That is very unfortunate and the reality is that "somebody" had to be first and act as the guinea pig of sorts. While they obviously dropped the ball on sending him home from the hospital initially I certainly don't think that blame necessarily lays on them for the nurse who was infected. Now the census will drop drastically, the staff will end up having their shifts canceled so they wont get paid. I feel sorry for their staff.
So there's this news story about people with flu like symptoms being detained at the airport and rushed to hospitals with full hazmat precautions, etc, to guard against Ebola. Turns out, they just had the flu or a cold or whatever and had been coming in from nowhere close to the affected African regions. I can't help but think that those kinds of precautions would actually make a lot more sense for the flu itself, an actual danger to us in America.
There is a Facebook page called I Am A Nurse, that I just recently discovered with much input from nurses regarding PPE protocols that were followed. If what they are saying is true, and it's not the only place I have heard this, it makes me worry just a little. Apparently instead of Hazmat suits, which is what I would have expected them to be using in Texas, they were using standard paper gowns, flimsy plastic face shields, and/or N-95 respirators. This is the kind of stuff you would expect to don for measles, TB, etc., not for something as infectious as ebola. I am in no way advocating that there is a need for panic, but you generally get better information from those with "boots on the ground" than from any other source. From what they are saying I would have hoped better protocols would be put in place, and I think I understand what Mya has been trying to get at. The following excerpt is in regard to the nurse who let Duncan go home with an antibiotic when he first showed up to the hospital: The next excerpt is regarding PPE. She does not say where she is from but I thought it telling that she mentions e-mails from their administrators: And as a nurse myself, I can attest to the flimsy nature of a lot of that stuff. I've donned it myself from time to time and the gloves especially can rip very easily if they are of the cheap variety that I have so often encountered.
I'd be very interested in seeing where he said that he's blamed nurses and healthcare workers, because I haven't seen it.
Even if he did blame nurses and others, its misguided. I've worked in some of the sickest wards in hospitals before and excellent precautions are taken to prevent spreading infectious diseases. The problem that I see, is that people who wear the protective gear don't remove it with a great deal of care. They just take it off and chuck it like its nothing more than a stained shirt. And that is when a lot of germs are spread. People just wear that stuff mostly to prevent nasty oozing burn victim juice from getting on their clothes.(Burn vics are the worst. So gross and smell awful) So they don't think about it too much.
Plus it is a complete change in why you typically are using the PPE. As I mentioned before, 99% of the time it isn't to protect YOU, it's to protect your other patients from germs that you may be tracking from Room A to Room B as you go about your shift. For example, you don't want your MRSA patient grabbing ahold of your scrubs and transmitting the bacteria to you and then have you moving on to help turn your cancer patient and brushing against him with your infected scrubs in the meantime. With my immune system, I was not a huge risk for contracting most of the diseases that I came in contact with. With ebola, you need to be donning all that shit to protect YOU. I don't blame these nurses for feeling like they are being tossed in to the lions den unprepared. In our local hospital, they mentioned the nurses who volunteered and received special training. That is how it needs to be handled.
He had to backpedal on it when he said that his "breach of protocol" wasn't meant to place blame. As somebody who has worked as a health care worker....the interpretation is that it was placing blame. After all, who was the one responsible for the "breach of protocol". I know this is from the Chicago Tribune so is mass media but I think the explanation is good and what I have been trying to explain (but apparently not doing an adequate job of it). Maybe it is something that is only truly understood by those who are more familiar with a hospital environment. http://www.chicagotribune.com/lifestyle ... story.html
Interesting read. It sounds like it's hospital administration that has to step up their game and deal with this. The CDC seems to have made the information available, but it's not making it to the front lines well enough. And as to his "breach of protocol" comment, I don't think he's wrong... he's just probably clinically detached and analyzing the situation, not placing blame. He didn't say that the nurse was wrong, he was saying that there was a breach of protocol and he was trying to figure that out. In other words, they have protocols in place to deal with it, and it's not like the disease has mutated to the point that the protocols are no longer effective, it's the fact that somehow that protocol wasn't properly adhered to. He's also said he's got his team working on a way of getting those protocols to be more easy to learn and follow. Seems to me that there's an extremely emotional side to this (the nurses) and an overly clinical side to this (the CDC), and that's where the appearance of problems are coming from.
