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October 21, 2014

CDC Announces Additional "Protocols" For Travelers Coming to US from Sierra Leone, Liberia, and Guinea

First of all, all travelers originating from those countries (whether by direct or indirect flight) will have to terminate at one of five specified airports, which I guess will supposedly be given additional training so they can perform better screenings.

But the only screening specified is... taking the passenger's temperature. Something we already know doesn't work.

This is obviously a political move designed to pretend that we're blocking ebola cases from entering the US. But the maneuver itself is calculated to not block potential ebola cases. Once again, we're relying on the taking-temperature "screening," which has failed to stop not one but two ebola-infected patients from traveling to or within the US.

Meanwhile, a Fox TV report stated that the CDC had announced new protocols for health care workers. I don't see a print story yet, and I forget the details mentioned. However, the new protocols, broadly, were:

1. personal protective equipment (PPE) must not leave any skin exposed. I would have thought this would have been the old protocol, but apparently it's a new one.

2. Health care personnel must practice and drill putting on and taking off PPE. Again, the time for practice and drilling was five months ago, when ebola had a historically-unprecedented outbreak Africa.

3. The reporter mentioned something about a supervisor or "buddy" making sure that personnel were putting on and taking off their PPE properly.

Incidentally, they ran some B-roll of people drilling at putting on and taking off the PPE; it appears that medical personnel are leaving their gloves on until last. Taking off one's gloves first -- per the old protocol -- exposes the user to ebola when he touches a piece of ebola-infected gear (such as his face shield). I mentioned that as a flaw in the old protocols.

Five months after a historically-unprecedented outbreak, we're implementing these (still inadequate) protocols.

Here are the new "tightened" protocols. The CDC, five months too late.

Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola

The Centers for Disease Control and Prevention (CDC) is tightening previous infection control guidance for healthcare workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely.

Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.

The enhanced guidance is centered on three principles:

All healthcare workers undergo rigorous training and are practiced and competent with PPE, including putting it on and taking it off in a systemic manner

No skin exposure when PPE is worn

All workers are supervised by a trained monitor who watches each worker putting PPE on and taking it off.

All patients treated at Emory University Hospital, Nebraska Medical Center and the National Institutes of Health Clinical Center have followed the three principles. None of the workers at these facilities have contracted the illness.

Principle #1: Rigorous and repeated training

Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step putting on and taking off of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.

Principle #2: No skin exposure when PPE is worn

Given the intensive and invasive care that U.S. hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.

CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single-use, disposable full-face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:

Double gloves

We're just getting around to recommending double-gloves?

There is a list of PPE equipment which I'm omitting. To all of it, I say: We're just finally recommending this?


The guidance includes having:


Designated areas for putting on and taking off PPE. Facilities should ensure that space and layout allows for clear separation between clean and potentially contaminated areas

Trained observer to monitor PPE use and safe removal

Step-by-step PPE removal instructions that include:

Disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment

Um, why limit this to disinfecting visibly contaminated PPE?

Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.

I can't believe that this disinfection step -- of the gloves, which you'll be touching yourself with doing anything -- is only now recommended.

Principle #3: Trained monitor

CDC is recommending a trained monitor actively observe and supervise each worker putting PPE on and taking it off. This is to ensure each worker follows the step by step processes, especially to disinfect visibly contaminated PPE. The trained monitor can spot any missteps in real-time and immediately address.

This seemed obvious from the get-go. A nurse getting off a difficult and dangerous patient encounter -- cleaning up vomit, etc. -- is going to be jittery, exhausted, and scatter-brained. And she's not going to have muscle memory for taking off PPE after just a few hours of drilling (which, by the way, she's only now required to do).

You're going to need to have someone watching her each move, instructing her how to take off her equipment safely.

And yet it's only being recommended now.

digg this
posted by Ace at 12:46 PM

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