Archive for Public Health

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.