Who To Blame When You Get Ebola: A CDC Guide For Healthcare Workers

[Yo_Mama]

15. I think you are dead wrong.

The CDC's guidelines have been and continue to be, inadequate. Tell us how this is adequate and helpful:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Tell us how this is adequate or helpful:
http://www.cdc.gov/vhf/ebola/hcp/case-definition.html

Early recognition is critical for infection control. Health care providers should be alert for and evaluate any patients suspected of having Ebola Virus Disease (EVD).
Person Under Investigation (PUI)

A person who has both consistent symptoms and risk factors as follows:

Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

Probable Case

A PUI whose epidemiologic risk factors include high or low risk exposure(s) (see below)
Confirmed Case

A case with laboratory-confirmed diagnostic evidence of Ebola virus infection
Exposure Risk Levels

Levels of exposure risk are defined as follows:
High risk exposures

A high risk exposure includes any of the following:

Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD patient
Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without appropriate personal protective equipment (PPE)
Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring*

Low1 risk exposures

A low risk exposure includes any of the following

Household contact with an EVD patient
Other close contact with EVD patients in health care facilities or community settings. Close contact is defined as
being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations)
having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.
Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact

No known exposure

Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no high or low risk exposures

Note that at intake, not one of the three confirmed US cases met these critieria. At intake Mr. Duncan's fever was well below the cutoff, and of course he did not disclose the exposure to a sick person in Liberia. So he wasn't segregated. And in fact if they had called CDC for a test it would have been refused. as so many others have. The hospital's original error was in not upgrading the risk when his fever rose above the threshold during that initial evaluation in the ER.

The nurses who are confirmed do not fit the case definition either.

Fumesucker's post could not be more appropriate, and all medical institutions are making up their own guidelines as we debate here. But note that the hospitals cannot, on their own responsibility, direct that a patient be tested for Ebola. That request can only be handled by calling a state or CDC hotline. and many of them are refused.

More funding doesn't fix this.