Presbyterian workers wore no protective gear for two days while treating Ebola patient

[cali]

Health care workers treating Thomas Eric Duncan in a hospital isolation unit didn’t wear protective hazardous-material suits for two days until tests confirmed the Liberian man had Ebola — a delay that potentially exposed perhaps dozens of hospital workers to the virus, according to medical records.

The 3-day window of Sept. 28-30 is now being targeted by investigators for the Centers for Disease Control and Prevention as the key time during which health care workers may have been exposed to the deadly virus by Duncan, who died Oct. 8 from the disease.

Duncan was suspected of having Ebola when he was admitted to a hospital isolation unit Sept. 28, and he developed projectile vomiting and explosive diarrhea later that day, according to medical records his family turned over to The Associated Press.

But workers at Texas Health Presbyterian Hospital Dallas did not abandon their gowns and scrubs for hazmat suits until tests came back positive for Ebola about 2 p.m. on Sept. 30, according to details of the records released by AP.

The misstep – one in a series of potentially deadly mishandling of Duncan — raises the likelihood that other health care workers could have been infected. More than 70 workers were exposed to him before he died, but hospital officials have not indicated how many treated him in the initial few days.

<snip>
http://thescoopblog.dallasnews.com/2014/10/presbyterian-workers-wore-no-protective-gear-for-two-days-while-treating-ebola-patient.html/

Unfuckingbelievable.

[In_The_Wind]

1. The news just keeps getting better.

Yes, it is unfuckingbelievable given the fact that Duncan had just arrived from an area known to have people dying from Ebola.

[jwirr]

44. Its as if the whole hospital lives in some desert island with no knowledge of what is happening in

the rest of the world. Most of us have known about Ebola since it started in Africa. I do not understand how they could not understand the danger. I do not believe that it is CDC that did not furnish the info. It looks more and more every day that they ignored advice.

[nc4bo]

2. dear god what the hell?!

And the words of the CDC keep screaming in my head........it's ok, no reason to panic, we have this under control, the hospitals are well prepared for this.........

disaster.

[HereSince1628]

5. really... some administrator doesn't get what I learned 43 years ago in NCO school...

1A) Your unit CANNOT complete its mission without its people, 1B) TAKE CARE OF YOUR PEOPLE!

2) When in a position of responsibility you -must- ACT RESPONSIBLY! Other people's lives can depend on you!

[KingCharlemagne]

70. Frieden reminds me of Paul Bremer or Michael Brown, too incompetent

to make it as an NCO or even a buck private.

[ChisolmTrailDem]

3. We've regressed into a fucking 2nd-world country. nt

[KamaAina]

43. We've always been a "2nd-world country".

Old World, New World, Third World.

[dixiegrrrrl]

46. 11 beds in the whole country for Ebola patients.

Of the thousands of hospitals in the United States, only four have biocontainment units and years of preparation in handling highly infectious disease like Ebola.

But between those four hospitals, there are only about 19 beds in the specialized areas: 10 at Nebraska Medical Center in Omaha; three at Emory University Hospital in Atlanta; three at Rocky Mountain Laboratories in Montana; and an estimated three at National Institutes of Health in Maryland.

Even the count of 19 beds may be deceiving, CNN's Drew Griffin said.

"The center director in Omaha says his staff could only realistically handle no more than two Ebola patients at a time," Griffin said. "That's because of the danger, the staffing and the waste removal necessary when you're treating any Ebola patient."

So that essentially means 11 beds for the entire country.

http://www.cnn.com/2014/10/15/health/ebola-fears/index.html

[TBF]

4. My daughter suggested they curtail

air travel out of those countries for a time. "Why are they letting planes in and out?" was her question when I was trying to explain the word "Ebola" that she has heard from friends. We do not watch much TV here so she has not seen news reports. We are in Texas, however, so I have no idea what her friends may be reporting to her and can only imagine.

I do wonder though if they could basically stop open travel for a month and just let military planes in/out with needed supplies etc. And I would ramp up those supplies - I'm not suggesting letting folks just die. I think we should be providing whatever we can to help.

[JDPriestly]

27. There should be a quarantine on those countries for all purposes except transporting medical

personnel and supplies. Sorry if that sounds horrible, but it looks like this disease is extremely contagious, extremely contagious. And it is not just a flu. We need to take the utmost precautions. Read about the plagues.

http://en.wikipedia.org/wiki/Bubonic_plague

Plague is associated with trade and travel. Looks like ebola may spread the same way. This could be devastating. It is a wake-up call to all of us.

