Second Texas health worker tests positive for Ebola

[Michelle]

Oct 15, 2014 14:53:46 GMT -5 ttt said:

Oct 15, 2014 14:48:11 GMT -5 iammalcolmx said:

Ok so it looks like it tells you to completely cover up. What on earth happened here then? Were they not covered up when he was there the first time around? Is the hospital not protecting it's workers properly? Why did they have skin exposed?

I read elsewhere that the suits are all one size and this does not account for people who are much smaller (like the first nurse who appears to be pretty tiny from the pics) or much bigger.

in the Mashable article on this topic the NNU stated that nurses reported that some supervisors told them they could wear the cloth masks, not the N95 masks used for droplet isolation.

In meetings at my hospital we have discussed claims that works did not have closed-top face shields so droplets from projectile vomit could theoretically get up and around the top of your face shield and into your eye.

[anonymous]

Oct 15, 2014 14:54:50 GMT -5 Michelle said:

Ebola can be sexually transmitted.
www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Ebola_Fact_Booklet.pdf

I have read somewhere (need to find) that it can be spread for 3 months

The WHO has this in their guidelines.

iammalcolmx I think there are still a lot of questions about what happened in Dallas.  CDC has said there was a breach in the protocol but I do not think they have identified the breach.  I believe that CDC develops the protocols but it is up to individual hospitals to train and implement.  With the current information I tend to think most of the blame lays in the hospital not properly training the staff-if they had would Duncan have been sent home in the first place?  However, I also think the CDC should have had a team on the ground in Dallas once they became aware that Duncan was positive for Ebola and was at first turned away-I think that was pretty telling about the hospital's capability to handle this.

[Michelle]

Oct 15, 2014 14:55:39 GMT -5 iammalcolmx said:

Oct 15, 2014 14:53:46 GMT -5 ttt said:

I read elsewhere that the suits are all one size and this does not account for people who are much smaller (like the first nurse who appears to be pretty tiny from the pics) or much bigger.

GIRL!! Wouldn't you be using that tape or something to make it fit? They got hazmat suits on Ebay? I would be buying one. 

You can buy ONE. Every time you leave a "contact isolation" patient's room you have to dispose of everything you are wearing as if it is radioactive waste.

Here is my doomsday survivalist tip for my CEP loves:

Research the MRSA infection rates at your area hospitals. If anyone is having trouble containing MRSA chances are they do not have strong enough protocols to contain Ebola. So you don't want to go there if Ebola is detected in your area.

[heyjude]

Question: a couple months ago we flew in two American medical workers from Africa with Ebola and treated them in American hospitals. They got better; no one else got sick. What differentiates what happened there and what's happening in Dallas?

Clearly we DO know how to handle Ebola properly because we did 2 months ago. What is wrong at the Dallas hospital? Is this a particularly bad hospital?

I haven't seen anyone else discuss this angle.

[ttt]

Oct 15, 2014 14:57:47 GMT -5 @therealmc said:

Oct 15, 2014 14:53:46 GMT -5 ttt said:

I read elsewhere that the suits are all one size and this does not account for people who are much smaller (like the first nurse who appears to be pretty tiny from the pics) or much bigger.

Also not true. However, wearing the suit is not part of the CDC recommendation.

ETA: I think people should be wearing them. Just wanted to point out that the CDC doesn't discuss them in their guidelines.

That is good to know!

[msmerymac]

Oct 15, 2014 13:46:43 GMT -5 AJL said:

I wouldn't have considered 99°F a fever at all. Normal human body temperature range is 97.02–99.68 °F.

Yeah, I run hot. When I went to give blood today and they took my temp it was 99 even. They were like, "good to go!"

[ttt]

Oct 15, 2014 15:02:03 GMT -5 heyjude said:

Question: a couple months ago we flew in two American medical workers from Africa with Ebola and treated them in American hospitals. They got better; no one else got sick. What differentiates what happened there and what's happening in Dallas?

Clearly we DO know how to handle the properly because we did 2 months ago. What is wrong at the Dallas hospital? Is this a particularly bad hospital?

