[MCOH-EH] MCOH-EH Digest, Vol 247, Issue 14

Hawks, Denise J hawks.denise at marshfieldclinic.org
Wed Oct 15 12:18:02 PDT 2014


We are an outpatient center with clinics everywhere in the central, north east and west of the state as well as Urgen Care and ASC's.
We have the same concerns with the CDC. I would customize the CDC hospital checklist to your facilities.
We have created a nurse line triage,  Urgent Care situation algorithm, and a center algorithm.
Amb. Surgery care is asking have you had travel and do you have a fever.

Because it is unknown the actual transmission, we know it is contact and droplet however the body fluids
Can also be aerosolized, we will be using N.95 masks and hoods.
I would say, do what it takes to protect your patients and staff. Call your HEICS team, incident command now 
Rather than later.
CDC website is good, just customize those areas that do not apply.
There is a nurse call with the CDC tomorrow, has everyone received this information?
I will send if not.

Dee Hawks RN MsM CIC
System Infection Prevention & Control Manager
Institute for Quality, Innovation & Patient safety
Marshfield Clinic
Marshfield WI 54449
1-715-387-5410


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-----Original Message-----
From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Marenick,Cheryl
Sent: Wednesday, October 15, 2014 1:31 PM
To: 'mcoh-eh at 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 at uchc.edu


 

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

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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 at watsonclinic.com>
To: 'MCOH/EH' <mcoh-eh at mylist.net>
Subject: [MCOH-EH] Ebola infected HCW
Message-ID: <4ADBC49F2610AB48BDED8CC66577A04103203FE43274 at 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
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Message: 2
Date: Mon, 13 Oct 2014 17:52:33 -0400
From: Mark Catlin <mark.catlin at seiu.org>
To: "MCOH/EH" <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
	<CAEErhHAa2MKbbB4BcLTJDshmPXiPKeYqn3Qy0aKocXeiyjdqPg at 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 at seiu.org

On Mon, Oct 13, 2014 at 5:30 PM, Band, Michael DO <MBand at 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 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.
>
> ---------------------------------------
> 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 at 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.
> ---------------------------------------
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> ---------------------------------------
> Send administrative requests to: drjoe at meditrax.com
> ---------------------------------------
>
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Message: 3
Date: Mon, 13 Oct 2014 22:51:01 +0000
From: "Thrasher, Terri" <Terri.Thrasher at cchmc.org>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
	<6D0F651D183C00439FDA321943976C13311FA20B at 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 at 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 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.
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Message: 4
Date: Mon, 13 Oct 2014 22:58:32 +0000
From: "Hudson, T. Warner" <TWHudson at mednet.ucla.edu>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
	<2134A5387858914BBE80D079ECF6880C3BD476C2 at 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 at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces at 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 at 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 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.

________________________________

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 at coh.org>
To: "MCOH/EH" <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID:
	<E007BC030513A144987D5A41E3A1DC5555E963CBCB at 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 at mylist.net] On Behalf Of Hudson, T. Warner [TWHudson at 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 at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>

From: MCOH-EH [mailto:mcoh-eh-bounces at 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 at 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 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.

________________________________

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: 6
Date: Tue, 14 Oct 2014 11:30:22 +0000
From: "Swift, Melanie" <melanie.swift at Vanderbilt.Edu>
To: MCOH/EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Ebola infected HCW
Message-ID: <D903F772-4E2E-49D5-87D3-EFD062BBFC07 at 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 at 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 at mylist.net] On Behalf 
> Of Hudson, T. Warner [TWHudson at 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 at mednet.ucla.edu<mailto:twhudson at mednet.ucla.edu>
> Website www.ohs.uclahealth.org<http://www.ohs.uclahealth.org>
> 
> From: MCOH-EH [mailto:mcoh-eh-bounces at 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 at 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 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.
> 
> ________________________________
> 
> 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 at 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 at meditrax.com
> ---------------------------------------



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

Subject: Digest Footer

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

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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 at mylist.net
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