[mainstreetonce]

30. Makes sense

I keep Harding on TV about why West Africa can't be isolated,but why can't we restrict all unnecessary travel?

[snagglepuss]

36. One expert said he would place a 21 day quarantine on people before they

leave those countries., that way important travel is not stopped while ensuring that no one infected is boarding a plane. I've only heard that one exert suggest this but to me its makes a lot of sense.

[jwirr]

45. A quarantine sound good but where would you keep the people who were quarntined? If they go

anywhere they will be re-exposed. So they would have to be kept at the airport for days. It is not as easy as that. I don't know what can be done but something needs to be done.

And what are we going to do now that it is here? This nurse traveled and exposed God only knows how many people. And she is doing it right here in the USA.

[snagglepuss]

47. Ebola is only contagious when symptoms are present. It appears she wasn't

symptomatin when she flew.

[Tweedy]

38. Never has worked

Last edited Sat Oct 18, 2014, 11:59 AM - Edit history (1)

When people are locked in, they find ways to get out. Then, things get worse.

[TBF]

55. Well, some find a way -

that's for sure. I'm not suggesting that they'd stop every single determined person, but you would slow things down for sure and that would buy CDC some time to get more stringent procedures in place, do some additional training, etc. Right now we're acting like this is similar to the common cold when it really is much more deadly.

[Tweedy]

58. Many find a way

My understanding is such mass lock downs result in mass exodus.

[TBF]

62. Well they are not going

to swim across the Pacific.

I'm mostly thinking about slowing things down so CDC can get it's act together. They haven't dealt with Ebola on this continent. And I do think we should be fully funding whatever they need (both for here and Africa).

[Tweedy]

67. True

Though this hospital's tragic screw up probably has plumbed up hospitals everywhere.

[Fumesucker]

69. This is *West* Africa...

It's the Atlantic they'll be swimming, it's much smaller.

[TBF]

72. lol -

you're correct of course.

[JDPriestly]

73. I was quarantined. It is not a matter of choice. A big sign is put on your house or the place

where you live stating that you are under quarantine. Quarantines help a great deal.

If they really seriously could use quarantines in the countries in East Africa, they would end ebola right there. The civic responsibility is not great enough. It may be too much to ask in those countries. Friend of mine's daughter-in-law is from a country in that area. She cannot read. She is illiterate. That makes a quarantine difficult.

And we spend so much money on war while people in Africa are illiterate and, therefore, that mch more vulnerable to disease. That makes me sad. What can I say? Where are our values?

[snagglepuss]

35. One man in Canada who was being watched for ebola is in the Canadian military, he was

in Liberia delivering supplies. What one expert said should be done is place a 21 day quarantine on people before they fly out from the affected areas.

[dixiegrrrrl]

49. What about airplanes IN the USA?

The 2nd nurse who treated Duncan and now has Ebola, was on voluntary isolation, not supposed to fly, she KNEW that,
and yet, hopped a plane to Ohio.
With a fever.

And now, Health Dept in Ohio and Frontier Airlines can't even agree on what day she flew, so they can screen the passengers.

The second Dallas health care worker who was found to have the Ebola virus should not have boarded a commercial jet Monday, health officials say.

Because she had helped care for Ebola patient Thomas Eric Duncan, and because another health worker who cared for Duncan had been diagnosed with Ebola, the worker was not allowed to travel on a commercial plane with other people, said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

The worker had a temperature of 99.5 Fahrenheit (37.5 Celsius) before she boarded her flight, he added.

Health care workers who had been exposed to Duncan were undergoing self-monitoring. They were allowed to travel but not on a commercial plane with other people, Frieden said.

http://www.cnn.com/2014/10/15/health/texas-ebola-outbreak/index.html?hpt=hp_t1

[TBF]

56. I hear you -

and it would certainly not stop everything but could slow things down to buy CDC some time. Stricter procedures, more training, maybe identify a few hospitals that could be centers to handle the cases.

I'm not suggesting we could wipe it out in a week, just slow things down and get organized. Does that make sense?

[dixiegrrrrl]

60. On site training and Quality assurance have always made sense to me.

I was always shocked at the number of professional peers who skipped training, or mocked it, or did not take it seriously.
Over the years there seemed to be more and more of them, and less and less training.

[ecstatic]

6. "Unfuckingbelievable" doesn't begin to describe this. nt

[deutsey]

7. Jesus, that's even worse than I had heard

I thought it was only a couple hours (which is bad enough).

This news combined with that nurse with Ebola having a low-grade fever when she flying to or from Ohio...I'm starting to feel some alarm beginning to set in.

