National Nurses Union/RoseAnn DeMoro on Ebola, new PPE and hospital preparedness

[Yo_Mama]

There's a news release from the union:
http://www.nationalnursesunited.org/press/entry/national-nurses-statement-on-new-cdc-ebola-guidelines/

With still significant questions regarding the most effective personal protective equipment, and the ongoing lack of any mandate on the hospitals to comply with the highest standards and protocols, “it is clear that nurses are going to have to continue to fight every step of the way to demand that every patient, every nurse, every frontline healthcare worker has the protection they need,” DeMoro said.

“The governing theme must be the precautionary principle, the highest safety standards in the face of this virulent disease, so that no nurses, other frontline health workers, or patients have to put their lives in jeopardy,” DeMoro said.

At the bottom of that release is a link to a petition:
http://www.nationalnursesunited.org/page/s/national-nurses-united-urges-you-to-take-action-now?utm_source=nnu&utm_medium=pr-cdc&utm_campaign=petition

Also they met with Jerry Brown in CA to discuss CA hospital preparedness:
http://www.sacbee.com/news/politics-government/capitol-alert/article3206175.html

“None of the hospitals in California are prepared,” DeMoro said after meeting with Brown. “We cannot name a hospital that we feel comfortable with, for patients in the state of California to attempt to have the appropriate response in an Ebola situation.”

Speaking at a news conference outside Brown’s offices at the Capitol, DeMoro said, “The deficiencies in the systems in California are outrageous.”

Read more here: http://www.sacbee.com/news/politics-government/capitol-alert/article3206175.html#storylink=cpy

I do not belong to this union nor am I a nurse, but I think they are doing good work and should be supported, and I think any of their claims should be taken very seriously. Also I would suspect that what is true in CA may be true in most states.

The new PPE guidelines are here, and one of the most important changes, aside from mandating much higher levels of protection, is that it mandates a separate "clean" area for donning and another area for doffing. This is SOOO important, but hospitals mostly will have to reconfigure space to get it done.
http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html

[gwheezie]

1. My hospital is not prepared

we cannot meet the new guidelines

[Yo_Mama]

2. I think that was expected - they are a huge step up.

Now that we've got them, the next step is implementation.

In practice, I think we'll have to select some hospitals in every area to prep to this standard, and transfer suspect patients to those hospitals.

There are very few hospitals in the US who are set up to do this. Getting this done isn't automatic, and those trying to move the ball along locally need to be supported.

[gwheezie]

3. We still can't meet the old guidelines

the attitude here is oh no one that sick would come here. I really enjoy the irony where I work.

[Yo_Mama]

6. Well, now that the CDC published the guidelines, it's time to take this up with mgmt

It seems to me that this comes down to the line staff - I don't think managers are going to automatically implement.

I suppose you could always anonymously tip the local public health department if you don't get a management response? That's why the CDC guidelines were so important in the first place.

In West Africa, Ebola has been spreading through the hospitals and clinics. It's critical that we don't let this happen in the US. It's entirely likely that if we don't take this seriously that a month or four months from now one undetected case turns into twenty. We're an incredibly mobile society, and twenty could turn into one hundred before we know it. The contact tracing/isolation thing works, but it only works for a limited number of cases.

It's a nightmare scenario that could really happen.

I think there is a good overall benefit, though. The examination and reworking this will force in infection control protocols and ER triage will probably save thousands of lives in the future, although those lives will be unreported. Not all hospitals do a good job of infection control. It's sad that the basics still aren't being done in many clinical settings.

[gwheezie]

8. We are becoming quite vocal

We're a very small community hospital but serve a poor population so we do have to throw a fit sometimes to get something done.

[bananas]

11. Are you getting any coverage on local news - tv or radio?

I'd think people would want to hear what their local nurses have to say,
have the local news stations been airing interviews with the local nurses?

[Downwinder]

4. How do accrediting groups like "The Joint Commission" (TJC)

fit into the picture?

[Yo_Mama]

5. Presumably they will have to respond

I am sure they will change their inspection standards to conform to the new CDC guidance.

They do link on their website:
http://www.jointcommission.org/topics/ebola_preparedness_resources.aspx

to this USA Today report:
http://www.usatoday.com/story/news/nation/2014/10/15/hospitals-infection-control-concerns/17317397/

• More than 250 hospitals surveyed by state and federal regulators from January 2011 through June 2014 were cited for deficiencies in infection control, according to data obtained from the U.S. Centers for Medicare and Medicaid Services. Those hospitals accounted for nearly 15% of 1,815 that were cited for any sort of violation. The facilities cited for infection control lapses were in 44 states, with the highest number in Texas (23), California (16) and Florida (16).

• In the first half of this year, infection control deficiencies were cited in about half of the hospital reviews conducted by the Joint Commission, which accredits more than 75% of the nation's hospitals. Those deficiencies, among the top five issues cited in the commission's reviews, related to hospitals' failure to adequately reduce infection risks linked to medical equipment, devices and supplies, such as sterilization of surgical instruments and proper disinfection of endoscopes.

One thing that struck me in the CDC new guidance was the requirement for a dedicated site monitor 24/7. There is no way that some smaller hospitals have the staff, or access to it.

So it will be interesting. I think if hospitals take this guidance seriously, it will force states to generate plans for focal hospitals that can do this. It's very unfortunate, but the Ebola epidemic in West Africa is intensifying. This is not going to magically go away and even quarantine proposals, if implemented, will fail sooner or later.

[Downwinder]

7. Are we even set up to control resistant TB and staph?

[Yo_Mama]

9. In a lot of hospitals, no

I think that having to prepare for this contingency could possibly have a good systemic effect on the US HC system.

[bananas]

10. "Briana will be remembered as the Karen Silkwood of our time"

Nuclear industry shills will go ballistic over this ...

Second, DeMoro called the guideline that any protective equipment leave ‘no skin exposed,’ a “direct testament to the courage of Briana Aguirre,” the Texas Presbyterian Hospital RN who “made the incredibly brave decision” to publicly disclose that the suits at her Dallas hospital left exposed the necks and other skin of nurses who cared for Ebola-infected patients.

“Briana will be remembered as the Karen Silkwood of our time,” DeMoro said. The gap in the suits was also revealed in a statement from Aguirre and other Dallas RNs released by NNU last week.