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The problem is asking the hospital how closely they observed safety procedures is like asking a security guard how carefully they patrol the day after a robbery. They're going to say they did everything properly just like the ER staff said they did everything properly.
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Oct 12, 2014 14:50
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Pryor on Fire posted:It's not clear that transmission happened from improperly removing gear from what I've read so far, are you just assuming that's what happened because it's the most likely scenario? Yes. It isn't a magic virus that can teleport through PPE, and we've been treating it for ~40 years now and have a very good idea of how it spreads. And how it spreads is contact to bodily fluids in one way or another, that means inadequate gear or contact during the doffing process (rarely, exposure during aerosol generating processes).
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Oct 12, 2014 14:51
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Yes I understand how it is spread, I just think that leaping to the assumption that a health care worker screwed up removing gear is premature and severely underestimates the myriad ways people are capable of loving up in these situations.
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Oct 12, 2014 14:56
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Do they have observers watching in the decontamination area and instructing personnel to take off PPE step-by-step, in accordance with a checklist?
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Oct 12, 2014 14:57
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Pryor on Fire posted:Yes I understand how it is spread, I just think that leaping to the assumption that a health care worker screwed up removing gear is premature and severely underestimates the myriad ways people are capable of loving up in these situations. It isn't a leap, it's that or they failed to wear the proper PPE at all. Or were exposed in the community, in which case we're completely hosed. This isn't her fault at all - this stuff is really hard to do properly and only stresses how poorly we are prepared for this. re: observers and checklist, there should be. Doffing/donning requires two people and has associated checklists. If they were used, who knows.
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Oct 12, 2014 15:07
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CSPAN Caller posted:Do they have observers watching in the decontamination area and instructing personnel to take off PPE step-by-step, in accordance with a checklist? In Spain I remember reading they record everyone decontaminating now. Experience is the son of loving up I guess.
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Oct 12, 2014 15:10
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Pryor on Fire posted:It's not clear that transmission happened from improperly removing gear from what I've read so far, are you just assuming that's what happened because it's the most likely scenario? It seems to be the most likely scenario by a few orders of magnitude. The only other way is that the patient's bodily fluids got transmitted through a needle prick or hole in the protective suit.
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Oct 12, 2014 15:13
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EtaBetaPi posted:It isn't a leap, it's that or they failed to wear the proper PPE at all. Or were exposed in the community, in which case we're completely hosed. I readily confess I am not terribly familiar with what these suits are made out of and the kinds of force you would need to puncture one - but is it within the realm of plausibility that it could have been worn correctly, donned and removed correctly, but compromised during her visit to Duncan via a puncture or tear? Like is it possible for such a thing to happen without the wearer noticing? Also what do you mean by 'community' exactly?
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Oct 12, 2014 15:13
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Pryor on Fire posted:Yes I understand how it is spread, I just think that leaping to the assumption that a health care worker screwed up removing gear is premature and severely underestimates the myriad ways people are capable of loving up in these situations. There are four primary ways of getting infected: putting your gear on wrong, taking it off wrong, or something crossing the barrier while you have the gear on or getting infected outside of the care setting. Category three gently caress ups - like needle sticks - are more obvious. It is vanishingly unlikely that she got infected out side of the care setting. So we're down to 'there was a gently caress up in donning or doffing the gear.' RoboChrist 9000 posted:I readily confess I am not terribly familiar with what these suits are made out of and the kinds of force you would need to puncture one - but is it within the realm of plausibility that it could have been worn correctly, donned and removed correctly, but compromised during her visit to Duncan via a puncture or tear? Like is it possible for such a thing to happen without the wearer noticing? Community = outside of a care setting. The suits are tough. It is possible to cut them (precautions are taken to prevent this, for example the outer gloves and apron are made of tougher plastics.s), but its most likely to happen via a needle stick injury. Healthcare workers are obsessive about them, and that would have been noticed. Cthulhu Dreams fucked around with this message at 15:21 on Oct 12, 2014 |
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Oct 12, 2014 15:16
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Maybe they should modify the protocols for PPE removal, like spray everything down with bleach before removing it?
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Oct 12, 2014 15:20
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deleted.
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Oct 12, 2014 15:25
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Trabisnikof posted:0<R<0.1 in US hospital settings. Is that so...
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Oct 12, 2014 15:26
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various cheeses posted:Maybe they should modify the protocols for PPE removal, like spray everything down with bleach before removing it? AFAIK, the PPE for ebola in a medical setting doesn't involve wearing a full mask, and the little paper ones will fall apart if you spray them with bleach. Spatter from a spray could have a risk of aerosolising the virus as well. http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf
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Oct 12, 2014 15:26
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ComradeCosmobot posted:Is that so... Probably, yeah.
