WHO has provided a guide for HC workers regarding appropriate PPE when caring for patients suspected of being infevted with Ebola. I am sure Emory Healthcare in Atlanta Ga would also share best practices with you
Kathy Dayvault RN BSN MPH COHN-S/CM
Sent via the Samsung Galaxy Mega™, an AT&T 4G LTE smartphone


-------- Original message --------
From: "Marenick,Cheryl"
Date:10/15/2014 13:30 (GMT-06:00)
To: "'mcoh-eh@mylist.net'"
Subject: Re: [MCOH-EH] MCOH-EH Digest, Vol 247, Issue 14

I wish this group would weigh in on the Ebola issue here!
This has caught many facilities off guard and administration, IC, Epidemiology, are scrambling to produce effective policies and procedures for protecting HCW with this outbreak.
The fact that the information going form the CDC is conflicted and still evolving makes me uneasy as to what should be the most effective treatment, protection, and information we can give our employees and patients.
If the group has anything to share, it would be most appreciated.

Cheryl J Marenick RN BSN MPH CN3
UCONN Health
Occupational Medicine/Employee Health Services
Farmington, CT 06033-6210
Ph (860)679-8327
Fx (860)679-1256
cmarenick@uchc.edu




-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of mcoh-eh-request@mylist.net
Sent: Tuesday, October 14, 2014 7:31 AM
To: mcoh-eh@mylist.net
Subject: MCOH-EH Digest, Vol 247, Issue 14

Send MCOH-EH mailing list submissions to
mcoh-eh@mylist.net

To subscribe or unsubscribe via the World Wide Web, visit
http://mylist.net/listinfo/mcoh-eh
or, via email, send a message with subject or body 'help' to
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When replying, please edit your Subject line so it is more specific than "Re: Contents of MCOH-EH digest..."


Today's Topics:

   1.  Ebola infected HCW (Band, Michael DO)
   2. Re:  Ebola infected HCW (Mark Catlin)
   3. Re:  Ebola infected HCW (Thrasher, Terri)
   4. Re:  Ebola infected HCW (Hudson, T. Warner)
   5. Re:  Ebola infected HCW (Johnson, Cathreen)
   6. Re:  Ebola infected HCW (Swift, Melanie)


----------------------------------------------------------------------

Message: 1
Date: Mon, 13 Oct 2014 17:30:58 -0400
From: "Band, Michael DO" <MBand@watsonclinic.com>
To: 'MCOH/EH' <mcoh-eh@mylist.net>
Subject: [MCOH-EH] Ebola infected HCW
Message-ID: <4ADBC49F2610AB48BDED8CC66577A04103203FE43274@Exchange07>
Content-Type: text/plain; charset="us-ascii"

I thought I would start the discussion on this topic.  I am surprised how quiet we are.

Something about Ebola does not pass my "sniff test."  I have always been disturbed that HCWs have been infected from patient care in Africa and now one of our HCWs has become infected.  Are we missing something?

I told our committee reviewing Ebola planning I disagreed with the Ebola PPE removal process as recommended by CDC.  They recommend removing gloves first and then removing rest of PPE with bare hand.   Seems like double gloving or donning a new pair of gloves would be better, then last step removing second set of gloves.

Is the spread through contact source still apply? Are we missing something?

Michael Band DO, MS
Watson Clinic
NOTICE OF CONFIDENTIALITY
---------------------------------------------------

The information in this email, including attachments, may be confidential and/or privileged and may contain confidential health information. 
This email is intended to be reviewed only by the individual or organization named as addressee. 
If you have received this email in error please notify Watson Clinic immediately by return message to the sender or to administrator@watsonclinic.com Destroy all copies of this message and any attachments. 
Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of Watson Clinic. 
Confidential health information is protected by state and federal law, including, but not limited to:
The Health Insurance Portability and Accountability Act of 1996 and related regulations.
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Message: 2
Date: Mon, 13 Oct 2014 17:52:33 -0400
From: Mark Catlin <mark.catlin@seiu.org>
To: "MCOH/EH" <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
<CAEErhHAa2MKbbB4BcLTJDshmPXiPKeYqn3Qy0aKocXeiyjdqPg@mail.gmail.com>
Content-Type: text/plain; charset="utf-8"

Thanks Michael for starting this discussion.

With the Ebola  transmission to the nurse in Texas over the weekend, this issue requires discussion from groups like this one.

