Ebola: Is the 'Protocol' the Problem?
Here's the stark contrast, In Emory and Nebraska multiple Ebola patients have been cared for (and released) without a single known/public transmission to a healthcare worker. While two healthcare workers ,unfortunately, have contracted the virus at Texas Presbytyrian. What accounts for this difference? Many will point to the differences in the extent of Training and Facilities which is well taken, but unfortunately, these are things that are not available at many US hospitals(at least not yet and it would take time and money to implement). So the question becomes what can be done if a patient shows up at a community hospital ER(for the sake of argument) with these symptoms? What guidance is offered by the CDC, towards hospitalized patients with Ebola in general? Take a look at it's website:
[link:http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html|
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
"As information becomes available, these recommendations will be re-evaluated and updated as needed. These recommendations are based upon available information (as of July 30, 2014) and the following considerations:
High rate of morbidity and mortality among infected patients
Risk of human-to-human transmission
Lack of FDA-approved vaccine and therapeutics
For full details of standard, contact, and droplet precautions see 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Setting."
Now here is the link to the 2007 guidelines (keep in mind these are 2007 guidelines, and there is no updated guide shown here)
[link:http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html#e|
http://www.cdc.gov/hicpac/2007IP/2007ip_part2.html#e
Specifically go to the area with regards to PPE, and ask yourself the question, does this guide give any direct protection to the neck? What is an area of the skin that may have many micro-abrasions due to shaving etc.? The neck.
Take a look at these slides.
[link:http://www.cdc.gov/hai/pdfs/ppe/14_250672-D_PPE_508.pdf]
http://www.cdc.gov/hai/pdfs/ppe/14_250672-D_PPE_508.pdf
Even with the face-shield(and the illustrations say 'goggles or faceshield') the head can still be exposed. And regardless, if you compare this to the PPE that is used by MSF or at Emory when Kent Brantly was being transported, do we all notice the difference(even putting aside to what degree N95 should be used vs. PAPR)?
The investigation is still ongoing, and I cannot say for certain what has caused these infections(I also don't know what additional advise the CDC may have given to the hospital and to what extent it was followed) but the confusion about what 'uniform guidelines' there are and whether they are effective is troubling.
We need to be consulting not only the health care staff at Emory and Nebraska but also MSF whom have treated hundreds of Ebola patients and have their own systems in place in facilities much less capable than our own. I was shocked that, apparently MSF's buddy system wasn't used in Texas. Regardless of potential added cost, considering the limited number of patients in this case(initially one) and the high consequence for any mistakes(not blaming here) it should have been in place in my opinion. And now, from just the point of view of cost, there will be considerably more now.
The currency of Public Health is Public Trust. If it is eroded, it can be very difficult to regain, and the cooperation of the public is absolutely essential to effective public health in my opinion. Hopefully it can be turned around, and proper care can be administered to the nurses that were unfortunately affected(I think they should be transferred to one of the four specialized centers before the condition deteriorates further)
Edit: My apologies to the mods if I posted this in the wrong section.
Edit 2: I also apologize if my topic headline suggests that 'protocol' may be the "only" problem here as that was not my intent. There were many problems that I think exposure some key problems with our healthcare system and its interplay with the local, state, and federal level (which are not always in coordination)