Fair Use Cited:
This is an inside story from some registered nurses at Texas Health Presbyterian Hospital in Dallas who have familiarity with what occurred at the hospital following the positive Ebola infection of first the late Thomas Eric Duncan and then a registered nurse who cared for him Nina Pham.
The RNs contacted National Nurses United out of frustration with a lack of training and preparation. They are choosing to remain anonymous out of fear of retaliation.
The RNs who have spoken to us from Texas Health Presbyterian are listening in on this call and this is their report based on their experiences and what other nurses are sharing with them. When we have finished with our statement, we will have time for several questions. The nurses will have the opportunity to respond to your questions via email that they will send to us, that we will read to you.
We are not identifying the nurses for their protection, but they work at Texas Health Presbyterian and have knowledge of what occurred at the hospital.
They feel a duty to speak out about the concerns that they say are shared by many in the hospital who are concerned about the protocols that were followed and what they view were confusion and frequently changing policies and protocols that are of concern to them, and to our organization as well.
When Thomas Eric Duncan first came into the hospital, he arrived with an elevated temperature, but was sent home.
On his return visit to the hospital, he was brought in by ambulance under the suspicion from him and family members that he may have Ebola.
Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present.
No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.
Subsequently a nurse supervisor arrived and demanded that he be moved to an isolation unit– yet faced resistance from other hospital authorities.
Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated.
There was no advance preparedness on what to do with the patient, there was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.
Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields. Some supervisors said that even the N-95 masks were not necessary.
The suits they were given still exposed their necks, the part closest to their face and mouth. They had suits with booties and hoods, three pairs of gloves, no tape.
For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own.
Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.
Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.
Patients who may have been exposed were one day kept in strict isolation units. On the next day were ordered to be transferred out of strict isolation into areas where there were other patients, even those with low-grade fevers who could potentially be contagious.
Were protocols breached? The nurses say there were no protocols.
Some hospital personnel were coming in and out of those isolation areas in the Emergency Department without having worn the proper protective equipment.
CDC officials who are in the hospital and Infectious Disease personnel have not kept hallways clean; they were going back and forth between the Isolation Pod and back into the hallways that were not properly cleaned, even after CDC, infectious control personnel, and doctors who exited into those hallways after being in the isolation pods.
Advance preparationAdvance preparation that had been done by the hospital primarily consisted of emailing us about one optional lecture/seminar on Ebola. There was no mandate for nurses to attend trainings, or what nurses had to do in the event of the arrival of a patient with Ebola-like symptoms.
This is a very large hospital. To be effective, any classes would have to offered repeatedly, covering all times when nurses work; instead this was treated like the hundreds of other seminars that are routinely offered to staff.
There was no advance hands-on training on the use of personal protective equipment for Ebola. No training on what symptoms to look for. No training on what questions to ask.
Even when some trainings did occur, after Mr. Duncan had tested positive for Ebola, they were limited, and they did not include having every nurse in the training practicing the proper way to don and doff, put on and take off, the appropriate personal protective equipment to assure that they would not be infected or spread an infection to anyone else.
Guidelines have now been changed, but it is not clear what version Nina Pham had available.
The hospital later said that their guidelines had changed and that the nurses needed to adhere to them. What has caused confusion is that the guidelines were constantly changing. It was later asked which guidelines should we follow? The message to the nurses was it’s up to you.
It is not up to the nurses to be setting the policy, nurses say, in the face of such a virulent disease. They needed to be trained optimally and correctly in how to deal with Ebola and the proper PPE doffing, as well as how to dispose of the waste.
In summary, the nurses state there have been no policies in cleaning or bleaching the premises without housekeeping services. There was no one to pick up hazardous waste as it piled to the ceiling.
They did not have access to proper supplies and observed the Infectious Disease Department and CDC themselves violate basic principles of infection control, including cross contaminating between patients. In the end, the nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own.
We want our facility to be recognized as a leader in responding to this crisis. We also want to recognize the other nurses as heroes who put their lives on the line for their patients every day when they walk in the door.
There were 77 hospital workers who came into direct contact with Mr. Duncan. Protocol would have minimized this number to an effective minimum so as to put fewer Medical Professionals at risk. Yet, as stated above (maybe you think they are merely "claims"?), there was No Plan Or Strategy, and no Effective Guidance. Look at the Nurse's Statement section above once more. Let it sink in how much DENIAL is at evidence here and throughout the American Healthcare System.
Previous article posted cites the Fact that there are only 3 private hospitals in the entire Nation which have any Level 4 Bio-Hazard patient facilities and that the total number of beds in these facilities is 13 or 14. Add National Inst. Of Health in MD, and the total comes up to 19 beds. Frontier Airlines is now seeking to contact 750 passengers (Now Updated to 900) who may have been exposed to Nurse Vinson's contagion. This would seem to indicate that the contagion remain active even after carrier or infected person has moved on.
CDC says hospitals in America are ready and every hospital can treat this disease. Read the statement of conditions and circumstances and consider if the CDC even understands the facility resources our Nation has to work with or the actual virulence of the virus/disease.
WE ARE ON OUR OWN! The only effective plan of action is self-quarantine, effort for avoidance.
Want to understand what we face? Read The Hot Zone by Richard Preston. Read the previously cited Flu Forums for discussion of news and commentaries.
Panic is not a solution. Consider what the African/Dallas Disease (you know its real name) will do to normal healthcare and all other forms of social interaction like business, shopping, manufacturing, education, I have previously discussed Just In Time Inventory plans placing obtainment of supplies, food, and equipment at risk. Since the middle-80s, American Medical Practice has been similarly "tuned" to try and maximize the value of the physician and support staff. Largely, this has not worked, and this comes from one who worked with several world-class medical practices and their administrators and lead physicians. American Medicine has no capacity to absorb this threat.
WE ARE LOOKING AT A SOCIAL BREAKDOWN POTENTIAL HERE. Haven't even addressed the lack of depth within the Utility Structure of our cities. All hands-on positions are very specialized technical occupations and there just aren't trained persons in reserve to step-in to do the work if more than a few of these personnel are out of the picture due to whatever reason.
I can only urge that you take all possible action for preservation of self and family. Self-quarantine, a voluntary isolation will require preparation and supply. The Time Is Now to acquire foodstuffs and some basic health supplies as well as assuring supplies for other basic home functioning needs are met. There will be a much greater emphasis on germ killing and prevention of infection. Lots to consider and plan for. May God Bless Your Efforts!