I haven't seen anyone else discuss this angle.

I think the difference is that those hospitals knew they were receiving Ebola patients. They were completely prepared before those patients came through the door. This hospital didn't know this guy had Ebola until later. It was a test and one they failed badly.

[KB]

Oct 15, 2014 15:02:03 GMT -5 heyjude said:

Question: a couple months ago we flew in two American medical workers from Africa with Ebola and treated them in American hospitals. They got better; no one else got sick. What differentiates what happened there and what's happening in Dallas?

Clearly we DO know how to handle Ebola properly because we did 2 months ago. What is wrong at the Dallas hospital? Is this a particularly bad hospital?

I haven't seen anyone else discuss this angle.

They were treated at Emory. Emory is one of four hospitals in the country specifically set up to handle ID patients with Ebola. 

[KB]

Oct 15, 2014 15:04:09 GMT -5 msmerymac said:

Oct 15, 2014 13:46:43 GMT -5 AJL said:

I wouldn't have considered 99°F a fever at all. Normal human body temperature range is 97.02–99.68 °F.

Yeah, I run hot. When I went to give blood today and they took my temp it was 99 even. They were like, "good to go!"

I doubt you would have gotten that answer if you had just taken care of an ebola patient and ran a temp of 99.5. 

[heyjude]

Oct 15, 2014 15:04:16 GMT -5 ttt said:

Oct 15, 2014 15:02:03 GMT -5 heyjude said:

Question: a couple months ago we flew in two American medical workers from Africa with Ebola and treated them in American hospitals. They got better; no one else got sick. What differentiates what happened there and what's happening in Dallas?

Clearly we DO know how to handle the properly because we did 2 months ago. What is wrong at the Dallas hospital? Is this a particularly bad hospital?

I haven't seen anyone else discuss this angle.

I think the difference is that those hospitals knew they were receiving Ebola patients. They were completely prepared before those patients came through the door. This hospital didn't know this guy had Ebola until later. It was a test and one they failed badly.

But no nurses got sick after treating the doctors. So they had a better protocol in place to deal with scrubbing down or what? It seems like all hospitals right now should be on the phone with those hospitals that treated the medical staff 2 months ago because they might have the most wisdom at the moment.

[heyjude]

Thanks all for the info.

[sunshine608]

Oct 15, 2014 15:02:03 GMT -5 heyjude said:

Question: a couple months ago we flew in two American medical workers from Africa with Ebola and treated them in American hospitals. They got better; no one else got sick. What differentiates what happened there and what's happening in Dallas?

Clearly we DO know how to handle Ebola properly because we did 2 months ago. What is wrong at the Dallas hospital? Is this a particularly bad hospital?

I haven't seen anyone else discuss this angle.

The hospital was better equipped and works closely with the CDC. My Atlanta geography is off, but they are pretty close to each other and I'm sure have a better working relationship than the Dallas hospital. Emory is a world class teaching/research facility. I don't think this means that the Dallas hospital is bad, but few hospitals are as good as Emory.

Emory also had advance notice and preparation time. Dallas did not.

According to the trending topics on FB, the 2nd nurse will now be treated at Emory.

[meshaliuknits]

Oct 15, 2014 14:53:46 GMT -5 ttt said:

Oct 15, 2014 14:48:11 GMT -5 iammalcolmx said:

Ok so it looks like it tells you to completely cover up. What on earth happened here then? Were they not covered up when he was there the first time around? Is the hospital not protecting it's workers properly? Why did they have skin exposed?

I read elsewhere that the suits are all one size and this does not account for people who are much smaller (like the first nurse who appears to be pretty tiny from the pics) or much bigger.

Those suckers definitely come in sizes.

[pescalita]

Oct 15, 2014 15:00:21 GMT -5 Michelle said:

Oct 15, 2014 14:55:39 GMT -5 iammalcolmx said:

GIRL!! Wouldn't you be using that tape or something to make it fit? They got hazmat suits on Ebay? I would be buying one. 

