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As I've written about (here and here) poor systems, a lack of protocols, and not adhering to protocols and standard practices are almost always “system problems.” A lack of proper training about protocols is a system problem.
System problems are the responsibility of hospital management, plain and simple.
National Nurses United is right to call for better planning and better protection of nurses and other caregivers. See their release: “Ebola-RNs Call for Highest Standards for Protective Equipment, including Hazmat Suits and Training.”
However, I think it's a bit of a straw man argument to say that recent news stories about the Dallas nurse, Nina Pham, who contracted Ebola through the treatment of Thomas Eric Duncan is “being blamed” for not following protocols.
I haven't read anything that said the nurse is anything other than a victim. I don't see blaming taking place. Maybe the general public reacts that way (ah, she's a bad nurse and she screwed up), but you can't control people's reactions.
If the nurse wasn't trained properly on Ebola protocols, including how to properly de-gown, she was a victim.
If the nurse was tired at the end of a long shift and wasn't properly supervised in how she worked or de-gowned (to prevent an inadvertent infection caused by touching her face with a dirty glove, as happened in Spain), she was a victim.
I guess the media can re-emphasize the systems component here.
From the NNU release (from what appears to be an unscientific survey):
Current findings show:
- 76 percent still say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
- 85 percent say their hospital has not provided education on Ebola with the ability for the nurses to interact and ask questions
- 37 percent say their hospital has insufficient current supplies of eye protection (face shields or side shields with goggles) for daily use on their unit; 36 percent say there are insufficient supplies of fluid resistant/impermeable gowns in their hospital
- 39 percent say their hospital does not have plans to equip isolation rooms with plastic covered mattresses and pillows and discard all linens after use; only 8 percent said they were aware their hospital does have such a plan in place
Lack of planning, lack of education, lack of communication — system problems.
Not having enough supplies and not having the right equipment — system problems.
Hospitals need to step up and prepare. It would have been better if this was already happening, but the wake up call has hopefully taken place.
The CDC says existing protocols are sufficient:
Frieden said investigators have yet to determine how Pham was infected. He stood by the protocols — including the use of masks, gloves and other equipment — saying they have proven safe for health care workers for decades.
Yet, officials want to establish an “official Ebola hospital” in each state.
“We'd like to have at least one hospital in every state that does feel they could manage a patient from start to finish.”
Maybe that doesn't speak well to the level of planning, or lack thereof that has already taken place.
Officials seem to be contradicting each other, with some saying things like “most American hospitals can safely treat Ebola” but others say “I don't think every hospital has the facilities or the wherewithal, or for that matter the desire, to care for Ebola patients.” Hmmm. We have to sort this out.
Nebraska Medical Center and Emory Medical Center are two of the existing Ebola centers. Maybe it's no surprise that they have both treated Ebola patients without any reported infections of staff. Do they have better processes and better training? Better supplies and equipment?
As the WSJ reports:
“The people at Emory have been training for, get this, 12 years,” said Trish Perl, a professor of medicine and a senior epidemiologist at Johns Hopkins Health System in Baltimore. “They have teams that are well-formed and well-developed.”
The news stories and recent actions paint a picture, to me, of a lack of planning. You could blame the CDC. You could blame hospital management. But don't blame the nurses and individual caregivers. We need to protect them as they serve and care for others. That's also a key step, it seems, in protecting the public.
What do you see happening (or not happening) in your hospital? Remember, you can post anonymous comments here, if y0u want.
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