The Emperor’s New PPE

By Sally Sellers

SallyAnnSellersSally Speak is the effort of Sally Ann Sellers, RN, BSN, MA Ed, an old battle-ax who is just delusional enough to think her pen is mightier than a sword. Good night & good luck!

“There is no greater evil than men’s failure to consult and to consider.” ― Sophocles, Antigone

Hospitals in the US cause about 400,000 premature patient deaths each year due to preventable harm (iatrogenic causes). This equates to three jumbo jets falling out of the sky each day (James, 2013). Our dysfunctional healthcare system tolerates the carnage of preventable patient injury and death, and potential occupationally-acquired infectious diseases by healthcare workers (HCW). But with the introduction of Ebola Virus Disease (EVD), we may be creating unsafe conditions that threaten communities outside of the hospital walls if our isolation protocols and personal protective equipment (PPE) do not work properly. This deadly problem may add to the list of poor outcomes of our healthcare system, spreading the disease, since caregivers are vulnerable to being infected and carrying it into communities. In West Africa, as of mid-October, WHO reports 420 HCW cases of EVD, and 239 deaths, and 2 HCW cases in the US and 1 in Spain.

The deadly outbreak of EVD has created the need for change within the U.S. healthcare system, but the leadership at the CDC and other healthcare in-groups are reacting slowly, with groupthink, creating a situation where those who set policies actively suppress dissenting viewpoints, isolating themselves from outside influences and even taking irrational stances that dehumanize other outside groups, such as “sloppy nurses” and a “panicky public.” When groups make faulty decisions that lead to a deterioration of mental efficiency, reality-testing or moral judgment, they are displaying symptoms of “Groupthink”, a term coined by social psychologist Irving Janis in 1972. What are the signs of groupthink, and how do those signs present during a crisis when we need to change healthcare standards and policies?
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Clutching our world views with a death grip

By Mary Odum

As I write, I am sitting in what might be my last airplane seat, stacked cheek to jowl with a couple with a cute but runny-nosed baby. My trip was with girlfriends on a bike tour in California, and I made the most of it, living very much in the moment. As I traveled, I wore my infection control hat, scanning the settings with new eyes for potentially dangerous situations. I was careful in public places such as airports, trolleys, and the BART, washing my hands frequently and keeping them folded in front of me. I was much more aware of impulses to touch my face. I watched a couple in the San Francisco airport who were headed to Nairobi touch their faces, many times, as they waited. Airport bathrooms were mostly hands-free, but the automatic toilets sprayed their contents powerfully in all directions when flushed. There was a new sign in the TSA line warning us to wash our hands because of Middle East Respiratory Syndrome (MERS), but no mention of Ebola (EVD). TSA used gloves to pat me down, but they were not washing their hands after contact with people. Boarding passes, drivers licenses, and credit cards were swiped and exchanged, along with bills and coins. I saw a large homeless population on the waterfront in San Francisco with no access to bathrooms or handwashing, who were using the streets as open latrines. I saw prostitutes. Hotels had carpets and mattresses that would defy cleaning in an outbreak. I saw people hugging, and shaking hands, and doing all kinds of human, caring, or even loving things that would be extinguished in a pandemic.

Today the first nurse within the US healthcare system has acquired EVD. My nursing friends are worried. Are we ready for this? How do we communicate risk, or should we settle for optimistic reassurance that our system can handle this? What are our biggest needs in preparation?
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Uncharted territory for a system in overshoot

By Mary Odum

http-:www.flu.gov:planning-preparedness:community:community_mitigation.pdf-fig3a
http-:www.flu.gov:planning-preparedness:community:community_mitigation.pdf 1918 pandemic CFR = <3%. Where would Ebola’s CFR line be on this graph?

We are in uncharted territory with the Ebola virus disease (EVD). The last time we had a plague that was this deadly was the Black Death in the 14th century, when there were only 450 million people in the world. That pandemic killed 30% to 70% of the population. There is no benchmark for EVD, which kills 3 out of 4 people it touches, and is emerging into a global population of 7 billion.

Ulgiati et al., 2011, Emergy-based complexity measures in natural and social systems - Emergy flows plateau in modern Rome as an example of a high-transformity system
(Ulgiati, Ascione, Zucaro & Campanella, 2011, Fig. 1) Emergy-based complexity measures in natural and social systems – Emergy flows plateau in modern Rome as an example of a high-transformity system

This pandemic signifies a turning point for society in response to peak oil, highlighting the problem of globalization for a planet of 7 billion people. We have lost control of a deadly outbreak, and our responses to its exponential growth are linear at best, ensuring that this plague will most likely spread further. Many in first world countries think we are immune to plagues. How might transmission of EVD change as it moves from a low-resource or low-transformity setting in West Africa to resource-rich (high-transformity) countries?  How might the battle against this epidemic change as it breaks out into different environments?

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The 4S’s of surge capacity

By Mary Odum

Welcome to the arcane and short-sighted world of public health strategic planning. This post introduces the term surge capacity, a term we will hear often in the coming months of this growing Ebola (EVD) epidemic. Surge capacity is the ability to manage sudden or prolonged increases in overall healthcare demand, and the key components are the 4 S’s of staff, stuff, structure and systems, for hospital and community preparedness (Adams, 2009). During a pandemic, lack of surge capacity in all four of these areas become key limiting factors:  hospital isolation beds (structure), healthcare providers (HCP-staff), isolation gear (stuff), and an efficient, just-in-time, high-transformity system, which is an obstacle to resilience.  Continue reading The 4S’s of surge capacity