Why Medical Personnel Are Getting Ebola (Nurses' Union Is Begging For Help)

[TexasMommaWithAHat]

The CDC guidelines have NOT BEEN ADEQUATE!

http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf[link:http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf|

It is very difficult to remove the second glove with a bare hand because that still dirty second glove overlaps the still dirty cuff of your gown.

Then, using your BARE hands you are supposed to remove your own gown by reaching behind you. This assumes that no one ever gets contaminated on their back side!

And on and on! This is NOT adequate PPE.

I worked in a hospital lab as an assistant and phlebotomist. We rarely took extra precautions when we saw a patient (normal cover was a disposable lab coat over our scrubs and gloves when dealing with patient). Extra precautions were not part of our daily routine. When we (rarely) saw a patient presenting with possible tuberculosis, we'd all get that "I'm doing this correctly? Right?" look when donning our PPEs (personnel protective equipment) and then removing them.

People are assuming that medical personnel are accustomed to suiting up and then removing their PPE , but with exceptions of surgical personnel (who suit up to protect the patient more than themselves and generally just "yank" off their gown and gloves), most medical staff rarely wear and then REMOVE PROPERLY the level of PPE required for diseases like ebola.

Yesterday on CNN the spokesperson for the nurses' union was pleading for more training for nurses around the country. Their polling suggesting that the majority of nurses in this country do not feel adequately trained to handle ebola patients.


Hospital personnel working with ebola patients need an immediate upgrade to better PPEs and need to learn to work on the buddy system to remove them, imo.

This is not a "Texas" problem" or a "Dallas Presbyterian Hospital" problem. Mistakes have been made (like sending Mr. Duncan home the first time), but this is a country wide problem of nurses not being adequately trained and and not having periodic drills on how to deal with this type of situation, imo.

The problem lies with the CDC guidelines as well as the "bottom line" hospitals, imo. And for the record, Dallas Presbyterian is a teaching hospital, where one of my kids did her nursing school clinicals. It is considered a good hospital, and is probably as good or better than most hospitals in the U.S.

[Skink]

1. Robots could work here

[Erich Bloodaxe BSN]

2. The gown designs I've run into seem more for 'cheapness' than serious protection.

I don't have trouble removing the gloves properly, but you're right about the gowns - they're not easy to remove safely. I'd far prefer something that has a foldover flap that then fastens on the side of the front. And maybe with the ebola patient treatment, there should always be a second (PPE'd) person who does not go more than a step or two into the room who never has contact with the patient or other surfaces in the room, and does nothing but help those who have direct contact disrobe carefully.

[TexasMommaWithAHat]

5. Well, the gowns are generally fine for general use

But not for this!

[Ms. Toad]

3. The glaring gaps in the recommended protocol were obvious

the moment I saw the protocol.

Anyone who thinks they are adequate should ask themselves if they would feel safe being a patient seen by a caregiver who had treated an ebola patient who perfectly executed those procedures.

The forehead, hair, neck, and parts of the cheek around the mask are exposed and never cleaned (following the protocol). So after cleaning her hands, the doctor rubs her aching neck - transferring the ebola virus from her neck to her hands. She grabs the pen from her pocket to do some charting, transferring the virus to her pen. Enters your room and dutifully washes her hands, then grabs the (now contaminated) pen from her pocket to take notes while in your room - recontaminating her hands, and then examines you...

Just one of the many ways this contamination could happen - even if the protocol is followed perfectly.

[TexasMommaWithAHat]

7. How do you slip your own bare finger under a second glove that is covering the cuff

This is a serious area of possible contamination. That finger is going to come in contact with that contaminated cuff.

A second person adequately suited up MUST help any medical personnel who were just with a patient if they are going to cut down on possible contamination while removing PPEs. It would be much easier if a second person wearing a clean pair of gloves were to slip his finger under that contaminated glove to remove it; he could then more easily dispose of his own gloves, which would likely have possible contamination on just one or two fingers.

SURELY, there are safer options for these hospital personnel!

[Ms. Toad]

8. Well - according to at least one medical personnel

you just stretch your arms out because the glove doesn't really stay over the cuff anyway, so a simple stretch should slide the gown cuff out.

(in case I need it).

There are so many gaps, I am amazed anyone who has been through the HIV years, or first aid/cpr training, or ever thought seriously about disease transmission, is defending that protocol.

As for safer options - start with double layers and complete coverage for any area that could come into contact with vomit, fecal matter, or blood which is not necessarily well contained just because of the nature of the beastie. That means no facial, neck, hair exposure for a start, and not ever touching a dirty area (the google straps and gown ties) with clean hands - unless you treat the clean hands from then on as dirty (meaning that there better be a second layer of gloves on so you can remove the second (now dirty) layer after you take the goggles and gown off).

[marions ghost]

4. Biosafety Level 4 procedures in a lab setting:

Biosafety level 4
The Galveston National Laboratory BSL-4 (P4) lab on the Campus of the University of Texas Medical Branch

This level is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections, agents which cause severe to fatal disease in humans for which vaccines or other treatments are not available, such as Bolivian and Argentine hemorrhagic fevers, Marburg virus, Ebola virus, Lassa virus, Crimean-Congo hemorrhagic fever, and various other hemorrhagic diseases. This level is also used for work with agents such as smallpox that are considered dangerous enough to require the additional safety measures, regardless of vaccination availability.

When dealing with biological hazards at this level the use of a positive pressure personnel suit, with a segregated air supply is mandatory. The entrance and exit of a level four biolab will contain multiple showers, a vacuum room, an ultraviolet light room, and other safety precautions designed to destroy all traces of the biohazard. Multiple airlocks are employed and are electronically secured to prevent both doors from opening at the same time. All air and water service going to and coming from a biosafety level 4 (or P4) lab will undergo similar decontamination procedures to eliminate the possibility of an accidental release. (wiki)

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Hospital personnel are not expected to come into contact with a level 4 virus.
You are exactly right--this is a very unusual situation and it is wrong to castigate the hospital for negligence. It's what they do NOW that counts.

It does indicate a nationwide problem with inexperience in dealing with "exotic" diseases.

[aquart]

6. Dallas Presbyterian has a long way to go to retrieve that "good" reputation.

Funny how fast that can fly away.