I work in an ER. In Texas. It’s not as big or as metro as the one in Dallas. We are not prepared. We don’t even have good TB isolation rooms, much less a plan to isolate anything like ebola. We certainly haven’t had a meeting about how to prepare for ebola should it arise in our area.
I can tell you how things likely went down when he presented to the ER sick the first time. He signed in, touching clip boards, pens, counters, etc. that other people then touched. He then sat in the lobby to wait for Triage. IF they were on the ball, they gave him a face mask, which since it’s “not airborne” wouldn’t matter at all.
Then he would have been called to Triage, had his vitals taken, and a quick 2-3 minute assessment would be done—just enough to determine if he needs to see a doctor, or if he can be fast-tracked for non-emergency conditions. Reports say he was thought to have a non-life-threatening condition, so the latter would have been the outcome. Mean time, in triage, he would sit in the same chair that others after him sit in, come in contact with pulse ox, BP cuff, and possibly part of the thermometer. These are not routinely wiped down completely between all patients at any hospital anywhere—it would make 3 minute Triage process take 10 minutes or more per person, and when you have people signing in to a large, busy ER at a rate of 20+ per hour, that’s not realistic. And since he had “just flu-like symptoms” it definitely wouldn’t have been done after him. Plus the nurse and maybe a tech in Triage would have made physical contact with him, and may or may not have cleaned their hands afterwards. In an ideal world, they would clean their hands after every patient contact. In the real world, a Triage nurse sees potentially hundreds of patients in a day, and it may not happen that they remember to rub alcohol cleaners on their hands 100+ times in a day. And even if he/she had, do regular alcohol cleaners kill ebola? We don’t know—it hasn’t been specifically addressed in any news reports I’ve seen.
Then he would head back out to the waiting room because hey, he wasn’t having an imminently life-threatening situation per reports, so there would have been no reason for him to go straight back. Perhaps he sat in a new seat and contaminated even more people.
Later (after unknown wait time) he would go to a room to be seen. In some hospitals, their fast tracks are large, open rooms containing chair or beds, sometimes divided by curtains and sometimes not, but almost never are they private rooms. After all, resources are limited, and these are non-emergent patients. We can all hope that all they at least cleaned their hands between all patients (rates nationwide hover around 50% for hand hygiene compliance among healthcare workers. It’s higher for nurses, lower for doctors).
Finally he would be discharged from the hospital to go home to rest and take his antibiotics. Anyone feel *more* confident about this hospital that sent him home with a presumed viral infection with a prescription for antibiotics?? How did he get home? Private car? Taxi? Bus? Walking? Did he stop at the pharmacy to fill his prescription on his way home? How many objects/people did he touch on his way? How long can ebola survive on dry surfaces? How often have you seen your pharmacist wiping down the counter between patrons? Even really sick-looking ones?
These are just surface thoughts. The extent of his contamination of the area could be staggering. Keep in mind also that this isn’t an “opportunistic” infection like TB that most people can actually be exposed to small amounts of the pathogen and not get sick if their immune systems aren’t weakened. We still have a whole lot of unknowns about this disease’s transmission process.
You are thinking it through...door handles handrails, counters, chairs, water fountains, bathroom fixtures, and almost endless list of common contact surfaces which could become contaminated and in turn, infect others. Add a couple of days of being sick, and we can only hope the patient stayed home and watched TV.
“Anyone feel *more* confident about this hospital that sent him home with a presumed viral infection with a prescription for antibiotics??”
Good catch there. I missed that one.
Then again, they were just following the traitor’s plan: take some asperin and go home to die.
Your comment made me ponder hand washing and nurses.
They may not wash their hands as often as they should.
When I cook dinner I wash my hands countless times. Constantly.
It makes my hands terribly dry even with gentle dish soap and lotion when I’m done for the day. Surgical soap and alcohol based “sanitizers” will really tear up skin if used constantly.
Nurses often have such beautiful hands and nails...
Excellent summary. My wife works at a hospital as well. She is in admin, but has spent a lot of time working with the ER as she is on, what I call, the SHTF committee to deal with mass injury events (plane crashes, pandemics, etc.)
The process of moving through her ER is EXACTLY what you describe.
What you don’t touch on is any language barrier, fear about “honest answers” and the impact on him and his family, and other problems with dealing with foreign patients.
When you combine the presentation is flu-like, the cultural differences in treatment, and the fact that most ERs are running on shoestring...it is a mixture that is rife with potential problems.
One difference is that her hospital has been doing all sorts of training lately—mostly because they are expecting a huge flu impact this year.
Thanks for your informative post. I hope you copied it. You will be posting it a lot in the coming days.
Mythbusters did a show about this same scenario. I think they used spreading a cold.
http://www.discovery.com/tv-shows/mythbusters/videos/flu-fiction.htm
Did the patient use the restroom? Could be very likely. What type of hygiene do they have? I don’t want to get gross, but can’t you spread microbes from feces and urine onto doorknobs upon exiting bathrooms? Could they carry them on their clothing when they sat down in a chair? If they wiped their wet hands on their pants after washing them, could there be any type of microbe transmission through the microscopic particles of water/moisture?
Don’t worry. Hussein Obama has everything under control.
I think I did read the Canadian health care guidelines that alcohol based hand cleaners do kill it. That link is in one the long Ebola thread of yesterday, the one w over a thousand replies, if you want to review recommended health protocols. I think it’s in the 700 or 750 post range. I don’t have time to look it up right now, sorry.
What kills it: hand rub of at least 60-90 percent alcohol; 1:10 dilutions of bleach at 5.25 percent( common household bleach) for 10 minutes; heat 30-60 minutes at 60 degC ; boiling for 5 minutes; radiation; ultraviolet light.
Prayers up for you and for all who may come into contact with this horror just in the course of doing their jobs.
I hope not for my fellow laboratorians but I suspect it happened.
Anyway now the hematology analyzer and parts of the lab have been exposed to potential viral particles.
Ha ha just wait till one of these ebola pts comes in as a code.