Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
It is in the discussion of the Hospital behavior. No I am not going to invest the 20 minutes to prove it was claimed by some at the time. Have fun...
Not my burden to prove, I just don't believe you. Like I said before, we just won't be agreeing on this. To me there's nothing to do but wait and see what unfolds. You don't think precaution is necessary, and I do. Pretty much somes it up, no need to spend pages and pages on it, imo.
When you get a crystal ball let me know.
Supposedly Duncan's household had no clue he had Ebola until he was offically diagnosed. Unless maybe they did have a clue!
I think they had to consider it. There is no way Ebola would not be on the list of causes of fever and vomiting to anyone in Liberia these days. You may hope it's malaria, but you have to be worried.
Quote:
Originally Posted by berdee
And the patient has the right to expect not to catch something from their health care worker.
About the lack of hand washing/sanitizing resulting in passing on infections to other patients - the "CDC estimates that each year nearly 2 million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection"
(which could be prevented by proper hygiene by the health care worker)
If hand washing is too difficult, then, if the hands aren't visibly dirty, use an alcohol-based hand rub. Much easier than taking the time to wash hands, less harsh on the skin, and takes hardly any time at all to squirt and rub while the health care worker is moving on from patient to patient. Plus, according to the CDC, the rankings of different products for hand sanitizing - plain soap - good, antimicrobial soap - better, alcohol-based hand rub - best (again, alcohol-based rub for hands that are not visibly dirty).
If the facility that you work in doesn't have bottles of alcohol-based hand rub for the staff to use - open your mouth and request that they start stocking it, and then use it! good grief.
Handwashing is good, but not all hospital acquired infections are due to poor hand hygiene by staff. Almost half of all postoperative infections are due to organisms patients bring with them to the hospital. For example, women who have Cesarean sections after long labors can get infections from bacteria transferred from the vagina. MRSA is now in the community, so patients can bring that with them, too. In fact, some docs will test patients before elective surgery to see if they carry MRSA, so it can be treated before the patient is operated on. In addition, what we need to know is how many of those 90,000 deaths were actuall preventable. If they were in cancer patients on chemo, for example neither the infection nor the death may have been preventable.
Every hospital I have been inside of in recent years has the alcohol based sanitizer just inside the door of every patient room, and staff used it. Certainly if staff does not use it you should ask them to do so or to wash with soap and water.
Quote:
Originally Posted by berdee
Since Zwinkels had included this in his paper - "It seems that Ebola can present without feverespecially in the first phase."
That leads me to believe that he felt the three patients had no fevers but were actually contagious during the first phase of the illness and not only, as you suggested, in the late stages.
I don't know if temperatures of Sacra's patients were taken, but I would imagine that it would be a standard practice, especially being where they were at, and that temps were taken.
(since some instruments are so un-reliable for reading temps, I wonder why they use them so much, instead of just using them on certain patients where they cannot, for some reason, use a reliable instrument)
edited to add - the lack of fever in ebola patients is not limited to this particular strain of the virus. it's also been noted in past outbreaks.
I still have a problem with saying someone does not have a fever when no thermometer was used. We cannot assume that Sacra's patients had their temperatures taken. Here in the US the thermometer is stuck under your tongue and the blood pressure cuff slapped on your arm as soon as you come through the door. In Africa, there may be no thermometers or blood pressure cuffs in the entire "hospital".
Sacra was taking care of obstetrical patients. Pregnant women with Ebola miscarry. Women with miscarriages can get uterine infections and have fevers even if they do not have Ebola. He may have taken care of a patient who died from a miscarriage without having a diagnosis of Ebola made.
Quote:
Originally Posted by berdee
I believe I've mentioned previously about why/how Ms. Troh and family, who are from Africa, never caught it even while living in such close contact with Duncan, if he was actually contagious during that time.
Troh and Duncan's other relatives would have been tested when they came out of quarantine. If they had antbodies to the virus, it would have been big news. I think we may assume they did not.
We are going to see formal case reports on the patients treated here in the US. You may count on that. All of Duncan's caregivers will be tested as they leave quarantine, too. So far, no reports on any of them having antibodies.
So it does not look like we have any asymptomatic infections related to the cases here in the US so far.
Quote:
Originally Posted by KathrynAragon
That's cool. We're sending 4000 and many other countries are sending substantial numbers as well. "Fight it there or fight it here" is pretty much how I see it.
The Cubans are sending people to provide patient care. The American troops, for the most part, will not be doing that. I do not know that I have seen a number for the actual number od Americans providing hands-on care in Africa.
I think that the estimate by WHO is that they need 5000 healthcare workers on the ground for the foreseeable future.
