[MCOH-EH] Evola infected HCW
Sharon Petersen
Sharon.Petersen at imail.org
Tue Oct 14 13:15:54 PDT 2014
Our nursing leadership is discussing this issue and will make a recommendation for managing employees who refuse to care for an Ebola patient. I am very interested in how others are approaching this, although I think we need to be careful about being punitive. We should first try to understand why employees refuse to care for these patients and address those specific fears. Employees may not trust their PPE will protect them. They may feel the institution has not prepared them for taking care of someone with Ebola or they might not feel like their institution's program is inadequate for safely managing these patients.
Certainly there is a duty to prepare employees by providing appropriate training and protective equipment so they feel comfortable responding. With a solid plan in place for managing Ebola patients and Ebola rule-out patients, employees should have more confidence about caring for these patients. The plan to manage employees who still refuse should include compassionate decision making.
Does anyone have dedicated Ebola teams in their organization? Does anyone offer premium pay for employees who care for Ebola patients?
Sharon Petersen, MHA, BSN, RN, COHN/CM
Director, Employee Health Operations
Intermountain Healthcare
sharon.petersen at imail.org
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From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of mcoh-eh-request at mylist.net
Sent: Tuesday, October 14, 2014 1:00 PM
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Subject: MCOH-EH Digest, Vol 247, Issue 16
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Today's Topics:
1. Re: Policy Request (Hodgson, Michael - OSHA)
2. Re: [Bulk] Ebola infected HCW (Kathy Dayvault)
3. Re: [Bulk] Ebola infected HCW (Vaughn, Andrew I., M.D., M.P.H.)
4. Re: Ebola infected HCW (Borkowski, Michael)
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Message: 1
Date: Tue, 14 Oct 2014 12:54:00 +0000
From: "Hodgson, Michael - OSHA" <Hodgson.Michael at dol.gov>
To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Policy Request
Message-ID:
<a8812009595f47078f9f7452cef2cab2 at BY2PR09MB128.namprd09.prod.outlook.com>
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Many years ago the Veterans Health Administration terminated health care workers who refused to take care of AIDS patients, led by Susan Mather, the chief public health officer, and Ralph Depalma, the head of surgery ________________________________
From: MCOH-EH <mcoh-eh-bounces at mylist.net> on behalf of Kevin Matson <kevin.matson at nghs.com>
Sent: Tuesday, October 14, 2014 7:57:30 AM
To: mcoh-eh at mylist.net
Subject: [MCOH-EH] Policy Request
Does anyone have a policy they would be willing to share for how to manage staff who refuse to take care of certain patient populations? Most hospitals have a policy for allowing staff to refuse to care for patients when it conflicts with their cultural or religious beliefs. I'm looking for language that provides guidance for, as an example, a nurse refuses to care for a patient with suspected Ebola.
Anything you have is appreciated.
Thanks,
Kevin Matson, Director
Occupational Health & Safety
Interim Director Employee Relations & Retention Northeast Georgia Health System, Inc.
(770) 219-3957 (Office)
(678) 851-5317 (Cell)
kevin.matson at nghs.com<mailto:kevin.matson at nghs.com>
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Message: 2
Date: Tue, 14 Oct 2014 10:39:11 -0400
From: "Kathy Dayvault" <kdayvault11 at att.net>
To: "'MCOH/EH'" <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] [Bulk] Ebola infected HCW
Message-ID: <007301cfe7bc$9f24ca10$dd6e5e30$@att.net>
Content-Type: text/plain; charset="us-ascii"
Coming from a manufacturing environment it was hard to folks to look beyond worker failure as the source of the problem. When you create a safety culture, you look for the root cause of the issue.
I agree with you.removing gloves first seems problematic. Back in the 70's the disposable gowns had ties that were not easily torn in the institution that I worked in.
The thought is the back of the gown is less likely to be contaminated than the other parts and you wanted to keep contaminated gloves away from the skin while untying the gown.
With new emerging infectious diseases and easier gown design, it seems it is not necessary to remove gloves first unless soiled. For me personally, double gloving reduces dexterity.
I think we should look at design of isolation protection ( gowns, gloves,
etc.) and best practices.is it possible to have a decontamination area or other processes that reduce contamination and transmission?
Just some thoughts...
