Nursing Practice & Patient Advocacy Alert -- Treatment of Patients with Ebola

NNU is calling on hospitals across the nation to immediately provide:

1. Highest, optimal standard of personal protective equipment for Health Care Workers

2. Extensive hands-on training, ongoing education and review of the use of protective clothing, equipment and infection control protocols

3. Adequate numbers of appropriately prepared nursing staff to safely meet patient needs

Ebola is an extremely hazardous disease and as such warrants being treated by the most bioprotective conservative methods available. It is not always possible to identify patients with Ebola early because initial symptoms may be non-specific.

For this reason, it is important that healthcare workers apply universal precautions and practices consistently with all patients – regardless of their diagnosis – in all work settings, at all times. These include meticulous hand hygiene before and after patient contact and the use of personal protective equipment (to protect against aerosolized secretions, the risk of splashes and drainage exposure or other contact with infected materials) when providing direct patient care, including end-of-life, environmental and body care practices.

NNU supports the highest standards and optimal level protections for health care workers!

NNU believes highest standards of education, training and PPE should be provided to all direct care nurses and healthcare workers treating patients at risk for and diagnosed with Ebola. This includes the use of full coverage Haz-Mat suits and PAPR with HEPA Filter with protective hoods/helmets and no worker skin exposure.  The rationale is based on provider observations that those suffering from Ebola may become debilitated, lose protective reflexes, and begin coughing productively, choking/vomiting, become incontinent of urine and stool, and have bloody secretions or begin bleeding at any time. This increases the risk of infection for health care workers who are not wearing protective suits.

The CDC has also stressed the importance of adequate and appropriate nursing staff in dealing with infectious diseases, and a buddy system for donning and doffing PPE. The association of nursing staff shortages with increased rates of Hospital Acquired Infections (HAIs) has been demonstrated in several outbreaks in hospitals and long term care settings. In most cases, when staffing improved as part of a comprehensive control intervention, the outbreak ended or the HAI rate declined.

BEST PROTECTION FOR HEALTH CARE WORKERS

The Occupational Safety and Health Administration has enforceable standards; employers have a duty to maintain a workplace free of known hazards:

• Employers must train workers about the sources of Ebola exposure and appropriate precautions.
• Employers must train workers required to use personal protective equipment-- the optimal protective equipment, when and how they must use it, and how to dispose of the equipment.
• In addition, where workers are exposed to blood and potentially aerosolized pathogens from bodily secretions that contain infectious materials, employers must provide the training required by the Blood-borne Pathogens/Aerosol Transmissible Diseases standards.
• Employers must also provide information about how to recognize tasks that may involve exposure and the methods to reduce exposure must be included: engineering controls, work practices
• Employers shall provide optimal personal protective equipment for Ebola that meets the highest standards including: (1)  Full-body hazmat suits that meet the American Society for Testing and Materials (ASTM) F1670 standard for blood penetration, the ASTM F1671 standard for viral penetration, and that leave no skin exposed or unprotected and (2) National Institute for Occupational Safety and Health-approved powered air purifying respirators with an assigned protection factor of at least 50.
• If you have further questions, need more information or help please call NNU’s Nursing Practice Program at 510/273-2250.

Please fill out the survey so that we can better determine the safety standards in your acute care hospital, and determine next steps to ensure the safest patient care.