Thursday, October 16, 2014
A Day Late...
On Wednesday I listened in on the teleconference held by National Nurses United on the topic of Ebola. I want to share some of the details of that webcast with you, because I think it's important for the public to get a picture of what is going on in health care from a health care provider's perspective, and how it could affect your health if you were to end up as a patient in a medical facility, regardless of what you come in to that facility for.
It's important to think about this, instead of listening to all the media hype, because they are great at scaring large segments of the public, and if you read the comment sections on any online news story, which I advise against, you will immediately see a list of diatribes from anti-Obama, anti-government, anti-everything psychotic rants that do nothing but finger the political party with which they disagree and blame them for this. The truth is much broader than that and it's a failure on many levels.
The fact is, you are highly unlikely to come in contact with Ebola in your usual everyday life. But I also want you to understand the magnitude of the problem because for those very few instances where there is an actual case of Ebola, it is a problem, the way it's been dealt with so far by hospital administrators and the government. And this needs to change.
I want you to understand that if you are admitted to a hospital for kidney stones, for example, and your nurses or doctors have been caring for a patient with Ebola, and have not followed proper procedures, your health could be at risk.
That said, nurses and doctors are human beings and they work for entities known as health care organizations aka hospitals and those hospitals have certain policies and procedures that they mandate the staff to follow when interacting with patients everywhere from signing admission paperwork to ordering meals to handwashing, not to mention handling isolation patients with highly contagious and deadly diseases.
The NNU teleconference started with statements from nurses stating their hospitals were unprepared, from all over the country. There were a few statements from nurses from other countries.
There was also the story of a Florida nurse who was "suspended indefinitely" for seeking her own information directly from the CDC, because her hospital did not provide the information.
The CDC did not act fast enough when it was known that there was a case of Ebola. The health care workers did not have the training or proper protection and for 3 days took care of the patient with less than adequate protection, even though the CDC's information on their website was dated June 2013 so we already knew that Ebola was a class 4 pathogen. The virus can live for up to 7 weeks outside the human body, so the disinfection process is much more intensive and specific than for many other pathogens.
The fact that hospital acquired infections from organisms much less dangerous and virulent than Ebola are epidemic in our health care system, even according to the CDC itself, to the tune of 1.7 million per year! and chronic understaffing of health care workers- from nurses to housekeepers, results in staff who are working being more likely to be rushed, pay less attention to detail, with more mistakes made, and important things missed.
Why the CDC did not immediately arrive in Texas is not known. Why did it take 3 days before the nurses caring for the first Ebola patient had barely adequate protection? Why did the administrators at the hospital allow the nurses working with Duncan to take care of other patients? Why did they not demand a visit from authorities to give them clear and immediate direction in handling this case? There are dozens of unanswered questions from the whole incident from the time Duncan arrived at the hospital the first time.
Where are the administrators of the Texas Presbyterian Hospital now? They are silent (CYA) hiding behind their lawyers, and of course bracing for legal action. They are no doubt formulating their defenses and not 100% concerned with health care at this point. After all, as a human being, you can only do so much. Here is the statement from the nurses at that hospital.
Why did the CDC tell the second nurse that it was okay for her to get on a plane? She should not have but she did seek their guidance. And that is what they told her. Two wrongs don't make a right. She should have used her own judgment in not getting on plane, but the CDC also should not have advised her to get on plane.
The plane that carried her from Cleveland was decontaminated. How many passengers could be exposed, probably few at the early stage of the disease but we all know that planes are filthy and not cleaned between flights, so there is a huge potential safety hazard to the public which the airline industry should be addressing now. Do we actually know how Ebola is spread at different points in the disease? What is the viral load at the beginning of symptoms as opposed to when the patient is extremely ill or dead? How are the virus particles spread- through the air? Or only by direct contact as they were saying. In the teleconference one of the scientists said that she was now changing her mind about how the virus might be spread, and it's possible that it could be airborne. We just don't know for sure yet.
So many pictures have surfaced in the news of workers wearing hazmat suits to transport patients and decontaminate. So why were the nurses not given this protection? The hazmat suits are Level 4 HazMat gear which is recommended for Ebola, Marburg, and several other types of extremely contagious pathogens. A secured area is required that will contain a method of decontaminating and removing the protective suits, the hazardous waste is handled in a completely different manner than most red bag waste in hospitals, and the rooms are cleaned and disinfected in an entirely different way than even most standard isolation rooms. Transporting and disposing of the waste (through incineration) requires another detailed and meticulous process. This is far beyond what is needed for meningitis, flu, TB, and other commonly encountered diseases in the U.S.
Employees who will be involved in any part of the process, from nurses to housekeepers to facilities and waste management people, will now have to be trained in flawless execution of these procedures. That costs money and takes time.
According to National Nurses United, it's a public policy failure, a result of long term underfunding of public health. The CDC’s budget for Public Health Emergency Preparedness fell from $1.1 billion in 2006 to $698 million in 2010 to $585 million last year. From 2008 to 2013, local health departments lost 48,300 jobs to layoffs and attrition, or about 15 percent. “Those job losses absolutely eroded the capabilities that would be needed if we had to deal with Ebola,” source: The CDC's funding had been cut in half over the past 6 years. Now we have a crisis.
Off the subject, but relevant, is the fact that so many public agencies have been underfunded. Take public education, for example. Eventually those chickens will come home to roost too. If the comment sections of any of the online news outlets are any indication, people have already lost the ability to think logically and critically, they just parrot the words of politically motivated hate spew.
National Nurses United is bargaining for adequate staffing, protection, and training. The ANA (American Nurses Association) has been much quieter, have not taken a strong and vocal stance. Nurses were the ones who made noise about it while the CDC and Texas hospital administrators, and administrators of hospitals all over the country were dragging their feet. We all know that if administrators had to go see a patient with Ebola you can bet they'd have the highest quality hazmat suits ever but with the workers they try to do it on the cheap. All about the bottom line.
Nurses are concerned with care and protection for patients and workers. Nurses will save your ass. In a pinch, count on a nurse.
There is a whistleblower hotline 1-888-381-4585 to call if your hospital is not taking adequate precautions. For more information firstname.lastname@example.org
The NNU says they will be not silenced and will not stop, will not back down to leadership or threats. Policymakers (Congress) are not helping, they need to take action. People and the public trust nurses, and for good reason. We are the ones screaming about this louder than anyone, and have acted to make changes in health care. (Except for maybe the news media, who have blown this all into a scare crisis to boost their own bottom lines.)
If you are a nurse or health care worker in a place that accepts patients from the public (urgent care, hospital, ER) and your employer has not yet come up with any sort of plan to address potential cases of Ebola and shared at least the relevant information with you, then you ought to be looking for a new job, and at the very least, blowing the whistle. There is nothing wrong with opening your mouth. You might save lives. Too many nurses have been silent about safety issues in situations far less deadly than this one. It's time to stop that submission to power and threats, and do what you know is right.
So if any heads should roll, let's start with the director of the CDC, the Texas hospital administrators, the administrators at the Florida hospital, and any other people who tried to suppress the actions of nurses who were acting in the interest of public health.
And if Congress does not act, their heads too. Election year or not, they better do something. We have a problem in this country, and it is our elected officials' addiction to power and money.
The bottom line is, there are a lot more important things than profit. If we would start valuing those things, like public health, and education, in a spirit of compassion and respect for our fellow human beings, it would go a long way toward solving so many of these crises before they even become crises.