "nurses don't know hygiene"?

With all respect due such a broadbrush insult, shame on you.

[Mojorabbit]

96. Have you ever been to nursing school?

Nurses do know hygiene. They work with people in isolation for infectious disease. It is parting of their training. What a crappy thing to say.

[uppityperson]

100. Thank you for calling her on that, on complete agreement with you.

[KamaAina]

116. Probably just as well that southlandshari no longer frequents DU.

She is, in fact, a nurse, and presumably would object strenuously to that statement.

[Dorian Gray]

123. Are you kidding me?

"He knows nurses don't know hygiene." Your words. Obnoxious statement.

[LisaL]

11. Only five days since Mr. Duncan died.

Incubation period up to 21 days.
Hello?

[Aerows]

28. Here is a Hello?

back at you. I don't think either one of us are eager for an Ebola outbreak in the US. We need to take some precautions.

[LisaL]

10. Don't count your chickens before they hatched.

There has only been five days since Mr. Duncan died.
70 people cared for Mr. Duncan.
CDC admits there could be other infected individuals among those 70 people.

[LiberalArkie]

13. I was watching AC360 and the statement was raised that the reason the CDC recommendation is

different than those of doctors without borders is that the CDC had to come up with protocols that used the clothes that the hospitals already had. Not water proof so they can not be sprayed down. Gupta trying taking off the "surgical gown" and did not manage it correctly. They made the note that if the person had just washed their gloved hands with bleach before removal, then it would probably be safe. Doctors without borders covers their entire body. The CDC does not require that.

[LisaL]

16. I saw it.Dr. Gupta tried to follow the protocol using chocolate syrup to see if he got contaminated.

His conclusion is that it's very easy to get contaminated while removing the gear.

[Aerows]

17. Well, you can't possibly cost the hospital CEO money

his bonus is far more important than someone's life!

[kestrel91316]

69. Exactly. Somebody would have Frieden's head if he dared to issue guidelines that cut

too far into the sacred hospital corporation profits.

[LiberalArkie]

29. Here are the 2 preferred outfits, I would not wear the one on the right

http://assets.nydailynews.com/polopoly_fs/1.1972514.1413218460!/img/httpImage/image.jpg_gen/derivatives/article_970/ebola-presser-bellevue.jpg?enlarged

[LisaL]

37. Even the one on the left appears to be less than what doctors without borders wear.

I don't think it's the full body suit?

[Aerows]

15. Excellent observation.

You bring up some very good questions, as usual.

[SickOfTheOnePct]

32. Thank you for saying this

No, the CDC is not perfect, but the scorn heaped on them is unbelievable. The quote below is from an article entitled, ironically "5 Ways the CDC Got It Wrong"

"We have to recognize that our safety work tells us that breaches of protocol are the norm, not the exception in health care," said Dr. Peter Pronovost, senior vice president for patient safety and quality at Johns Hopkins Medicine. "We routinely break precautions."

Now, I'm not saying that's what happened in this case, but come on folks. If the senior VP for patient safety and quality at Johns Hopkins is saying that the compliance is the exception rather than norm, why is the CDC being blamed.

There is a nursing student in Liberia that nursed four family members with Ebola, at home. Three of the four survived, which is a better result than the hospitals are having in West Africa. She did not catch the disease. Why? Because she devised her own protective clothing, from garbage bags and was committed to protecting herself completely, every single time. Even though it took a long time, even though it was cumbersome, and hot and uncomfortable. The key was that she DID NOT SKIMP ON THE TIME IT TOOK TO PREPARE. No shortcuts. No exceptions.

No one can tell me with a straight face that if a nursing student in Liberia can protect herself while saving three people, our doctors and nurses here can't do it.

Rant over.

[LisaL]

39. You can't make this conclusions on the basis that one person didn't get infected

while using garbage bags.
Mr. Duncan's family members were not using any protection but haven't gotten infected (so far).
Would you then argue that no protection whatsoever is necessary?

