<p>It frustrates me that they had a 26 year old young woman who earned her critical care cert. just last month on the front line of the “fight” against Ebola. To me that’s unfair and irresponsible staffing. How can any of the people in charge thing that’s a sound plan. It also bothers me when they say that they expected and still expect more infections to surface as if these nurses are the medical equivalent of cannon fodder.</p>
<p>laralei, it is important to underatand that by stating that there was a “breach”, no one is blaming the nurse. Typically, removal of the PPE is the weakest link where such breaches happen because the level of contamination is high, and the worker is tired. It will take a while to trace back what had happen, but it needs to be done to understand where this weak link is. It is not instantaneous, it takes some work. The investigation is also looking at the possibility that the two desperate heroic procedures that the team performed (dialysis and intubation) could have created the extra hazard. </p>
<p>"Those procedures were “a desperate measure to try to save his life,” Frieden said. “Both of those procedures may spread contaminated materials and are considered high-risk procedures.”</p>
<p>He said, “When you have potentially soiled or contaminated gloves or masks or other things, to remove those without any risk of any contaminated material … touching you and being then on your clothes or face or skin … is not easy to do right.”</p>
<p>Or the problem could have been something else entirely.</p>
<p>Taking extra precautions outside recommended CDC protocols can actually increase the odds of infection, Frieden has said. Caregivers are supposed to double their gloves in some situations, but triple gloving is a violation of CDC protocol because it increases the steps to remove gear and could expose a health care worker for longer than needed."</p>
<p>You can’t get it without breaking protocol, period. Doctors with Borders and CDC doctors have been treating Ebola for many years without an infection. I will say that they probably were performing more aggressive measures on this patient than in a lot of hospitals in Africa. Not sure they have ventilators and dialysis machines in the places where Ebola routinely occurs. And in the late states, the virus is essentially liquefying internal organs and tissues… it could have been a very messy process. Add to that caregivers who weren’t very practiced in the protocol, and you could see how it could happen.</p>
<p>It could be that SHE did nothing wrong. Maybe they have a rinse solution they use as each layer of protection is taken off, and it wasn’t the recommended strength. Maybe there was a pinprick hole in her glove, or the tape on her sleeves wasn’t tight enough. All “breach in protocol” means is that somewhere the process that has worked a lot of times before didn’t work this time, and it is likely that there was some flaw somewhere in the equipment or process. </p>
<p>^^^^Yep times ten. </p>
<p>It’s interesting that so many people immediately interpreted the CDC director’s statement as throwing the nurse under the bus.</p>
<p>As to the nurse just getting her ICU certification:</p>
<p>I’ve thought about this, and I’m conflicted. When I just got my ICU certification, I was a babe who needed MUCH direction from the other ICU nurses, but I was also a new grad. This nurse was 4 years out, so she was probably MUCH more competent.</p>
<p>Also, there may have been some kind of volunteer thing going on, I don’t know. I really have no inside information, so I’m guessing. </p>
<p>I can tell you this: there are some AMAZING nurses who work ICU at that hospital. But I don’t think many, if any, had any experience with this kind of thing. Not many in the US have.</p>
<p>Yesterday we were watching more darts being thrown at the CDC staff for stating that this was a breach of protocol. As many have repeated here, researchers and clinicians have worked with samples and cared for patients without contamination for quite some time. The less experienced but dedicated staff are to be honored, and we need to learn from their oversights or mistakes. The continued attacks are unhelpful as we try to discuss civilly this world health crisis. Those who are willing to step up to the plate to treat victims and contain this outbreak are not helped by those who prefer to attack and insult the system that is trying to address this from multiple angles. </p>
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<p>ALL int’l pax should be temperature screened coming into the US. This has been common practice for YEARS at the major international airports I transit through in asia, europe, middle east. For YEARS I’ve been wondering why the US hasn’t been doing this.</p>
<p>There’s a lot of bad stuff out there besides ebola that other int’l airports in the world are on the lookout for, including MERS, H7N9… if an 80 year grandmother from Wyoming w a high temperature is trying to enter the US from a trip to France, she should be pulled aside and questioned.</p>
<p>Since Mr. Duncan’s people are so incensed at Texas Health Presbyterian, I assume if any of them get sick they will not go there, so are the rest of Dallas’s hospitals prepared to take on a case?</p>
<p>I’m curious which internatonal airports it is common practice at? I have never once encountered it, certainly not in Europe. (Admittedly it is some years since I’ve travelled to Asia or the Middle East but do travel to Europe often).</p>
