All north country hospitals are educating staff on how to protect themselves from potential Ebola infections and prevent the spread of the deadly virus.
But it takes practice, skill and patience to properly don and remove personal protective equipment for that or other hospital-acquired infections.
“We’re really looking out for our safety,” said Wendy D. Henry, nurse manager at , who led a recent training session.
At Samaritan, hair should be pulled up, all jewelry taken off, then surgical leg covers and a waterproof gown put on, followed by a mask that covers the mouth and nose and a face shield.
“We don’t want anything to splash up in our mucus membranes,” Mrs. Henry said, because an exchange of bodily fluids is how the Ebola virus spreads.
Once the shield is on, other personal protective equipment includes a surgical hood and two pairs of surgical gloves that go over the cuffs of the gown to avoid potential skin-to-skin contact. The only visible skin on intensive care unit registered nurse Debra A. Sheridan and employee health registered nurse Kristin E. Worden was the neckline.
A special gel was put on their hands to show the possibility of potential contamination.
Mrs. Henry said the first step to removing equipment is to sanitize hands after coming out of the room. Fifteen seconds of “vigorous scrubbing,” is encouraged for all Samaritan employees for that step. Then, the first set of gloves is taken off, hands are sanitized again, then booties are untied, slid down and put in trash receptacle. Sanitize. The second set of gloves is removed from the inside out. Sanitize. Staffers then are expected to untie their hood, bring it around from the back to take it off where it isn’t potentially contaminated, sanitize again, remove the face shield from the back, sanitize again and then remove the gown by untying the waist first and then the neck and rolling the gown forward away from oneself. Sanitize. The last step is to remove the mask from the strap in back. Hands then should be washed with soap and water.
CDC RECOMMENDATIONS COMING
This isn’t how all hospitals don and remove personal protective equipment, but Karen A. Abare, registered nurse and Samaritan’s infection preventionist, said she suspects sanitizing after each step may become a recommendation from the U.S. Centers for Disease Control and Prevention.
“We’ll do immediate training upon any change in recommendation,” she said.
According to the CDC’s website, as of Saturday, specific “PPE recommendations are forthcoming,” but there are related guidelines for infection control, visitors, hand hygiene and patient placement, among other suggestions.
Little tweaks in those categories, whether by the CDC, the state Department of Health or the World Health Organization, happen frequently, sometimes daily. Hospital staff throughout Jefferson, Lewis and St. Lawrence counties constantly review that information. Samaritan and other Northern New York hospitals are staying on top of guidelines and recommendations for Ebola preparation from the CDC, the Health Department and the WHO.
Samaritan’s drill was spot on, as both Mrs. Worden and Mrs. Sheridan were 100 percent contamination-free, as a black light showed not even one drop on the two nurses. They removed their equipment perfectly.
“I’d rather be prepared,” Mrs. Sheridan said. “It makes you nervous because you don’t want to have to (treat Ebola). We don’t mind (practicing) multiple times.”
It’s not just about Ebola, Mrs. Abare said. The equipment donning and removal session is given for all new Samaritan hires. This round just may be more specific, or tailored to Ebola.
As protocols change, the American Hospital Association, American Medical Association and American Nurses Association will share updates. All three associations issued a joint statement last week on how a “collaborative approach to Ebola preparedness is essential to effectively manage care of Ebola patients in the U.S.”
“We are committed to ensuring that nurses, physicians and all frontline health care providers have the proper training, equipment and protocols to remain safe and provide the highest quality care for the patient,” the joint statement read.
When a Times reporter reached out to Service Employees International Union Local 1199 for comment on Ebola preparations and regulations, Vice President Kathleen M. Tucker referred comment to Chelsea-Lyn Rudder, New York City, press secretary for SEIU. The union represents dietary and housekeeping staff, licensed practical nurses, certified nursing assistants, phlebotomists, respiratory therapists, pharmacy technicians and unit coordinators. Ms. Rudder was unavailable via cellphone Sunday.
Evolving preparedness plans
Gov. Andrew M. Cuomo designated eight hospitals last week to treat Ebola patients, the closest one being Upstate Medical University, Syracuse. The state Department of Health, meanwhile, issued an order that requires all hospitals, diagnostic and treatment centers and ambulance services throughout the state to follow all protocols for people who present with Ebola. North country hospitals stand ready to accept potential Ebola patients, and anyone else who walks through their doors.
Meanwhile, at River Hospital, Alexandria Bay, Dr. Alfredo Torres, director of inpatient care, said some staff members there think the CDC and other governmental health organizations should be doing more to help protect health care workers to avoid potential Ebola contamination and its spread.
Some people, he said, have been running scared. Should they be?
“Yes,” he said. “This is bad stuff. It would not be out of the question we get someone with Ebola or an Ebola scare.”
That is because River Hospital could accept patients brought in by the Border Patrol, any shipping crews coming through the St. Lawrence River or international visitors.
“We go through this every year with the flu season,” Dr. Torres said. “We’ve all gone through H1N1, SARS, and we’re prepared for TB. Our hospital is ready. We’re refreshing people so we’re super-ready.”
Ebola has a 50 to 90 percent death rate. There is no treatment. Confirmed Ebola patients are given IV fluids and supportive care. There have been a few cases nationally, but none in the north country or elsewhere in New York. An Ebola outbreak in West Africa has claimed the lives of about 4,000 people this year.
Dr. Torres said since Ebola tests may be negative for up to three days, patients often are kept in isolation and then retested as a precaution.
“I’ve got goose bumps,” one River Hospital employee said during an in-service Ebola-related training last week. “It freaks me out.”
The best thing everyone can do, health care workers and the public alike, Dr. Torres said, is to read credible information from the CDC and World Health Organization. Staying informed is the best way to learn, he said.
By Rebecca Madden, Times Staff Writer