You can buy ONE. Every time you leave a "contact isolation" patient's room you have to dispose of everything you are wearing as if it is radioactive waste.

Here is my doomsday survivalist tip for my CEP loves:

Research the MRSA infection rates at your area hospitals. If anyone is having trouble containing MRSA chances are they do not have strong enough protocols to contain Ebola. So you don't want to go there if Ebola is detected in your area.

How does one go about doing this?

[Michelle]

Oct 15, 2014 15:09:05 GMT -5 @therealmc said:

I posted a presentation from Emory on page 5. Might help with your questions.

This.

What SBP said.

And drills.

The Emory team did drill after drill after drill after drill to prepare. They were focused, ran through a multitude of scenarios and were ready and waiting by the time the patients arrived.

This is why I say any hospital not doing drills is being negligent. I'm not gonna lie - the first drill we ran was not what we'd want reported on the news with a real patient. And that is normal. That is why you do drills. And you get better every time and then you KEEP drilling even after practice makes perfect until the threat level is zero again.

It is like taking two comparably skilled pianists: One, who has not touched a piano in 5 years and the other, who has been practicing the same piece for hours every day for a month. Who is likely to perform that same piece with fewer mistakes?

[anonymous]

Oct 15, 2014 14:57:47 GMT -5 @therealmc said:

Oct 15, 2014 14:53:46 GMT -5 ttt said:

I read elsewhere that the suits are all one size and this does not account for people who are much smaller (like the first nurse who appears to be pretty tiny from the pics) or much bigger.

Also not true. However, wearing the suit is not part of the CDC recommendation.

ETA: I think people should be wearing them. Just wanted to point out that the CDC doesn't discuss them in their guidelines.

are you talking specifically about the hazmat type suits not being part of the CDC recommendation?

[msmerymac]

Oct 15, 2014 15:06:53 GMT -5 KB said:

Oct 15, 2014 15:04:09 GMT -5 msmerymac said:

Yeah, I run hot. When I went to give blood today and they took my temp it was 99 even. They were like, "good to go!"

I doubt you would have gotten that answer if you had just taken care of an ebola patient and ran a temp of 99.5. 

It's my usual temp, though. Of course they have no way of knowing that, but if her usual temp was 98 and she had temped at 98 on the 13th, we wouldn't be freaking out. So without knowing her average base temperature, there's little need to flip out about the fact that she was on a plane at that exact moment (except for the fact that she... should not have been on a plane).

[Michelle]

Oct 15, 2014 15:14:00 GMT -5 pescalita said:

Oct 15, 2014 15:00:21 GMT -5 Michelle said:

You can buy ONE. Every time you leave a "contact isolation" patient's room you have to dispose of everything you are wearing as if it is radioactive waste.

Here is my doomsday survivalist tip for my CEP loves:

Research the MRSA infection rates at your area hospitals. If anyone is having trouble containing MRSA chances are they do not have strong enough protocols to contain Ebola. So you don't want to go there if Ebola is detected in your area.

How does one go about doing this?

You may have trouble getting MRSA specific infection rates for hospitals in your area, depending on state reporting laws. Some state health and human services departments list the rates publicly.

However, everyone should have data accessible through Hospital Compare.gov.

Here is what I did to look at hospital acquired infections rates for hospitals in the texas medical center.

Go to the Hospital Compare website. www.medicare.gov/hospitalcompare/search.html

Search for your zip code. I put in 77030 which is the zip code for the Texas Medical Center.

I picked the first 3 hospitals that came up and selected them to be compared.

Then I clicked the tab that reads, "Readmissions, Complications & Deaths."
Then I clicked on "Healthcare Associated Infections"

I got these results:
www.medicare.gov/hospitalcompare/compare.html#cmprTab=3&cmprID=450289%2C670008%2C450674&cmprDist=14.2%2C14.5%2C15.1&viewmap=1&loc=77584&lat=29.5321026&lng=-95.3207069

(I hope that link works).

It shows me that as compared to the national benchmark, the 3 hospitals I selected (Harris Health, Houston Physicians Hospital and The Women's Hospital of Texas), Harris Health and The Woman's Hospital infection rates for MRSA are no different from the national benchmark. It tells me that data wasn't available for Houston Physician's Hospital).

