Dallas nurses cite sloppy conditions in Ebola care

[Omaha Steve]

Source: AP-Excite

By MATT SEDENSKY and MARTHA MENDOZA

DALLAS (AP) — A Liberian Ebola patient was left in an open area of a Dallas emergency room for hours, and the nurses treating him worked for days without proper protective gear and faced constantly changing protocols, according to a statement released late Tuesday by the largest U.S. nurses' union.

Nurses were forced to use medical tape to secure openings in their flimsy garments, worried that their necks and heads were exposed as they cared for a patient with explosive diarrhea and projectile vomiting, said Deborah Burger of National Nurses United.

Burger convened a conference call with reporters to relay what she said were concerns of nurses at Texas Health Presbyterian Hospital, where Thomas Eric Duncan — the first person to be diagnosed with Ebola in the U.S. — died last week.

RoseAnn DeMoro, executive director of Nurses United, said the statement came from "several" and "a few" nurses, but she refused repeated inquiries to state how many. She said the organization had vetted the claims, and that the nurses cited were in a position to know what had occurred at the hospital. She refused to elaborate.

FULL story at link.



FILE - In this Oct. 8, 2014 file photo, a sign points to the entrance to the emergency room at Texas Health Presbyterian Hospital Dallas, where U.S. Ebola patient Thomas Eric Duncan was being treated, in Dallas. The Liberian Ebola patient was left in an open area of the Dallas emergency room for hours, and the nurses treating him worked for days without proper protective gear and faced constantly changing protocols, according to a statement released late Tuesday Oct. 14, 2014 by the largest U.S. nurses' union. (AP Photo/LM Otero, File)

Read more: http://apnews.excite.com/article/20141015/us--ebola-dallas_nurses-31d00a2fd5.html

[Cha]

1. That's just very sad. Not taking the proper precautions to avoid later catastrophe. Why?!

Thank you, Steve

[aquart]

32. Texas deliberately under regulates and under taxes.

They like to give business a break.

Hey, wanna move your business, wife and kids to Dallas?

[SkyDaddy7]

37. I wish everyone who was attacking the CDC...

For stating the obvious the other day would admit error, yeah right!

Many here on DU & across the web were attacking the CDC for saying there had to have been a breach in protocol as if they were attacking the workers & trying to pass blame, they were NOT! The CDC knows for a FACT their protocol works as they have been working with far more contagious diseases than Ebola for decades & Emory in Atlanta had no problems nor did the hospital in Boston or the European hospitals...All of which follow the same CDC protocols. They understand the virus & how it operates...It is called SCIENCE!

[Ms. Toad]

41. Really?

The protocol from the CDC that is currently circulating would be laughably bad, if it was not so serious.

It leaves hair, forehead, chin, and neck exposed, as well as a stripe down the center of the back (no medical personnel ever turns his/her back on a patient, and certainly no nurse lifting or turning a patient would ever encounter a situation where a patient's arm might encounter the uncovered space down the center of the back.

Not only that, but the removal protocol for the PPE exposes clean hands to these dirty areas because you remove your gloves before removing your goggles (by touching the dirty strap and hair), and by untying the gown.

The final step is to wash your hands - leaving whatever has landed on your hair, forehead, chin, and neck exposed. So even if you managed to avoid exposure in removing your gown, the first time you rub your aching neck, rest your forehead on your fingertips, scratch your chin, etc. you have now transferred the ebola virus to your fingertips - and to whatever you later touch - perhaps your lunch.

[Sunlei]

45. care givers themselves should have refused that kind of exposure.They have had a medical education?

Personally, I think it's ridiculous the hospital said 70!! people cared for/ were exposed to Mr. Duncan.

[Ms. Toad]

46. I think they tried to -

But here I was primarily responding to the poster (one of many) who was championing how well the CDC performed because, you know, science!

If that is their science, it is severely flawed.