[SickOfTheOnePct]

43. Totally different situations

Mr. Duncan's family was not caring for him, cleaning up after him, etc.

This woman was doing all of these things for not one, but four people. Apparently health officials in Liberia were impressed enough that they're teaching her methods to others.

Instead Fatu, who's in her final year of nursing school, invented her own equipment. International aid workers heard about Fatu's "trash bag method" and are now teaching it to other West Africans who can't get into hospitals and don't have protective gear of their own.

My point is that it has been acknowledged by a leader at one of the nation's top hospitals that health care workers routinely cut corners on protocols. And when you do that, even if you have the best in PPE, you are increasing your chance of becoming infected.

I'm not arguing that no protection is necessary, I'm arguing that the best protection won't work if you don't use it properly and follow protocols, while the most primitive protection will work when used properly.

[LisaL]

45. OMG.

You are making conclusions based on the fact that one person didn't get infected.
You can never get any statistical significance with the n of 1.
This woman could have been immune to Ebola.
She was not carrying out procedures such as dialysis and ventilation.
I think it's absurd to reach these sorts of conclusions from the one case.

[SickOfTheOnePct]

47. Tell it to the international aid agencies that are teaching her methods

They are apparently quite impressed with what she was able to accomplish.

Why won't you address the quote from Johns Hopkins about protocols routinely not being followed?

Are you willing to admit that even the best PPE won't protect you if you routinely don't follow protocols?

[LisaL]

48. Because these countries have no room in the hospitals

so they want Ebola patients treated at homes.
Do you want us to do the same thing?

[SickOfTheOnePct]

50. Why won't you answer the question I asked?

Why won't you address the fact that it has now been stated by a leader at one of the top hospitals in the country that healthcare workers routinely fail to follow protocols?

And why won't you acknowledge that the best PPE won't work if protocols aren't followed?

And why do you continue to try to mislead anyone reading this thread by trying to ascribe to me something that I've already denied, namely, that I want our healthcare workers to use nothing or to use garbage bags?

These are very simple questions - why won't you answer them?

[LisaL]

52. Why don't you answer this:

If the protocols were so perfect, why is CDC rethinking them?
Why does CDC require less protection than what is being used by doctors in Africa?
Why doesn't protocol require all skin to be covered?
Why doesn't protocol require workers be sprayed with disinfectant like they do in Africa?

[SickOfTheOnePct]

54. You first

My guess is that you can't answer them, but I could be wrong.

[LisaL]

55. Can you answer my questions?

Yes, of course, even best protocols won't work if people don't follow them.
But I certainly don't think that's what we have is a best protocol.
Even CDC doesn't appear to think so, as they are rethinking their protocols.
Can't you admit as much?

[SickOfTheOnePct]

58. Sorry, no pony for you

You forgot this one:

Why won't you address the fact that it has now been stated by a leader at one of the top hospitals in the country that healthcare workers routinely fail to follow protocols?

I'm confused as to why you're blaming the CDC for healthcare workers not following protocols. If they can't follow the protocols in place, it's a pretty sure bet that they won't be able to follow more complex ones.

[LisaL]

59. I don't need a pony.

CDC can't tell what protocol this nurse didn't follow.
When it can, then you can get back to me.

[pnwmom]

46. The CDC has been blaming the nurse for "breaching" its protocols,

but those protocols might not be taking human fallibility into account. And they don't even know for sure that the nurse breached them.

Knowing how hard it is for human beings (rather than robots) to scrupulously follow complicated protocols, the CDC should take that into account when designing them. One thing they failed to do in this regard is to instruct the hospitals handling Ebola patients to use the "buddy system" when carrying out complicated procedures, just as they do at the four centers.

This is why I think the CDC should have Human Factor Engineers take a look at their protocols -- to see where the weak spots are.

http://www.democraticunderground.com/10025661574

[kestrel91316]

71. CDC has not blamed this nurse specifically. They do have strong reason to believe that SOMEBODY

breached technique and now somebody (possibly a different somebody) is paying the price.