Kathy Dayvault RN, BSN, MPH, COHN-S/CM
JET Consulting
Independent Occupational Health Nurse Consultant
Kdayvault11 at att.net
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Band, Michael DO
Sent: Monday, October 13, 2014 5:31 PM
To: 'MCOH/EH'
Subject: [Bulk] [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
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Message: 3
Date: Tue, 14 Oct 2014 15:50:40 +0000
From: "Vaughn, Andrew I., M.D., M.P.H." <Vaughn.Andrew at mayo.edu>
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] [Bulk] Ebola infected HCW
Message-ID: <31062c$994af7 at ironport10.mayo.edu>
Content-Type: text/plain; charset="us-ascii"
I note that Mt. Sinai prefers the WHO approach to doffing PPE (see http://online.wsj.com/articles/new-york-health-system-opts-for-who-ebola-protocol-1413145347 and http://www.who.int/csr/disease/ebola/remove_ppequipment.pdf )
With regard to the presumed, unknown "protocol breach" that led to a nurse getting infected in Dallas, a recent news item said that the CDC isn't considering a respiratory route of infection because PAPRs were in use during aerosol-generating care. It would be good to know if/when the PAPR had last been flow-checked. The devices to do so are cheap ($25), and can identify clogged filters, weak/underpowered batteries, and other issues that may compromise effectiveness. PAPRS are certainly convenient, but their intrinsic complexity requires more care and attention than an N95.
- Andrew
Andrew Vaughn, MD MPH
Medical Director, Occupational & Environmental Safety Mayo Clinic, Rochester MN vaughn.andrew at mayo.edu
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Kathy Dayvault
Sent: Tuesday, October 14, 2014 9:39 AM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] [Bulk] Ebola infected HCW
Coming from a manufacturing environment it was hard to folks to look beyond worker failure as the source of the problem. When you create a safety culture, you look for the root cause of the issue.
I agree with you...removing gloves first seems problematic. Back in the 70's the disposable gowns had ties that were not easily torn in the institution that I worked in.
The thought is the back of the gown is less likely to be contaminated than the other parts and you wanted to keep contaminated gloves away from the skin while untying the gown.
With new emerging infectious diseases and easier gown design, it seems it is not necessary to remove gloves first unless soiled. For me personally, double gloving reduces dexterity.
I think we should look at design of isolation protection ( gowns, gloves, etc.) and best practices...is it possible to have a decontamination area or other processes that reduce contamination and transmission?
Just some thoughts.....
Kathy Dayvault RN, BSN, MPH, COHN-S/CM
JET Consulting
Independent Occupational Health Nurse Consultant Kdayvault11 at att.net<mailto:Kdayvault11 at att.net>
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Message: 4
Date: Tue, 14 Oct 2014 17:38:09 +0000
From: "Borkowski, Michael" <Michael.Borkowski at froedtert.com>
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
<3F3478AD8214E44296EB1A186F275BC65205A60E at FCHEXMBP01.fm.frd.fmlh.edu>
Content-Type: text/plain; charset="us-ascii"
Dr. Band
Thanks for generating discussion and support for infected/injured healthcare workers. Blaming the healthcare worker/victim by promulgating that a breach occurred in PPE use (without knowing or confirming it) has done nothing but enrage healthcare workers and their unions. Understandably.
We, too, double glove. Is that cause of this healthcare worker's infection? Perhaps.
"Are we missing something?" A respiratory component? Asymptomatic or pre-symptomatic viral shedding? Better direction from regulatory bodies?
We know that PPE is not 100% effective, so we need to work hard to ensure that we are not "...missing something."
Please continue to share best practices, articles and ideas.
Michael Borkowski, MD, MPH
Medical Director, F&MCW Occupational Health Services
Phone: 414-805-7997 | Fax: 414-805-7995 Cell Phone: 414-881-3762
E-mail: michael.borkowski at froedtert.com
Froedtert & the Medical College of Wisconsin Occupational Health Services
9200 West Wisconsin Avenue
Milwaukee, WI 53226
froedtert.com
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Band, Michael DO
Sent: Monday, October 13, 2014 4:31 PM
To: 'MCOH/EH'
Subject: [Marketing Mail] [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 at watsonclinic.com<mailto:administrator at 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.
Confidentiality Notice: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.
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