Ebola: N=2, Now What?

A lot of us woke up again to the horrible news that yet another health care worker in Dallas has acquired Ebola from the index patient during patient care. There are a lot of accusations flying around most of which will prove misleading or unfounded and some others might be true. We do not know. My sense of the situation is that what we learned from the first transmission still applies. We have further evidence that the standard way of wearing droplet/contact precautions during routine care of patients with pathogens like MRSA or Acinetobacter is ineffective in protecting health care workers.

Each hospital with an ICU must develop infection prevention training teams that utilize existing PPE protocols or adapt them to their local PPE supplies (e.g. their unique gowns, masks or PAPRs). These training teams must initially target experienced ICU nurses and physicians and this training must occur before any patients with Ebola can be cared for in their hospitals. You can't just practice this once. Most of us who have tried donning and doffing have failed to do it correctly the first time. We failed when there was no stress and no risk and will be much more likely to fail when focusing on the care of a sick patient. Once these trained cohorts of health care workers are established, they should be organized into buddy-teams. For example, while one trained ICU nurse provides care, another is watching his every move from donning of PPE, to caring for the patient, to doffing of PPE. The buddy must be in PPE themselves. The buddy's job is to be the second "infection control" brain for the nurse focusing on the clinical care. It is simply impossible to focus on critical care and PPE at the same time. Let's implement a system for success.

A final note today: I want to acknowledge the many many infection preventionists, hospital epidemiologists, ICU nurses, critical care physicians, emergency department staff, environmental services staff and the many unnamed others who are working tirelessly to prepare their hospitals. Most of their hard work will go unnoticed. Most of their hospitals will never care for a patient with Ebola but they are the backbone of our health care system. So, thank you!


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