[Sunlei]

48. I think the CDC (Federal) did fine, it was the states hospital & their medical people, that failed

The Tx health care 'system' is unacceptable. They could have consulted with all the other expert medical people who haven't had a breech. The transport service with the helicopters and the other USA state hospitals all handled ebola patients) haven't had any medical employee contaminations.

[Ms. Toad]

51. Have you read the protocol?

It is the CDC protocol I was reciting about which you said they
"should have refused that kind of exposure.They have had a medical education?." You still think the CDC did a fine job?

Look at all the exposed skin, and imagine yourself handling uncontrollable diarrhea, potential or sputum spray during intubation or initiation/maintenance of dialysis.

Do you really think leaving portions of the face and neck uncovered, and using clean hands to remove dirty garments (untying the back of hte gown & removing the goggle/mask straps) can be accomplished without a significant possibility of contamination?

Even if the protocol is executed perfectly, it would be a trivial matter for medical personnel to rub their neck, rest their forehead on their hand, scratch a cheek, etc. and move the ebola virus from a place it landed which the CDC protocol does instruct them to clean (none of those are included in the wash after removal instructions), to a mucous membrane.

[Sunlei]

54. Their training should have told them that type of PPE needed to vary for Ebola.

"The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne infection isolation precautions. The procedure for putting on and removing PPE should be tailored to the specific type of PPE.""

[Psephos]

55. you sound ridiculous

You think thousands of health care workers are all going to magically arrive at an effective prevention protocol overnight when the CDC itself, with its billions of dollars and years of prep time, has failed?

The political lens is not useful here. Ms. Toad's posts are worth another read.

This is not a political matter. It is a biological one. No health worker, hospital, state system, or federal bureaucracy has all the answers yet. Politicizing it makes uninformed public outcry the driver instead of science. I think we all have enough evidence of how badly that can distort outcomes.

[Sunlei]

58. Of course not. It is the hospital management who 'failed', made more than one 'mistake'

Anyway the second ebola nurse will be transported to a different hospital for care.

This has nothing to do with politics. The hospital management should have known better. It's good the nurses asked for help.

I hope more of those 70! hospital persons, waiting room persons & all the other exposed don't become sick.

[Ms. Toad]

56. Since the CDC PPE was specific to Ebola,

It should not have illustrated PPE which was inappropriate for ebola.

[snagglepuss]

60. Every doctor in working in infected areas has a coach with them when they remove their

hazmat suits. The doctor who was being interviewed said the stress is so intense that without a coach walking him through each step of disrobing it would've be easy for him to make a slip up. I don't think that procedure is required in US hospitals.

[snagglepuss]

59. A big part of that education is obeying doctors.

[enlightenment]

53. There doesn't seem to be a protocol

that is sufficient, if one goes by your reasoning.

Here is the WHO protocol:
Putting on the protective gear: http://www.who.int/csr/disease/ebola/put_on_ppequipment.pdf?ua=1
Taking off the protective gear: http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf?ua=1

The CDC protocol is essentially the same - with the admittedly rather glaring exception of not specifically telling workers to wash their hands after removing their gloves and gown, and again after removing the goggles and head-covering. They do continually stress hand hygiene throughout, but it probably is a good idea to specifically add it as a line item in the disrobing process.

As far as the covering of the forehead, chin, and neck - that really isn't covered in either protocol.

The CDC does address why it seems workers in the African nations affected seem to be wearing more protective gear:

Why do responders in Africa wear so much personal protective equipment (that can include full body suits) for this Ebola outbreak when CDC says hospitals here could safely manage the care of an Ebola patient without a full body suit?

There are important differences between providing care or performing public health tasks in Africa versus in a U.S. hospital.

In field medical settings, additional PPE may be necessary to protect healthcare workers. In some places in Africa, workers may not have the ability to prepare for potential exposures. For example, in some places, care may be provided in clinics with limited resources (e.g., no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different PPE than what is used when providing care for infected patients in a hospital.

