A Better Emergency

Reposted from:
http://www.abetteremergency.com/blog/ola outbreak and response: it’s time to learn the real lesson

The reaction to the Ebola outbreak reminds me of the response to HIV when it first presented. In my early days of working on the ambulance, blood was not viewed as a bad thing. Gloves were rarely used except when delivering a child.

HIV changed all of that. This disease caused AIDS — there was no cure and death seemed to be assured if contracted. We begrudgingly started to wear gloves, but only after it became clear that dispatch could not give us a heads up the caller might have AIDS. Expecting dispatch to uncover an Ebola patient is an exercise in futility, too.

Determining what level of PPE is appropriate based upon information that a 9-1-1 operator can determine is never a good idea. Adopt precautions for every patient based upon a standard assessment of risk. Else, face the threat of exposure from numerous diseases spread via direct contact with body fluids or as droplets on hard surfaces.

My opinion does not align with current thinking. The current CDC interim guidance for EMS and 9-1-1 Public safety Answering Points (PSAPs) states:

When risk of Ebola is elevated in a community, it is important for PSAPs to question callers about:
Residence in, or travel to, a country where an Ebola outbreak is occurring (Guinea, Liberia, Sierra Leone) or Mali
Signs and symptoms of Ebola (such as fever, vomiting, diarrhea) and
Other risk factors, such as direct contact with someone who is sick with Ebola.
PSAPS should tell EMS personnel this information before they get to the location so they can put on the correct PPE following proper procedures.
EMS staff should immediately check for symptoms and risk factors for Ebola. Staff should notify the receiving healthcare facility in advance when they are bringing a patient with suspected Ebola, so that proper infection control precautions can be taken at the healthcare facility before EMS arrives with the patient.
Is the risk of Ebola in communities more elevated than the risk from HIV, MRSA or Hepatitis? Should PPE only be used following proper procedures when there is a risk of Ebola? Should hospitals wait for EMS crews to give them a heads up on when they should use proper infection control procedures?

This guidance says we don’t think it’s important to worry about proper use of PPE or utilizing proven infection control processes until we are faced with a disease that impacts the healthcare worker. By not consistently using good infection control procedures, health care workers contribute to the estimated 1.7 million infections and 99,000 deaths associated with Hospital Acquired Infections (HAI) each year. What does it take to institutionalize better infection control procedures given these numbers?

Police officers are taught that hands kills. I’m an advocate for healthcare providers adopting a similar mind set when it comes to infection control. They can and do pass disease from one patient to another and take disease home. I think the lessons we should learn from Ebola, or any contagious disease outbreak, are:

1. Process beats products. You may have the best PPE or cleaning and sanitation products, but improperly used, these may contribute to the spread of disease.

2. Read the labels. Follow manufacturer recommendations when it comes to proper use. Not all products works in every case. Base product use off of the Hazard Vulnerability Analysis. For example, cruise ships are prone to the Norwalk virus, an organism much harder to kill than the Ebola virus. Don’t suddenly start worrying about Ebola when it is probably the least likely disease to be found in your work environment.

3. Understand contact time. Products may have a kill claim for an organism, but read the fine print. It’s based on contact time. Rushing through a recently discharged patient’s room to prepare it for re-occupancy is a great way to pass disease from the previous patient on to the next.

Interested in assessing how well your infection control processes are? Want to improve them to keep your employees and patients safe? Contact me at abetteremergency@gmail.com.

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