Who To Blame When You Get Ebola: A CDC Guide For Healthcare Workers

[Fumesucker]

http://thehappyhospitalist.blogspot.com/2014/10/Ebola-CDC-Flowchart-Blames-Nurses.html

Atlanta, GA -- The Centers for Disease Control and Prevention (CDC) announced new flowchart guidelines Monday to help healthcare workers understand who they could blame once they contract Ebola in the hospital setting. The new recommendations follow declarations by Dr Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention, that nurse Nina Pham in a Dallas, Texas hospital contracted Ebola due to 'protocol breach' while caring for the now deceased Ebola victim Thomas Eric Duncan.

Nurses are used to getting blamed for everything. In fact, most nursing programs teach nurses how to take one for the team when bad things happen. Getting blamed for spreading Ebola is naturally accepted by most nurses as business as usual.

"After speaking with representatives from the American Nurses Association, everyone agreed blaming nurses for spreading Ebola was just the easiest thing to do," said Jason Fenster, a CDC spokesman who blamed his nurse last year for undercooked eggs while hospitalized for an undisclosed infection contracted at a CDC laboratory.

Following the release of these CDC guidelines, officials at the Dallas, Texas hospital confirmed they are probably going to blame three or four nurses for spreading Ebola while taking care of Mr. Duncan, including one on maternity leave for the last six weeks.

<snip>

[TorchTheWitch]

1. someone posted this a few days ago

But the chart in itself is still funny the second time around.

And it's sadly too true. Seems like it's always the "little people" that get finger pointed to when the higher ups screw up. Had that happen to me regularly as a paralegal.

[Fumesucker]

2. I've been watching the process here on DU

The experience has prompted a couple of fairly well received OP's on my part..

[TorchTheWitch]

3. they've been good

I especially liked the one about what Ms. Vinson may have been thinking when told it was fine for her to travel.

[Fumesucker]

4. So much of DU fell for the "blame the nurse" thing

It was depressing to read all the vitriol against someone who faces a possible horrible death here on a nominally liberal website, the lack of empathy and desire to blame the victim was stunning.

Ms Vinson is a victim of a desperately dysfunctional healthcare system and did us a huge favor by revealing it in graphic terms.

[TorchTheWitch]

5. it's so upsetting

All the compassion in the world for Mr. Duncan who brought it here in the first place and had to have known that his landlord's daughter had Ebola. Don't get me wrong, if I were him I likely would have plowed my way onto that plane if I had to to get the hell out of Liberia where I'd be sure to die and die horribly.

Yet no compassion for a nurse who was grossly used and lied to yet put herself in harms way anyway to care for him. Me? I would have called out sick.

And for all this she may end up dying because she wasn't experienced or knowledgeable in caring for an Ebola patient and given incorrect protocols and no guidance.

[KingCharlemagne]

18. Duncan's relatives insist he had no idea he was infected with Ebola. (The woman he helped was in the

labor in the 8th month of pregnancy, IIRC.)

Saw the story yesterday and forgot to bookmark it. Was an interview with one of his surviving relatives (maybe a nephew?).

[LisaL]

19. I read an article where his nephew claimed Duncan denied even helping the pregnant woman.

I don't believe everything relatives say. And even if they say what they think is entirely accurate, how would they know what Duncan did or didn't do, or what he knew?

[KingCharlemagne]

21. Good points all. I was merely posting in reaction to the phrase that

Duncan "had to have known" when, as you correctly note, no one among us including his relatives can know with certainty what he did and didn't know.

[Yo_Mama]

13. If you include the CDC, yes. Otherwise, no

Because the CDC recs were inadequate and are now inadequate. The screening protocols aren't any good either.

Here's the page:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

They have deleted the original PPE recs, which were mask, goggles or face shield, gloves, gown. Those recs were less comprehensive than those for AGP's, which are hilariously still up, and hilariously inadequate. They haven't substituted others.

There's a learning curve as others have noted, but the "breach in protocol" comment was inexcusable. Because CDC had apparently changed the protocol on the fly at Texas Presbyterian (while not changing it for other institutions), so that was truly reprehensible at the time he said it.

Anyway, I just wanted to thank you for your posts on this topic, and point out that your post today is even more appropriate. We've been sitting for several days with the notice that PPE recs will be posted. Suppose you are an ER with the next Ebola patient? Whatever you do you can be blamed for not following protocol!!! As this wears on, that chart seems to me to become ever apter.

This is not amusing.

I assume that they are not changing them because of the supply issue - whatever they put on there that's reasonable, some hospitals won't have it available for intake.

I'm hoping these two nurses are the last hospital transmissions, but I am not optimistic. We are all just improvising now. We know we can have intakes of patients with active disease with very mild symptoms that suddenly exacerbate.

[Bluenorthwest]

6. 56 healthcare workers, mostly nurses, contracted HIV from caregiving duties in the US

There has not been a new case since 1999. This is because the protocols that work are something that is learned and in infectious diseases that learning can come the hard way.
I've been surprised that people expect utter perfection in dangerous work starting with patient one. That perfection has never existed in the past.

[LisaL]

7. Patient one in the US.

Not in Africa. Where there have been many patients and many health care workers got infected.
Are you saying we can only learn when it happens in the US?
And we can ignore anything that goes on outside of US?