If you see a hospital that is performing lower than the national benchmark for MRSA or other HAI's, I'd steer clear if there is Ebola in your area. If you see a hospital that is performing above the national benchmark, they probably have learned some good lessons, have good infection control protocols and are a safe bet.



Unfortunately, Texas Health Presb. Hospital shows up as no different from the national benchmark for MRSA. They are "worse than" the national benchmark for catheter line infections, but then "better than" Central Line infections (which is all about hand-hygiene).

So poop on that confidence builder. Except you want to steer clear of those who fall below the national benchmark for sure!

[twotrue]

From the CDC update above "Oversight and monitoring The single most important aspect of safe care of Ebola is to have a site manager at all times who oversees the putting on and taking off of PPE and the care given in the isolation unit. A site manager is now in place and will be at the hospital 24/7 as long as Ebola patients are receiving care."


How the hell was a site manager not in place since the start of this?

[Michelle]

Oct 15, 2014 15:37:42 GMT -5 twotrue said:

From the CDC update above "Oversight and monitoring The single most important aspect of safe care of Ebola is to have a site manager at all times who oversees the putting on and taking off of PPE and the care given in the isolation unit. A site manager is now in place and will be at the hospital 24/7 as long as Ebola patients are receiving care."


How the hell was a site manager not in place since the start of this?

You don't want to know how different the quality of care in hospitals is at night vs. during the day.

That is not to disparage night nursing, but management presence in most hospitals is sparse on nights and weekends.

And most important is someone who specializes in infection control protocol to be on site 24/7 as the "site manager."

[ttt]

I'm just reminded how incredibly grateful I am to be living near Emory and the CDC. iammalcolmx I know you are with me. My daughter was born at the Ebola hospital and it's a terrific place, even before the Ebola thing happened.

[FloFTW]

Big fan of the title of this article:

www.clevescene.com/scene-and-heard/archives/2014/10/15/regarding-ebola-mayor-jackson-city-officials-implore-media-not-to-freak-the-fuck-out

[weardogbride]

So I am local and my son was delivered at presby. I was formerly a surgical rep and have done cases at this hospital. This is not a bad hospital. I firmly believe that this is a result of poor protocols from the CDC. No hospital in texas is equipped to my knowledge with the kind of isolation unit Emory has. A very close family friend is the COO of another hospital in N Texas. He said that the CDC protocols have literally changed every day leading him to believe that they do not fully understand the disease and makes being fully prepared nearly impossible.

[pescalita]

Oct 15, 2014 15:35:29 GMT -5 Michelle said:

Oct 15, 2014 15:14:00 GMT -5 pescalita said:

How does one go about doing this?

You may have trouble getting MRSA specific infection rates for hospitals in your area, depending on state reporting laws. Some state health and human services departments list the rates publicly.

However, everyone should have data accessible through Hospital Compare.gov.

Here is what I did to look at hospital acquired infections rates for hospitals in the texas medical center.

Go to the Hospital Compare website. www.medicare.gov/hospitalcompare/search.html

Search for your zip code. I put in 77030 which is the zip code for the Texas Medical Center.

I picked the first 3 hospitals that came up and selected them to be compared.

Then I clicked the tab that reads, "Readmissions, Complications & Deaths."
Then I clicked on "Healthcare Associated Infections"

I got these results:
www.medicare.gov/hospitalcompare/compare.html#cmprTab=3&cmprID=450289%2C670008%2C450674&cmprDist=14.2%2C14.5%2C15.1&viewmap=1&loc=77584&lat=29.5321026&lng=-95.3207069

(I hope that link works).

It shows me that as compared to the national benchmark, the 3 hospitals I selected (Harris Health, Houston Physicians Hospital and The Women's Hospital of Texas), Harris Health and The Woman's Hospital infection rates for MRSA are no different from the national benchmark. It tells me that data wasn't available for Houston Physician's Hospital).