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<p>Are those experienced professionals stepping up to the plate in the US cases? Its weird to me that people claim we have been dealing with Ebola for decades (since the 70s?) without a breach, and yet we cannot manage to do that on our own soil.</p>
<p>Doctors without Borders DID have a breach. A Norwegian contracted Ebola and was flown back to Norway just a week or so ago. I haven’t heard whether that person died or survived. </p>
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<p>You can bet the CDC was there with the Emory doctors every step of the way. There is a reason those first patients were taken there. </p>
<p>As others have said, no one is perfect. No system is 100% perfect. The healthcare worker from Norway did become exposed, but what percentage is that of the many caregivers handling the many patients in less than ideal field and rural hospitals. They don’t have the same facilities as in urban hospital centers. They work in less than ideal situations and are caring for many, many patients.</p>
<p>Until a month or so ago, there was no real need to have trained staff in the US. in other than research settings. The staff at Emory were trained and ready and did an admirable job. Ditto for the staff and the containment unit at the facility in Nebraska.</p>
<p>Dallas was not prepared. It is unlikely the nursing and perhaps the critical cares staff had as much training in the guidelines/ protocol and how to get in/out of the protective gear. From posts here it sounds like some city hospitals are gearing up. Medical teams do need to be prepared. But we don’t need to build bomb shelters and stock up on canned goods.</p>
<p>That’s it? Sorry, it is not satisfying to me, as an average American, to hear that we have a public crisis on our hands, Ebola is not that big of a deal in the US, and yet in the one unexpected incidence of Ebola in the US, we have a 100% failure rate. I’m not trying to be difficult, I’m trying to understand what is really going on.</p>
<p>When you read the earliest accounts of Ebola, the stories are actually quite terrifying of the doctors going into huts with no electricity to see patients. Maybe with gloves and a mask, but sometimes not even those before they realized the patient had Ebola. </p>
<p>I have been wondering about the companies that make this protective gear, and if there is going to be a shortage of it at some point. I bet they are working round the clock.</p>
<p>The Norwegian health worker is improving.</p>
<p>What are you expecting, Bay? Perhaps you can write the answer you are looking for.
Atlanta has successfully treated 3 ebola victims. The third had such little fanfare that I completely forgot about it. But the low key approach was smart, given the idiots that called in death threats to the transport teams. </p>
<p>Bay,
Would you have a person who is fresh out of cosmetology school cut the hair of the Queen of England? Granted, she could use a new hairstyle, but some people might need a little more experience and training, despite basic certification, to take on a high risk, high profile responsibility.</p>
<p>I’m guessing your obscure post means you think Ms. Pham was not prepared to be treating Mr. Duncan? I have no idea, as I am not a professional. If this is what you think the problem was, it is amazing and awfully disheartening that it happened. All that overseas experience our professionals have accrued apparently did not pay off when it came to treating people here, I guess.</p>
<p>It just occurred to me that what we, Westerners, consider the norm of personal hygiene and care - shaving legs, plucking eyebrows, waxing, etc. - can make the person more vulnerable to contracting Ebola via skin contact. </p>
<p>^^^on that note, when Emory accepted those patients, I read so much doom and gloom: Oh, this is opening the floodgates, the nurses will all get sick and spread it to the community, etc. My response was that bringing in known patients to a state of the art facility extensively trained and ready for this situation should be the LEAST of our worries, and that it was the UNKNOWN person, entering the country during their incubation period, which would present the more frightening problem. Turned out to be totally right. And I’m not happy I was correct.</p>
<p>In my experience as a nurse, we always trained for the things we were most likely to encounter. And we got good at treating those problems because we saw them over and over. In medicine, practice is so much of the equation. I’m sorry that the hospital who receive the first ebola patient in our history didn’t rise to the occasion. I think that many facilities would have had the same dismal results because it is an unprecedented event, no matter how much attention in theory it was given. You better believe that much is being learned from these mistakes, and each subsequent encounter will go better, because people will remember what happened in Dallas.</p>
<p>I really wish that the Emory events could have been recorded so that others could learn from them. Videos of the nurses providing care, removing PPG, etc. would provide so much valuable information. To see what actually worked vs. reading it in a manual would be very instructive for a visual learner like myself. </p>