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Oct 12, 2014 15:29
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Aromatic Stretch posted:AFAIK, the PPE for ebola in a medical setting doesn't involve wearing a full mask, and the little paper ones will fall apart if you spray them with bleach. The MSF ones specify that operation should continue when wet - and if you watch the MSF videos they spray people with chlorine solution as they leave the high risk zone. I suspect that what is happening is that unless you submerged yourself in bleach its not perfect (they soak the gear for ages in high strength solutions to decontaminate it) so you still need to be drat careful when taking the gear off. They also obsessively wash their hands The MSF solution of having someone shout at you as you go through the process to make sure each step is done right is a good one.
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Oct 12, 2014 15:33
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Kiwi Ghost Chips posted:Probably, yeah. Well we're at one nosocomial infection with 7-10 patients (Brantly, Writebol, the two here, the cameraman (and a few more?) in Nebraska, the NIH patient and of course Duncan, so we may actually be no better than R=0.1 (lower in Level 4 facilities, higher in general hospitals?)
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Oct 12, 2014 15:37
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ComradeCosmobot posted:Well we're at one nosocomial infection with 7-10 patients (Brantly, Writebol, the two here, the cameraman (and a few more?) in Nebraska, the NIH patient and of course Duncan, so we may actually be no better than R=0.1 (lower in Level 4 facilities, higher in general hospitals?) At one transmission out of seven patients the data is way too sparse. The p-value for r>=.1 is .52.
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Oct 12, 2014 15:44
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ComradeCosmobot posted:Well we're at one nosocomial infection with 7-10 patients (Brantly, Writebol, the two here, the cameraman (and a few more?) in Nebraska, the NIH patient and of course Duncan, so we may actually be no better than R=0.1 (lower in Level 4 facilities, higher in general hospitals?) That is not a statistically significant R value.
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Oct 12, 2014 15:47
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Kiwi Ghost Chips posted:At one transmission out of seven patients the data is way too sparse. The p-value for r>=.1 is .52. It is true that it is early. But it clearly indicates that it is not something hospitals can afford to take lightly. The recommended decontamination procedures are what they are for a reason. EDIT: As if the Spanish nurse wasn't indication enough. The critical takeaway from both cases is that hospital transmission absolutely can happen if procedures are not followed to the letter. ComradeCosmobot fucked around with this message at 15:55 on Oct 12, 2014 |
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Oct 12, 2014 15:49
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Oh yeah speaking of that Spanish nurse: http://www.msn.com/en-us/news/world/spanish-ebola-nurse-in-better-state-and-talking/ar-BB8I5Pk Guess she pulled through!
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Oct 12, 2014 16:00
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I bet she can't wait to get home and see her dog.
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Oct 12, 2014 16:10
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 Well poo poo...
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Oct 12, 2014 16:11
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joeburz posted:I bet she can't wait to get home and see her dog. I feel horrible for laughing at this.
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Oct 12, 2014 16:16
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joeburz posted:I bet she can't wait to get home and see her dog. They killed my dog, meow i'm out for revenge! Wait...
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Oct 12, 2014 16:30
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joeburz posted:I bet she can't wait to get home and see her dog. You mean they haven't told her that they murdered her dog? They would never get away with that here in the States.
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Oct 12, 2014 16:35
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For all the people saying it will never spread here, it's not that contagious, etc. - here you have transfer from the sole Ebola patient in the region to an HCW wearing full PPE, in a hospital that has the magnifying glass on them for loving up previously and has had hand-holding from the CDC. This is a warning sign that should not be dismissed, and something that should not be taken lightly.
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Oct 12, 2014 16:59
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Helicity posted:For all the people saying it will never spread here, it's not that contagious, etc. - here you have transfer from the sole Ebola patient in the region to an HCW wearing full PPE, in a hospital that has the magnifying glass on them for loving up previously and has had hand-holding from the CDC. Sure. Except, the health care workers are becoming infected while trying to treat the patient at his most infectious. Meanwhile, the patient has zero energy. They can't move. If people infected with Ebola ran around biting people like 28 Days Later, then I'll be concerned about a large-scale outbreak in the US.
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Oct 12, 2014 17:05
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swampcow posted:Sure. Except, the health care workers are becoming infected while trying to treat the patient at his most infectious. Meanwhile, the patient has zero energy. They can't move. Sawyer repeatedly got up and forcefully removed his IVs and moved around a lot.
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Oct 12, 2014 17:06
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Tim Raines IRL posted:Sawyer repeatedly got up and forcefully removed his IVs and moved around a lot. Where did you see this?
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Oct 12, 2014 17:15
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Arsenic Lupin posted:Where did you see this? many places in the Sawyer coverage, here's the first one I found on Google. http://newtelegraphonline.com/my-ebola-story-nurse-infected-by-patrick-sawyer/ quote:But many reports had it that Sawyer was not a cooperative patient and was removing his IVs. How did that happen? "Five men would have to hold hold" != "too weak to move around at all".
