The testimony given in the Congressional hearing today about the Ebola outbreak in Texas was very reveling. First the hospital administrator acknowledged they only posted the CDC warning from last July on the ER bulletin board. A nurse said they had an OPTIONAL in-service (training) via a webcast about dealing with Ebola. But it was not stressed that they attend it. Apparently no one at that hospital attended. Hospitals are suppose to have an infectious disease committee made up of doctors, nurses and administration to constantly review protocols to reduce hospital acquired infections. Since the notice from the CDC was only posted on the ER bulletin board, this committee did not review their Ebola protocol, which they actually had not established. So the internal process failed. This is very typical of privately operated hospitals. The only oversight they have is from what is called the Joint Commission that accredits hospitals for participating in Medicare and other government funded healthcare programs. But that only happens every 5 years or so. As far as I know, Ebola protocol was not required for accreditation. When Mr. Duncan showed up, no one was even in the mind set to think about Ebola. Thus being turned away. Then when he came back, again, no one even thought about Ebola. CDC sent them a protocol, but the hospital only had gowns and gloves used for HIV patients, which is not adequate for Ebola, because of the size of the virus, smaller, and the viral load (the amount of virus contained within a unit of bodily fluid) in the bodily fluids expelled by the infected patient. No one knew how to even gown up or to remove the gowns without contaminating themselves. It is a different process than what you use in a surgical suit. There was no decontamination room next to the isolation room. Also they did not use the appropriate decontamination procedures, which is basically a Clorox and water mix sprayed on the person before they remove the gown and then after to clear all contamination potential. Blood drawn from Mr. Duncan was sent to the lab without isolation and put in the centrifuge and analysis machine mixed with other patients samples, because they are done in batches. Lab techs did not know of its potential infectiousness of the sample. The infected waste was improperly handled and disposed of. As is known now, it is critical that hospital personnel have hands-on in-service training understanding the symptoms and differentiate it from the flu and other normal presentations. How to isolate the patient immediately. How to gown-up with the proper equipment and how to decontaminate after contact. Without this, staff do not have a clear appreciation of serious it is and how important it is to follow the protocol exactly.
Posted on: Fri, 17 Oct 2014 00:33:38 +0000