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October 5th 2014

How to Prevent the Spread of Ebola Virus in the U.S

U.S. Officials: We’re well equipped to stop Ebola. If you have worked in the U.S. hospitals over the years, you start to scratch your head! You are wondering what planet they are speaking from. They must be speaking from another planet or referring to a totally different system from the U.S. healthcare system. Complacency can lead to greater tragedy folks! Experience from working in the U.S. hospitals painted a very different picture. Understanding facts hopefully lead us to take better precautions besides lip service and positive political statements. We use the word "proactive" in healthcare to mean the opposite; we do nothing. It translates to mean just a lip service, and pray that nothing happens. When disaster strikes, then we resort to "crisis response intervention." That is our history in the U.S. healthcare system. Book reference: 101 Ways to Prevent Medical Errors. http://www.amazon.com/101-Ways-Prevent-Medical-Errors-ebook/dp/B00GVJG6MK/ref=sr_1_1/186-0567125-5325926?s=books&ie=UTF8&qid=1412548211&sr=1-1

Now that the Ebola virus has officially arrived in the U.S. we need to do more than just talk to prevent the spread. I have heard President Obama and other healthcare officials talk about how we can combat the virus and prevent the spread. This is good for public service announcement to prevent panic. I agree when people panic they do crazy things. However, the reality is the entire nation is presently in grave danger if we do not take some precautions to be outlined later in this article. I worked in the U.S. hospitals close to 40 years and headed system redesign projects for many years. We do not have a good compliance record on system redesign. As evidence, we also do not have good records in controlling nosocomial infections. How do we think we will be able to do better with such a virulent infection as Ebola? Making positive public service comments to allay public anxiety is one thing, but reality is another for many reasons. We need to take actions that can actually prevent the spread of Ebola in the U.S. We need to design a new system, and train selected healthcare professionals as Special Forces to be ready to fight Ebola virus, both at home and abroad. The present set-up in hospitals to control infections is very poor; poorly designed, poorly monitored, poor compliance, ineffective and will eventually lead to the spread of Ebola in the U.S. Take for example a case in which there was a bacteria outbreak in a particular hospital in the U.S. It was the story of a superbug. The story featured how the hospital took so much care wearing all the spacecraft looking outfits in the hospital to curtail the spread of the bacteria. Despite all the exuberant efforts and military academy to fight the bacteria, the bug got to the general patient population. Some patients including healthcare workers died before the bacteria were brought under control. I pray to God that we learn from this failure and take appropriate and viable precautions instead of the lips service being displayed on the media with smiling faces. We have serious problems in the U.S. hospitals over systemic failures. This is the reason why we have never been able to reduce the number of medical errors across the nation despite we have spent over a billion dollars to fight medical errors since 1999 after the IOM (Institute of medicine) report. Before I discuss the best approach to curtail Ebola virus based on what I learned working in hospitals, there are some factors for us to consider.

First Fact: U.S. nurses say they are unprepared to handle Ebola patients. http://www.huffingtonpost.com/2014/10/03/nurses-unprepared-ebola_n_5926828.html

Important Factors to Consider

First, regardless to how hard we try, Ebola is going to get to general population in the U.S. Do we have a contingency plan if it does? Unfortunately, making money has always been one of the reasons why we side step process re-design to fix systemic failures in the U.S. hospitals. The result is the staggering number of medical errors in the nation still killing so many patients. Now, we do not have a choice, human lives are at stake if we mess this up. There is great potential we will mess up and many people will be infected except if we take viable precautions. In curtailing the spread of Ebola, the nation need to engage healthcare professionals that are more interested in fixing the problem compared to people who want to make money from other people’s misery. Engage healthcare professionals to administer over the control of Ebola that are very adept in system redesign to fix the problems. Look for healthcare workers trained to handle infectious disease and effective design for infection control. Many of the hospital staff today are not trained or ready to handle Ebola patients. This is the time, now to start training healthcare professionals before we are caught off guard as always.

Second, in spite of giant efforts, and most of the employees doing the right thing, all it takes is one person to sidestep the process. When this type of systemic failures happens, many people will be exposed and many may die before we realize what is happening.