If it's the equipment or the guidelines, why aren't they ALL sick?????

[LisaL]

74. Because incubation period hasn't passed yet?

There could be more people infected.
CDC said that.

[pnwmom]

77. For the same reason that many medical mistakes happen only sometimes.

If the guidelines are too complicated, or even contradictory, they might have a higher failure RATE. That doesn't mean they always fail; just that they fail sometimes. (This is a basic engineering principle -- the more complicated something is, the more opportunities it has to fail -- the more likely it is to fail.)

There is no room for error in dealing with Ebola -- if a protocol is broken, or if it just isn't adequate, it isn't just one life at stake. So,in the chain of actions that make up the protocol, they have to figure out where the weak link was. And if it turns out that every action was carried out according to protocol, and the equipment wasn't faulty, then they have to look at the protocol itself.

I read that one infectious disease specialist says we might need more than one protective protocol; one set of gear for providers caring for patients early in their illness; and another set of protective gear (possibly including respirators) for people attending patients near the end of their lives, when the fluids are profuse.

[kestrel91316]

79. That probably is going to be the case. It still doesn't translate into "stupid Frieden"

or "worthless CDC" and "dead wrong useless guidelines" like some people are implying.

The purpose for all this PPE and protocol is to minimize the impact of human error. Quintuple backup systems.

The humans who err are not evil or deserving of ostracism. They can and MUST help to figure out where the error occurred so that systems can be improved.

Nurses and physicians are humans, not saints. They can and do err ALL THE TIME, sometimes with catastrophic results. People who deny that they can err need their heads examined.

[Ms. Toad]

33. Ebola transmission factor is R2

On average one Ebola patient will infect 2 new individuals, in the very short time s/he lives.

One has already been documented - among those he came into contact with for whom there should have been no risk. We're halfway to the average - an average developed in places where there are not normally transmission precautions in place. So yes - in practice - the CDCs protocols are flawed.

[Aerows]

34. Exactly n/t

[gwheezie]

40. The hospital was not prepared to treat him

i want to know if they used the same ppe as the 4 hospitals that train for treating ebola use. We don't have that here. We have had no training for ebola where I work. We got an email about body fluid precautions. I could not begin to quess where I would get the appropriate ppe off hours where I work. We got a flow chart on how to screen for ebola and how to document it. No in person demonstration etc. we are not ready for an Ebola pt. I also wonder if she was a dialysis nurse.

[LisaL]

44. You can talke a look at the photos from the hospitals that are biosafety level 4 and see that

they are using higher levels of PPE than what is in the guidelines.

[gwheezie]

70. Clearly there is a difference

we don't have that ppe where I work

[kestrel91316]

72. So do you blame CDC for your hospital's lack of preparedness, or do you blame

hospital administration?

Not snark. A legitimate question.

[gwheezie]

89. Hospital admin

im at work now. Just checked with nsg supv if we have the same ppe as the 4 hospitals that treat ebola. No we don't we are using our standard contact isolation ppe. They are going to schedule mandatory in services starting tomorrow since a local hospital now has a patient in isolation for Ebola screening.

[ecstatic]

41. asymptomatic perhaps?

Not everyone will catch it after exposure, and some catch it, but their immune system successfully fights it off and/or are asymptomatic.

[pnwmom]

42. Why are you taking everything to such an extreme? There's a difference between "horribly flawed"

and "could be better."

They could be better. For example, the CDC protocols for hospitals should encourage the use of the "buddy system" that the four special centers used.

[Aerows]

49. Kestrel is just stating the bland and solid truth.

It's ugly, but refraining from stating it doesn't aid the situation.

Would you prefer that people not look at things in the perspective of disaster preparation and keeping chaos to the minimum, or would you prefer a chorus that sings sweet songs instead of figuring out what can be done to minimize casualties?

