As Nursing Review went to press, three nurses in Western hospitals had acquired Ebola after caring for patients originally infected in West Africa. Though the chance of an Ebola victim arriving in New Zealand still remains very slim, both the Ministry of Health and the Infection Control Nurses’ College believe the devastating West African epidemic is a good wake-up call.
The first Ebola victim walking into a US hospital recently brought one step closer to home the possibility it might happen here.
Thomas Duncan, a recent arrival from Liberia, was initially sent away from a Dallas hospital by a physician with just antibiotics for a fever, despite a triage nurse recording he had recently been in Africa. Infection control nurse leader Robyn Boyne says that situation just “beggars belief”.
Boyne, the chair of the Infection Prevention and Control Nurses College, NZNO, hopes
ew Zealand never has to prove that its triage system is better.
Duncan has since died and two nurses caring for him at Texas Health Presbyterian Hospital (see web link in sidebar) have contracted Ebola, as well as a Spanish nurse caring for an Ebola victim who had been airlifted to Madrid.
America's largest nursing union, National Nurses United, has reported anonymous Texas Health Presbyterian RNs’ concerns that their hospital was not prepared for Ebola, with staff not trained in or aware of protocols and what PPE should be worn.
Dallas has shown a health system’s IPC protocols are only as good as the training and equipment provided and a hospital's management and staff's readiness and ability to carry them out.
The Ministry of Health’s director of public health Dr Darren Hunt says district health boards and public health managers have been receiving regular updates on the viral haemorrhagic fever outbreak and requested to ensure that their response plans are up to date, including ill traveller protocols and border emergency response plans. A suspected or confirmed case would be transferred to a tertiary hospital, with the four preferred facilities being Auckland, Middlemore, Wellington, or Christchurch, and the patient to be placed in an airborne infection isolation (negative pressure room).
The Ministry says hospitals and nurses are experienced at dealing with a variety of infectious diseases transmitted through direct and indirect contact with blood, secretions, organs, and body fluids, and Ebola is less easily transmitted than many other viruses.
But the seriousness of the illness and the high mortality rate of Ebola has prompted the Ministry to provide, and continually update, information and guidance to health professionals – including extra personal protection equipment (PPE) requirements – and to establish a technical advisory group to provide advice as needed on managing a suspected Ebola case.
Supervised donning and doffing of PPE
The 16 October update of the Ministry's Ebola advice to health professionals –in the wake of the Spanish and Texas cases – stresses that the donning and removing of PPE should be supervised by a staff member “competent in PPE management to reduce the risk of accidental skin exposure or self-contamination”.
As Nursing Review went to press, three nurses in Western hospitals had acquired Ebola after caring for patients originally infected in West Africa. Though the chance of an Ebola victim arriving in New Zealand still remains very slim, both the Ministry of Health and the Infection Control Nurses’ College believe the devastating West African epidemic is a good wake-up call to be ready for what could walk through the door someday.
It also stresses that staff should be regularly trained in procedures around how put on and take off PPE, along with clear instructions on how PPE should be used and disposed of. Hunt says practice and being comfortable with PPE cannot be over-emphasised.
A retrospective Canadian study of how health care workers became infected in the 2003 SARS outbreak in Toronto – after special infection control procedures were introduced –highlights the importance of training to ensure protocols are followed (see http://bit.ly/1qEAzPf). That study, as in the Texas case, indicates that extra vigilance is needed in high-risk, aerosol-generating procedures like suctioning airway secretions or intubation.
The Ministry advice emphasises that the basic key to minimising any healthcare infections remains, as always, good hand hygiene and strictly carrying out the 5 moments of hand hygiene.
Boyne said IPC clinical nurse specialists like herself were using Ebola as a “wake-up call” for nurses and other health professionals to take getting accurate travel histories seriously, to brush up on their standard and droplet transmission precautions, and PPE use and to emphasise once again the importance of hand hygiene.
“Because if it’s not Ebola it could be something else – like the Middle Eastern Respiratory Syndrome (MERS) virus – and that’s the message we are trying to get out – that all staff should be prepared at all times for anything unexpected that could come through the door.”
The ministry is advising people to wear semi-impervious splash-resistant disposable isolation gowns or all-in-one disposable coveralls when caring for a suspected or confirmed case of Ebola.
Boyne says some DHBs don’t have all-in-one suits and they are not routinely used. The suits are more complicated to remove than the gowns that most staff are used to so they would next extra training to do this safely.
“So you’ve got to look at your risk: it might be better to use something that staff are familiar with, and are going to use correctly, until they can be safely trained in the use of the all-in-one suits.”
She says the Texas cases show that, while health care workers try to do the right thing, it can take just a small lapse in procedure to contract this disease, particularly when removing PPE.
*We need to always be aware of where our potentially contaminated hands are, and never to touch our bare skin, especially on the face, whilst removing PPE.” :
NZ-recommended PPE gear for suspected or confirmed Ebola victim
Gloves: Double gloving if risk of heavy contamination.
Disposable gowns: fluid-resistant long-sleeve isolation gown or an all-in-one coverall.
Disposable white plastic apron: If risk of significant exposure to blood or bodily fluids.
Face, mouth and eye protection: Wear a surgical mask plus full facial shield and goggles to protect the eyes.
Respirator mask: If involved in aerosol generating or splash procedures, wear a N95 or P2 respirator mask and do ‘fit checking’ of mask.
Shoe and hair covers: Wear disposable shoe and hair covers.
More info at: Ministry of Health: www.health.govt.nz/ebola or http://bit.ly/11xvRND
More useful websites
- Infection Prevention and Control Nurses College, NZNO: www.infectioncontrol.co.nz
- World Health Organisation (WHO): hwww.who.int/csr/don/en
- Centres for Disease Control & Prevention (CDC): www.cdc.gov/vhf/ebola/
- The Texas Health Presbyterian Hospital, Dallas: www.texashealth.org/ebola-virus
- US nursing union National Nurses United: www.nationalnursesunited.org