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Press Start: Lead an Empowered Life as a Clinical Laboratorian

Get Back to Basics: Ebola and Other Things

Published October 22, 2014 5:46 PM by Glen McDaniel

It is extremely important to get back to basics in whatever we do. This simple edict is so often ignored because- well, because it is so basic. We tend to go for the complicated and glitzy. I thought about this truism when the CDC issued its new more rigorous guidelines this past Monday.

There is nothing really complicated about the guidelines at all. What is remarkable is that these guidelines have been used with thousands of Ebola patients for years in Africa. The group Médecins Sans Frontières (MSF) or Doctors Without Borders has treated hundreds of Ebola patients under horrendously primitive conditions for years with very few cases of provider-infection by using very basic guidelines similar to these finally adopted by the CDC.

We like to think we have the best healthcare system in the world, the most sophisticated  equipment, and the most knowledge. We are reluctant to modify our more high-tech rituals; we certainly do not like to borrow ideas from less developed countries. CDC first issued Ebola guidelines in 2008 and again as recently as August of this year.  But we have a situation where 2 American nurses using CDC guidelines became infected on American soil. The CDC admits they have not been able to identify any specific breach in protocol so it’s possible the problem was the ineffectiveness of the protocol itself.

According to CDC Director Dr. Thomas Frieden, the new, MSF-type guidelines are based on 3 principles:

-healthcare workers should be rigorously trained in both donning and doffing PPE

-there should be no skin exposure at all

-each episode of donning and doffing should be supervised by a trained monitor

Looking at the protocol in more detail, consider how basic certain steps and concepts are

1.     Full coverage of the body, no neck or face exposed as in previous guidelines

2.     Use of face shields versus goggles that leave skin exposed, fog up, and may be adjusted inadvertently with contaminated hands

3.     Decontaminate gloved hands and soiled  PPE with a virucide during and after removal

4.     Use extra covering such as aprons if the patient is producing excessive body fluids like vomiting and  diarrhea

5.     Use a “buddy” monitor to observe, coach, and correct in both the donning and doffing of PPE to ensure there are no shortcuts or violations of protocol

6.     Hand washing, hand washing, hand washing

7.     Staff should be trained, practice and be familiar with the protocol before they have to actually use it

It is worth noting that as scientists with highly sophisticated instrumentation at our disposal, specimen processors, auto verification and the like we sometimes give up autonomy and abandon critical thinking. Nothing is a substitute for ensuring the right specimen is collected from the right patient, the right test is performed, the result makes sense, and the correct result gets back to the right decision maker in a timely manner.

 No matter what our instruments say, we can over-ride technology and should still go with the basics whenever there is doubt. Or if there is a problem of any sort. Or as part of troubleshooting. Or if we have a gut feeling.  

Technology and established protocols are great helpmates. But I cannot think of one instance in which going back to the basics is not a sound principle by which to operate.


Press Start: Lead an Empowered Life as a Clinical Laboratorian : Get Back to Basics: Ebola and Other Things

December 3, 2014 4:06 AM

Press Start: Lead an Empowered Life as a Clinical Laboratorian : Get Back to Basics: Ebola and Other Things

November 28, 2014 7:20 AM

I agree wholeheartedly. I don't think it's a coincidence that since hospitals have adopted the new guidelines that no one has become positive from infection in the States.

It makes sense that those  African countries which have been dealing with this disease for so many years have  mastered the infection control PPE aspect. What is troubling is that the US, even the CDC, are so reluctant to adapt best practices if they were not develop din the States. There is  a degree of xenophobia and arrogance. Don't you think so?

As scientists we ought to go with what works no matter the origin.

Melissa T. November 1, 2014 6:14 PM
Boston MA

Very good point. We think of the CDC as the authority on infection and all diseases. But they too fall into the trap of developing protocols based on little input or an American mind set. Then they hesitate to change them.

I bet these more basic commonsense guidelines will work better.

Thank you for reminding us of getting back to basics.

Tyrone, MLS October 23, 2014 1:04 PM

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