After watching a recent documentary of the current outbreak in Liberia, which focused on the workers and the treatment facilities, it was clear that almost every worker wears a full-cover biohazard suit. Still, it is clear that even those that do are getting sick - and dying. The documentary is incredibly powerful - and informative.

http://www.pbs.org/wgbh/pages/frontline/ebola-outbreak/

Perfect protocols are only as effective as the people following them. If the worker errs - and humans do err - they may contract the disease. That isn't blame - or shame. Just facing a reality. It doesn't seem to matter if it is an experienced, but exhausted MSF doctor in a field hospital in Liberia or a relatively inexperienced young nurse (and I say inexperienced because she is young and probably hasn't been a nurse for too many years) in a hospital in Dallas. It doesn't seem to matter if it is a full-body biohazard suit or the protective gear outlined in the WHO and CDC protocols. A small error can have tragic consequences.

I don't really understand why so many people are so willing to toss the CDC under the bus when the reality is probably much more simple. If highly trained infectious disease specialists with years of experience can - and do - make mistakes and contract this disease despite their best efforts, why is it so difficult to accept that hospital staff with no real experience with the disease could do the same?

[madokie]

2. This kind of shit worries me

My wife, my love is a nurse

[Earth_First]

3. This is walking the line of gross incompetence and liability...

The staff director at Presbyterian is going to be facing some very uncomfortable questioning in the near future...

[RobinA]

21. Maybe

but it's also walking the line of standard operating procedure in health care today. Understaffed. Training doesn't produce revenue.

[deutsey]

30. Bingo

[RKP5637]

47. Exactly! None want to invest in quality, it cuts the profits, and also most

patients are not going to argue with providers when seriously ill, and nurses probably face retribution. And, we have a health care system that is shabby as compared to many other nations. And, we have ridiculous insurance programs. In short, the US health care system is pretty fucked up. ... but, what is one to except in USA, Incorporate where only $$$$$ and bottom lines count.

[hollysmom]

4. remember for profit hospitals emerged because they

would run hospitals better than city run ones. Well, if you have money. They turned the man away the first time because he did not have insurance, - these corporations will kill us all. In the name of the god of all, money.

[Yo_Mama]

14. It is a non-profit hospital, honestly.

http://texashealth.org/Facts

[hollysmom]

15. I should have checked before shooting off my mouth.

[Yo_Mama]

16. Our anger and concern is completely understandable.

It's just that we need to focus on the real problems in order to get real solutions.

[hollysmom]

17. I was reading about the Dr from NBCthat voluntarily

put that in quotes agreed to isolate herself since she had contact with someone with ebola. Caught getting take out around town.
this is not that far from me.
http://gawker.com/nbc-chief-medical-correspondent-quarantined-for-ebola-1645924287

I know that odds are low, but if she is supposed to be so smart, why is she not sensitive to our own stress on the topic?

[Yo_Mama]

18. It's a terrible example to set.

Yes, sure, she is a very unlikely candidate. But as you have more potential exposures, the contact tracing burden becomes much larger, and therefore isolation is important to limit the burden.

So I think her conduct is reprehensible. I spoke to a doctor in that area yesterday and he was utterly furious about her behavior.

[Zoonart]

28. Toxic Brew

That toxic brew of arrogance and celebrity exceptional-ism rears it's ugly head again and again, even trumping this woman's scientific training. Celebrity=Immunity

[RobinA]

22. Just Because

it's nonprofit doesn't mean that their reimbursement rates cover the amount it costs them to deliver services decently.

[Yo_Mama]

40. Exactly!!! There is no insurance company in the land that covers the cost of the

treatment necessary. Therefore hospitals are not staffed or equipped to do what is necessary. They never have been. We were not prepared. This hospital probably did better than 90% of hospitals country-wide would have done. Obviously its efforts are insufficient. Medicaid, Medicare and all insurance companies don't pay for the equipment and the facilities, so hospitals don't have the equipment and facilities.

What happened at this hospital was inevitable. Treating acutely ill Ebola patients in special units that are set up for true biocontainment should be safe. Treating them at regular hospitals is not.

