Ebola and its Lessons

general
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Ok, at first when I heard about the nurses in Dallas getting sick I was angry at them. Then as information is coming out today I hear they are nurses assistants… and there has been lots of talk of not having suits that fit right, or proper equipment and everything else.

Ebola is not a unique disease in the way it spreads. The fact that a hospital appears to be the only place outside of Africa to catch it is damning. How many flue epidemics start in hospitals, where does MERSA come from?

If nothing else maybe we’ll get two things out of this. People taking protocol at hospitals a bit more seriously for a bit, along with more accountability for hospital borne diseases. And maybe people will start paying more attention to their own hygiene.

I’m not a fan of the feds stepping in and producing SWAT teams to combat Ebola. From the news I’m reading the precautions they took with the gentleman in Dallas wouldn’t have stopped any disease. It’s not that this is that easy to catch, it’s that hospitals are so bad at preventing the spread of disease.

Gloves, alcohol, masks. Pay janitors enough to clean stuff instead of wiping it with a dirty rag, train and test your staff, don’t use a CNA for something an RN needs to do. You had one job… At least treat it like you would a patient with a normal flu.

2

We thought that about HIV, too.

There will always be people who skip protocols because they’re in a hurry or some other lame excuse. There will always be people who have not been trained in those protocols.

As far as the proper equipment, including suits… The bottom line does not care about people.

3

It certainly does. People cost money, insurance costs money, training costs money. How much you want to bet the proper equipment was available but no one knew where or how to use it. Nurses are supposed to suit up frequently, they mostly don’t bother, . It seems like the more information I hear on these people the less prepared they were to take care of this guy. It seems like they weren’t even paying as much attention to protocols as they would have if he had the flu.

OSHA runs annual training and testing, for which I might as well burn my tax money.

4

Every time - every time - I run into something at work where I find myself saying “well, it’s not like we didn’t send email/produce training materials/train them at their desk”, I have to remind myself that you can only lead a horse to water.

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5

Lawsuits cost money.

6

Anecdotally, as I’ve aged I’ve gotten better about washing my hands and not rubbing my eyes/nose/mouth as much, and I swear I haven’t gotten sick as much. I know an RN and a CNA and both are almost never sick, but they are both germaphobes, gosh, maybe there is a connection.

It’s not like this is some scifi movie where he spit on them and it ate through their suit. They were either elbow deep in vomit and feces without proper equipment, or they were not wearing the most simple of protection. Both are possible and I want to know, since the government is the fix for everything dontyaknow, what my billions on disease research and preparedness money has gone to.

We can give tanks to rural police, but not hazmat training to hospitals?

7

My brother was a mechanic for about a dozen years, and a few years ago decided to become a nurse (LPN for now, working on RN). Since he started working as a nurse, he hasn’t been sick but a fraction of the times that he was before, despite having three disease vector/daughters in school.

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@Woodman, @sig, Correlation != Causation. I’ve been hit with general illness much less frequently since joining the gym 3+ years ago, despite gyms typically being breeding grounds for all manner of bugs.No change in hygiene habits.

On the flip side, my kids have been a lot healthier since switching daycare centers, and the new place does clean much more thoroughly and regularly.

So who knows. It’s a crapshoot.

9

I also quit smoking, so who knows. I’ll hold to my cargo-cult and keep washing my hands and not smoking.

10

Valid point, but it’s something he noticed and has pointed out. He’s much more conscientious about washing his hands and general hygiene, and given what we know about communicable disease and illnesses, it’s a reasonable connection to make.

11

Not really applicable to the hospital setting, but applies to the average workplace:

Couple years back we had the Great H1N1 Scare. Protocol we developed for our own office was:

  1. Cover your mouth and nose if you sneezed or coughed. Amazing, but we have one ass who sneezes very wetly, audibly, and doesn’t cover.
  2. Everyone wiped down their desk, keyboard, mouse, phone at the start of the day with a disinfectant wipe.
  3. If you had sick people at home, you got your temp taken if you came to work (honor system, but mostly worked). If higher than 100, sent home.
  4. Everyone was STRONGLY encouraged to limit phone, keyboard, mouse touching away from your own desk.
    and most importantly:
  5. If you were sick - at all - you went home. Period. If you could work from home, and your manager approved, fine. Otherwise, YOU USED SICK TIME.

We had less folks sharing colds, and if anyone did get sick, it was the grade school/ day care vector that did them in.

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H1N1 had me taking two weeks off between two kids being vaguely sick and then me. I only had about days of time, I worked from home when I could and it all evened out. I never really got sick sick, but generally icky, same as the kids.