Okay, found a source. Pham treated Duncan after he was admitted to the isolation unit. The medical records sent to Duncans mother indicated Vinson treated Duncan in the isolation unit too. If I find that source again I'll post it. I believe we have a twofer with no one being infected from the two ER visits. The infections occurred later when the nurses were in full CDC recommended garb, which is scary imo.
The nurses who were on 60 Minutes described not having full PPE for the initial contacts they had with Duncan. One said she had a single mask, not a hood, and a gown, not a jumpsuit. Their "necks were exposed", remember. The initial guidelines were the ones used in Africa, where the more sophisticated gear is not available. CDC updated the guidelines for the US when it found out people were using tape to cover their necks.
Quote:
Originally Posted by PoppySead
Where did you hear that? Thinking and knowing are two different things, are you saying they should have taken precautions before they knew it was in fact Ebola? Thats priceless.
No, that is exactly what every hospital in the country has to be able to do. If there is concern about Ebola, you cannot wait for test resuts to begin isolation. It's necesssary to isolate when you first suspect the possibility of the disease, then test. The same would be true of any infectious disease, such as tuberculosis.
Our hospitals (and even walk-in clinics) have to be able to isolate a patient and get him transferred to one of the units being set up for actual treatment.
The complaint from the nurses union staes the nursing supervisor asked for the isolation unit but administration denied the request. He was put in a private room and isolated there instead.
If this happened before the test result came back, the hospital should get a pass, because no one in the country had seen a case of Ebola before and it would not be high on the list of suspects (especially with the travel history being hidden by Duncan.) With a low index of suspicion, I could see not using an "isolation unit."
If the request for the isolation unit came after the test results were positive, it may be that they decided dedicating the ICU to him was better.
I have seen nothing that indicates to me that the hospital withheld any resources based on Duncan's inability to pay.
The complaint from the nurses union staes the nursing supervisor asked for the isolation unit but administration denied the request. He was put in a private room and isolated there instead.
If this happened before the test result came back, the hospital should get a pass, because no one in the country had seen a case of Ebola before and it would not be high on the list of suspects (especially with the travel history being hidden by Duncan.) With a low index of suspicion, I could see not using an "isolation unit."
If the request for the isolation unit came after the test results were positive, it may be that they decided dedicating the ICU to him was better.
I have seen nothing that indicates to me that the hospital withheld any resources based on Duncan's inability to pay.
So he was isolated, and since it's not airborne that sufficed? Did the administration talk to the CDC upon suspicion?
This is exactly the scenario that could happen again that I'm concerned with. According to you and Ivoc even though the hospital suspected Ebola they couldn't take the proper precautions.
So he was isolated, and since it's not airborne that sufficed? Did the administration talk to the CDC upon suspicion?
This is exactly the scenario that could happen again that I'm concerned with. According to you and Ivoc even though the hospital suspected Ebola they couldn't take the proper precautions.
I think we have to keep in mind that Duncan was not forthcoming about his history on either admission. Doctors are taught to look for the most common explanation for a set of symptoms first. So even when someone in Duncan's family raised the possibility of Ebola, I think the medical people were still not ready to buy it.
However, once someone said, "Let's test for Ebola," even though they did not think that would be the diagnosis, then, yes, isolation is needed until the result is negative (and a confirmatory test is also negative.)
I doubt anyone called CDC until the positive test result came back. CDC may have actually done the test.
My son's mother-in-law is an RN. Her hospital is stopping people at the door and asking the travel questions. She has been asked if she would be on the ER team if they get a case. She works in one of Georgia's larger cities, so it's conceivable they might see a case. All they need to do is isolate, use proper infection control proedures, and refer, probably to Emory.
Last edited by suzy_q2010; 11-01-2014 at 11:49 PM..
^^I don't think we're ever going to know all the intimate details. Such things like the decision to put Duncan in isolation, etc, will not likely show up in the medical record, or any record. These were all likely verbal discussions that didn't get written down, and recollections of what happened and what was said are bound to vary. It does not seem that finances were a major decision. A lot of money was spent on Mr. Duncan, as it should have been.
Location: where you sip the tea of the breasts of the spinsters of Utica
8,297 posts, read 14,163,488 times
Reputation: 8105
I guess we'll see what happens when January rolls around - that's about the time the logarithmic curve is supposed to take off, if they can't control it. If they get it under control, we shouldn't see more than a very few tiny clusters here before the wave dies out.
The drug companies are getting a good start on developing antiviral drugs and especially a much faster test. I suppose within a year they'll have substantial progress in working up a sufficient number of vaccine shots. Public and private money is starting to flow.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