Third, hospital emergency rooms are operated by people. They can make mistakes like what happened when a patient from Liberia was turned away from the emergency room he first reported. Training of emergency room staff, to those admitting patients, to nurses and physicians is highly important. Quick identification of potential carriers is very critical. The U.S. nurses indicate they are not prepared for Ebola patients. http://www.huffingtonpost.com/2014/10/03/nurses-unprepared-ebola_n_5926828.html

Fourth, consider this, about 3,500 passengers from Ebola affected nations were allowed into the U.S. without any special screening since January 1, 2014. http://www.breitbart.com/Breitbart-Texas/2014/10/2/Exclusive-Thousands-from-Ebola-Nations-Allowed-to-Enter-US-Without-Additional-Screening/

Fifth, don’t ignore the potential that some angry nut or crazy fanatic may use Ebola as bioterrorism. We have to keep in mind this can be more dangerous than blowing up a plane because of the quick multiplicity of exposures within a short period of time. Such a patient riding on mass transit can be a potential source of explosive transmissions. Should we be concerned about the threat of Ebola virus as an aerosolized biological weapon? http://vet.sagepub.com/content/50/3/514.full

Sixth, the U.S. hospitals handling of nosocomial infections have been a very tragic failure! That is the fact! What are we doing to control this type of spread to be sure we don’t repeat the same situation as the spread of nosocomial infections in hospitals across the nation? How easy is it to get healthcare workers to wash their hands when going from patient to patient? Fighting Ebola will need more than just wearing gloves and hand washing.

Spread of Superbugs have increased in the U.S. hospitals from 2008 to 2012 http://www.cnbc.com/id/101856131#.

Rate of antibiotic resistance to superbugs doubled in the past decade http://america.aljazeera.com/articles/2014/10/1/study-deadly-diarrhearatesnearlydoubledin10years.html

NIH campaign to help stop the spread of superbug http://newsinhealth.nih.gov/issue/feb2014/feature1

Superbug: An epidemic begins http://harvardmagazine.com/2014/05/superbug

Superbug Are not Dropping in Children http://www.medicinenet.com/script/main/art.asp?articlekey=173833

Six, many of the nurses and nurse assistants tend to have more physical contacts with patients than even physicians. How are they going to be trained to take proper precautions? Is behavior modification needed as part of the training?

Two million nosocomial infections in hospitals per year http://www.rightdiagnosis.com/n/nosocomial_infections/stats.htm

Hospital acquired infections cost Ten billion dollars a year! http://health.usnews.com/health-news/news/articles/2013/09/03/hospital-acquired-infections-cost-10-billion-a-year-study

Seventh, if each hospital is expected to design its own Ebola ward, how are we sure each hospital will effectively control the infection? Send out inspectors? Don’t we have the same issue with Joint Commission of Hospitals doing inspections and we still have a high number of medical errors killing patients annually?

Center for Disease Control’s strategies to Reduce Superbug http://www.cdc.gov/drugresistance/national-strategy/

Eighth, must understand and accept people are very resistant to change especially from my personal experience working in hospitals. Many may not want to follow recommended procedures to handle Ebola patients for many reasons. Any healthcare worker exposing systemic failures within hospitals may immediately be terminated. Hospitals do not like bad publicity. The code of silence is still strictly enforced in hospitals! If you identify problems, you may lose your job. Even when the identification of problems is brought up within the secrecy of hospital walls, problems still exist. Many of the problems are not fixed. Why do we have problems with the V.A hospitals? Because V.A hospitals mimic the same systemic failures endemic in hospitals across the nation sustaining increase in medical errors!

Ninth, with a bad record on fixing systemic failures, should we trust each hospital across the nation to handle and treat Ebola patients? Those who never learned from history are doomed to repeat it.

Tenth, do we need duplications of services in hospitals across the nation to treat Ebola? How cost effective will such a system be?

Solution Implementations

1. Remove patients from regular or general hospitals. As soon as a patient is identified, we quarantine them by removing them from general population to avoid spread. Why should we take them out of one population and place them back in another population inside the hospitals? Place such infected patient in a hub hospital. Design an IDH - an Infectious Disease Hospital with special training for healthcare professionals. The less number of hospitals handing Ebola patients the better the chance of control.

2. If an outbreak is suspected, every state in the U.S. should designate a hub hospital to treat only Ebola patients. This will reduce cost instead of all the hospitals in the state creating an Ebola section in their hospital, and costing a lot of money. Another way is for two states to share one hospital to transport and treat Ebola patients in an outbreak, God forbid a pandemic, depending on how each state is affected. We always worry about cost containment. Hub hospital to treat Ebola may be one way to go since many of these patients may not have medical insurance. If you want to make money treating such patient, you are out of luck, except if receiving government special funds.

3. Give special training to healthcare professionals and workers intending to work in IDH, with restricted accommodation, in another building away from the hospitals. They can only go home once a week to prevent them from infecting their family members in case they may be infected. The new design should be pilot tested for effectiveness. Following testing, the results should be evaluated for positive outcome. Adjustments should be made where needed before general implementation of the new design. The protocol of the new design should strictly be adhered to by all members of the special healthcare team fighting Ebola.

