Fauci: Ebola protocols to call for no skin showing

[Omaha Steve]

Source: AP-Excite

WASHINGTON (AP) — Revised guidance for health care workers treating Ebola patients will include using protective gear "with no skin showing," a top federal health official said Sunday.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said those caring for an Ebola patient in Dallas were left vulnerable because some of their skin was exposed.

The Centers for Disease Control and Prevention is working on revisions to safety protocols. Earlier ones, he said, were based on a World Health Organization model in which care was given in more remote places, often outdoors, and without intensive training for health workers.

"So there were parts about that protocol that left vulnerability, parts of the skin that were open," Fauci said.

FULL story at link.



Dr. Anthony Fauci, director of The National Institute of Allergy and Infectious Diseases, testifies on Capitol Hill in Washington, Thursday, Oct. 16, 2014, as the House Energy and Commerce Committee's subcommittee on Oversight and Investigations held a hearing to examine the response to the Ebola outbreak and whether America's hospitals and health care workers are adequately prepared for Ebola patients. (AP Photo/J. Scott Applewhite)


Read more: http://apnews.excite.com/article/20141019/us-ebola-us-response-f7b9a63fc4.html

[Wellstone ruled]

1. First time we have seen this story,

what gives,three days old. Funny how common sense takes over in a crisis. Every Health Care person we know said from the get go,you have to cover all exposed skin and you must provide a decontamination room or tent with support personnel. It ain't cheap,but it is the bottom line.

[LisaL]

6. They were tring to follow WHO guidelines for remote places, apparently,

when coming up with original CDC guidelines.
This is about the most ridiculous thing I ever heard.
Did they think our US hospitals are remote places?

[SunSeeker]

8. Some of our hospitals are so bad, they might as well be.

I'll never forget us taking my brother with a gash in his foot to Charity Hospital in New Orleans. An overwhelmed nurse told him to sit in the hallway with a towel to sop up the bleeding. Then they produced a beat up old bucket with soapy water in it and told him to soak his foot it in. He finally got his stitches four hours later. Thankfully, they gave him a course of antibiotics to take, although I felt I needed some just being in that Hospital. And that was years before Katrina flooded the place.

More recently, here in Southern California, my mom suffered a stroke and they put her in an ICU bed separated by a short flimsy curtain from another patient who was projectile vomiting blood. As I stood next to my mom's bed, the man let loose like a sprinkler and my shoes were splashed by the man's bloody vomit from under the curtain. The nurses just looked at me and told me I may want to change my shoes. They did not even give me a plastic bag to dispose of my shoes nor booties to wear out of there. They had me just walk out of there in those shoes. This was in Los Alamitos Hospital just 6 years ago.

[Yo_Mama]

9. Lisa, I posted a link a day or two ago referencing the issue

http://annals.org/article.aspx?articleid=1899515
Read that article. Back then a lot of institutions were saying "we need to do more," and this was part of the rebuttal.

Hospitals in the United States are scrambling to develop plans to manage patients with suspected or confirmed Ebola. A major emphasis of planning is specifying measures to protect health care personnel and prevent transmission within health care facilities. However, infection prevention and control teams are struggling to reconcile official guidance from the Centers for Disease Control and Prevention (CDC) with the temptation to maximize precautions that exceed CDC recommendations.

The CDC recommends placing patients with suspected or confirmed Ebola in a single-patient room and instituting contact and droplet precautions (1). These entail donning a fluid-impermeable gown, gloves, a surgical mask, and either goggles or a face shield. If the patient has “copious” secretions, the CDC also recommends shoe and leg coverings. If an aerosol-generating procedure is planned (such as intubation or bronchoscopy), the CDC recommends wearing an N95 mask and placing the patient in a negative-pressure room. Despite this guidance, many hospitals are planning to place all patients in negative-pressure rooms at all times, to compel all personnel to wear full-body hazardous material (HazMat) suits, and to require N95 masks or powered air-purifying respirators rather than surgical masks at all times.
...
Exceeding these recommendations may paradoxically increase risk. Introducing new and unfamiliar forms of personal protective equipment could lead to self-contamination during removal of such gear. Requiring HazMat suits and respirators will probably decrease the frequency of provider–patient contacts, inhibit providers' ability to examine patients, and curtail the use of diagnostic tests. Patients without Ebola may also inadvertently be harmed because Ebola precautions will be required for all suspected cases even though malaria and other infections are more likely in patients from West Africa presenting with fever. Using extra gear inflates patients' and caregivers' anxiety levels, increases costs, and wastes valuable resources. More insidiously, requiring precautions that exceed the CDC's recommendations fans a culture of mistrust and cynicism about our nation's public health agency.

And here's an article arguing that all of those who were recommending higher levels of protection were messing up really badly:
http://globalbiodefense.com/2014/09/16/airborne-precautions-ebola-hcw-really-bad-idea/

There was an argument that if top regulatory bodies in the west required higher levels of protection then it would adversely affect the response in West Africa.

Which is why I find it so odd that so many are assuming that the hospital was negligent in Dallas. CDC was arguing up and down that exceeding the standards would cause problems and even possibly more risk. I guess that argument is over.

[LisaL]

10. Yea, well, that Dallas hospital is a ghost city.

Maybe CDC finally figured out that if nurses gets infected, it will be much more expensive in the end.

[Yo_Mama]

12. Okay, but CDC did believe what it said. Or at least it had evidence to say it did.

To say that this has harmed the CDC's reputation in the US medical community is to understate the matter, and every hospital that ignored the advice is only going to continue to ignore CDC's protocols.