[Dreamer Tatum]

8. Health care workers treating Thomas Eric Duncan IN A HOSPITAL ISOLATION UNIT

I have to call these workers idiots. Sorry. I know I'm programmed to blame fat cat CEOs,
but walking into an isolation unit unprotected is just asking for it.

[ecstatic]

24. Remember, "it's really hard to catch." Or so we've been told. I don't fault the nurses for believing

what they were told.

[AwakeAtLast]

26. I can.

They left themselves open to many, many other diseases - not just Ebola. What if he had HIV or TB instead? There are precautions that have to be taken with those diseases, too. Basic actions should have happened that didn't, which is what is causing people to worry.

[LisaL]

29. We've also been told that numerour health care professionals caught it and died.

[Tweedy]

39. if you are a health care worker dealing with bodily fluids it is infectious

This is especially true if the patient is in the end stages of the disease. Google it.

[procon]

9. That's criminal.

How could the hospital be so negligent regarding even basic safety precautions? Why, money, of course! Anyone can go to Amazon and buy a full body protection coverall to guard against bloodborne pathogens for the low price of $156.08, plus the additional costs for equipment for face, hands and feet protections. Hospital workers would need a new suit every time they entered an isolation unit, so the hospital would go through cases of these suits everyday. Instead the hospital management gambled with their employee's (and the public's) lives, betting that they could beat the odds and no one would get ebola by not initiating strong safety protocols from the start. Voila ~ the corporate bean counters saved thousands of dollars.

[Dreamer Tatum]

10. And you know this was the cause how?

Oh, that's right. You just do.

[riverwalker]

63. exactly

that is exactly why it happened, and is still happening.

[morningfog]

11. That sure sounds like a breach of protocol.

I would like to know the number of workers who treated him those first few days.

We know Pham treated him as early as his first day there.

What a major fuck up. It is reassuring in the since that it is consistent with just idiocy and poor oversight rather than "virus mutation" or hightened infectibilty.

[LisaL]

25. How does it sound like a breach of protocol?

CDC's protocol does not require a hazmat suit.
Gowns, gloves, face masks and goggles (or face shields) are perfectly appropriate wear, per CDC.

[Tweedy]

40. Breached protocol repeatedly

First, the hospital failed to ensure the doctor read the patient's admitting record. Then, the patient was sent home with a 103 degree fever. Then, cdc was not called until Ebola confirmed-- 2 days after second admission. Then, they had the nurses use medical tape to secure gowns. I still cannot determine if the original gowns were impermeable.

We need every hospital able to deal with infectious diseases. If we see an epidemic again, we will need every bed everywhere.

[undeterred]

12. Projectile Vomiting and Explosive Diarrhea

Means they have to clean every kind of surface and even then its hard to know if you've gotten it all.

The ebola virus certainly has a good strategy for finding new hosts.

[JPZenger]

13. The administrators of this hospital should be sent to Liberia

This hospital has repeatedly lied to the public. The hospital's story keep changing, as they look for scapegoats. They even provided the wrong date for the initial treatment of the man from Liberia, and they kept changing their story about how much the physician knew or should have known when he was first treated.

If they knew nothing about Ebola, it might have been excusable for the first couple hours until they learned more. However, they had just completed a training exercise on Ebola right before the man came into the hospital, and been certified by the feds as being ready.

[HereSince1628]

16. I suspect it isn't actually lies, from the hospital or the CDC, but carefully constructed speech

When we think of those nice people who save our lives, we just aren't prepared to parse everything they say to understand how it avoids casting light on things they want to remain in darkness.

[LisaL]

14. CDC does not require hazmat suits.

So the article is misleading.
If they were wearing gowns, gloves, goggles (or face shield) and face masks, then they were following cdc guidelines.

[ctaylors6]

15. That title is a little misleading

It sounds like they had on no gowns and gloves, etc. They did not have on hazmat suits for the 2 days until the test confirmed he had ebola. They had on protective gear.

I'm not saying they did everything correctly. But even people like Mark Rupp, chief doctor for the center's infectious-diseases division at Nebraska Medical Center, have said how difficult it is to take off all the protective gear properly even when you have on ALL of the most protective gear.

And frankly I blame the CDC for not being there - why are they just now saying they should have had a quality control person there overseeing each of these steps. Despite all the anti-Texas comments in threads here, this is not some terrible, backwards hospital. This was the first ebola case to walk into a regular hospital in this country. Saying the CDC is not responsible for a lot of this is like saying FEMA wasn't responsible for stuff during and after Katrina.

