Archive for November 25, 2014

Update on Ebola Virus Precautions: Training Hospitals’ Top Concern

The latest news on hospitals Ebola virus preparedness shows that they are most concerned about issues surrounding the proper training of staff and Hazmat shipment, according to a recent study by Environmental Health & Engineering (EH&E).

In late October 2014, EH&E, a prominent environmental and engineering consulting service, surveyed hospital environmental health and safety managers (EHS), risk managers and facilities managers in U.S. hospitals to gain an update on Ebola virus precautions and procedures. The results reveal how hospitals have responded to the threat of Ebola and areas of particular concern to those professionals responsible for ensuring hospital safety. Potential vulnerabilities in hospital preparedness may lie in the lack of available time patient care staff members have to participate in training, and uncertainties about the proper certification of staff to ship infectious substances.

Almost half (48 percent) of hospitals participating in the survey identified ‘available time for patient care staff’ to participate in training as their top challenge to hospital safety. Another 20 percent indicated money or a lack of qualified staff and internal resources to support training as their main limitation. Such limitations prompted widespread strikes amongst nurses across the nation this month. Hospitals believe it is essential to provide direct, hands-on, Ebola-specific training to clinical staff, particularly to those who may treat such patients directly. EH&E indicates that it is particularly important for hospitals to train staff in the correct way to put on and remove Ebola personal protective equipment (PPE). While it may not seem significant to the lay observer, it is crucial for staff to don and doff protective equipment, such as Ebola suits, boots and double sets of disposable nitrile gloves, in the correct order, and to follow proper safety procedure. Experts have identified failure to follow PPE removal protocol as a potential source of Ebola infection among medical staff.

In response to hospitals’ concerns, EH&E recommends that a select number of staff, ranging from physicians and nurses to respiratory therapists and environmental safety staff, receive a high level of Ebola virus training. Since there may not be time to train all staff in effective precautions, members of the select Ebola-trained staff will be available to be called upon to deal with any such patients who may arrive. Bryan Connors, MS, CIH, Senior Scientist and Healthcare Division Practice Leader with EH&E, has added that it is also critical that hospitals train staff to play the role of safety monitor. The safety monitor will observe other staff to ensure that they follow proper Ebola protocol when treating patients at close range. “It works like a buddy system, assuring front line critical staff don and doff PPE appropriately and any safety issues are addressed in real time,” Connors said.

Hospitals are also concerned about providing adequate Hazmat shipment training. More than half (55 percent) of hospitals indicated that they do not have or do not know whether they have staff trained to ship Category A infectious substances. Specimens from patients who have or may have Ebola are considered Category A infectious substances, and so must be shipped in accordance with a rigorous safety protocol to prevent any potential infection. Such training can take upwards of eight hours to complete and requires attendant documentation. Hospitals simply cannot rely on ad hoc training.

On the plus side, a majority (64 percent) of hospitals indicate that they have been actively conducting Ebola training, including courses specifically on the proper use of PPE. Only 5 percent reported having conducted no Ebola training to date. Meanwhile, 21 percent reported having some preparedness, either through training for other infectious diseases, or on Ebola specifically, but without PPE training. Awareness of safety precautions has likely increased across all categories since the survey was taken, but adequate staff training, Hazmat shipment, and PPE preparedness remain areas of concern at hospitals nationwide.

Nurses’ Dissatisfaction with Ebola Safety Standards Heightens; Strikes Enacted

Nurses are making their dissatisfaction with hospitals’ Ebola safety measures heard. On November 11, approximately 18,000 nurses employed by Kaiser Permanente-owned hospitals and clinics in Northern California went on strike. Another 800 nurses employed by other Northern California hospitals also went on strike, and 400 nurses at a Washington, D.C. hospital will also went on strike on November 12, Global Ebola Awareness Day. Efforts were successful for California nurses, who have since won the enactment of regulations requiring hospitals within the state to provide better Ebola safety training and gear for workers. The striking nurses are members of National Nurses United (NNU), a 190,000-strong labor union that has been outspoken about their desire for better safety equipment and training for nurses in preparation for dealing with the virus.

