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posted 10 Oct 2014, 21:57 by Gerry Kangalee   [ updated 10 Oct 2014, 21:59 ]
Well, in typical Trini style it’s the cart before the horse again! Stop the carnival, we shout, Ebola is on the march and it takes only one person to slip through, just imagine with thousands flooding in for carnival what could happen. 

It’s as if Ebola was just lurking around somewhere just waiting for carnival to come so that it could plunge in and do what it does or, as some would have it, what it is programmed to do.

The point is every day people are flying in and out of the country and the risk of someone infected with this virus coming through Piarco is ever present. Stopping the carnival is not going to reduce that risk.

Instead of focusing on the carnival what we should focus on is how prepared are we to deal with this Ebola virus. You will only


If a patient in a U.S. hospital is suspected or known to have Ebola virus disease, healthcare teams should follow standard, contact, and droplet precautions, including the following recommendations:

Isolate the patient: Patients should be isolated in a single patient room (containing a private bathroom) with the door closed.

Wear appropriate PPE: Healthcare providers entering the patients room should wear: gloves, gown (fluid resistant or impermeable), eye protection (goggles or face shield), and a facemask. Additional protective equipment might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to double gloving, disposable shoe covers, and leg coverings.

Restrict visitors: Avoid entry of visitors into the patient's room. Exceptions may be considered on a case by case basis for those who are essential for the patient's wellbeing. A logbook should be kept to document all persons entering the patient's room. See CDC's infection control guidance(http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html) on procedures for monitoring, managing, and training of visitors.

Avoid aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these procedures, PPE should include respiratory protection (N95 or higher filtering facepiece respirator) and the procedure should be performed in an airborne infection isolation room.

Implement environmental infection control measures: Diligent environmental cleaning and disinfection and safe handling of potentially contaminated materials is of paramount importance, as blood, sweat, vomit, feces, urine and other body secretions represent potentially infectious materials should be done following hospital protocols.
know if a person is infected when that person is tested. For that person to be tested contact would have had to be made with her prior to being tested. The critical issue, therefore, is that health care workers who make first contact with the person to be tested are those most at risk of becoming infected.

But they are not the only persons at risk. Those who take patients to the isolation wards and those who care for persons in those wards are also at grave risk as are laboratory workers who have to handle samples. Then there is the risk to those who have to dispose of the waste which must be handled in special packaging by people with hazardous materials training. Some of the waste matter to be disposed of may include soiled sheets and virus-spattered protective equipment. Faulty disposal puts the community at risk.

Ebola symptoms include large amounts of vomit and diarrhoea. Emory University Hospital in Atlanta Georgia, USA treated two Ebola evacuees from West Africa and at peak they were producing forty bags of waste per day.

Interestingly, the US Centers for Disease Control and Prevention (CDC) and the Department of Transportation have significant differences as to how Ebola waste should be handled and disposed of, this being new and uncharted territory.

The virus has killed 10 percent of the medical staff in Kenema District hospital in Sierra Leone. In Liberia, 15% of those who have died from the virus were doctors or nurses who contracted it at work. It is not always possible to identify Ebola infection early because initial symptoms are non-specific. It is important, therefore, that health-care workers apply standard precautions consistently with all patients, regardless of their diagnosis, at all times.

To deal with the Ebola virus, health care workers must be rigorously trained in best practices and protocols that apply internationally. The training must not be restricted to a few medical bureaucrats who seize the opportunity to go on trips to observe what applies abroad.

Workers must be provided with the best personal protective equipment and intensive training in how to use the equipment particularly in relation to disrobing. Even in the countries that have developed rigorous protocols there are serious problems with the types of personal protective equipment to employ and how they are utilised, because of the lack of experience in dealing with Ebola. The equipment used to test the suspected cases must be top of the line and functioning properly and there should be clear protocols dealing with cleaning infected areas, waste handling and disposal.

When it comes to Ebola, carnival is the least of our problems. The protection of health care workers is critical and the training of these workers in the protocols of dealing with Ebola are vital.




Gerry Kangalee,
10 Oct 2014, 21:57