Sorry for the mini-rant. I live in Dallas, close to this hospital and the places these nurses live. I'm getting ebola news nonstop, and it's driving me crazy to read people far away talking about the stupid, untrained people in Texas and our bad hospitals. If the most experienced experts on this say how hard it is to protect the health care workers, why has the CDC continuously told everyone everything was perfectly under control and that any hospital could handle these steps to protect its workers.

[LisaL]

17. Is a lot misleading.

Since CDC doesn't require hazmat suits, if they were wearing gowns, masks, goggles and gloves, they were following guidelines.

[kestrel91316]

34. Hospitals MUST accept full responsibility for proper handling of whatever illness or injury comes

through their doors. If they are unwilling or unable to do so, they need to close their doors and retire to play golf.

This is basic professional responsibility we are talking about. No different than if it had been a MDR TB case. Or MRSA. Or measles.

I am expected to know how to handle a rabid cat, both the mechanics of it and the logistics of reporting and ensuring that PROTOCOLS are followed. If I need somebody else to tell me how to do MY JOB, I need to surrender my license.

This is inexcusable incompetence.

[Tweedy]

61. Hospital did not follow protocols

Maybe you are right and this would have caught any hospital off guard. Still, they failed to follow basic protocols. The cdc was there within hours of notification.

Incidentally, I like Dallas a lot and I agree it is not a backward city. It is a beautiful city. Yet, the hospital did not follow basic protocols.

[jonjensen]

18. tort reform prevents law suites against hospital unless gross negligence can be proved!

hospital can get away with negligence you have to prove gross negligence.

[uppityperson]

19. The hospital fucked up, but no need to exaggerate as reality is bad enough.

Wrong, they wore protective gear, just not the right kind or well fitting which is bad enough no need to exaggerate and say they wore "none".

[Baitball Blogger]

20. At what point did the CDC get involved?

They are going to get a hit for this, and it's deserved, but does anyone know if the two nurses had access to Duncan in that narrow window before they were called in?

[LisaL]

21. They send the team in before Mr. Duncan's results were announced.

[Rex]

22. Oh man.

Like I said, entropy.

[City Lights]

23. Wow.

I am speechless.

[valerief]

28. "Move along, folks. We got this." Like hell, they had this. nt

[Crunchy Frog]

31. Shit.

[Dreamer Tatum]

32. Evidently this report has been debunked.

http://thescoopblog.dallasnews.com/2014/10/presbyterian-workers-wore-no-protective-gear-for-two-days-while-treating-ebola-patient.html/?hootPostID=c7c473e639ad2859ea04ad2773012ff1

[Zorra]

57. I see nothing in the article at that link that debunks the report. nt

[kestrel91316]

33. This is all Obama's fault, and Frieden's fault, and CDC's fault according to several DUers.

[ecstatic]

41. I think President Obama is caught off guard by Frieden's incompetence,

and Frieden is caught off guard by THP's incompetence. It's now clear that the the response to this outbreak cannot be delegated out, it must be micromanaged even down to the minor details.

The second biggest obstacle is conflicting and/or misleading information: The CDC continuously touts outdated information that conflicts with recent, peer reviewed research. "Unlikely" does not mean never. "Don't know" does not translate to "impossible." You cannot make the right decisions if the information you're basing it on incorrectly describes a scenario as "impossible." The perfect example of this is the "you're not contagious if you don't have symptoms." Symptoms can include something as minor as a headache, or, as we just witnessed, a fever of less than 100! You can't screen for that.

[kestrel91316]

50. You got a link to a published peer-reviewed article that says Ebola is contagious before

symptoms occur???

Friedman practices EVIDENCE-BASED medicine. If there is no EVIDENCE, it didn't happen. And that evidence must stand up to scrutiny (peer review process) or it won't make it into publication.

We simple do not know with 100% certainty that no patient ever shed Ebola for perhaps 12 hours before symptoms. But the EPIDEMIOLOGIC EVIDENCE says that it either doesn't happen, or is so rare that it may as well not happen.

I know all this science-y stuff is hard, but you gotta get up to speed on the concepts and stop coming up with nonsensical speculation.

[ecstatic]

51. um, yes. go to PubMed and search

for asymptomatic ebola.

[kestrel91316]

53. I am well aware of that study that demonstrated, in a very few patients, evidence of asymptomatic,

transient Ebola infection. IIRC they made no determination whether those patients were at any time CONTAGIOUS, which is the entire point of this discussion.

Just between you and me, I'd put money on the asymptomatic cases being transient shedders, and asymptomatic dogs, too (both of which would be very bad). But if we are going to claim that, we have to have some hard evidence and not just speculation about hypotheticals.