If you see a hospital that is performing lower than the national benchmark for MRSA or other HAI's, I'd steer clear if there is Ebola in your area. If you see a hospital that is performing above the national benchmark, they probably have learned some good lessons, have good infection control protocols and are a safe bet.



Unfortunately, Texas Health Presb. Hospital shows up as no different from the national benchmark for MRSA. They are "worse than" the national benchmark for catheter line infections, but then "better than" Central Line infections (which is all about hand-hygiene).

So poop on that confidence builder. Except you want to steer clear of those who fall below the national benchmark for sure!

Thank you! This is great data.

[ttt]

Oct 15, 2014 15:55:51 GMT -5 weardogbride said:

So I am local and my son was delivered at presby. I was formerly a surgical rep and have done cases at this hospital. This is not a bad hospital. I firmly believe that this is a result of poor protocols from the CDC. No hospital in texas is equipped to my knowledge with the kind of isolation unit Emory has. A very close family friend is the COO of another hospital in N Texas. He said that the CDC protocols have literally changed every day leading him to believe that they do not fully understand the disease and makes being fully prepared nearly impossible.

Regardless, they shouldn't have sent a guy who just came from Liberia presenting with a 103 fever and abdominal pain home with a "see ya" and rx for antibiotics. If they had been able to diagnose him during his first visit, it's possible that none of this would have even happened on his second visit. 

[weardogbride]

Oct 15, 2014 15:59:53 GMT -5 ttt said:

Oct 15, 2014 15:55:51 GMT -5 weardogbride said:

So I am local and my son was delivered at presby. I was formerly a surgical rep and have done cases at this hospital. This is not a bad hospital. I firmly believe that this is a result of poor protocols from the CDC. No hospital in texas is equipped to my knowledge with the kind of isolation unit Emory has. A very close family friend is the COO of another hospital in N Texas. He said that the CDC protocols have literally changed every day leading him to believe that they do not fully understand the disease and makes being fully prepared nearly impossible.

Regardless, they shouldn't have sent a guy who just came from Liberia presenting with a 103 fever and abdominal pain home with a "see ya" and rx for antibiotics. If they had been able to diagnose him during his first visit, it's possible that none of this would have even happened on his second visit. 

Unfortunately, hindsight is 20/20. It's really easy to say that but I don't think anyone would have initially thought "OMG, EBOLA!!" We had never had a case diagnosed on American soil, so why should it have been at the forefront of the ER staff's mind?

[ttt]

Oct 15, 2014 16:03:28 GMT -5 weardogbride said:

Oct 15, 2014 15:59:53 GMT -5 ttt said:

Regardless, they shouldn't have sent a guy who just came from Liberia presenting with a 103 fever and abdominal pain home with a "see ya" and rx for antibiotics. If they had been able to diagnose him during his first visit, it's possible that none of this would have even happened on his second visit. 

Unfortunately, hindsight is 20/20. It's really easy to say that but I don't think anyone would have initially thought "OMG, EBOLA!!" We had never had a case diagnosed on American soil, so why should it have been at the forefront of the ER staff's mind?

Even if they thought it was just a random viral infection, they shouldn't have sent him home with antibiotics! 

Ebola has been all over the news for the past few months. This guy had just arrived from Liberia, which cannot be a super-common thing. The travel alone should have set off some red flags to at least look into him a little farther. I'm not saying it should have been the very first thing they thought of, but it should have been *one* of the things they thought of at some point. 

But of course, black guy, no insurance, who cares. 

[ttt]

Oct 15, 2014 15:35:29 GMT -5 Michelle said:

Oct 15, 2014 15:14:00 GMT -5 pescalita said:

How does one go about doing this?

You may have trouble getting MRSA specific infection rates for hospitals in your area, depending on state reporting laws. Some state health and human services departments list the rates publicly.

However, everyone should have data accessible through Hospital Compare.gov.

Here is what I did to look at hospital acquired infections rates for hospitals in the texas medical center.

Go to the Hospital Compare website. www.medicare.gov/hospitalcompare/search.html

Search for your zip code. I put in 77030 which is the zip code for the Texas Medical Center.

