“There’s a Person Behind Ebola”

Ebola-EDNurses

Rush emergency department nurses Lauren Callahan (standing) and Jenna Pederson (seated)

Rush emergency department (ED) nurses Lauren Callahan, MSN, RN, and Jenna Pederson, MSN, RN, wanted to show compassion for a patient who arrived in the ED on Oct. 21 in the same way they usually would for any patient. But this time was different.

The nurses were dressed in protective equipment, including a face mask that only showed their eyes behind a plastic shield. They also had to keep contact with the patient to the minimum degree necessary to provide care. In fact, Pederson had to stay on one side of a strip of tape that divided an ER decontamination room, with Callahan and the patient on the other.

Only a few hours off a long plane flight, the patient had been brought to Rush for medical evaluation after a screening at O’Hare International Airport flagged the traveler as being at risk for Ebola, given that the patient reported certain symptoms and came from Liberia, which is one of the West African nations where Ebola originates.

Yet even as they took stringent precautions to protect themselves from infection with a disease that horrifies many, Callahan and Pederson were moved by the patient’s situation – alone, frightened and possibly seriously ill.

“It was very humanizing. You hear, ‘Ebola, Ebola, Ebola,’ but there’s a person behind Ebola,” Callahan says.

“Jenna and Lauren were a bit anxious at first, but when they looked into the patient’s eyes, their caring nature and professional skills took over,” says Dino Rumoro, DO, chairperson of the Rush Department of Emergency Medicine. “I was moved by their swift reaction and compassion for a person in need of help.”

While Rush’s infectious disease experts ultimately determined the patient did not have Ebola symptoms, it was a powerful and instructive experience for the two young nurses (both of whom are enrolled in Rush’s Doctor of Nursing Practice program). Here, Callahan and Pederson discuss the evening and how their training and compassion prevailed over fear. (For privacy reasons, the interview has been edited to omit references to the patient’s gender.)

Why were you the nurses chosen to receive the patient?

Callahan: Jenna and I have a hazmat (hazardous materials) background. We’re both part of the hazmat team at Rush. We’ve been in drills and PPE (personal protective equipment) training prior to this event. We’ve been in suits together that cover us from head to toe. We were very comfortable not only in the suits but communicating with each other as well. When we got the call and they said, ‘we need someone in the suit,’ I said, why not?

Was it difficult to get into the equipment?

Callahan: We were getting regular updates about the patient’s arrival time from EMS (Chicago’s Emergency Medical Services division), 45 minutes, 30 minutes, 15 minutes. We suited up around 15 minutes. With the help of everyone we were able to get suited up really fast to limit our time in the suits. It’s a team effort. There’s someone who’s dressing us, who’s checking us.

Pederson: Anna Candoleza (another ED nurse) was our spotter. She was there for every moment of doffing (removing the protective equipment), because you’re tired, you’re drained emotionally, you’re drained physically from wearing it.

What happened when the patient arrived?

Callahan: I met the patient in the ambulance bay with our EMS director, Dr. (Louis) Hondros. The patient was able to walk in to the decontamination room, was covered in a blanket, and then zipped inside an isolation bag. We asked about symptoms, presenting complaints, and then we waited for the infectious disease doctors to get involved.

Then we just chatted. We found out about the patient’s favorite food, kids, work, a friend in Chicago.

What was different about caring for this patient?

Callahan: The biggest thing was being reminded that there is a person behind Ebola. The patient was afraid of being judged walking through the hallway.

Pederson: The patient was saying, ‘I would never want anyone to be injured.’ This person wanted to find out if it was Ebola as much as we did, and was happy to see we were taking it seriously.

Callahan: It was a little bit hard, because we were trying to limit contact until we knew. The patient care, the actual care aspect, isn’t the hands-on that we were used to.

The patient was crying at one point. I knew where a hand was (inside the protective bag), and I put my hand there.

Jenna: Normally, if you had a patient who said the things that this person said, you would sit next to them and give them a tissue, take their hand. We couldn’t provide the personal touches that you would at the bedside. We only could provide comfort by talking.

How did you feel when the doctors said the symptoms didn’t indicate Ebola?

Callahan: I was relieved, for the patient, the patient’s family, the grandkids that we learned about, relieved for the MICU (medical intensive care unit) team, relieved for my co-workers, everybody.

