On October 15, we solicited your questions about the Ebola outbreak. Our author Sten Vermund, MD, PhD, Professor of Pediatrics and Amos Christie Chair and Director at the Vanderbilt University School of Medicine Institute for Global Health has graciously taken the time to answer your questions.
Sharon Slockbower, RN, asked: Some articles I have read indicated that if body fluid of patient even gets on someone's skin has the potential to infect the caregiver. How is this possible if the nurse washes with soap and water or alcohol gel and did not have opening in her skin?
Sten Vermund: We honestly do not know much about the infectiousness of the Ebola virus. But we do know that the human skin is rarely fully intact: eczema, small scrapes, people biting their fingernails, and the like. The more intact the skin, the more protection one expects.
Sharon Slockbower, RN, asked: Is the CDC planning to send staff to oversee the hospital effected to assure that proper procedures are being instituted and followed?
Sten Vermund: Yes, CDC has deployed hundreds of staff to the field for this purpose and for prevention activities.
Sharon Slockbower, RN, asked: Is it true that there was no-one assigned to oversee that proper disrobing and application techniques for PPE's was being followed?
Sten Vermund: This was not done the way that MSF [Medecins Sans Frontieres, aka Doctors Without Borders] does it in West Africa, so I think it's fair to say that de-gowning was not optimally practiced.
Melva Bostik asked: What chemicals are being used to decontaminate?
Sten Vermund: Diluted bleach works very well.
Melva Bostik asked: What will small critical access hospitals with no isolation room do if a patient presents?
Sten Vermund: Patients should be isolated and transferred to an institution with sufficient treatment capability ASAP.
Melva Bostik asked: Will larger hospitals allow transfer in of a patient suspected?
Sten Vermund: The CDC is mobilizing hospitals now for voluntary referral to facilities with sufficient capacity, learning from the disaster in Dallas.
Beverly asked: Is it really safe to travel on an airplane with someone who is incubating Ebola?
Sten Vermund: Incubating, yes, symptomatic for Ebola, no.
Beverly asked: What will happen in hospitals where a nurse refuses to treat an Ebola patient?
Sten Vermund: This reminds me of my days as a pediatrician in NYC in the 1980s when I had to feed the babies with HIV infection because the staff refused. Best to have a trained Ebola team that is fully trained in infection control for this disease. Volunteers are likely to step forward, given the commitment of most nurses and doctors to their professions.
Beverly asked: Why would a nurse wearing personal protective equipment get Ebola and the Dallas man's family not get Ebola?
Sten Vermund: A nurse is in intimate contact with a sick patient. The family may have spent time with him before he was maximally infectious and symptomatic, and may also have had less exposure with bodily fluids.