Healthcare environments and why, perhaps, Ebola cases are on the rise

Those who work in Health Care know, all too often and well, the challenges of following established protocols for worker and patient safety. Many times the equipment needed to follow these protocols is not readily available. "I'm ordering more, it just hasn't come yet." or similar excuses are offered by Central Supply personnel who, admittedly, aren't the ones on the front lines. Administration representatives go into hiding when a "new" protocol comes into play, mainly because they don't have the answers that they know they're going to be asked by those front line employees. And the worst, and possibly most common, challenge is that no one has actually updated or, even read, the protocol, don't really know where to find it, and, realistically, don't have the time to hunt it down.

Case in point: I was a newbie RN during the initial AIDS scare. I took intimate care of a patient with AIDS without, at first, knowing it. Was the diagnosis on his medical record? No. Did anyone in a supervisory role inform me or my co-workers of any precautions needed? No. Several months after this patient's death, the staff was informed that he had had AIDS and they were all welcome to be tested for this disease on the company's dime. I happened to have been informed, on the 'QT', by a fellow, yet senior, nurse who was on friendly terms with the doctor of record in the case. She didn't come out and say "So-and-so has AIDS," since she had promised this physician that she would keep the "secret." She did speak to me, while we had a moment alone, about AIDS. She suggested that there could be cases in our workplace that were being kept under wraps "to protect the patient's privacy." I got her gist and was more careful. I kept the secret of his diagnosis, but did talk about taking precautions with all patients to my co-workers whenever I felt the need.

Another time, there was a patient who exhibited what looked like herpes lesions and required treatment. Knowing this is a contagious condition, I reported it to my supervisor. She directed me to notify the MD for a treatment order and to "ask about infection control restrictions." I did so and was blasted by the MD for "wanting to ostracize this woman" by instituting any infection control protocols (ICPs). I assured him that was not my intent but that I was following directions from my superior. He did not back down and refused to offer any infection control directives. As it turns out, it really wasn't his decision anyway, it was the supervisor's call, but I didn't know that at the time. We ended up putting a table with gloves and gowns outside her door which the doctor, on his next visit, was livid about and succeeded in having removed by administration directive.

While serving, many years later, in a supervisory role, our facility was to care for a resident who, among other maladies, was infected with "C-diff" (clostridium difficile), a contagious bacterial infection that can effect those being treated with certain antibiotics. The ICP requires a series of steps to follow: separate bagging of linens and clothing, gowns and gloves, even goggles, for all personnel giving direct care or cleaning the immediate area. The admissions coordinator did not inform staff of the diagnosis; the patient was received and cared for by staff; and, some time later, when supporting staff (MDS, Wound Care, Care Plan teams) arrived to begin their review, the diagnosis was "discovered" and appropriate steps began to be implemented. Administrative nursing personnel, who dropped the ball initially, were notified and promptly poo-pooed the "overkill" in precautionary measures. Not one to be intimidated, at this later stage in my career, I assured my superior that we were merely following protocol as per the company policy and procedure manual and that to fail to do so would surely be in violation of state guidelines. And so ended that conversation.

This is the environment many healthcare workers have to deal with on a day-to-day basis, and I'm sure there are others in health care who have experienced similar scenarios. The main emphasis is to avoid scaring anyone, downplay the dangers to employees in the workplace, and, perhaps more importantly, avoid emphasizing the risks to other patients. This philosophy serves to promote continued confidence from the public sector (read: client base). Sadly, this is often carried out by discouraging the sharing of information about inherently dangerous situations.

According to the CDC, the simple answer in Dallas was "No," and at Emery University Hospital in Atlanta and the Nebraska Medical Center, apparently, the answer was "Yes." Success is difficult to argue with, and the latter two facilities were able to contain and prevent transmission of the disease to the workers who cared for the patients there. They obviously followed protocols that were in place and followed them properly.

The initial 10 person team that the CDC sent to Dallas on Sept. 30, 2014, somehow missed the boat. The CDC is now ramping up their efforts and have put new protocols in place there. They are reviewing the use of Personal Protective Equipment (PPE) and how it is being donned and doffed; they are reviewing medical procedures performed on the initial patient that could have exposed workers to contamination; they are checking on decontamination procedures done when leaving the isolation unit; and, they have established a continuous oversight of the use of PPE and decontamination procedures in the areas deemed isolated.

Further, the CDC has determined that PPE be standardized to include a specific type suit and that the application and removal of the suit and its parts follows their specific guidelines.

According to the most recent CDC fact sheet media release, "The single most important aspect of safe care of Ebola is to have a site manager at all times who oversees the putting on and taking off of PPE and the care given in the isolation unit. A site manager is now in place and will be at the hospital 24/7 as long as Ebola patients are receiving care."

This initial oversight may prove to be the culprit in the unfortunate spread of the Ebola virus to two of the workers at this Dallas hospital.