If you don't believe the CDC can make mistakes and/or distort the truth, you might peruse Twenty-First Century Plague: The Story of SARS by Thomas Abraham. Of course, they can't compare to the Chinese health ministry in that debacle. Any bureaucracy's main goal is to protect itself and then to grow as big and as fast as it can. Accordingly, its stated mission tends to suffer.
I do understand and deeply sympathize with the nurses and hospital staff who are being asked to deal with a disease they are both ill-prepared and untrained to deal with. I work in the healthcare space and have spent a lot of time in hospitals and with nurses, so I'm very familiar with their challenges. But, uh, I don't know that white washing something is helpful. If a breach in protocol caused the infection, calling it what it is does not mean that there weren't multiple failures in the system that led to it. At the end of the day, it's important to know what happened. The nursing community absolutely should be up in arms, but not over what the head of the CDC said. They should be up in arms because they're being asked to deal with a disease they clearly have neither the resources nor the training to deal with. I'm not sure what attacking one guy over his choice of words is going to do.
Its going to do what "outrage" always sets out to do- create a fake problem to divert from the real one because the real one is difficult. It sucks that the nurses got sick, but theres a certain degree of assumable risk that goes into any job. Unfortunately healthcare runs the risk of contact with a super infectious disease. Maybe they could have taken the proper precautions (isnt PPE training like the first day of nursing school?), or maybe they did and it was just happenstance, but it will be interesting to see how these blood transfusions work from that guy that was cured.
[quote The nursing community absolutely should be up in arms, but not over what the head of the CDC said. They should be up in arms because they're being asked to deal with a disease they clearly have neither the resources nor the training to deal with. I'm not sure what attacking one guy over his choice of words is going to do.[/quote] I think their point is that they feel like it was the CDC's responsibility to ensure that these providers were equipped with the proper resources and training, and the head honcho insinuating that the nurse made a breach in protocol felt like adding insult to injury. I think what people are forgetting is that this isn't something providers are in the habit of treating, and there are conflicting reports of what the nurses' training actually entailed. The PPE required isn't the same as it is for MRSA or Cdiff. This entails 2 sets of gloves, dipping your gloves in a bleach solution, etc, etc. Not at all similar to donning mask, gloves and gown.
Sure. I guess my point was really that I understand what the complaint is but it's undermining and distracting from the real issue that's actually putting the nursing staff at risk. The real issue is lack of training and availability of proper gear, and it's really important that be the focus because it's putting caretakers in danger. Distracting from that because of hurt feelings due to a lousy choice in wording isn't useful. Frankly, I don't know where the hospital administrators are in all of this. If a deadly disease like this shows up, the very first thing they should be doing is to sequester a few nurses, provide them with the best training they can, and allow that staff to cover until the rest of the staff can get up on it. That's the way emergency events are handled in most industries including outbreak response: lock down a first response team, inform them, and use them as your buffer while you train the rest of the team. It's insane that they're reporting this nurse might not have had any training. The CDC needs to shoulder some responsibility but if they've fallen down on the job, the hospital leadership can't just shrug and say they didn't know.
The nursing community is up in arms because they are on the front lines of a disease that they aren't trained to properly care for with ineffective PPE, not about the "terminology", although that point came up. That is what net pointed that the CDC stated was the obvious explanation. If you brush it off a "breach" then you are ignoring the bigger picture. Now a second of the health care workers has tested positive. I obviously cant speak for the entire nursing community but I wouldn't be surprised if this was the intention behind the criticisms. Again, it sounds as if the CDC has stepped up at this point but it is a shame that it had to come to this. Hospital administration should be more proactive. The CDC should be more proactive. They haven't been. The people placed at risk due to this are the workers. I think (hope) that things will change now. Read the claims by National Nurses United based on information from the people who were actually there (instead of you or I who are getting the information behind a computer or TV screen) regarding how well prepared the hospital was if you have any doubts. Having worked at a hospital I have no problem believing this information. "National Nurses United, the largest union of registered nurses in the country, said that more than 80 percent of nurses the union surveyed report they have not been given adequate training on Ebola. Thirty-six percent say their hospitals do not have sufficient supplies — including face shields and fluid-resistant gowns — to care for an Ebola patient, according the report by National Nurses United, which surveyed more than 1,900 nurses in more than 750 facilities in 46 states. Seventy-six percent