While some of our hospital employers are stepping up and trying to figure out the complex site specific procedures and policies to implement the CDC guidance for Ebola (or better), other hospitals are doing nothing or next to nothing to prepare.  Without these site specific plans, no amount of training of front-line healthcare workers, no amount of care taken by workers or wearing of PPE will be effective.

Many lesson have been learned that could be useful to consider from those in the environmental field over the past 30 years regarding donning, wearing and working in and doffing of contaminated PPE and equipment.

I look forward to sharing good ideas and solutions and learning lessons from everyone.

Sincerely,


Mark Catlin

Health and Safety Director
SEIU
1800 Massachusetts Ave NW
Washington, DC 20036
(202) 730 - 7290
(202) 436 - 0856 cell
mark.catlin@seiu.org

On Mon, Oct 13, 2014 at 5:30 PM, Band, Michael DO <MBand@watsonclinic.com>
wrote:

>  I thought I would start the discussion on this topic.  I am surprised
> how quiet we are.
>
>
>
> Something about Ebola does not pass my ?sniff test.?  I have always
> been disturbed that HCWs have been infected from patient care in
> Africa and now one of our HCWs has become infected.  Are we missing something?
>
>
>
> I told our committee reviewing Ebola planning I disagreed with the
> Ebola PPE removal process as recommended by CDC.  They recommend removing gloves
> first and then removing rest of PPE with bare hand.   Seems like double
> gloving or donning a new pair of gloves would be better, then last
> step removing second set of gloves.
>
>
>
> Is the spread through contact source still apply? Are we missing something?
>
>
>
> Michael Band DO, MS
>
> Watson Clinic
>
> NOTICE OF CONFIDENTIALITY
> ---------------------------------------------------
>
> The information in this email, including attachments, may be
> confidential and/or privileged and may contain confidential health
> information.
> This email is intended to be reviewed only by the individual or
> organization named as addressee.
> If you have received this email in error please notify Watson Clinic
> immediately by return message to the sender or to
> administrator@watsonclinic.com Destroy all copies of this message and
> any attachments.
> Please note that any views or opinions presented in this email are
> solely those of the author and do not necessarily represent those of
> Watson Clinic.
> Confidential health information is protected by state and federal law,
> including, but not limited to:
> The Health Insurance Portability and Accountability Act of 1996 and
> related regulations.
>
> ---------------------------------------
> The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
> List membership is free, but only subscribers may post to the list.
> To post send messages to: mcoh-eh@mylist.net To become a subscriber,
> or to change your subscription options (turn off
> email while you're on vacation, etc):   http://www.mcoh-eh.net
> MediTrax / Occupational Health Systems, Inc. provides financial
> support to ensure the list remains a free resource for the
> occupational health community.
> ---------------------------------------
> List archives (public): http://mylist.net/archives/mcoh-eh/
> ---------------------------------------
> Send administrative requests to: drjoe@meditrax.com
> ---------------------------------------
>
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Message: 3
Date: Mon, 13 Oct 2014 22:51:01 +0000
From: "Thrasher, Terri" <Terri.Thrasher@cchmc.org>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
<6D0F651D183C00439FDA321943976C13311FA20B@MCEXMB1.chmccorp.cchmc.org>
Content-Type: text/plain; charset="us-ascii"

At Cincinnati Children's we are planning double gloving so that one set of gloves is removed at the end of the doffing

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Band, Michael DO
Sent: Monday, October 13, 2014 5:31 PM
To: 'MCOH/EH'
Subject: [MCOH-EH] Ebola infected HCW

I thought I would start the discussion on this topic.  I am surprised how quiet we are.

Something about Ebola does not pass my "sniff test."  I have always been disturbed that HCWs have been infected from patient care in Africa and now one of our HCWs has become infected.  Are we missing something?

I told our committee reviewing Ebola planning I disagreed with the Ebola PPE removal process as recommended by CDC.  They recommend removing gloves first and then removing rest of PPE with bare hand.   Seems like double gloving or donning a new pair of gloves would be better, then last step removing second set of gloves.

Is the spread through contact source still apply? Are we missing something?