Concern for nurses’ safety increased last month when news broke that two Dallas nurses, Nina Pham and Amber Vinson, contracted the virus after treating Thomas Eric Duncan, the first person to die from Ebola in the United States. After treatment, both nurses are now Ebola-free. The spread of the infectious disease to the nurses highlighted the importance of proper medical safety gear and safety procedures. An official with direct knowledge of the case stated that there were “inconsistencies” in the type of personal protective gear Nurse Pham wore and with the procedure she followed when putting on and removing the gear. However, NNU President Deborah Unger has identified the Dallas hospital’s failure to establish a set of safety rules and standard procedures for dealing with Duncan as a potential cause of the infections.

Members of the NNU have criticized what they see as efforts to blame nurses for such instances of the virus’ spread. They hold hospitals accountable for failing to provide nurses with appropriate gear and adequate training on how to use it. Those staging the strike are calling for powered air-filtration masks and full-body hazmat suits to be available at all of the nation’s hospitals and at the ready to be put to use should an Ebola patient arrive to seek treatment. Putting on and removing medical gear must be performed in a particular order to minimize the risk of infection, with, for example, pant legs needing to be tucked into boots. Full-body suits would potentially minimize the number of steps nurses would be required to follow, thus minimizing the opportunities for risk-causing errors. Nurses are also upset about the lack of preparation they have been provided with. The striking NNU nurses have stated that the Kaiser-Permanente hospitals have failed to address these and other related concerns they have raised.

Since the first cases of Ebola were reported in the United States, much fear and paranoia has surrounded nurses and other medical professionals who work directly with infected patients. For instance, Doctors Without Borders nurse Kaci Hickox has created controversy by riding her bike outside in defiance of New Jersey’s mandatory 21-day quarantine order, despite the fact that she has tested negative for Ebola and is no threat to others. Given the climate of fear, nurses want to ensure not only that they are safe, but also that they are not stigmatized. As Ebola can only be transmitted through the blood and bodily fluids of those who carry it, medical professionals who directly care for such patients are at the highest risk of contracting the virus. The nurses’ strikes join an expanding group of voices calling for the government to lay out federal standards for hospitals to follow in response to Ebola. The NNU argues that such standards should entail better training and Ebola safety products for nurses to minimize the risk they face.

Latex & Non-Latex Glove Allergies: Symptoms & Relief

Latex and non-latex disposable gloves are indispensable safety tools for a variety of worksites. However, this variety of work gloves can also present problems when individuals who use them experience the uncomfortable symptoms of allergies. Those experiencing such reactions should first receive a proper diagnosis to correctly identify whether the symptoms are indeed an allergy, as well as the likely source of the physical response. When the cause of the reaction has been identified, avoidance of the material and substitution with an alternative should solve the problem and bring soothing relief.

Glove Allergy Symptoms: Latex & Non-Latex

So, how do you know if you’re allergic to latex, one of the most common glove manufacturing materials? Some workers who experience a reaction to this particular textile may have a Type I latex allergy: hypersensitivity to latex proteins. This kind of allergy usually begins within minutes of exposure, but sometimes occurs hours later. It is a systemic allergic reaction, and symptoms commonly include sneezing, runny nose, coughing, scratchy throat, itchy eyes, hives, rashes on the face, swelling and itching of the skin, particularly on the hands. In some cases, the reaction to the latex gloves may also involve more severe reactions, including nausea, abdominal cramps, low blood pressure, dizziness, asthma marked by difficult breathing and, in rare cases, anaphylaxis (shock) and death.

Another glove-related allergy is the Type IV response, or Type IV allergic contact dermatitis. This particular sensitivity manifests itself as itchy, red, small blisters, and, in chronic cases, as dry, thickened skin, crusting and scabbing sores. Luckily, is usually restricted to the areas of contact. Type IV symptoms occur in response to residues from chemical accelerators used in manufacturing both latex and non-latex hand protection, such as neoprene and nitrile gloves.

Some patients present symptoms of both Type I and Type IV reactions, so it is essential to have an accurate diagnosis from a qualified medical professional, such as an allergist or dermatologist, in order to determine the cause of the allergic reaction. Sometimes, the problem is not in fact an allergic reaction at all. For instance, reactions to vinyl gloves are almost never allergic reactions but may be contact urticaria, a simple skin irritation caused by perspiration and lack of ventilation inside the glove. Type I latex allergy and Type IV allergies are diagnosed by symptoms as well as medical history. Additionally, a skin-prick or blood test can determine Type I, and a patch test can determine Type IV.