Sick enough for everyone to call me a carrier, doubtful that I actually had it.

13

I am exposed to zoonotic diseases all the time (multiple times a day). I have never, ever, gotten one, because of simple hygiene. Don’t touch poop. Use gloves. Etc. I just can’t believe that someone with enough education to work with illnesses in hospital setting would be dumb enough to not follow simple simple protocols even without extensive training. I feel bad for them, I really do, but it shows how badly an overhaul is needed when the professionals can’t even stay healthy because they won’t use the simplest levels of hygiene.

14

So, apparently the instructions above are wrong. But it’s from the CDC site, or was. The people who spend millions of dollars a day preparing us for an outbreak don’t even have correct procedures for removing protective equipment.

Seen lots of people complaining about lack of funding to do things. Except it’s not that Ebola is a new thing and all they should have had to do was dust off the file folder marked “Ebola Spreads to US” and tell people what to do. That’s all the CDC has to do in this situation, be the expert on a 40 year old disease, and they can’t seem to do it.

Now, frankly you shouldn’t have to tell a hospital that spraying with alcohol and using anti bac isnt’ going to stop a virus, just like they can’t get a grip on MERSA, but at the least they shouldn’t tell them the wrong things to do.

The glove removal technique looks a little flaky (I am not a doctor), but using an antibacterial sanitizer to clean up after a viral exposure is bad right?

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I am not a doctor, but my recollection is that viruses—especially non-airborne ones like ebola—are very fragile. > 70% alcohol solutions will kill a pretty big bunch of viruses on contact.

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Using an antibacterial against a virus is useless, barring other ingredients (as @Lee_Ars pointed out). Viruses (and a lot of other single-celled animals)are indeed fragile most of the time; for instance, the cold virus (or viruses) and others can’t survive temperatures above a certain point. This is the purpose behind “inflammation” - the body is raising the temperature to kill off germs, viruses, bacteria, etc.

This is where “feed a fever, starve a cold” comes from; it has nothing to do with food. It means making the fever hotter, by bundling up, drinking hot liquids… Although hotter or spicier foods can help with this.

Using an antibacterial when it is not needed, however, is bad in a completely different way. There were some studies about five or six years ago, where they observed grade-school children. Those that used hand sanitizer frequently had more severe colds, allergies, etc. than those that used them in moderation. It was proposed that the reason for this was that the first group was unable to develop immunity or immune responses to many common allergens, bacteria, etc.

I’m not sure what is wrong with the instructions you posted, other than it would be better to remove the gloves outside the patients room (such as in a positively-pressured entry), provided that you do not touch any surface there with the gloves (including the door itself).

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I live in a different city that had 2 Ebola patients…and you aren’t hearing about anyone here getting infected. In fact the first patient was released after a successful course of treatments. But since they are following the protocols developed, utilizing the safety equipment provided and generally being awesome, it’s not in the news as much. I am happy to be here instead of Dallas.

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“Time and thoroughness are what matters when it comes to washing your
hands,” says Schaffner. “Not the type of soap.” It’s the scrubbing that
counts. You’re not killing the virus with soap so much as dislodging it from
your skin and sending it down the sink drain.

This is what soap does with a virus, wild.

Both alcohols, ethyl and isopropyl, can kill several
bacteria in 10 seconds or fewer in the lab, including Staph aureus,
Strep pyogenes, E. coli, Salmonella typhosa, and Pseudomonas species,
some of the bad actors in infections. For M. tuberculosis, it may take
as long as five minutes of contact. Many, but not all, viruses are
goners, too, like HIV, hepatitis B, herpes, influenza, etc. Even some
systemic bad fungal infections are susceptible, but again not all.

Ohh, I’m edumacated again. I notice Ebola isn’t on there, but I looked it up specifically and apparently a 60% solution will kill it.

Hand sanitizer can kill the Ebola virus living outside a host, as can chlorine, heat, direct sunlight, soap and detergents.

I think the doctor’s issue was only one pair of gloves and no head, leg, or foot covers. I was guessing that an anti-bac wouldn’t work on a virus, but I was way off base. Apparently there is also an issue with taking gloves off before the gown, which is why some suggest two pairs of gloves I guess.

But really, I’m not sure why this wasn’t already all in place. I had always thought the CDC had it more together than FEMA, but apparently that was just because they hadn’t been really tested.

And this is one of the reasons we have artisan soaps in our showers. But anti bac soap in the kitchen and guest bathroom. I mix up a gallon of bleach with a gallon of ammonia to clean with and I find it kills everything in the house.

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I presume it also gets rid of the bodies as well?

20

For that you need a solution of HF in H2O.