[LisaL]

53. What she says is nowhere near the truth.

Fact is, we don't know how many workers got infected because it has been nowhere near 21 days since Mr. Duncan died.
It has only been five days.
Even CDC is suggesting there could be more infected personnel.

[Aerows]

56. I don't have the medical knowledge

in my little finger that Kestrel does. I'm not going to pretend I do, and she raises some good damn points. I don't see where she ever suggested that there couldn't be more infected medical personnel, in fact, she pretty much stated that there would be MORE.

What on Earth? We know this situation sucks. Yelling at people that are adept at managing epidemics is fruitless.

[LisaL]

57. When she is asking where are the other medical care workers who worked Mr. Duncan,

what exactly does she mean by that? She claims they should have had Ebola by NOW. This is blatantly false.
Incubation period is up to 21 days.
Only five days since Mr. Duncan died.
You don't need any medical knowledge to figure this out.

[Aerows]

60. I didn't realize that you didn't know

that she doesn't live in Dallas, isn't working at Texas Presbyterian Hospital and is a VMD.

[LisaL]

61. What does that have to do with a price of tea in China?

[Aerows]

62. About the same that my answers to your questions

would amount to the price of tea in China.

[pnwmom]

68. How so? Who here is saying that the protocols are "horribly flawed"

or that the guidelines are a "complete failure"?

She is setting up a straw man and then knocking it down.

[kestrel91316]

80. Plenty of people all day have been screeching about horrible Frieden and the horrible guidelines.

And how CDC is totally to blame for the nurse getting Ebola.

Surely you have noticed. Since you were among them at one point, IIRC. (forgive me if you were not - I can't keep all the haters straight anymore)

[pnwmom]

92. I wasn't among them. You can see my posts here. I haven't posted anything stronger than what's here.

[lapislzi]

104. Folks, this isn't binary.

It is possible, likely, even, that given what we *don't* know about ebola, that the CDC protocols are inadequate and should be enhanced. That's a real possibility, for medical and public health minds to consider and act on.

It is equally possible that one or more health care professionals can and will make mistakes with their PPE during this outbreak. We've seen it several times in both western and the developing world. Not everyone does it perfectly every time, no matter what. The stressors on health care professionals are myriad--including being terrified of a deadly disease.

I doubt that health care professionals deliberately cut corners, especially where their personal safety is concerned. But, when you look at chronic understaffing and other problems plaguing a for profit health care system (unique in the developed world), it's easy to appreciate how a simple misstep, combined with possibly inadequate protocols, can result in disaster, disease, and death.

By all means expand and improve the protocols if that is what is required. But the protocols are meaningless if health care professionals are unable to put them into full effect due to lack of training, overwork, or other factors.

[pnwmom]

105. Agreed. Which is why I posted this:

http://www.democraticunderground.com/10025661574

[lapislzi]

109. Brilliant.

Thanks for linking. I missed this.

[hedgehog]

110. A very reasonable post! Someone questioned above why the CDC is reviewing its

protocols - maybe to look for flaws and see where improvements can be made?

[uppityperson]

128. Exactly, thank you. Iam glad to see others recognizing the multiple issues

at work here. Thank you very much.

[morningfog]

63. Totally agree. These protocols work, when they are followed.

I not suggesting they are easy to follow or that others may not have breached, but the protocols have been proven to work to control past infections.

[LisaL]

64. CDC is rethinking the protocols.

So they themselves don't seem to think these protocols were perfect. Which they were not, regardless of how much some people argue that they are.

"And they are now watching hospital personnel as they put on and take off their protective garb, retraining the staff and evaluating the type of protective equipment being used. They were considering using cleaning products that kill the virus to spray down workers who come out of the isolation unit where the nurse is being treated."

http://www.nytimes.com/2014/10/14/us/dallas-nurse-ebola-patient.html?_r=0

[morningfog]

66. Yes, human inability to follow protocols may require new

safeguards. The virus hasn't changed. What has changed is an increase in health care workers expose to it and a decrease in the level of adherence to the protocols.

