Was the Texas Health Presbyterian Hospital Prepared for Ebola? Probably not.

This is breaking news as of Tuesday PM. According to the nurses at the hospital, no, not initially. Anonymous nurses have claimed via their union:

-Patient Zero was left for several hours in a place with up to seven other patients, not in isolation. When a senior nurse attempted to insist he be moved to an isolation unit she was met with "hostile" responses.
-Blood samples were transported through the hospital tube system instead of hand carried.
-Nurses were not entirely covered with protective wear. The gear they had left their necks exposed. To remedy this they were told to wrap tape or gauze (not sure) around their necks.
-People were going in and out of isolation areas without protective equipment.
-Medical waste was not properly handled, with hazardous waste piled nearly to the ceiling as there was no plan to dispose of it.

The hospital has not responded.

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If these allegations are true, then it is obvious that the weakest link in this pandemic will be humans - our consistent failure to realise the significance of protective measures and implement them. In this case the action failures alone if true were enough to spread the disease liberally throughout Texas. The importance of uncovering these errors of emission - cannot be over emphasised

By Elsdon Ward (not verified) on 14 Oct 2014 #permalink

It strikes me that it is of supreme importance to ensure that proper procedures for the segregation, containment and safe disposal - (incineration) of infectious waste are immediately reviewed and standardised globally. In itself this could prevent spread of the disease. I say this because the safe treatment of infectious waste can be one of the most abused aspects in our medical systems and one which could have the most serious consequences.

By Elsdon Ward (not verified) on 14 Oct 2014 #permalink

Speaking as a business person who has been in both types of hospitals in the last five years, there seems to be a great difference between for-profit and non-profit hospitals. The response to the senior nurse at Texas Presbyterian makes me wonder if it's a for-profit. My experience is that they invest more in marketing, advertising, and cross selling than staff and training. Knowing both side now, I have more trust in a University affiliated hospital and in fact have been a patient at the excellent University of Nebraska Medical Center.

By JustA Civilian (not verified) on 15 Oct 2014 #permalink

@3 :

I guess Ebola protocols aren't the only thing confused about Texas Health Presbyterian Hospital--

from their own webiste page, "About Us" we learn both that

Texas Health Resources is one of the largest faith-based, nonprofit health systems in the United States and the largest in North Texas in terms of inpatients and outpatients served. The health system includes Texas Health Physicians Group and hospitals under the banners of Texas Health Presbyterian, ... (emphasis added)

and, that,

$3.8 billion in total operating revenue (FY 2013)
$6.1 billion in total assets (FY 2013)

So, in my opinion, it seems that although they call themselves a "non-profit" even as they operate fully, for all practical intents and purposes, as what amounts to a genuine for-profit operation.

By proximity1 (not verified) on 15 Oct 2014 #permalink

Disposal of waste generated by patient care is going to be a gigantic problem not because it can't be done logistically, but because the regulations relating to highly hazardous waste place such limits on who can handle it and how that it took even the experts at Emory several days to come up with a way to get rid of waste. The usual waste hauler at an average community hospital will neither be permitted to deal with Ebola-infected waste nor willing to do so. Stacking barrels to the ceiling while they try to work something out is pretty much unavoidable.

Also, if case numbers increase, do the authorities plan to continue to incinerate all of the personal property and furniture of patients' families? The first apartment so cleared out had six truckloads of stuff, and last I heard, they haven't been able to get rid of it because the Jindal administration threw a hissy fit and wouldn't let it be shipped over Louisiana roads to an incinerator facility. (And if those tables, dishes, other people's clothes and papers, etc. are really such a lasting contamination threat as to justify that hysteria, isn't it an utter outrage that the healthy family members were caged at gunpoint, surrounded by those objects and forced to use them to live, throughout the entire time when active virus might really have been present on them?) Perhaps they should start making a distinction between things that might harbor virus for an extended period (e.g., soiled clothes and bedding) and things that wouldn't plausibly be expected to (e.g., nonporous furniture) and incinerate only the former; it would substantially reduce the volume of material to be trucked around.

Do you have any sources for the story of burning, or trying to burn, all the stuff, transporting it, etc? I've seen nothing at all on that.

Ebola is an RNA virus. It isn't difficult to kill. Autoclaving is certainly good enough. Why don't hospitals have facilities to autoclave potentially infectious waste?

There is only one reason that hospitals wouldn't have facilities to autoclave potentially infectious waste, the cost of such facilities.

That cost is tiny. Is "disposal of infectious waste" another privatization scam? Autoclave infectious waste on site, and it becomes non-infectious, non-hazardous, and cheap to dispose of.

Who has the infectious waste disposal contract for this hospital?

By daedalus2u (not verified) on 15 Oct 2014 #permalink

@4 - Yes I'm aware the distinction is blurred. Non profit doesn't mean "no profit" In point of fact the first, "For Profit" hospital I mentioned had been a faith based hospital and remains a nonprofit legally. They have merged multiple times with other faith based hospitals with increasing emphasis on revenue generation and advertising. A couple years ago they quit trying to imply a faith affiliation in their naming convention, and went with a construct that is meaningless in the language but suggests words that mean faith, service, trust.
And now I'm done corresponding. I have a lot more business than science experience and education, and will resume my former role of reading and learning.