Pederson: Still, we did everything we would have done if the patient had been high risk. We doffed (the protective equipment), and I preferred that. If we were going to start high risk, we’re going to finish high risk. It’s still good practice. Even if it’s 100 percent there’s no chance, we’re still going to doff the same way.

The training we had helped. They make you doff in a slow, methodical fashion. I took off Lauren’s equipment fully before I started, and I was roasting. I felt like I was in an oven. But it had to happen that way.

Were you scared during all of it?

Pederson: Before we started, you had all this built up anxiety. This is the first case, and everyone’s running around. Once I was in the room and fully dressed, I wasn’t scared. Here it is. It’s go time.

Callahan: It’s the same if you get a call if there’s a cardiac arrest.  You rely on your training and your instincts. That initial adrenaline, we all have it in the ER, and we like it.

Ebola: Cause for Concern, But Not for Panic

Dino Rumoro, DO

The worst recorded outbreak of the virulent Ebola virus has killed more than 2000 people in West Africa and is believed to have infected about 4,000 people since it began in March.

So far, the outbreak has been confined to West Africa (primarily Guinea, Liberia and Sierra Leone) and two suspected cases in the U.S. (in Dallas and Washington, DC).

Dr. Dino Rumoro, head of the Rush Department of Emergency Medicine, sees little danger to the U.S. from Ebola. He explained why in the following interview.

Q: Are you worried about Ebola coming here?

Rumoro: There are a lot of diseases that cause us a lot of concern. In the ‘80s, when we saw the emergence of HIV and AIDS, that made us very nervous as well, and we learned how to deal with it. Our experience dealing with other infectious diseases makes us prepared for this disease. This is a disease that we know about in the scientific community, but it’s not native to the United States.

Q: How is Ebola spread?

Rumoro: The key thing to remember with Ebola is that it’s not an airborne virus, so we’re not worried about it being transmitted through the air. We’re worried about contact with bodily fluids like blood, vomit and diarrhea. If those fluids enter another person’s eyes, nose, or mouth, an infection could occur.

Q: Who’s at risk for Ebola?

Rumoro: Anyone who comes in direct contact with body fluids of an infected person is at risk. Health care workers are at higher risk, just because they’re getting in close contact with body fluids. A close family member who may be caring for a patient is at even higher risk than a health care worker, because they don’t have the personal protection we use. Family members, if they’re cleaning up the diarrhea or the blood, they think, ‘it’s part of my job,’ and may ignore the need to protect themselves.

While Ebola is a highly dangerous and infectious disease, we can control it by using blood and body fluid precautions. We want to protect ourselves from any types of secretion. All we really need to do it is wear a face mask with an eye shield, wear gloves, gowns, and boot covers, and we need to wash our hands frequently.

There’s reason to exercise caution, but with the proper equipment, if you follow the rules you’ll be safe. The problem they have in the third world countries is they don’t have the personal protective equipment we have.

Q: Ebola is fatal between 60 and 90 percent of the time. What can be done to treat it?

Rumoro: The standard of care is support. Meaning, you’re going to treat the symptoms. One of the end stages is cardiovascular collapse. The blood pressure drops, the patient starts going into cardiac arrest.

Ultimately though, the source of that collapse is the virus, there is no treatment for the virus. So it would be supportive care at this point. We would try to ease the discomfort, try to keep the blood pressure maintained. It appears that the people who die of Ebola virus don’t mount the same immunologic response as the ones who live through it. If you get them through some of those rough points, maybe you give them enough time for a reactive response and they can fight the virus off.

(This post was updated on Oct. 3, 2014)

MRSA Study Slashes Deadly Infections in Sickest Hospital Patients

Dr. Mary K. HaydenUsing germ-killing soap and ointment on all intensive care unit patients can reduce bloodstream infections by up to 44 percent and significantly reduce the presence of methicillin-resistant Staphylococcus aureus (MRSA) in ICUs, according study results published in today’s New England Journal of Medicine.

The REDUCE MRSA trial, funded by the Department of Health and Human Services, was conducted in two stages from 2009-2011. It tested three MRSA prevention strategies and found that using germ-killing soap and ointment on all ICU patients was more effective than other strategies.

“The strategy that proved to be most effective was perhaps the most straightforward: All patients were bathed daily with chlorhexidine antiseptic soap for the duration of their ICU stay and all received mupirocin antibiotic ointment applied in the nose for five days,” said Dr. Mary K. Hayden, associate professor of infectious diseases and pathology at Rush University Medical Center, and one of the co-authors of the study.

Read the entire news release.