But the reason I originally lined up the links in this post here, was to show that there was a genuine medical controversy with arguments on both sides:
http://www.democraticunderground.com/?com=view_post&forum=1014&pid=922128

The settled literature drawn from experience in past outbreaks led to one conclusion. Experience in the current outbreak led to another.

But this wasn't done from purely commercial motives, but at least partly from humanitarian motives. If western countries instituted guidelines for very high levels of PPE, then the effort against Ebola in those countries most affected would be damaged and hindered.

It's incredibly expensive to operate a treatment facility with really high levels of PPE, and in Africa, WHO is planning to set up and run thousands of new beds. They're trying to raise money for the effort.

Just for perspective, here's NY's OSH guidance on Ebola. It is far more restrictive (and note the expanded case definition) than CDCs.
http://nycosh.org/uploads/news/id186/NYCOSH-EbolaFactsheet-Final.pdf

I honestly don't know what to think any more.

[TomCADem]

2. Of course, if staff is not directed to put on gear...

...until after the patient has been formally diagnosed with Ebola, as was the case at the Texas private hospital, then what use are the protocols? One also has to wonder whether private hospitals will be willing to rigorously observe such protocols given the associated costs.

[Man from Pickens]

3. Lawsuits will force it

Private hospitals will observe protocol or get sued into oblivion.

My question is why wasn't the CDC able to figure out proper protocol for Ebola until after the fact? Isn't being properly prepared for such things their top mission?

[Yo_Mama]

7. That is one of the issues.

You have to start this before diagnosis.

But yes, they'll do it. It may take a bit to get the gear ready in some hospitals, but this type of guidance is what is needed.

[Chemisse]

4. No wonder so many health care workers in Africa have been infected.

Not so long ago I read that they were infected because they broke protocol.

Yet another fumble.

[LisaL]

5. I am not sure what this has to do with Africa.

As far as I can tell, doctors in Africa were covered from head to toe and still got infected.

[Chemisse]

11. Well then none of this makes any sense.

Why would the CDC protocols, which this article said is based on WHO recommendations, be less rigorous than those being used in West Africa?

[Yo_Mama]

13. Because well-funded western organizations are doing one thing

and less-funded hospitals and clinics in the region are doing another.

And if the west institutes the higher standards, then we are in effect murdering HCWs in Africa when we set them up with lower levels of protection, and the WHO control plan relies on setting up tons of health care beds to treat these patients in these countries with those lower levels of protection.

But western HCW won't go in to work without these protections.

[LisaL]

16. But why should they go in to work without these protections?

[Yo_Mama]

18. I don't think they should, but many are.

This article cites 21 MSF infected and 12 dead. They just closed a non-Ebola hospital last week. I think everything's folding up:
http://www.bloomberg.com/news/2014-10-19/ebola-front-line-doctors-at-breaking-point.html

MSF has been the first -- and often only -- line of defense against Ebola in West Africa. The group raised the alarm on March 31, months ahead of the World Health Organization. Now, after treating almost a third of the roughly 9,000 confirmed Ebola cases in Africa -- and faced with a WHO warning of perhaps 10,000 new infections a week by December -- MSF is reaching its limits.

“They are at the breaking point,” said Vinh-Kim Nguyen, a professor at the School of Public Health at the University of Montreal who has volunteered for a West African tour with MSF in a few weeks. MSF has already seen 21 workers infected and 12 people die, and “there’s a sense that there’s a major wave of infections that’s about to wash everything away,” Nguyen said.

http://www.doctorswithoutborders.org/article/sierra-leone-msf-suspends-emergency-pediatric-and-maternal-services-gondama

Only read this one if you are strong:
http://www.doctorswithoutborders.org/news-stories/voice-field/ebola-impossible-choices-liberia

Then imagine looking at your child, your spouse, your parent, and knowing that you are sick, and knowing that the other is sick, and that if you die no one will come to help the other. That is what is going on.

[candelista]

14. Fauci is the former CDC head who said AIDS could spread by "casual contact."

Now he is back in the limelight as an "expert." I wouldn't believe a thing this fucker says.

http://books.google.co.uk/books?id=3XnWAAAAQBAJ&pg=PA145&lpg=PA145&dq=anthony+fauci+aids+transmitted+by+casual+contact&source=bl&ots=aSkj0jH5q4&sig=BFEruivZrghEojcZ3ryVcbbcM7Y&hl=en&sa=X&ei=ezlEVJjCB4XEO9n-gagH&redir_esc=y#v=onepage&q=anthony%20fauci%20aids%20transmitted%20by%20casual%20contact&f=false

[TomCADem]

17. Do You Mean You Can't?

Watching Fox News, I thought it is possible to catch Ebola by giving someone the stink eye or, at least, you can't 100 percent rule it out, right, so why take chances? This is why I walk through public places staring at my shoes. Can't be too safe!

[FarPoint]

19. The learning curve was in progress at that time...

It's always better to be over cautious than infected during the research and development phase.

[candelista]

20. I guess you didn't click on my link.

Try again, and read a little: "Public health experts had determined that AIDs wasn't spread by casual contact...."

The "cautious" thing to do would be to respect the research and not shoot your mouth off to the contrary, especially if you are the head of the CDC.

[tclambert]

15. So burqas for everybody?

[Yo_Mama]

21. Still waiting for the release. CDC site had not been updated

http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html