Testimony is met with applause from RNs in audience
The Massachusetts Nurses Association represents over 23,000 registered nurses and health care professionals across Massachusetts, and our membership includes those working in 70% of the state’s acute care hospitals- the very individuals who will be called upon to respond to any individual(s) presenting with a suspected case of the Ebola virus. We therefore believe it is imperative to provide the Joint Committee on Public Health with the staff nurse and frontline health care perspective on the state of Ebola preparedness in the Commonwealth. Despite what you might hear from other officials and hospital administrators, if the nurses are telling you we are not properly prepared, then we are not prepared.
As you know, the first case of Ebola contracted by an American on American soil was a 26 year old staff nurse in Dallas, TX who was caring for an Ebola patient who later died and we now know a second nurse caring for this patient has also tested positive for the virus. Both are now fighting for their lives. And in the past few weeks, there have been cases where a patient has presented at a clinic or hospital in Massachusetts with symptoms and/or a clinical history that suggest an Ebola infection. If and when the time comes that a patient does present with a suspected case of Ebola, we need to be fully prepared, with the right protective equipment, the correct environment, the safest protocols and procedures and the rigorous training and education to make the system work.
As nurses on the front lines who will be responsible for identifying and treating patient with Ebola, as well as providing a vital role in preventing the spread of this deadly infection, we are concerned by reports from our colleagues across the state- and the country- that thus far very few have had any training on the issue or have what we consider to be appropriate protective equipment and that there is no uniform plan in place on how to handle Ebola in our state. In short, the nurses of Massachusetts are reporting that we are not currently prepared to deal with this potential crisis.
We need to ensure that we are properly prepared to deal with a case of Ebola which could present at a hospital or health care facility.
First, I would like to begin with some examples of what does not constitute Ebola preparedness:
- Preparation is not handing out a color-printed flyer or sending staff an e-mail with links to the CDC website.
- Preparation is not telling nurses to lower their expectations, that they should not count on the same protective suits used by Emery University or the CDC when they transport Ebola patients.
- Preparation is not announcing you will do training in 4 or 6 weeks.
- Preparation is not waiting until a patient arrives in the hospital with Ebola like symptoms.
Proper preparation means interactive training and live drills, for all hospital personnel who may encounter Ebola patients, with the ability to interact, ask questions, and hands-on practice in teams putting on and taking off the right protective equipment with the support of a colleague for nurses to put on or take off the suits and the proper environment in which to treat a confirmed or suspected Ebola patient.
Protective Gear
The infected Dallas nurses wore the CDC approved protective gear, including a gown, gloves, a mask and a face shield while caring for Duncan on multiple occasions. We do not believe this provides enough protection for frontline health care workers. All health care workers who treat Ebola patients must be provided with the proper protective equipment, including full body hazmat suits with hoods including positive pressure HEPA filtered air, impermeable or fluid-resistant gloves, foot and shoe coverings. These suits should be available at every Massachusetts hospital. Since we do not know where a case might present itself. It is irresponsible to provide us with any less. Further, the Occupational Safety and Health Administration (OSHA) hazmat rules for donning and doffing the protective gear should be followed- and properly educated and trained on these standards.
Proper preparation means having adequate supplies, on site at all times, of Hazmat suits and other personal protective equipment used by those who interact with Ebola infected patients. Nurses and their colleagues need to be properly trained in the use of this protective gear, as Ebola can infect anyone who comes into contact with bodily fluids of an Ebola patient- the smallest slip or change in protocol in putting on or taking off protective gear can open the door to the virus. Because the virus can incubate for up to 21 days, any contamination can result in an exponential increase in exposure to others. This is why it is vital that the highest standards be used, those that have worked, up front at the first lines of exposure.
Training
On Marathon Monday our nurses and doctors responded quickly and professionally, saving lives and preventing further injury to bombing victims. Our successes that day were largely due to the training and drills we had run in preparation for a natural disaster or terrorist activity. Proper preparation includes the same sort of training and live drills to prepare us for potential Ebola cases.
Those who work with Ebola patients at the Nebraska Medical Center Isolation Unit receive 80 hours of training before they begin working in the unit. This training is then followed by monthly meetings and quarterly drills. We believe that similar protocols should be put in place at Massachusetts hospitals beginning immediately.
The training of healthcare workers is essential in the safe practice of donning and doffing proper protective equipment and Hazmat training should be conducted by certified professionals.
Environment
Proper preparation also includes having the right environment and equipment on hand to care for infected individuals. In order to stop the spread of the virus and lower the risk to any health care worker who cares for an infected individual, the MNA has compiled the following recommendations regarding the environment that must be in place when caring for an infected or suspected case of Ebola.
Admission
- A telephone should be placed outside of the Emergency Department (ED) for when a patient presents to the ED with a suspected case of Ebola. This enables the nurses to perform a quick assessment over the phone. If Ebola is suspected, the patient is then directed to a private entrance where employees wearing the personal protective equipment described previously meet the patient to isolate him or her from the general population and a complete patient assessment is performed.
- Ambulance personnel should be educated to alert the ED of any incoming high-risk patients and the patient will be admitted following the protocol outlined above.
Accommodations
- Hospitals should be equipped with a negative pressure isolation room with a bathroom and ante room. The ante room should be equipped with ultraviolet light in order to kill viruses and bacteria on all surfaces.
- Nurses and any other health care personnel treating the patient should be outfitted in the personal protective equipment as described previously at all times they are in contact with the patient.
- There should be a steady supply of bleach into the toilet water to ensure waste disinfection.
- When a nurse or health care professional is finished caring for the patient, he or she should then enter the ante room. Before leaving the ante room, the contaminated nurse should shower and be sprayed from head to toe with a bleach solution, while still wearing the protective gear. Two additional personnel, one of whom will be the replacement nurse, working together should then carefully remove the nurses’ hood and roll it down off of her body. The nurse then steps out of the personal protective equipment and it is dispose of by the additional personnel who is not the replacement nurse.
- The replacement nurse then goes into take care of the patient
Further considerations
In addition to the recommendations outlined above, the MNA strongly supports the following with regards to any nurse caring for a suspected or confirmed Ebola patient:
- Each work shift should be no longer than four hours unless a nurse needs to come out sooner. Notification of the need to leave the patient’s room will initiate a second nurse to don the personal protective equipment.
- Nurses and other healthcare workers should be cleared through Employee Health and free from any medical conditions that may interfere with their ability to wear and function in the personal protective equipment.
- Nurses caring for Ebola patients or those with similar infectious diseases patients should care for no more than one patient with additional nurses added as needed based on nurse judgment. There should be no other patient assignment given during the time the nurse is caring for an Ebola patient.
- Two healthcare workers (in full PPE) should be available at all times, one nurse and another person to help don and doff the personal protective equipment.
- The number of healthcare workers present should be limited during any procedures involving an infected patient.
- Individuals who will and can work with patients infected with Ebola should be identified ahead of the presentation of any suspected or confirmed cases of Ebola.
It is essential that we take the correct and necessary actions now to be sure that our hospitals and health care facilities are prepared in the event of a suspected or confirmed case of Ebola. The MNA and our members are available to work with the Committee and well as other state agencies and hospitals to ensure that we are protecting health care workers and the public.
You would not send soldiers to war without the proper equipment or training, nor should you expose front line nurses and other caregivers to confronting a highly virulent virus without the proper safeguards.
The best way to assure the public that everything that can be done is being done is to take the steps that I have outlined here today. We know we can contain this disease, we know we have the resources – but we must take the correct action now.
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