Latex & Non-Latex Glove Allergy Relief

Successful latex allergy treatment is all about avoidance. Those who have developed this reaction should, as far as possible, prevent all subsequent exposure to the protein. They should wear only non-latex gloves, such as nitrile or vinyl. To better decrease the risk of further reaction, other workers around the allergic individual should also wear non-latex or reduced-protein, powder-free latex gloves. When powdered hand protection is put on or taken off, particles of allergen-laden latex protein powder are released into the air and may be inhaled by those who are allergic, contacting mucous membranes and potentially causing respiratory symptoms. As a general precaution, it is a good idea to avoid using such products altogether. Sensitivity to latex proteins can develop after repeated exposure, and individuals who wear powdered gloves increase their skin’s exposure to those proteins and their potential for experiencing allergic reactions.

In response to concern over Type IV allergic reactions, many manufacturers have introduced accelerator-free products. Some glove brands advertise “Low Dermatitis Potential,” which is regulated for accuracy by the Food and Drug Administration. Those concerned about Type IV allergic reactions may want to seek out such alternatives.

Employers can help prepare for latex and non-latex glove allergies by educating staff about the accompanying signs and symptoms. In the vast majority of cases, allergies to glove material can be easily controlled once the offending allergen or irritant is identified and eliminated. The use of alternative products presents a simple solution to an otherwise troublesome situation.

Protecting Medical Professionals from Ebola: What’s the Appropriate Protocol?

As hospitals across America prepare for the potential of handling Ebola cases, concerns are increasing regarding determining a uniform protocol for treating patients while securing the safety of medical staff. Given that two Dallas nurses, Nina Pham and Amber Vinson, contracted the virus in the course of their work, the Centers for Disease Control and Prevention (CDC) and the nation’s medical experts are anxious that hospitals establish guidelines for treating Ebola patients and effectively protecting doctors and nurses. This need has created certain controversies. For instance, medical facilities now face the dilemma of whether or not to forgo certain aggressive treatments for Ebola patients as a safeguard against exposing medical professionals to the virus.

Currently, there are no national guidelines for what procedures to use or to forgo in treating Ebola patients. There are conflicting practices at medical facilities nationwide, giving rise to ethical debates. Some facilities have opted to forgo cardiopulmonary resuscitation, which requires mouth-to-mouth contact with patients, and invasive surgical procedures, which put the several medical professionals necessarily involved in such a procedure at increased risk of contracting the virus. Proponents of this approach argue that such aggressive treatment would only be called for in patients for whom there is little chance of saving, and so pursuing such treatment is not worth the increased risk of spreading the virus. However, it is contrary to the instincts of most doctors to decline to do everything possible to intervene, and some argue that it is not certain what constitutes futile care. The CDC calls for keeping lab testing and medical procedures to a minimum, but states that decisions should be made by attending physicians in each particular case.

There is also some debate over whether just any hospital is prepared to carry out the necessary protocol. Ebola cases present particular challenges. For instance, there is the question of how to properly handle infectious waste, such as garments soiled with bodily fluids, from Ebola patients. Some hospitals have more experience dealing with infectious diseases and perform regular drills in how to handle biohazards. Tom Skinner, a spokesman for the CDC, has been quoted as saying the agency is “exploring further” the idea of making particular hospitals designated Ebola treatment units. Restricting Ebola treatment to the most prepared and well-trained facilities may help prevent the virus’ spread to medical professionals.

Proper training of nurses and medical staff, particularly with regard to the Ebola PPE (personal protective equipment) they wear when treating patients, is essential to ensuring the safety of those professionals and that all vital protocol is performed. It is necessary to have the right gear, from Ebola suits to protective hoods, to put such gear on in the right order, and to remove it properly. CDC Director Tom Frieden identified gear removal as a “major potential area for risk.” Extreme care must be taken to avoid contaminating regular clothing, eyes or mucous membranes. An official with direct knowledge of Nurse Pham’s case reported that there were “inconsistencies” in the type of personal protective gear Pham wore and with the process she used to put the gear on and remove it. Teresa Romero, a nurse’s aide who contracted Ebola while treating a patient in Spain, has said she received only 30 minutes of training in putting on protective gear, prompting her husband to publish a scathing letter and to call for the resignation of Madrid’s regional health minister. The World Health Organization advises that the dressing and undressing of protective wear should be supervised by another trained member of the medical team. A “buddy system,” in which a safety supervisor consistently monitors the worker from the time he or she puts the gear on until the time it is taken it off, has been effective in stopping other kinds of infection in hospitals.