Yammering about political stuff like Medicaid is dumb under the circumstances. A public health threat this big - you just do what is necessary and figure out how to pay for it later. We cannot afford to equip all hospitals properly, so we'd better be setting up an alternative.

But we hadn't started the realistic process of figuring out how we would handle the inevitable, and blaming nurses (as I have seen here at DU) or the hospital is totally unjustified.

The reason they are using the full-body containment suits in Africa is because they are necessary in some settings when dealing with Ebola patients.

I will say this - the reason why unions are terribly important to the life of our country is now evident. Unions are the best mechanism to control safety hazards. In this case, it is not just a hazard to the HCW, but to the public. The only realistic information hitting the airwaves is what is coming through the nurses' organizations.

Here's the reality - many "line" doctors had questioned the CDC's recommendations as being insufficient. They are insufficient. Figuring out how to make the situation safer should be the priority of every citizen in the US. This is not the only case of Ebola that will be found in the country - there will be others who arrive and are infected, and now we have our own domestic lines of transmission to worry about.

Doctors are calling CDC for testing of suspect patients and can't even get through to CDC. In August doctors had called 57 or 58 times and CDC only authorized the test about 10% of the time. CDC guidelines for who should be considered a "suspect" case and tested are inadequate and don't cover some potential exposures.

The problem here has started at the very top and it can only be fixed by working from the bottom up without politicizing a risk which absolutely no one expected to have to deal with even three months ago. But now it's here, it's real, and it is not going to vanish. To deal with it properly requires major changes.

Very, very few hospitals are set up with the multiple layers of isolation necessary to treat acutely ill Ebola patients, and very, very few hospitals can easily be reconfigured to achieve it. If they do try to do it, we will knock out so much health care capacity that other patients will be endangered.

[pangaia]

25. Glad you posted that.

Might keep MANY of us from 'shooting our mouths off."

[salib]

33. BS - Privatization is privatization. They just hold on to names that sound like charities, like:

Presbyterian, Methodist, etc.

See http://www.nytimes.com/2013/12/17/us/benefits-questioned-in-tax-breaks-for-nonprofit-hospitals.html?pagewanted=all&_r=0

“The standard nonprofit hospital doesn’t act like a charity any more than Microsoft does — they also give some stuff away for free,” Professor Colombo said. “Hospitals’ primary purpose is to deliver high quality health care for a fee, and they’re good at that. But don’t try to tell me that’s charity. They price like a business. They make acquisitions like a business. They are businesses.”

[Yo_Mama]

43. That's true, but how is it relevant?

Whether you are a non-profit hospital or a for-profit hospital, you still have to bill and collect in order to stay in operation.

It costs a tremendous amount of money to run a hospital. Real reimbursement rates keep dropping. This forces all hospitals, profit or non-profit, to put more funds into attracting the money-generating care.

They lose money on Medicaid patients. They lose money on uncompensated care. They lose money on Medicare patients most of the time. They are now losing money on Obamacare patients some of the time, because of the tight networks. We have situations in which "insured" patients aren't insured if they travel an hour away. Some people aren't insured for care at the places where they WORK every day. If they get in an accident and go to a local ER, the hospital gets beat.

Hospitals have to pay for equipment, medicines, staff and utilities.

Hospitals don't have infinite streams of revenue, and the more they act like you think they should act, the less they have. So blaming these hospitals for not having biocontainment wards is ridiculous. In a health care system, you get what you pay for, whether it's universal single-payer or whatever.

[salib]

50. Privatization is privatization

The distinction is:
- Lesser management oversight by the public (not public, but private)
- Making money by any way possible (because it is private and they can, public they cannot)
- Trying to affect policy in order to make more money (lobbying for simple greedy purposes)
- etc.

Why is it necessary for you to defend these organizations? It is part of the commons (health care) and should be public (democratic and egalitarian, as well as publicly managed and efficient).

[cosmicone]

5. Appalling

The nurses in Liberia are better protected.

[TerrapinFlyer]

6. Very worrisome

But at least this is bringing attention to every hospital's protocols.