By JustA Civilian (not verified) on 15 Oct 2014 #permalink

Daedalus, I'm guessing this is a case of interactions between regulations, the regulated, and the businesses that benefit (and lobby), as you suggest.

JustA: What hospital was that?

Presby is a pretty bougie hospital in North Dallas, so they're not likely to have a whole lot of experience with infectious diseases period. I'm an HIV social worker in the Harris Co Hospital District, and it seems like most of the folks with really solid ID experience are affiliated with the medical schools and public hospital systems (most HIV+ patients are uninsured, so that makes sense). Don't have any stats to back that up or anything, just an impression. I'm willing to bet that if Duncan had shown up at Parkland (that's the main public hospital in Dallas) instead of Presby, the response would have been more competent.

Another minor point, the Presby RN's are NOT represented by National Nurses United, the union that released the statement re: Ebola protocols being inadequate. VERY few nurses in Texas are represented by a union. This explains why the Presby RN's needed to be anonymous (they're at will employees, and can be fired for any reason).

Putting a link below, hoping it works: According to the Times-Picayune, the property has now been incinerated. But Texas wants to deliver the ash to the hazardous waste landfill in Louisiana and the Jindal administration has successfully obtained a restraining order to keep the "Ebola ash" from crossing his state border. Here's the link, which includes the complete text of the petition for the restraining order.


ASH!!!! I thought this was the guy who didn't want the GOP to be the Stupid Party!

Anyway: According to the petition, the "material ... potentially contaminated with Ebola virus" and transported by Stericycle to the Veolia, TX incinerator consisted of six truckloads of material, consistent with previous news reports, which it says were contained in 142 55-gallon plastic drums. Even the hoarders I know don't own 142 drums' worth of small stuff, so I presume that they busted up the furniture and put the pieces in drums to keep the Ebola from getting out and getting them.

We are told: "The management company acknowledged the ash posed NO RISKS to people [my emphasis], but decided to stay out of the issue." IOW, if they are too noisy about pointing out the shrill hysterical imbecility of their state's "leadership", some excuse could be found to put them out of business. Welcome to Louisiana.

So there's another logistical nightmare associated with furniture-burning. First you have to burn it, then you have to find a hazardous waste landfill in a state whose governor is still sane to take the ash. And while as far as Ebola is concerned you should be able to dump it in the dumpster out back, most people's personal property these days contains enough heavy metals in TVs, computers, electronics, batteries, etc. that you may not put the ash of it in an ordinary landfill. (If the waste disposal problem gets desperate enough, public health authorities may start realizing that letting the TV sit for a week and wiping it off with bleach should be more than adequate.)

Cleaning and waste disposal is a weak spot in many hospitals. Doctors and nurses get trained, whether or not they follow that training is a different issue, and getting the administration to supply the necessary protective equipment is another, but the wiping, scrubbing, mopping, and handling of the trash is often left to people with little or no training and no standing to point out potential problems if they see them even though they are often the most likely to be able to observe errors.

In one case not related to ebola an infection was tracked back to medical staff not washing their hands between rooms. This only came to light when a smart infection control nurse asked the janitor how often he had to replace the soap cartridges in the one place the staff could wash their hands between rooms. Based on the size of the cartridge capacity and the output per use, and traffic, the unit should have needed changing every third or fourth day but it had only been replaced once a week, at most. On close questioning it came out that a good part of the medical staff had been lazy, and a few had assumed there was no need because the two patients were said to have the same infection.

It is often the janitors and housekeeping staff that are in a position to effectively monitor use of protective equipment simply because they are handling the new and used PPE when taking out the trash and restocking.

Off course few nurses, and very few doctors, are going to talk to the janitors or take their observations seriously. It is a matter of race, wage, and dignity. Training, motivating, and listening to the lower level staff , making them part of the team, is a vital piece of infection control. Sadly one missing in many healthcare settings.

There is something that Texas Health Presbyterian isn't telling the public. Texas Health Presbyterian is just like ALL hospitals in the US--they exist to make a PROFIT. Nurses, like myself, who have spent years and years working in hospitals, all know that the priority of hospital administrations is to make a PROFIT. Patient care is very much the secondary concern of the business people who run hospitals. This is nothing new. It has been going on for decades.

These big corporate institutions never fail to claim that high quality patient care and the safety of their staff is their main concern. THEY ARE LYING!! All they care about is the bottom line. Regardless of the religious denomination that is lit up on the side of these buildings, PROFIT is the ONLY concern. Hospitals are corporations; businesses. The administrators treat nursing staff horribly and they have done so for many, many years in this country. Nurses are required to do as they are told by the administrators. Many times the people calling the shots regarding nurse / patient staffing ratios, know nothing about taking care of people. Nursing isn't part of the curriculum in hospital administration programs.

The hospital likely didn't want to pay for the needed protective equipment. The hospital likely demanded that the nurses take care of multiple patients while also taking care of Mr. Duncan. The more patients a nurse takes care of, the bigger the PROFIT for the hospital. This hospital doesn't give a crap about these nurses. The only reason they care now is because the media is breathing down their necks and exposing them for what they really are which are huge corporations making huge profits from sick people.

By Kathryn Brown (not verified) on 16 Oct 2014 #permalink