Michael Band DO, MS
Watson Clinic

NOTICE OF CONFIDENTIALITY
---------------------------------------------------

The information in this email, including attachments, may be confidential and/or privileged and may contain confidential health information.
This email is intended to be reviewed only by the individual or organization named as addressee.
If you have received this email in error please notify Watson Clinic immediately by return message to the sender or to administrator@watsonclinic.com<mailto:administrator@watsonclinic.com>
Destroy all copies of this message and any attachments.
Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of Watson Clinic.
Confidential health information is protected by state and federal law, including, but not limited to:
The Health Insurance Portability and Accountability Act of 1996 and related regulations.
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------------------------------

Message: 4
Date: Mon, 13 Oct 2014 22:58:32 +0000
From: "Hudson, T. Warner" <TWHudson@mednet.ucla.edu>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
<2134A5387858914BBE80D079ECF6880C3BD476C2@SOPEXMB2.ad.medctr.ucla.edu>
Content-Type: text/plain; charset="us-ascii"

Same at UCLA; monitor for donning, use and doffing; 2:1 nurse: patient ratio; CAPRs (Maxair) in ICU care team, dedicated ebola team, and probably N95 for others in addition to the rest of the full PPE.   I noticed WHO has convened a group of  about a dozen top experts to relook a the science; as I recall Peter Piot is chairing it, and I see CDC is relooking at best approach:  http://www.cidrap.umn.edu/news-perspective/2014/10/ebola-texas-nurse-triggers-changes-battle-plan.  This is one of those things we need to get right and learn from what's not working as we want.

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health UCLA Health System and Campus Office 310.825.9146 Fax 310.206.4585 Pager 800.233.7231  ID 27132 E-mail twhudson@mednet.ucla.edu<mailto:twhudson@mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Thrasher, Terri
Sent: Monday, October 13, 2014 3:51 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Ebola infected HCW

At Cincinnati Children's we are planning double gloving so that one set of gloves is removed at the end of the doffing

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Band, Michael DO
Sent: Monday, October 13, 2014 5:31 PM
To: 'MCOH/EH'
Subject: [MCOH-EH] Ebola infected HCW

I thought I would start the discussion on this topic.  I am surprised how quiet we are.

Something about Ebola does not pass my "sniff test."  I have always been disturbed that HCWs have been infected from patient care in Africa and now one of our HCWs has become infected.  Are we missing something?

I told our committee reviewing Ebola planning I disagreed with the Ebola PPE removal process as recommended by CDC.  They recommend removing gloves first and then removing rest of PPE with bare hand.   Seems like double gloving or donning a new pair of gloves would be better, then last step removing second set of gloves.

Is the spread through contact source still apply? Are we missing something?

Michael Band DO, MS
Watson Clinic

NOTICE OF CONFIDENTIALITY
---------------------------------------------------

The information in this email, including attachments, may be confidential and/or privileged and may contain confidential health information.
This email is intended to be reviewed only by the individual or organization named as addressee.
If you have received this email in error please notify Watson Clinic immediately by return message to the sender or to administrator@watsonclinic.com<mailto:administrator@watsonclinic.com>
Destroy all copies of this message and any attachments.
Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of Watson Clinic.
Confidential health information is protected by state and federal law, including, but not limited to:
The Health Insurance Portability and Accountability Act of 1996 and related regulations.

________________________________

IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
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------------------------------

Message: 5
Date: Mon, 13 Oct 2014 21:52:47 -0700
From: "Johnson, Cathreen" <CaJohnson@coh.org>
To: "MCOH/EH" <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
<E007BC030513A144987D5A41E3A1DC5555E963CBCB@EXCHMBX2.coh.org>
Content-Type: text/plain; charset="windows-1252"

Hello,

Not sure about protocol with the list.  May I forward these emails to my Infection Prevention team?  Thank you for the discussion.

Thank you,

Cathreen Johnson  FNPc
Employee Health
City of Hope
________________________________________
From: MCOH-EH [mcoh-eh-bounces+cajohnson=coh.org@mylist.net] On Behalf Of Hudson, T. Warner [TWHudson@mednet.ucla.edu]
Sent: Monday, October 13, 2014 3:58 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Ebola infected HCW

Same at UCLA; monitor for donning, use and doffing; 2:1 nurse: patient ratio; CAPRs (Maxair) in ICU care team, dedicated ebola team, and probably N95 for others in addition to the rest of the full PPE.   I noticed WHO has convened a group of  about a dozen top experts to relook a the science; as I recall Peter Piot is chairing it, and I see CDC is relooking at best approach:  http://www.cidrap.umn.edu/news-perspective/2014/10/ebola-texas-nurse-triggers-changes-battle-plan.  This is one of those things we need to get right and learn from what?s not working as we want.