[Demit]

7. "Hospital managers have assured nurses that proper equipment has been ordered but

it has not arrived yet." Oh well, at least you've ordered it. Maybe you could've put "Rush" in the Special Instructions box?

[AllyCat]

8. Just like it took around a week for a contractor to be hired to clean

The late Mr. Duncan's apartment.

[Sunlei]

13. Tx state hired first contractor, CDC made the state change to a better contractor.

Though I think Mr. Duncan 'himself' self-isolated from family contact enough where his family members may not get sick at this point. It was one of Mr. Duncans family members who contacted the Federal CDC first.

The healthcare of state of Texas failed.

[bklyncowgirl]

23. What! And pay extra, surely tou jest. nt

[pangaia]

26. Hell, I order parts from McMaster-Carr and they arrive the next day.

Same with RELIABLE and ULINE.

What's the big problem here?

[Demit]

36. Personal protection equipment doesn't grow on trees, you know

The hospital has to tamp down this childlike desire for immediate gratification. Build up the anticipation so the staff truly appreciates it when it finally comes.

[In_The_Wind]

9. Texas Health Presbyterian Hospital botched this from their first encounter.

Apparently everything they did (as per hospital procedures) was wrong.

[MannyGoldstein]

10. They should move all US Ebola patients to first-world hospitals.

Move the ones in Africa too, if we can accommodate.

[jehop61]

19. Saw yesterday on Huff PO (sorry no link)

that NBC and friends of the ebola patient from NBC have started a fund asking for people to donate money to pay for this man's treatment in Nebraska. It said bills could be as high as $500,000. If NBC won't/can't pay, I guess it's up to the rest of us to do it.
Who would pay for all the unfortunate people from Africa? Not in this political environment!

[RobinA]

24. Wouldn't It Be

a workers comp claim for him? Oh now he's in BIG trouble. I bet there's many workers comp doctors with Ebola knowledge.

[Enthusiast]

11. Simply incredible.

[Sunlei]

12. perhaps Tx hospitals need some training from Africias clinics, they manage with tents & bleach.

[Hubert Flottz]

20. "Left in an open area in the emergency room."

We have all been left for hours in those waiting areas. A place where everyone has no choice, but to use those public restrooms in those ER waiting areas.

So there could have been many people, besides the people who work at that hospital, exposed. People who probably will not put 2 and 2 together, until they too may expose even more people, before they present with any major Ebola symptoms.

[RobinA]

27. I Wish

people would stop blaming Texas and this hospital. This situation exposes conditions and ways of doing things that exist in many (most) hospitals in this country today. I can only hope that when this washes out the take home message is that there is a systemic problem that needs to be addressed. Training, staffing, real preparation with understanding of what the prefix "PRE" means, education in what constitutes good care, e.g learing a patient's history.

I recently went to a new Dr for a yearly check up. I asked him if he wanted my records from my previous doctor and got a breezy "no." Now, I am middle-aged and healthy with just a few minor issues in the past, but he had no idea of this at the time.

[Triana]

29. Don't mess with nurses. They mean business and will not lie

for anyone or anything - at least not the ones I know. If "a few" of them said this was the case, I've no doubt it was. And - in light of the fact that these medical centers - all of them, knew an ebola outbreak was occurring in parts of the world this man had been to - yet had no protocols or procedures or plans in place is inexcusable. It's not up to the nurses to put these things in place. It's their job to follow them. Yet they were given constantly changing protocols and left without proper gear.

The only nurse I question is the one who saw Duncan initially and didn't bother to tell the rest of the medical team he'd recently returned from Monrovia. But who knows, may they'd have ignored that. It seems several balls were dropped in this case.

[My Good Babushka]

31. It's a private, non-profit hospital

Just because it's called non-profit doesn't mean it's run like a charity. The president does make over a million dollars. Non profit doesn't mean what it used to. Non profits can be just as self-dealing as for profit industries, so I think it's fair to evaluate whether corners were cut for financial reasons.

