SO I have been thinking about Nina Pham. Who is Nina? Well if you have to ask; then I think you should stop reading and go check your heart and soul. The Center for Disease Control and Prevention (CDC) has a poster that has been put out that shows you exactly how to put on and take off your Personal Protective Equipment (PPE) in case you have a patient in isolation for whatever reason.
However, I have been studying this poster and thinking about all my years of training; not only in the civilian world; but the military as well. What is missing from the poster? Can you guess?
The Poster provided to us by the CDC is shown as follows:
Well, have you guessed? What about the healthcare provider cover their hair or head? What is a patient with the EBOLA virus is having a coughing spell; or having massive diarrhea and you are the one having to help them and care for them? What if those small particles get on your head and hair? No, not possible? Then look at the next part of the CDC poster when you are to remove your PPE.
Look at numbers 2, 3, and 4 in the photo below. You have already taken off your gloves the way you have been trained; but then you reach up to remove your goggles; then untie or pull off your mask and at anytime in these steps it would be easy for a healthcare provider to brush against the back of their hair. TRUE, the next step is to wash your hands; however, what if you are hot and sweating and you forget and accidentally rub your face without even blinking and eye.
The average person touches his or her face 2000 times a day or more without even recalling that we did it. Just like driving home in the morning after a long twelve hour shift and cannot even recall what we did or saw because it has become automatic.
Well what does the World Health Organization (WHO) say about EBOLA and how to protect yourself? Well, they say that a provider should use rubber boots if at all possible; but if not available, then shoe covers. Did you hear me? Rubber boots!! This is what we used in the military during chemical warfare training. They also go on to say that "If an impermeable gown is not available, place waterproof apron over gown." Where is that in the CDC Protocol?
What about the products we use to clean and disinfect. The "Purple Top Super Sani-Wipes." How effective are they at killing the EBOLA virus? Have they been tested on this virus? Did you know it can live on inanimate objects outside the body for up to seven weeks? What is the kill time when using these products on this specific virus? Well, there is a lot of information out there to try and protect yourself; the only issue is there are a lot of conflicting protocols and standards and no one seems to be on the same page. Speaking of page; read page 29 in the CDC's Viral Hemorrhagic Fever Manual and you can see the conflicts I am referring too..
The WHO is much more specific in removing the PPE especially the mask, headgear,
and face shield.
This is only the tip of the Iceberg as when dealing with such a virulent pathogen; there really should be a designated spot between the clean and dirty side of the decontamination area as well as nurses should be using the buddy system. Did Nina have a buddy? What is the patient to nurse ration in Texas? Do they have one? These are all important questions that should have been raised before Nina stepped into the room. However, as nurse for over 20 years, I know that if one were to ask such simple questions you may get an answer of; "well if you do not like it, find another job."
Well, I am not advocating for nurses to walk off just yet; remember you took a pledge when you were pinned as a nurse.
"I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care."
Stay Safe and Speak Up! We are all in this together and we must rely on each other to get the truth out and save our own lives as well as our patients.