That may require new measures, to account for more people (less qualified) in dealing with it.

[LisaL]

73. We never had an Ebola patient in a regular (not bisoafetly level 4) hospital before.

So I fail to follow your post.
Virus didn't change? Since when? This was the first patient in a regular US hospital.
Increase in health care workers exposure to it? Yes, there was zero exposure before because there was no patients.
Decrease in the level of adherence to protocols?
Says who?

[morningfog]

76. Sorry you couldn't follow the post. But not surprised.

[LisaL]

102. The post made no sense.

We don't have experience working with Ebola patients in this country. Until very recently.
First case treated in a regular hospital already resulted in nurse being infected.

[KMOD]

65. protocols and CDC

No hospital is perfect. We all know that.

But to place the blame on the health care workers, who have none, to limited experience with this disease is also wrong.

Protocol must be looked at, absolutely.

Training must be done, absolutely.

But to expect that American Hospitals and health care workers are prepared fully for this is naïve.

Everything must be evaluated at this point.

[kestrel91316]

75. I am beginning to think that we should do enhanced training at regional medical centers and send

the patients there, and make other hospitals off limits for known Ebola cases. Since it's obvious that so few people/facilities are up to the task. They might look at the ones with the lowest rates of nosocomial infections to help them decide who "gets" infection control and who doesn't.

[KMOD]

78. Yes, kestrel91316

We absolutely should be treating these patients at our best and finest and prepared hospitals. But don't knock the "obvious" hospitals that are not up to the task. This is a new situation for our hospitals, I hope that this situation causes them to look into preparedness, but to expect it from the get-go is unrealistic.

[kestrel91316]

81. Deadly infectious diseases are nothing new. Isolation wards are nothing new.

Even PPE of varying degrees is nothing new.

Until hospitals can get the hand washing thing down, they might want to avoid asking for Ebola patients. The PR value isn't worth it.

[KMOD]

84. hyperbole

the hand washing thing is pretty down.

[kestrel91316]

87. Um, in theory. But certainly not in practice.

[kestrel91316]

88. Nah, not even close.

http://www.pbs.org/wgbh/pages/frontline/health-science-technology/hunting-the-nightmare-bacteria/do-hospital-workers-really-wash-their-hands/

[pnwmom]

93. Very good idea. And that means you would be changing the CDC's current protocol

which calls for sending patients to any hospital capable of isolating patients.

[kestrel91316]

106. It wouldn't change the PPE protocol, which is what all the kerfuffle is about.

Though we DO probably need to yank the permission to handle diseases needing any isolation from any hospital that can't get PPE usage and sanitation techniques down pat. Make them be second-tier, lesser places. With less compensation for their services.

I've managed 32 years without giving any of MY patients a nosocomial infection. It's not rocket science. It DOES require intelligence, attention to detail, and the willingness to follow certain rules in spite of inconvenience.

[B2G]

107. Your self righteousness is getting a little hard to stomach

Ever dealt with a BLS 4 virus before? No?

Didn't think so.

[hedgehog]

113. The BLS 4 designation is used in research labs because there is

no vaccine or cure for Ebola right now. When people are working with the virus on a daily basis, year after year, it makes sense to take the most stringent precautions to avoid exposing anyone to the disease and to avoid tracking the virus outside the lab. I suspect that it is far easier to catch tuberculosis than Ebola, but we have treatments for that now.

http://www.cdc.gov/tb/topic/basics/default.htm

http://en.wikipedia.org/wiki/Tuberculosis

[pnwmom]

120. Actually, Ebola is far more contagious than tuberculosis, HIV, hepatitis, etc.

And it has no vaccine or treatment.

http://www.nytimes.com/2014/10/14/us/questions-rise-on-preparations-at-hospitals-to-deal-with-ebola.html?_r=0

Ebola patients lose enormous amounts of fluid from diarrhea and vomiting, as much as five to 10 quarts a day during the worst phase of the illness, which lasts about a week. Doctors struggle to rehydrate them, replace lost electrolytes and treat bleeding problems. Some patients need dialysis and ventilators.