[aquart]

38. Texas encourages that behavior by refusing to properly regulate or protect its citizens.

Oh, gosh. What if one of the people exposed was the maid or chauffeur to somebody rich?

[SCVDem]

34. These are professionals, correct?

So why didn't they call the CDC and demand assistance? Did they think they would get charged?

How can you work in the health care field and not study and learn everything there is to know about the next worst thing?

I was in charge of the NBC (nuke, bio and chem) in my military unit. We knew the dangers of exposed skin.

Again, these are professionals, right?

[snagglepuss]

61. i've been wondering whether social media is to blame. I am referring to

the millions of people nowadays who never watch the news, as all their time is spent on FB, games etc. i remember being floored after Katrina when several people I worked with didn't know what I was talking about. i would love to know how many people in the hospital admin and staff actually knew what was happening in Africa and how dire ebola is.

[dynasaw]

35. Hospitals are corporations

Regrettably, hospitals are corporations and run like corporations. Workers in hospitals face all the negative factors face by workers in other companies: Inequitable wages, long hours, lack of attention to safety etc.

[aquart]

39. Under regulation and under enforcement.

Encouraged by a flat refusal to adequately tax the residents of Texas.

[Moostache]

42. Ebola and the CDC do not care about profits...hospitals DO.

And therein lies the problem.

Safety protocols for BSL4 infectious agents are extreme because the threat posed by these viruses (mainly) are extreme.
None of the caregivers should be allowed to exit an infected area without an airlock, decontamination shower, followed by a second rinse shower, followed by a second worker removing the outer layer of PPE (and THAT second worker ALSO being decontaminated before exiting the area).

If you want to stop a virus, especially a deadly virus like Ebola, then doing so is a 100% full-time precautionary activity and costs are not counted in money spent but rather in infections prevented and stopping the outbreak, period.

Ebola is said to be non-transmissible unless an infected person is symptomatic, but MOST people don't realize that they are already symptomatic well BEFORE they run a fever. How many times have you had a stuffy nose? Do you realize that is caused by inflammation of the mucus membranes as a reaction by your body to a foreign antigen? When you first sneeze and blow your nose, THAT is infectious waste if you have Ebola. That is way before you are dying on a bed, bleeding from every orifice on your body.

Our sick society deserves to disappear. Whether by viral outbreak, climate catastrophe, social upheaval or outright World War III, this bastardization of civilization; where the ONLY thing that matters is wealth and / or profits, and EVERYTHING else - public health, safety, environmental protection, social justice, human rights - everything else is a secondary concern, is an abomination and the sooner nature destroys us, the better. Maybe a few will survive and rebuild with the hard lessons learned (for a while anyway....within 3 generations of total annihilation humanity would revert right back to the level we're at now IMO)...maybe not. But this sick ass society we inhabit now WILL fall, the only question is how many will be crushed beneath it when it goes.

[Dustlawyer]

44. Republicans are very quick to take advantage of situations, Democrats not so much!

The Nurse's unions should be trying to organize like crazy over this. Also, this "Right to Work" crap should be attacked as these nurse's should have the freedom to speak without the worry of being fired for it. A union would give them protection on the job and off. This is what happens when you don't have unions. You have to take what the employer does or doesn't do, work in the conditions brought on by the company/hospital being cheap and saving a buck!

[OKNancy]

49. kick

[hedgehog]

52. The worst part? Since Ebola is not airborne, all they had to do was put him in a private room, keep

the door closed, and limit the people entering the room. Ebola isn't like small pox, which can be carried by ventilation systems or a breeze through a window.

The industrial Tyvek suits i wore had hoods and came up to the chin; it sounds like these weren't in use.

I'm thinking over the gear anyone who removes asbestos wears; it would probably be fine for caring for an Ebola patient.

[seveneyes]

57. Sloppy is jetsetting around America shortly after handling live Ebola

A Nurse should damn well know better.

[snagglepuss]

62. A lot of people lack common sense. I too find that shocking but it does

suggest that that hospital had a laissez faire attitude. I am willing to bet nursing students don't learn ebola protocols.