[Bluenorthwest]

23. There is no 'patient one' known in either case. No one even knows how many died from HIV related

causes before it was noticed as a specific virus. The first US death now known to have been HIV related was in 1969. He was not patient one. Patient one was probably never a patient but just a sick person who died somewhere, probably in Africa, probably in the 1920's. Yes. 'Patient Zero' is a myth. Not a reality.
In 1975 a Norwegian sailor and his family died of what we now know was HIV. That was in Norway. He'd picked up other sexually transmitted disease in Africa.
Did you know any of this? Of course not.
To be blunt with you, when you say 'patient one in the US' it is you who is ignoring things that happened elsewhere. You have deemed some American to be 'patient one' when that is simply not the case. There is no known patient zero.
Knowledge = Life

[Fumesucker]

9. The knowledge of how to prevent this infection already exists

This isn't the 1990's, all this information is just a few mouse clicks away or at most a phone call.

A system that is optimized for maximum efficiency in one measure is less robust in other measures, Dallas Presbyterian is optimized for extracting maximum monetary value from the patients as is almost all the rest of our healthcare industry, that means other aspects of the healthcare system are well below par.

The nurses were not trained and equipped properly, that is not their fault it is the fault of those who said everything was fine and hospitals were all trained up and equipped to care for Ebola patients.

Management is the problem, not the nurses.

[Bluenorthwest]

14. I did not say the nurses are the problem. And it is not right of you to suggest that I did.

I gave recent history. I think that it would be terrible if we saw such a number again. If people know that such numbers are real and actually possible, perhaps greater attention will be paid to the issues at hand. Since few Americans paid attention at the time, and almost none recall that high prices have been paid in the past by the very professions we are again asking to take such risks it might be worthwhile to remind them that real people die in these jobs from things which proper attention, equipment, experience and exchange of information can reduce and eliminate.
My guess is that the management in Dallas does not remember the prices paid in the last round. I think that's part of the problem. America does not remember the last round.

[Fumesucker]

17. I was expanding a point like you did rather than being accusatory

And we agree regarding memory..

[Bluenorthwest]

24. Thanks for that.

I'd never blame nurses. If it was not for the nurses in the 80's and 90's....damn. For much of that time my next door neighbor was a hospice RN, a wonderful and amazing person. More than once she cared for another of our neighbors. What a time it was.

[Avalux]

8. This is not helpful AT ALL. n/t

[Fumesucker]

10. I understand the satire is a bit subtle

Hopefully most readers will realize it's not serious when they get to the part about the nurse who has been out on maternity leave getting blamed.

[KingCharlemagne]

20. It makes fun of American's proclivity to blame workers for the errors

of management and does it most deliciously using a preferred tool of management itself, the Visio flowchart.

[woo me with science]

11. K&R

[greatlaurel]

12. Bashing the CDC plays into the GOP and Koch brothers' anti government agenda.

There are legitimate concerns about the protection of the staff at First Presbyterian Hospital in Dallas, but bashing the CDC is not helpful. The slashing of the CDC budget needs to be discussed over and over again. That is why we do not have an Ebola vaccine and advances for dozens of other disease. We need to attack the anti-science anti-life Republican party and their corporate and religious backers, not the CDC. Slashing government regulations, privatizing public health, and allowing corporate management strategies to run rampant in areas like public health, public schools and environmental regulation are destroying the our future.
When Dr. Frieden spoke about failures of protocol at the hospital, it is telling about our society in general that most people assumed he was blaming the infected nurses. It is my opinion, from my experience working as a regulator, that he was blaming the hospital in government speak. If one is a regulator one can never come out directly and say that managers failed. Some of it has to do with legal issues, but it is also because if one blames managers, politicians go nuts.

[Yo_Mama]

15. I think you are dead wrong.

The CDC's guidelines have been and continue to be, inadequate. Tell us how this is adequate and helpful:
http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

Tell us how this is adequate or helpful:
http://www.cdc.gov/vhf/ebola/hcp/case-definition.html

Early recognition is critical for infection control. Health care providers should be alert for and evaluate any patients suspected of having Ebola Virus Disease (EVD).
Person Under Investigation (PUI)

A person who has both consistent symptoms and risk factors as follows:

Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

Probable Case

A PUI whose epidemiologic risk factors include high or low risk exposure(s) (see below)
Confirmed Case

A case with laboratory-confirmed diagnostic evidence of Ebola virus infection
Exposure Risk Levels

Levels of exposure risk are defined as follows:
High risk exposures

A high risk exposure includes any of the following:

Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD patient
Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without appropriate personal protective equipment (PPE)
Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring*

Low1 risk exposures

A low risk exposure includes any of the following

Household contact with an EVD patient
Other close contact with EVD patients in health care facilities or community settings. Close contact is defined as
being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations)
having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.
Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact

No known exposure

Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no high or low risk exposures

Note that at intake, not one of the three confirmed US cases met these critieria. At intake Mr. Duncan's fever was well below the cutoff, and of course he did not disclose the exposure to a sick person in Liberia. So he wasn't segregated. And in fact if they had called CDC for a test it would have been refused. as so many others have. The hospital's original error was in not upgrading the risk when his fever rose above the threshold during that initial evaluation in the ER.

The nurses who are confirmed do not fit the case definition either.

Fumesucker's post could not be more appropriate, and all medical institutions are making up their own guidelines as we debate here. But note that the hospitals cannot, on their own responsibility, direct that a patient be tested for Ebola. That request can only be handled by calling a state or CDC hotline. and many of them are refused.

More funding doesn't fix this.

[Crunchy Frog]

22. CDC's incompetence plays into the GOP and Koch brothers' anti government agenda.

As do attempts to excuse it or sweep in under the carpet.

[fadedrose]

16. Stay away till you need one . . .

then it's okay to change your mind....

[ileus]

25. We blame nurses for everything.

and here I sit, waiting for a nurse to screw something up so I'll get called in...

[MannyGoldstein]

26. The guy that apologized to Cheney

after Cheney shot him in the face?

Honorary nurse.