A concern for health workers is that as patients grow sicker, the levels of virus in their blood rise and they become more and more contagious. The researchers at Emory tested patients and found high levels of the virus in their body fluids and even on their skin.

At the peak of illness, an Ebola patient can have 10 billion viral particles in one-fifth of a teaspoon of blood. That compares with 50,000 to 100,000 particles in an untreated H.I.V. patient, and five million to 20 million in someone with untreated hepatitis C.

“That helped us to understand why, if this is only spread by body fluids, why it is more contagious than hepatitis A, B and C, and H.I.V.,” Dr. Ribner said. “It’s just that there’s so much more virus in the fluids they put out.”

[hedgehog]

122. As it turns out, Tuberculosis currently has about the same Reproduction number as

Ebola, each case generating another 1-3 cases depending on various factors such as general health, living conditions, medical treatment, etc.

http://en.wikipedia.org/wiki/Basic_reproduction_number

[pnwmom]

124. But not the same number of viruses in a teaspoon. And people don't usually get TB

from a single exposure to someone with the disease -- it usually takes extended contact. (And, of course, antibiotics can make TB non-transmissible).

Who would you rather be in a room with? Someone with still contagious TB, or someone with contagious Ebola?

[hedgehog]

125. Since you ask - Ebola

TB is transmitted through respiratory aerosols.

[pnwmom]

126. But TB can be treated. My niece got it from someone in her elementary school class.

She was TB positive and had to take 9 months of meds, but she never felt sick.

[uppityperson]

129. There are strains of tb that are resistant to all known antibiotics and that is very scary

[pnwmom]

131. I realize that. But there are no strains of Ebola that can be treated now, and it's far more

contagious than TB. Even if a TB patient has a cough, a single exposure is very unlikely to transmit the disease.

[uppityperson]

85. There you go again with that dichotomous thinking mixed up with broadbrush insults

One nurse makes a mistake, breaking proper isolation technique and you go off on "supposed medical professionals need to be reminded endlessly..to wash their hands"?

Saying nurses and doctors have to be nagged endlessly to wash their hands is indeed grotesque and a huge insult.

I do hope you were using hyperbole.

[kestrel91316]

86. I'm just citing the many peer-reviewed articles that show

that hospital staff tend to have rather poor hygienic habits. Apparently there is a large difference between the amount of handwashing they claim to do and the amount they actually do.

This is common knowledge, or so I thought. And it kills at least 100k people every year in the US.

I'm using this as an example of why we should not automatically assume medical professionals exercise due caution where pathogens are concerned.

I've personally observed far too much hubris and denialism from them. And gross medical ignorance of matters they don't deal with every single day.

[Fumesucker]

90. Automatically assuming anything when dealing with something like ebola is a mistake

One thing that surprised me a bit was that given the ubiquity of video recording these days there were no recordings of Mr Duncan's care or those caring for him doing the disrobing procedure. A video of the nurse doffing her gear would certainly help answer any questions regarding the following of protocols.

[uppityperson]

99. Uh.Huh. Nurses don't know hygiene, "supposedly" medical professionals needing endless badgering tow

wash their hands is common knowledge?

While some of what you write is apt, broadbrush insulting an entire profession is unneeded nasty bigotry that tells us a lot about you. You're a vet, I get that. But that on no way gives you any right to slander my profession.

[kestrel91316]

117. Hmmm. A vet finally dishes out what we've been on the receiving end of for well over a century as a

profession, and a nurse gets all snippy.

We're just supposed to sit down, shut up, and know our place, right? Vets have been slandered and insulted by the human medical profession as long as I've been in practice and far longer than that. It's not usually overt - it tends to take the subtle or not-so-subtle implication that we aren't "real" doctors (oh yes we are) and that we just go down to city hall to buy our licenses right out of high school.