4. Hugging and kissing of any kind should be forbidden in Ebola treating hospital between patients and loved ones, or even between hospital employees. Any behavior should be forbidden that exposes a person to contact with body fluids including sex on the campus.

5. Be sure staffing of IDH treating Ebola patients are volunteer healthcare workers. Never force anybody to work in such a facility. Avoid disgruntled, angry, vicious or vindictive workers from working in such a hospital. Evaluate workers using psychological profiling tests to weed out potentially dangerous staff. Remember Charles Cullen, the nurse who killed many patients by injecting them with toxic drugs -the angel of death and the hospital who allowed the serial killer nurse. http://www.thedailybeast.com/articles/2013/04/14/the-angel-of-death-and-the-hospitals-that-put-a-serial-killer-to-work.html

                Ten serial killer nurses http://listverse.com/2013/09/16/10-serial-killing-nurses/

6. Another article featuring the "angel of death nurse" Charles Cullen murdered over 40 patients. http://www.dailymail.co.uk/news/article-2316571/Charles-Cullen-Serial-killer-nurse-murdered-40-patients-speaks-prison-time-claims-mercy-killings.html

7. Prevent immune-compromised healthcare workers or those on immune-suppressants from working in Ebola hospital or unit. If they are infected, due to their poor immune state of health, death may come very swiftly. Like any viral infection the ability to survive depends on the immunological viability or strength of the patient.

8. Hospital workers should take universal precaution-plus when dealing with Ebola patients. There should be special ways to dispose of soiled and other clothing items in direct contact with patients.

9. Once a hospital worker violates the universal protocol-plus, he or she should immediately be removed from the facility treating Ebola patients to avoid danger to the worker, the rest of the staff and public. This is very critical because employees who take universal precaution lightly endanger the life of other staff members.

10. There should be a strict and guarded way with security to dispose of blood samples and specimens from Ebola patients to avoid contamination into drinking water, soil, or even the sewer system. At times, drinking water is contaminated by sewer. Be careful in disposing such contaminated body fluids and tissues from infected patients.

11. The CDC working with Hospital Joint Commission must issue directives on how each hospital should handle Ebola patients to curtail an outbreak, or epidemic. Every hospital in the nation treating Ebola patients MUST follow and adhere to the same protocol. Good luck!

12. Better idea is to create one hub hospital in the nation to handle and treat Ebola patients. On the national, we do not have many patients at the moment. Each hospital treating single or two patients infected with Ebola may not be cost effective for such hospital. Learning from my study on medical errors for duration of more than 20 years of study, the more hospital workers performing a procedure, the more the chances of deviation, increasing the chances of systemic failures and consequently errors. When we reduced the number of those drawing blood, for example to specially trained hospital staff, the error rate from specimen collection drops and in some situation almost disappear. So, if we want to increase compliance of protocol and reduce the spread of Ebola in the nation, we must reduce the number of hospitals treating Ebola patients. Otherwise, we are doomed!

13. We can’t rely on national compliance from different hospitals in the nation to follow set protocol. Such new design may cost a lot of money some hospitals may not have. Sad result from evaluating system redesign in many hospitals across the nation for many years is the resistance from staff to management in reactions to "system redesign." We cannot combat Ebola until we design a new system and every hospital follows such protocol. Our previous record in the nation in following such a protocol has been a shameful failure.

14. Don’t just ask questions alone from travelers at the airport where they have been. Check their passports and itinerary. People have good reasons to lie because of stigmatization, shame, isolation and possible bad treatment from the public. The guy who lied before he got on plane in Liberia did it for good reason. He probably preferred to come to the U.S. and get better treatment compared to his country where he may end up dead. I used to work in IDH (Infectious Disease hospital); family members never used to tell other people living in the same building that their loved ones had contacted an infectious disease. They do this not to be hateful, but due to shame and public humiliation. During that time in the early 1960s and 70s, African nations were fighting tuberculosis. Such patients were placed in separate hospitals from general population thereby reducing the spread. Can we do the same in the U.S. God forbid, before we have an epidemic?

15. Water from Ebola patients contaminated with Ebola virus should not be going directly into public sewer without being initially treated to inactivate the virus. Now, we need a lot of prayers for the sake of needed compliance.

By Yinka Vidal, author of 101 Ways to Prevent Medical errors. Book site: http://www.amazon.com/s?ie=UTF8&page=1&rh=n%3A283155%2Cp_27%3AYinka%20Vidal

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