I just checked and that article did not discuss virus shedding and made no attempt to determine if those patients at any point shed virus.

[ecstatic]

65. That's the point. It hasn't been ruled out.

It can't be, because new symptomatic cases can always be blamed on contact with another symptomatic person (while the asymptomatic person is never considered).

[kestrel91316]

66. True. But if you have that many people running around with Ebola I'm not sure it's a

distinction that makes a difference. A healthy transient shedder probably doesn't shed much virus because there is a known high correlation between how sick humans are and how much their viral load is.

The DOG thing, OTOH, could be very significant. The many outbreaks over the past 20 years, they really don't have a clear idea how they got started in people. They know about the bush meat issue and fruit bats specifically, but they don't have proof of an index patient with known Ebola reservoir contact at the right time. And the West Africa index case was a 2 yo boy, which is weird.

I think it might be possible for dogs to transiently shed ebola after eating infected wildlife and picking it up. And then hanging around humans in villages, pooping everywhere, and leaving virus everywhere, especially accessible to TODDLERS. This has unsettling implications for dogs AND people.

[ecstatic]

68. The study done in 2005 suggests it's very possible:

Thus, dogs appear to be the first animal species shown to be naturally and asymptomatically infected by Ebola virus. Asymptomatic Ebola infection in humans has also been observed during outbreaks (18) but is very rare. Although dogs can be asymptomatically infected, they may excrete infectious viral particles in urine, feces, and saliva for a short period before virus clearance, as observed experimentally in other animals. Given the frequency of contact between humans and domestic dogs, canine Ebola infection must be considered as a potential risk factor for human infection and virus spread. Human infection could occur through licking, biting, or grooming. Asymptomatically infected dogs could be a potential source of human Ebola outbreaks and of virus spread during human outbreaks, which could explain some epidemiologically unrelated human cases. Dogs might also be a source of human Ebola outbreaks, such as the 1976 Yambuku outbreaks in Democratic Republic of Congo (19), the 1995 Kikwit outbreak, some outbreaks that occurred in 1996 and 2004 in Gabon and Republic of Congo (5), and the 1976 (6), 1979 (20), and 2004 (21) outbreaks in Sudan, the sources of which are still unknown. Together, these findings strongly suggest that dogs should be taken into consideration during the management of human Ebola outbreaks. To confirm the potential human risk of Ebola virus–infected dogs, the mechanisms of viral excretion (i.e. body fluids and virus kinetics of excretion) should be investigated during experimental canine infection. This research would also offer insights into the natural resistance of dogs.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298261/

Of course, none of that will be taken in consideration because people would get mad.

[kestrel91316]

71. I've read that about 100 times in the past couple of weeks, lol.

It's the only study in existence that pertains to companion animals and Ebola. Pretty slim pickings for us veterinarians.

sigh

[TBF]

59. I don't think that's it at all -

in fact in more posts that not I've preferenced my own concerns with the comment that cuts to CDC are of major impact here. That's Congress - specifically the House - not Obama.

We also can't sweep an epidemic under the rug because a Democrat happens to be president as this is happening.

[Tweedy]

37. Important reminder about federalism

I didn't think it was necessary to point out the obvious; yet, much of the media appears clueless. State hospitals, like Texas Presbyterian, are under the jurisdiction of the state in which they are situated. They are not under the cdc.

Moreover, the cdc arrived within hours of being informed Texas Presbyterian had a patient suffering from Ebola. May the poor man rest in peace.

[KeepItReal]

42. Texas Health Presbyterian Hospital is a private, corporate-owned hospital

It is not a "State" hospital.

It is owned by Texas Health Resources, Inc. - a private "non-profit" corporation.

[KittyWampus]

52. But it must be inspected/authorized for business by the State. Not arguing with you...

just a part of the same picture.

[Tweedy]

54. Still regulated

The state of Texas still regulates it.

[procon]

64. But regulations are anathema in Texas

This is the state that brags about being the most "business friendly" with few restrictions from those pesky public health and safety regulations that might impede making money. Instead, they offered some sort of voluntary seminars and skipped the formal hands on training and regular drills necessary to keep staffing skills current

There's simply no excuse for the incompetence the hospital management has displayed throughout these events. They held themselves out to be the best of the best, but they utterly failed to provide even the minimum standards of basic isolation protocols that would be applicable to any of the other contagious disease vectors that can present at a large urban hospital.

[KatyaR]

48. Are you fucking kidding me?

Holy cripes, I worked as non-medical staff for doctors and hospitals for YEARS, and I would have known better...

Somebody needs to fire their nursing director and infection control staff NOW.