T. Warner Hudson, MD FACOEM, FAAFP
Medical Director, Occupational and Employee Health UCLA Health System and Campus Office 310.825.9146 Fax 310.206.4585 Pager 800.233.7231  ID 27132 E-mail twhudson@mednet.ucla.edu<mailto:twhudson@mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Thrasher, Terri
Sent: Monday, October 13, 2014 3:51 PM
To: MCOH/EH
Subject: Re: [MCOH-EH] Ebola infected HCW

At Cincinnati Children?s we are planning double gloving so that one set of gloves is removed at the end of the doffing

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Band, Michael DO
Sent: Monday, October 13, 2014 5:31 PM
To: 'MCOH/EH'
Subject: [MCOH-EH] Ebola infected HCW

I thought I would start the discussion on this topic.  I am surprised how quiet we are.

Something about Ebola does not pass my ?sniff test.?  I have always been disturbed that HCWs have been infected from patient care in Africa and now one of our HCWs has become infected.  Are we missing something?

I told our committee reviewing Ebola planning I disagreed with the Ebola PPE removal process as recommended by CDC.  They recommend removing gloves first and then removing rest of PPE with bare hand.   Seems like double gloving or donning a new pair of gloves would be better, then last step removing second set of gloves.

Is the spread through contact source still apply? Are we missing something?

Michael Band DO, MS
Watson Clinic

NOTICE OF CONFIDENTIALITY
---------------------------------------------------

The information in this email, including attachments, may be confidential and/or privileged and may contain confidential health information.
This email is intended to be reviewed only by the individual or organization named as addressee.
If you have received this email in error please notify Watson Clinic immediately by return message to the sender or to administrator@watsonclinic.com<mailto:administrator@watsonclinic.com>
Destroy all copies of this message and any attachments.
Please note that any views or opinions presented in this email are solely those of the author and do not necessarily represent those of Watson Clinic.
Confidential health information is protected by state and federal law, including, but not limited to:
The Health Insurance Portability and Accountability Act of 1996 and related regulations.

________________________________

IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
-------------- next part --------------

---------------------------------------------------------------------
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Because this e-mail has been sent without encryption, individuals other than the intended recipient may be able to view the information, forward it to others or tamper with the information without the knowledge or consent of the sender. If you are not the intended recipient, or the employee or person responsible for delivering the message to the intended recipient, any dissemination, distribution or copying of the communication is strictly prohibited. If you received the communication in error, please notify the sender immediately by replying to this message and deleting the message and any accompanying files from your system. If, due to the security risks, you do not wish to receive further communications via e-mail, please reply to this message and inform the sender that you do not wish to receive further e-mail from the sender. (fpc5p)
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------------------------------

Message: 6
Date: Tue, 14 Oct 2014 11:30:22 +0000
From: "Swift, Melanie" <melanie.swift@Vanderbilt.Edu>
To: MCOH/EH <mcoh-eh@mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID: <D903F772-4E2E-49D5-87D3-EFD062BBFC07@Vanderbilt.Edu>
Content-Type: text/plain; charset="Windows-1252"

Yes, unless the person who shared expressly requests not to share. In which case they'd probably not post it!

Melanie Swift, MD
Medical Director, Vanderbilt Occupational Health Clinic occupationalhealth.vanderbilt.edu

Excuse any typos please - Sent from my iPad.