of nurses surveyed report their hospitals have not issued adequate policies on how to deal with patients who might be infected with Ebola. “We are seeing that hospitals are not prepared,” said Bonnie Castillo, director of Registered Nurse Response Network, which is part of National Nurses United. “They are not doing active drilling and education they need to be doing.” Castillo said most of the nurses surveyed reported they have received only single pages of information about Ebola that refers them to a Web site. “That is woefully insufficient,” Castillo said. “We have to continue to sound the alarm. There is the potential for many more Dallases if hospitals are not mandated and do not commit to more vigorous standards. We see potential gaping holes for this to spread.” Castillo said the union has been trying to contact nurses at Texas Health Presbyterian Hospital, where Thomas Eric Duncan, the Liberian man diagnosed with Ebola, died Wednesday. “That hospital has issued a directive to all hospital staff not to speak to press,” Castillo said. “That is a grave concern because we need to hear from those front-line workers. We need to hear what happened there. … They have them on real lockdown. There is great fear. This hospital is not represented by a union. Our sense is they are afraid to speak out.” Castillo said when she heard the news Sunday morning that a nurse at Texas Health Presbyterian had been diagnosed with Ebola, she reacted with anger. “I am angry because it was preventable in this country,” Castillo said. “We should be able to contain and eradicate it, but hospitals are not providing adequate training. Castillo said she is concerned about other nurses working on the front lines. “I’m fearful for my nurse colleagues who are putting it on the line when they walk through hospital doors,” Castillo said. “They walk through those doors every day and they know they could be exposed to infectious disease. The hospitals are not providing them with measures they need — the equipment, education and training, and without that, we know they are at great risk.” http://www.nationalnursesunited.org/new ... for-ebola/
Isn't the US sending some troops to Liberia soon to help out with the crisis? I hope they get the +1000 soldiers trained properly if there's a) that much unknown about protocol for PPE b) that much room for human error. What's really important, though, is how this will impact the number of ladies who dress up as sexy nurses for Halloween.
I am still wondering how in the hell the people who he was living in the apartment with who were taking care of him until he went to the hospital a second time are all fine when two people who cared for him who were wearing "appropriate" PPE but possibly didn't dispose of it properly have contracted it. This is no attempt to stir up controversy, just a clincal how da fuck is that possible?
If I was going to speculate, and I am, I would say that we are forgetting that it actually is pretty difficult to contract and requires direct contact with specific bodily fluids. It would seem to me that someone is more likely to be infected once the disease reaches "end stage" when it is causing the body to "ooze fluids" a lot more including blood and feces that has a much more highly concentrated amount of virus. The people caring for him at home where present at an early stage and the nurses were caring for him at that later stage. Just a guess, but probably pretty close to the truth. This would explain why so many healthcare workers, or people directly caring for the dying end stage patient wind up contracting the disease, rather than just by casual contact. And why it is SO preventable here with the proper equipment and training.
What I found interesting is that a fair number of people seem to be angry at the CDC for their role (or lack of) in all of this, and yet if you go take a look at what their mandate and legal authorities are, they've done exactly what they were supposed to and authorized to do. http://www.cdc.gov/quarantine/specificl ... tions.html More and more I'm getting the impression that it's hospital administrations that are fucking up by cutting corners and reducing costs, by not stocking correct equipment, discounting the possibility of various scenarios, reduced training, etc, and yet I don't see them being lambasted anywhere. And yes, the people that are paying for it are the people on the front lines... The conspiracy nut in me is betting that those hospital administrators are in full-on cover-your-ass mode and throwing suspicion and blame anywhere but at themselves, and the CDC is a convenient target, especially when a few simple words can be emotionally redirected at them. I was talking to a cousin of mine last night who is a nurse in Ontario (University Hospital in London), and she was saying that at least her administration has started on full preparatory procedures (training, equipment, etc) as a precautionary measure. Her impression is that all required information, policies, and process have been provided to that administration by the Canadian Public Health Agency (working with the CDC), and they are now implementing them.
And get in between warlords that are still feuding 20 years after their civil war? No thanks. Liberia is a cesspool. Granted it's a monster the US created after we sent all the freed slaves there, who turned around and enslaved the native Liberians. If anyone wants to know what a horrible place it is, go watch Vice Guide to Travel: Liberia. I give the humanitarians credit for trying to help out over there though. It's a nightmare.
Just to lighten the mood, this is made me chuckle. http://thehappyhospitalist.blogspot.com ... urses.html