I picked the first 3 hospitals that came up and selected them to be compared.

Then I clicked the tab that reads, "Readmissions, Complications & Deaths."
Then I clicked on "Healthcare Associated Infections"

I got these results:
www.medicare.gov/hospitalcompare/compare.html#cmprTab=3&cmprID=450289%2C670008%2C450674&cmprDist=14.2%2C14.5%2C15.1&viewmap=1&loc=77584&lat=29.5321026&lng=-95.3207069

(I hope that link works).

It shows me that as compared to the national benchmark, the 3 hospitals I selected (Harris Health, Houston Physicians Hospital and The Women's Hospital of Texas), Harris Health and The Woman's Hospital infection rates for MRSA are no different from the national benchmark. It tells me that data wasn't available for Houston Physician's Hospital).

If you see a hospital that is performing lower than the national benchmark for MRSA or other HAI's, I'd steer clear if there is Ebola in your area. If you see a hospital that is performing above the national benchmark, they probably have learned some good lessons, have good infection control protocols and are a safe bet.



Unfortunately, Texas Health Presb. Hospital shows up as no different from the national benchmark for MRSA. They are "worse than" the national benchmark for catheter line infections, but then "better than" Central Line infections (which is all about hand-hygiene).

So poop on that confidence builder. Except you want to steer clear of those who fall below the national benchmark for sure!

This is great, thanks!

Atlanta peeps, did you see this?? 
GRADY MEMORIAL HOSPITAL

Average time patients spent in the emergency department, before they were admitted to the hospital as an inpatient:  511 Minutes

Average time patients spent in the emergency department before they were seen by a healthcare professional: 160 Minutes

:?

[weardogbride]

Oct 15, 2014 16:16:08 GMT -5 @therealmc said:

Oct 15, 2014 15:55:51 GMT -5 weardogbride said:

So I am local and my son was delivered at presby. I was formerly a surgical rep and have done cases at this hospital. This is not a bad hospital. I firmly believe that this is a result of poor protocols from the CDC. No hospital in texas is equipped to my knowledge with the kind of isolation unit Emory has. A very close family friend is the COO of another hospital in N Texas. He said that the CDC protocols have literally changed every day leading him to believe that they do not fully understand the disease and makes being fully prepared nearly impossible.

I am sure you feel the need to stick up for your previous employer and I get that. However, I work for a small town hospital and we have been having meetings and re-education for months. I hate to say if we can do it why can't you but I seriously just can't get behind blaming a complete lack of preparedness on the CDC. Your hospital has infection control and they should have known better.

I was never employed there. I was a rep so I've pretty much been in every hospital in the state. I'm just saying that I have first hand experience with this facility and it is not the hell hole that is being portrayed here and on the news. As soon as a patient was identified as having ebola, the CDC should have had a team in place to assist this facility. Comparing presby to Emory is not fair - two totally different types of facilities. I honestly do not know of any facility here that could handle the type of isolation required for one patient, much less multiple patients.

[ttt]

Oct 15, 2014 16:26:17 GMT -5 weardogbride said:

Oct 15, 2014 16:16:08 GMT -5 @therealmc said:

I am sure you feel the need to stick up for your previous employer and I get that. However, I work for a small town hospital and we have been having meetings and re-education for months. I hate to say if we can do it why can't you but I seriously just can't get behind blaming a complete lack of preparedness on the CDC. Your hospital has infection control and they should have known better.

I was never employed there. I was a rep so I've pretty much been in every hospital in the state. I'm just saying that I have first hand experience with this facility and it is not the hell hole that is being portrayed here and on the news. As soon as a patient was identified as having ebola, the CDC should have had a team in place to assist this facility. Comparing presby to Emory is not fair - two totally different types of facilities. I honestly do not know of any facility here that could handle the type of isolation required for one patient, much less multiple patients.

Nobody is saying they should have been able to handle the isolation. We are saying they shouldn't have dismissed this guy and sent him home without thinking more seriously about a diagnosis than "eh, probably a virus, here's some abx."