It's 20 times harder to get into vet school than medical school. We have to learn 20 times as much material in the same length of time, and are expected to be capable of real world practice the second we graduate - only a small minority goes on to internships and residencies. If you were stuck on a desert island, trust me, you'd want to have a veterinarian there with you rather than almost any physician.

From cardiologists trying to dictate my pharmaceutical choices in treating a chronic immune-mediated disease, to nurses saying that vaccinating cats for anything including rabies is stupid and unnecessary, to having to watch the poor dog of a surgeon suffer for years with an untreated (and highly operable) perineal hernia until its poor urinary bladder became incarcerated, necrotic, and then ruptured..................I've seen a lot from you folks. The ophthalmologist who actually put amoxicillin pediatric suspension into his cat's eyes instead of its mouth (because why would you want to follow verbal instructions or read a label??), the nurse who said "I want to see the MAN doctor", and the pharmacist who let a treatable malignant tumor on a cat's face grow from being highly resectable to so large the cat had to be put to sleep............not very impressive.

I'm done with giving human medical professionals unearned respect. Each and every one has to prove themselves to me individually now. Just like everyone here says vets have to.

[uppityperson]

121. wtf. I know good & bad drs and vets

some of each I trust, others I refer people away from.

Calling me, an individual "you folks" is broadbrush and uncalled for as I am me, not the whole profession or all those people. You are right that every individual needs to earn respect as NO profession is comprised of all good people.


fwiw, I will no longer reply to your insults, broadbrush statements or the like where you try to place all health care providers into 1 small category and claiming negative whatever for them all. There are good and competent ones, bad and incompetent ones, same as with vets or any job classification. Broadburshing is completely unhelpful and not worthy of being taken seriously.

[Recursion]

97. Checklists save lives but doctors don't want to admit that

When supposed medical professionals need to be reminded endlessly to do something so basic as WASH THEIR HANDS

I remember that study. Checklists can be reliably shown to reduce iatrogenic injuries and death by an absurd amount because of simple crap like that.

[HockeyMom]

103. You need a medical degree to know to wash your hands?

What??? You use the toilet and don't wash YOUR hands? Your MAMA should have told you that when you were being potty trained.

Medical professionals need the CDC to tell them to wash their hands? I seriously DOUBT that.

[Avalux]

112. You obviously have never worked in a hospital.

I know of many physicians who just don't bother because they have to take the time do to it.

If everyone working in a hospital washed their hands as directed, it would drastically decrease the number of nosocomial infections. But they don't.

[Avalux]

111. I won't blame the nurse, but sometimes mistakes are made. That's just they way it is.

She cared for Mr. Duncan on repeated occasions, and it's probably in the removal of her protective garments especially the gloves), where contraction occurred.

No blame needs to be placed, but as humans, we love to do that don't we? We need someone to blame, something to blame...it's not helpful in a public health crisis.

The CDC's protocols are solid if implemented appropriately. Anyone saying they aren't are just playing the idiotic blame game.

[hedgehog]

115. Another reasonable post!

[TexasMommaWithAHat]

114. Even if she wasn't a stringent hand washer, does anyone REALLY believe

that she was careless around a patient with EBOLA?

Really?

Come on, people, think!

The PPEs and guidelines set by the CDC are not adequate.

Just for starters, the CDC should require a buddy system for all workers around patients and for all workers who are taking off their PPE. Buddies are required for level 4 biohazard healthcare workers, if I understand correctly.

[hedgehog]

119. I agree that the buddy system is a vital part of keeping everyone safe.

[Man from Pickens]

127. It only takes one to breach containment

The goal is black and white - stop the virus from spreading. That's the job that needs to be done. If the people in charge now can't handle that responsibility, it's past time for them to step aside for someone who can and will.

[LeftInTX]

130. Dr. Gupta - How can people in proper gear contract Ebola?

Demonstration at link
http://www.hlntv.com/video/2014/10/14/how-wearing-protective-gear-catch-ebola-gupta