Monday, October 13, 2014

Ebola Update: Breach in Protocol blamed for second infection in U.S. - Guidelines for Personal Protective Equipment (PPE)- Kansas patient isolated | USA Today/CDC


University of Kansas Hospital isolates patient, runs Ebola tests

Official says patient at low to moderate Ebola risk+KMBC 9 News Kansas City 

6:45 PM CDT Oct 13, 2014 
The University of Kansas Hospital said a person who came into the hospital with a high fever and other serious symptoms has been placed in isolation and is undergoing tests.

The patient had recently worked on a medical boat off the western coast of Africa, the region hit hard by Ebola. Officials said the patient is a medic who had been treating patients with a lot of different types of illnesses.

The hospital said that while doctors can't rule out the possibility of Ebola, the patient is at a low to moderate risk. Dr. Lee Norman said many other diseases fit the patient's symptoms.

The patient had been sick on the medical boat but showed signs of recovery after returning to the United States. On Sunday, the patient started to feel worse and came to the hospital.

'Breach in protocol' caused second U.S. Ebola infection USA Today 

A Dallas health care worker who provided care for Ebola victim Thomas Eric Duncan who died there last week has tested positive for the deadly virus. VPC

Rick Jervis and John Bacon, USA TODAY9:17 p.m. EDT October 12, 2014

DALLAS — A health care worker who cared for the Ebola patient who died last week tested positive for the deadly virus, sending health officials scrambling Sunday to find the "breach in protocol" that resulted in her infection.

The woman was among caregivers for Thomas Eric Duncan, who died Wednesday at Texas Health Presbyterian Hospital. A state test finding that she had Ebola was confirmed Sunday by the Centers for Disease Control and Prevention, making it the first known case transmitted in the U.S.

CDC chief Thomas Frieden said his agency will investigate how a worker in full protective gear contracted the virus.

"At some point there was a breach in protocol," Frieden said. "That breach in protocol resulted in this infection."

The White House said President Obama discussed the news with Health and Human Services Secretary Sylvia Burwell, directing that the CDC "investigation into the apparent breach in infection-control protocols at the Dallas hospital move as expeditiously as possible."

Dallas Police officers stood sentry outside the two-story beige-brick apartment building Sunday in the leafy East Dallas neighborhood where the patient lived. Across the street, a scrum of news media lined up along the curb. A few neighbors wandered over to survey the scene.

In patient's neighborhood, business as usual — almost

Lynda Edwards, who lives down the street, said she became alarmed when helicopters began hovering overhead around 7 a.m. and news crews began arriving.

"It's scary," she said, adding that televised news conferences from the CDC haven't eased her fears.

"It doesn't sound like we have a plan," Edwards said. "The public needs to know what the plan is."

The phone call from the CDC of the Ebola confirmation reached Dallas Mayor Mike Rawlings around midnight Saturday, triggering a new round of decontamination and new steps to reassure residents.

"I was disappointed but not surprised," Rawlings told USA TODAY. "The odds were we would have another one."

For the next seven hours, members of the Dallas Fire-Rescue Department descended on the apartment building where the infected medical worker lived and decontaminated everything outside and in the common areas of the building, including the laundry room, entrance way, elevator and hallways, he said. They did not enter the worker's apartment.

A man dressed in protective clothing leaves after treating
A man dressed in protective clothing leaves after treating the front porch and sidewalk. (Photo: Mike Stone, Getty Images)

As workers in hazmat suits scrubbed nearby, Rawlings personally walked through the neighborhood, talking to residents. As a precaution, the workers were ordered to do a second cleaning of all common areas.

"We knew the patient was being taken care of at the hospital," Rawlings said. "We focused on the safety of the city."

City and county officials, who are heading the response effort, will be increasing the number of people monitored by CDC staffers in Dallas, Rawlings said. At least 19 hospital staffers who dealt with Duncan during his two hospital visits were monitoring themselves for signs of Ebola. Now that group will be closely monitored by the CDC team, which includes taking their temperature twice a day, daily visits by CDC staff and restrictions on their movement, he said.

"This shows the system's working," Rawlings said. "That's what's making me feel most comfortable."

Rawlings said the patient's dog, still inside the apartment, will soon be sent to a new location to await a reunion with its owner. There were no plans to euthanize the dog as Spanish officials did in a case last week, he said.

The Ebola epidemic has killed more than 4,000 people in West Africa, the vast majority of them in Liberia, Guinea and Sierra Leone. In the U.S., tougher scrutiny for Ebola began Saturday at New York's Kennedy Airport, where federal Homeland Security officials began screening travelers from those nations, taking their temperature and observing them for other Ebola symptoms.


The Messy Truth about Ebola - CNN

Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Virus Disease in U.S. Hospitals

Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola virus disease (EVD) (See Table below). Note that this guidance outlines only those measures that are specific for EVD; additional infection control measures might be warranted if an EVD patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.).

Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients. This guidance is not intended to apply to persons outside of healthcare settings.
As information becomes available, these recommendations will be re-evaluated and updated as needed. These recommendations are based upon available information (as of July 30, 2014) and the following considerations:
  • High rate of morbidity and mortality among infected patients
  • Risk of human-to-human transmission
  • Lack of FDA-approved vaccine and therapeutics
  • For full details of standard, contact, and droplet precautions see 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Setting.

For information on symptoms of Ebola Virus Disease infection and modes of transmission, see the CDC Ebola Virus Disease Website.

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