> On Oct 13, 2014, at 11:54 PM, Johnson, Cathreen <CaJohnson@coh.org> wrote:
>
> Hello,
>
> Not sure about protocol with the list.  May I forward these emails to my Infection Prevention team?  Thank you for the discussion.
>
> Thank you,
>
> Cathreen Johnson  FNPc
> Employee Health
> City of Hope
> ________________________________________
> From: MCOH-EH [mcoh-eh-bounces+cajohnson=coh.org@mylist.net] On Behalf
> Of Hudson, T. Warner [TWHudson@mednet.ucla.edu]
> Sent: Monday, October 13, 2014 3:58 PM
> To: MCOH/EH
> Subject: Re: [MCOH-EH] Ebola infected HCW
>
> Same at UCLA; monitor for donning, use and doffing; 2:1 nurse: patient ratio; CAPRs (Maxair) in ICU care team, dedicated ebola team, and probably N95 for others in addition to the rest of the full PPE.   I noticed WHO has convened a group of  about a dozen top experts to relook a the science; as I recall Peter Piot is chairing it, and I see CDC is relooking at best approach:  http://www.cidrap.umn.edu/news-perspective/2014/10/ebola-texas-nurse-triggers-changes-battle-plan.  This is one of those things we need to get right and learn from what?s not working as we want.
>
> T. Warner Hudson, MD FACOEM, FAAFP
> Medical Director, Occupational and Employee Health UCLA Health System
> and Campus Office 310.825.9146 Fax 310.206.4585 Pager 800.233.7231  ID
> 27132 E-mail twhudson@mednet.ucla.edu<mailto:twhudson@mednet.ucla.edu>
> Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>
>
> From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of
> Thrasher, Terri
> Sent: Monday, October 13, 2014 3:51 PM
> To: MCOH/EH
> Subject: Re: [MCOH-EH] Ebola infected HCW
>
> At Cincinnati Children?s we are planning double gloving so that one
> set of gloves is removed at the end of the doffing
>
> From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Band,
> Michael DO
> Sent: Monday, October 13, 2014 5:31 PM
> To: 'MCOH/EH'
> Subject: [MCOH-EH] Ebola infected HCW
>
> I thought I would start the discussion on this topic.  I am surprised how quiet we are.
>
> Something about Ebola does not pass my ?sniff test.?  I have always been disturbed that HCWs have been infected from patient care in Africa and now one of our HCWs has become infected.  Are we missing something?
>
> I told our committee reviewing Ebola planning I disagreed with the Ebola PPE removal process as recommended by CDC.  They recommend removing gloves first and then removing rest of PPE with bare hand.   Seems like double gloving or donning a new pair of gloves would be better, then last step removing second set of gloves.
>
> Is the spread through contact source still apply? Are we missing something?
>
> Michael Band DO, MS
> Watson Clinic
>
> NOTICE OF CONFIDENTIALITY
> ---------------------------------------------------
>
> The information in this email, including attachments, may be
> confidential and/or privileged and may contain confidential health information.
> This email is intended to be reviewed only by the individual or organization named as addressee.
> If you have received this email in error please notify Watson Clinic
> immediately by return message to the sender or to
> administrator@watsonclinic.com<mailto:administrator@watsonclinic.com>
> Destroy all copies of this message and any attachments.
> Please note that any views or opinions presented in this email are
> solely those of the author and do not necessarily represent those of Watson Clinic.
> Confidential health information is protected by state and federal law, including, but not limited to:
> The Health Insurance Portability and Accountability Act of 1996 and related regulations.
>
> ________________________________
>
> IMPORTANT WARNING: This email (and any attachments) is only intended for the use of the person or entity to which it is addressed, and may contain information that is privileged and confidential. You, the recipient, are obligated to maintain it in a safe, secure and confidential manner. Unauthorized redisclosure or failure to maintain confidentiality may subject you to federal and state penalties. If you are not the intended recipient, please immediately notify us by return email, and delete this message from your computer.
> <mg_info.txt>
> ---------------------------------------
> The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
> List membership is free, but only subscribers may post to the list.
> To post send messages to: mcoh-eh@mylist.net
> To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   http://www.mcoh-eh.net
> MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
> ---------------------------------------
> List archives (public): http://mylist.net/archives/mcoh-eh/
> ---------------------------------------
> Send administrative requests to: drjoe@meditrax.com
> ---------------------------------------



------------------------------

Subject: Digest Footer

---------------------------------------
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh@mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   http://www.mcoh-eh.net
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Send administrative requests to: drjoe@meditrax.com
---------------------------------------
When replying to a message, PLEASE delete all footers, and all messages to which you're NOT replying, so the topic of your reply is immediately clear to other list members.

------------------------------

End of MCOH-EH Digest, Vol 247, Issue 14
****************************************

---------------------------------------
The MCOH-EH List is moderated by Joe Fanucchi MD FACOEM and Mike Band DO.
List membership is free, but only subscribers may post to the list.
To post send messages to: mcoh-eh@mylist.net
To become a subscriber, or to change your subscription options (turn off email while you're on vacation, etc):   http://www.mcoh-eh.net
MediTrax / Occupational Health Systems, Inc. provides financial support to ensure the list remains a free resource for the occupational health community.
---------------------------------------
List archives (public): http://mylist.net/archives/mcoh-eh/
---------------------------------------
Send administrative requests to: drjoe@meditrax.com
---------------------------------------