Morning Edition: Do you know if any of your members, if they have been receiving training at their hospitals for possible Ebola cases?
Lisa Baum: Some of our members have received training. We’re currently in the process of receiving information from all of the hospitals where we have members. But we do know some of them have begun doing training, some of them have done extensive training, some have done less training, and some I believe have done no training.
ME: So for, I guess, the high-end, the people who have done the most training, what sort of things are they being trained in?
LB: Well, just as an example, Bellevue Hospital here in New York City, which is the designated hospital to handle Ebola cases in the city. And here they’ve done extensive training on the use of personal protective equipment, triage procedures, lab procedures, etc.
ME: And then what sort of protective equipment are they being trained in?
LB: We have concerns that the CDC’s guidelines on personal protective equipment may not be adequate. At Bellevue, they have gone a step up from these recommendations and they are providing what we call Powered Air Purifying Respirators, which provides a higher level of respiratory protection.
ME: Could you talk a bit about why respiratory protection is needed?
LB: We still don’t know at this point all the ways that Ebola may be spread and there is some evidence that it could be airborne, particularly when certain medical procedures are done.
I don’t believe that this is a significant risk for the general public. But for a healthcare worker who is working directly with a patient who has Ebola virus disease, it is a significant risk and we think that the precautionary principle should be followed and that the highest level of protection should be provided to healthcare workers in this type of situation.
ME: There is some evidence that it becomes airborne when there is a large amount of fluid that the virus is present in, right? That’s the main concern?
LB: We don’t really know. There have been past studies that have shown that Ebola virus can be spread through airborne particles. We are not seeing that in Africa but we don’t know what the circumstance is for a healthcare worker here who is working closely with an infected patient, particularly when they are conducting certain procedures that can cause sputum to become what we call aerosolized, which is small, airborne particles.
ME: Let’s say you have someone who’s traveled to West Africa recently who maybe is showing a fever, comes into an emergency room, at what point do you think that these protective measures should be taken?
LB: It depends how close the healthcare worker is to the patient and what procedures are being done. The person should be put in isolation immediately and the infection control officer should be notified and brought in immediately. An extensive history needs to be taken and symptoms need to be analyzed to consider whether this would be a suspected case or not. Most times, the cases are ruled out quickly.
But in those cases when it cannot be ruled out quickly, then appropriate measures should be taken, including proper isolation with negative air pressure and proper personal protective equipment. And of course there needs to be training on this, including practice donning and doffing ppe and that means putting on and taking off personal protective equipment safely.
ME: Would these measures have to be set up on a hospital-by-hospital basis or is there someone in New York that could make all of the hospitals do this?
LB: The Department of Health has the ability to mandate hospitals to take certain actions.
ME: Ok, so you said in Bellevue they went by the CDC guidelines and a bit above. Is that the hospital that’s doing the most in New York State, that you know of?
LB: That I’m aware of. We’re still in the process of gathering information from the hospitals where we have members so I cannot speak to all hospitals.
ME: Do you think the same measures should be taken at all hospitals statewide?
LB: I do. If a hospital does not have the facilities to handle an Ebola-infected patient then hospitals that can, should be designated, and patients should be sent to those hospitals because there are a lot of very specific requirements in terms of isolation facilities, ventilation, etc. And smaller hospitals may or may not be equipped to handle these types of cases. And even larger hospitals may not be ready. But I think the CDC is looking at designating specific hospitals and I think that’s wise.
Now, that doesn’t mean that every hospital doesn’t have to be prepared to quickly identify patients because those patients should not be sitting in a waiting room for long periods of time nor should they be interacting with healthcare workers without proper protection.
So every hospital has to be prepared but in terms of treating a patient who has been determined to have Ebola virus disease, that should probably be handled by hospitals that are properly equipped for these kinds of diseases.
ME: Could you explain to me why this is important, from a nurse’s perspective?
LB: Our members take very seriously their mission to care for the public and they cannot care for the public properly if they’re not cared for. They have to feel safe, they have to know that they are protected so they can do their jobs.
The risk to healthcare workers who are treating patients with Ebola is significantly different than the risk to the general public. I do not believe that the general public needs to be worried about their exposure to Ebola. But I do believe that every protection possible should be taken to protect healthcare workers because they are at significantly higher risk.