Tag Archive for Ebola

Latest Ebola Virus News: 46 U.S. Hospitals Named Treatment Centers

America is now better prepared for the possibility of additional cases of the Ebola virus, as 46 U.S. hospitals are now designated Ebola treatment centers. The U.S. Department of Health and Human Services has responded to new concerns about Ebola by designating the 46 hospitals as part of a nationwide health system to treat infected patients and stem potential spread of the illness. The Centers for Disease Control and Prevention (CDC) announced the designation of the first 35 facilities in early December 2014 , and promised that more would be assigned in the following weeks. “We continue our efforts to strengthen domestic preparedness and hospital readiness,” Health and Human Services Secretary Sylvia Burwell said in the CDC news release.

State health officials have chosen the Ebola virus treatment centers in collaboration with local health authorities and the administrators of each designated hospital. The designated control centers have specially trained staff, appropriate Ebola personal protective equipment (PPE), from Ebola suits to the proper disposable gloves, and ample resources available to provide the particular kinds of treatments necessary to care for Ebola patients.

The designation of the Ebola treatment centers follows in the wake of concerns over whether most hospitals were prepared to care for patients potentially carrying the highly infectious disease. Almost half of hospitals responding to a recent survey conducted by Environmental Health & Engineering, a prominent environmental and engineering consulting service, reported that finding time to train staff to properly treat Ebola patients was a top challenge. Nurses’ groups have also expressed dissatisfaction with the level of training they’ve received in such crucial areas as the proper use of PPE. Nationwide nurses strikes over Ebola occurred in November.  The CDC asserts that the staff at the 46 designated treatment centers is trained and the facilities are optimized to minimize the risk health care workers face of contracting the disease while treating infected patients.

Individuals who believe they may have contracted the Ebola virus are encouraged to go to go to one of the designated centers for treatment. The centers are strategically placed to help ensure that they are within reach of those individuals who are most likely to need the resources they provide. The CDC has indicated that more than 80 percent of travelers returning to the United States from West African countries affected by Ebola live within 200 miles of one of the designated centers. The designated control centers will play an important supplementary role to the nation’s three bio containment facilities at Emory University Hospital, Nebraska Medical Center and the National Institutes of Health, which are the main care centers for patients who are medically evacuated from overseas, among others.

Current Ebola treatment entails isolation of the potential carrier, combined with active monitoring throughout the virus’ 21- day incubation period. During that time, state and local health authorities remain vigilantly attentive to the situation, communicating every day with the potentially exposed individuals to check for fever or other symptoms of the virus.

Ebola is a highly contagious disease transmitted through exposure to the bodily fluids of infected individuals. In West Africa, where the epidemic is centered, Ebola has killed more than 6,000 people, according to the World Health Organization. There have been eight cases on U.S. soil thus far, two of which were nurses who contracted the virus while treating an Ebola patient, fueling concern over the danger faced by health care workers. The designated Ebola treatment centers are prepared to reduce the danger of such risks. The CDC has released guidance for hospitals and state health officials to refer to when selecting more hospitals to be designated as Ebola treatment centers in the future, potentially further reducing the risks faced by non-designated hospitals. However, all hospitals still need to be prepared for potential Ebola patients.

WHO Revises Ebola-Specific Standards for PPE

The World Health Organization (WHO) has released revised technical specifications for personal protective equipment (PPE) selection, in order to reflect the latest Ebola news updates. According to the International Safety Equipment Association (ISEA), the revisions are “a step in the right direction,” as they make an important addition by including performance standards in the PPE selection guidelines. The update, released October 31, encompasses information on effective test methodologies for ensuring that PPE can protect healthcare workers from transmitting Ebola.

Ebola is very much a global concern, with recent cases occurring in the United States and Europe, in addition to the outbreak in West Africa. The WHO’s new guidelines are meant to help establish standards to assist healthcare workers the world over in protecting themselves from Ebola transmission, in the hope of ultimately stymying the virus’ spread. An international panel developed the new guidelines after consulting with leading infection control experts as well as healthcare workers with field experience caring for Ebola patients. The panel’s findings emphasize the importance of thorough hazard analysis in selecting PPE. The panel’s specifications highlight that medical organizations must properly select and use protective clothing and equipment based on product safety standards to most effectively protect against biological hazards.

The panel’s findings reinforce the crucial role PPE plays in preventing Ebola transmission. Healthcare workers not only save lives, but they are our first and best defense against the virus’ spread. Those who treat Ebola patients directly are at the highest risk of contracting the disease, leading to some popular paranoia regarding healthcare professionals in the United States and abroad. In response to cases of Ebola transmission by healthcare workers in the United States, some nurses’ organizations have demanded better PPE, including hazmat coverall suits, as well as more thorough instruction in the proper methods of wearing and safely removing PPE. Some of these demands were met after a series of Ebola strikes were enacted across the country in mid-November.

The WHO’s guideline updates for Ebola PPE selection based on hazard analysis form an important addition to the WHO’s essential recommendations for the types of PPE that are essential for healthcare workers. The experts on the WHO panel agreed that it is most important to have gear that protects the mucosae — the mouth, nose, and eyes — from contaminated droplets and fluids. This would include fluid-resistant medical masks, paired with safety goggles. Proper hand hygiene and gloves are also essential. The WHO also recommends that healthcare workers wear a gown/coverall and protective footwear; the Center for Disease Control and Prevention (CDC) and other similar organizations provide guidelines concurrent with those of the WHO.

The ISEA believes that, by linking PPE selection guidelines with product performance standards, the WHO has taken important action to guide healthcare providers to choose the right safety products to best protect healthcare workers. The ISEA draws on its member companies’ deep knowledge of protective product performance standards, and has been working with the CDC to develop effective gear and methodologies to keep healthcare workers safe. They report that demand for PPE has acutely increased in response to Ebola, and that manufacturers are working hard to supply protective clothing and equipment.

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.

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.