Healthcare workers are the nation’s best defense in preventing the further spread of Ebola. Ensuring their safety from infection as they treat Ebola patients is paramount. For more information on the CDC’s current recommended Ebola protocol, visit their website.

How New York is Protecting Against the Latest Ebola Outbreak

On October 23rd, the Ebola virus made its latest appearance in outbreak news in New York City, when Dr. Craig Spencer, a resident of Harlem, had returned on the 17th from treating infected patients in Guinea. He had taken the appropriate actions to keep himself and others safe by regulating his body temperature twice a day and, when he felt sluggish and developed a 100.3 fever, he swiftly sought medical attention and was isolated.

While the Doctors Without Borders participant was asymptomatic for the majority of his time in the Big Apple (and was most likely not contagious), Sal Pain, Chief Safety Officer for Bio-Recover Operation, and his crew have been working diligently to prohibit any spreading of the virus and qualm public fears. Dr. Spencer continues to be the only confirmed Ebola case in New York City and has undergone antiviral and blood-plasma therapies since his hospitalization. On November 3, the doctor’s condition was changed from “serious but stable” to “stable,” according to New York’s Health and Hospitals Corporation. As Ebola becomes an increasing reality for workers in numerous related fields, we take note of what the rest of the world can learn from these New York-based professionals.

What Actions Were Taken to Sterilize Environments

Pain and his crew have handled intense biological incidents similar to an Ebola outbreak, including the New York anthrax scare in 2001, and are well-trained and well-equipped. Given the nature of Dr. Spencer’s fifth-floor apartment and four-feet-wide hallways, the team forwent a typical Ebola decontamination station in favor of a more compact design using 6 millimeters of plastic and a PVC frame. High contact items such as bedding and personal hygiene products were removed from the apartment. The Ebola virus has a tendency to live longer in colder environments, so food was disposed of as well. The process took 12 hours and ended with chemical and water showers for all those involved before they headed back out into the city.

Although the doctor was said not to have a contagious stage of the disease while visiting The Gutter in Williamsburg, the bowling alley opted to close and undergo sterilization for the sake of safety. Outfitted in $1,500 protective suits, Pain’s employees put in seven straight hours of work overnight from October 25 to October 26 to painstakingly sterilize every object – from the interiors of bowling balls to the buttons of arcade games – within the venue. Various methods and tools were used in the decontamination process, including a thorough scrub-down of all surfaces and objects with rags and wire brushes doused in sanitizing products and chemical cleaners developed by the federal government for such disease control scenarios. The floors were cleaned with a solution containing 10 percent bleach, as recommended by the federal Centers for Disease Control and Prevention (CDC).

How Ebola Spreads

Although it is not clear as to how this virus originated, scientists believe that the first patient becomes infected through an animal such as a fruit bat or primate, which is referred to as a spillover event. When an infection is found in humans, the virus can spread through direct contact through bodily fluids (such as urine, saliva, vomit, semen, breast milk, sweat, etc.), needles and syringes, or infected fruit bats or primates. Although a patient who recovers from Ebola can no longer spread the virus, it has been shown to be found in semen for up to three months.

Ebola is not spread through water, air or legally purchased food. According to the CDC, there is no evidence that this decease can be spread through any other animals. For these reasons, healthcare providers are most susceptible to Ebola outbreaks. Wearing the appropriate Ebola protection equipment such as gloves, masks, safety suits and protection goggles is recommended when in an area where exposure to Ebola can occur.

Dedicated and disposable medical equipment should be used by healthcare providers. If instruments used are not able to be disposed, they should be thoroughly sterilized before being used again. Without these precautions and procedures in mind, the virus can continue to be transmitted.

Most of Dr. Spencer’s possessions remain intact, but the apartment will be sterilized and livable when the doctor and his fiancée return. Keeping Ebola under control in New York is the number one priority at the moment, and having a trustworthy and cautious crew like Pain’s is in order for every delicate situation.