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Oct 12, 2014 17:20
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swampcow posted:If people infected with Ebola ran around biting people like 28 Days Later, then I'll be concerned about a large-scale outbreak in the US. That's not even remotely what I said. The message I constantly heard was "it's not that contagious, they'll have it under control, it won't come to the US, it won't come for a long time, it won't spread in the US". poo poo keeps happening that is "unlikely". I hope the MO isn't "hope for the best, plan for the best", because even just a 1:1 patient/spread will cause nurses to walk off the job, and rack up some incredible care/cleanup bills.
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Oct 12, 2014 17:21
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quote:I was not told that he was positive then. It was after nursing the man on Wednesday that I read his folder; but we had already started hearing and reading the news. They did the test and wanted to confirm. We started using the protective gear that morning. Does this mean she worked on him before precautions? The writing is ambiguous. quote:He gave me $30 and I called one of the guys to help him change it and buy a recharge card for him. It was when I wanted to scratch the card for him that I removed my gloves which I had been wearing all along. After scratching the silver panel, I forgot to wear my gloves again and collected his phone to help him load the airtime. So...incredibly lovely but she hosed up protocol badly there. edit: ok my mistake, I thought this was describing the dallas nurse that became infected but its a different patient. esto es malo fucked around with this message at 17:27 on Oct 12, 2014 |
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Oct 12, 2014 17:23
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Arsenic Lupin posted:Where did you see this? Now you know the origins of ragepiss. http://www.frontpageafricaonline.com/index.php/news/2506-sawyer-s-final-hours-in-lagos-indiscipline-rage-strange quote:FrontPageAfrica has now learned that upon being told he had Ebola, Mr. Sawyer went into a rage, denying and objecting to the opinion of the medical experts. “He was so adamant and difficult that he took the tubes from his body and took off his pants and urinated on the health workers, forcing them to flee. Ebola Roulette fucked around with this message at 17:37 on Oct 12, 2014 |
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Oct 12, 2014 17:32
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Helicity posted:That's not even remotely what I said. I know that wasn't what you said. My point is, when the person is most infectious, they are also immobile. Meaning, the window that they're able to live normally while also being infectious is probably small. It therefore makes sense that Ebola patients are more likely to infect caregivers than non-caregivers.
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Oct 12, 2014 17:33
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Helicity posted:For all the people saying it will never spread here, it's not that contagious, etc. - here you have transfer from the sole Ebola patient in the region to an HCW wearing full PPE, in a hospital that has the magnifying glass on them for loving up previously and has had hand-holding from the CDC. Let's all quit our jobs and prepare for the end times! Hallelujah! Or you can stop imagining nightmare American Ebola zombie invasions and donate to people doing poo poo about Ebola where it is demonstrably a nightmare. http://www.doctorswithoutborders.org I donated $50 bucks and solicited you DnD goons to match a page ago... So far know takers, but lots of "the end is here, let's go hide!"
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Oct 12, 2014 17:39
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ZombieLenin posted:Let's all quit our jobs and prepare for the end times! Hallelujah! Saying something shouldn't be taken lightly is apparently the same as saying we're all going to die. I'll keep that in mind.
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Oct 12, 2014 17:43
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Kiwi Ghost Chips posted:At one transmission out of seven patients the data is way too sparse. The p-value for r>=.1 is .52. Seph posted:That is not a statistically significant R value. Gotta love how everyone comes out of the woodwork to point the sample size on the day that a health care worker gets infected, while ignoring the conversation the conversation the day before where that same sample size was being used to claim nosocomial infection rate was significantly below Rn=0.1. I mean, that's the context of Trabisnakof's quote that you are defending. Failures in donning/doffing PPE are exactly the kind of thing I was pointing out about how CityName General Hospital might not have a nosocomial reproduction rate any better than MSF. They're not tricked up in PPE 24/7 like doctors in outbreak zones, they don't have the practice following the procedures, and they have to divide their focus between dealing with a highly infectious disease and delivering normal medical care like setting bones and birthing babies. Normal GP stuff and normal ER stuff are way different from how you need to treat potential ebola cases. Everyone loves to poo poo on MSF because their showers are made of plywood, but it gets the job done. If a big outbreak happened in the US, our system wouldn't be at 100% either by the time we shifted our health care system to focus on treating ebola instead of broken bones. Paul MaudDib fucked around with this message at 17:54 on Oct 12, 2014 |
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Oct 12, 2014 17:48
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Paul MaudDib posted:Gotta love how everyone comes out of the woodwork to point the sample size on the day that a health care worker gets infected, while ignoring the conversation the conversation the day before where that same sample size was being used to claim nosocomial infection rate was significantly below Rn=0.1. I mean, that's the context of Trabisnakof's quote that you are defending. 
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Oct 12, 2014 17:52
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Ebola Roulette posted:Now you know the origins of ragepiss. ... wow.
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Oct 12, 2014 17:54
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Does ebola make you act erratically?
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Oct 12, 2014 18:06
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