米国ダラスのエボラ感染 Update 2014/10/17

リベリアからのエボラ感染者Duncan氏(死亡)を受け入れて、看護師2名が感染したTexas Health Presbyterian Hospitalのエボラ対応について、当初、CDCは看護師の手順ミスの可能性を指摘していたが、その後、それは看護師たちの責任を問うものではにと謝罪していた。
Frieden also apologized to Texas Health Presbyterian Hospital about his previous “breach of protocol” comments, saying that he did not intend to put the blame on the hospital or on Pham. “I apologize if people thought I was criticizing the hospital,” Frieden said. “And I feel awful that a health care worker became infected while helping an Ebola patient.”

[CDC training hospitals to ‘think Ebola’ after first case contracted in U.S. (2014/10/13) on PBS]
There was no advance preparedness on what to do with the patient, there was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.

Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields. Some supervisors said that even the N-95 masks were not necessary.

The suits they were given still exposed their necks, the part closest to their face and mouth. They had suits with booties and hoods, three pairs of gloves, no tape.

For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own.

Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.

Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.







["Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United" (2014/10/15) on National Nurses United]
エボラ感染した看護師Nina PhamとAmber Joy Vinsonが何らかの手順ミスをしたのではなく、そもそも病院側が医師や看護師を防護できる準備をしていなかったことが、感染の原因のようである。

Federal health officials effectively acknowledged the problems with their procedures for protecting health care workers by abruptly changing them. At 8 p.m. Tuesday, the Centers for Disease Control and Prevention issued stricter guidelines for American hospitals with Ebola patients.

They are now closer to the procedures of Doctors Without Borders, which has decades of experience in fighting Ebola in Africa. In issuing the new guidelines, the C.D.C. acknowledged that its experts had learned by working alongside that medical charity.

[DONALD G. McNEIL Jr.: "Lax U.S. Guidelines on Ebola Led to Poor Hospital Training, Experts Say" (2014/10/15) on NYTimes]
先週エボラで死亡したリベリア人Thomas Eric Duncanの治療チームにいた看護師2名がダラスでエボラ陽性診断されて以降、連邦保健当局は米国の病院のエボラ感染者対応ガイドラインを厳格化した。North Shore Long Island Jewish Health Systemや、米国の4つのバイオコンテイメント設備(危険な感染症患者の隔離))の1つであるオマハのNebraska Medical Centerなどの多くの病院が、CDC(2014/10/15)よりも厳格なガイドラインを以前から定めている。
  • Original C.D.C. Guidelines: 感染者の血液や体液に触れない医療従事者向けの、CDCの最初のガイドラインに沿ったもの。
  • North Shore-L.I.J. Level 2 Suit: 感染者の血液や体液に触れる可能性のある医療従事者向け。Nebraska centerを含む、多くの病院はこれは最低基準としている。North Shore-L.I.J.では先週までは、これでエボラ感染者に対応していたが、Level 3にアップグレードした。
  • North Shore-L.I.J. Level 3 Suit: ダラスで2人目の看護師がエボラと診断されて以降、North Shore-L.I.J.は不浸透性の頭部を加えた。これが西アフリカの医療従事者の標準装備となり始めている。CDCは米国で全身防護服を義務付ける

[Changes to Ebola Protection Worn by U.S. Hospital Workers (2014/10/15) on NYTimes]
この改定以前のガイドラインは、バイオコンテイメント設備のあるEmory University hospitalの感染コントロールを監督するSean G Kaufmanによれば、ゆるすぎて役に立つものではなかった。
Sean G. Kaufman, who oversaw infection control at Emory University Hospital while it treated Dr. Kent Brantly and Nancy Writebol, the first two American Ebola patients, called the earlier C.D.C. guidelines “absolutely irresponsible and dead wrong.”

Speaking by phone from Liberia, where he was training workers for Samaritan’s Purse, the medical charity that Dr. Brantly and Ms. Writebol worked for, Mr. Kaufman said he had warned the agency as recently as a week ago that its guidelines were lax.

[DONALD G. McNEIL Jr.: "Lax U.S. Guidelines on Ebola Led to Poor Hospital Training, Experts Say" (2014/10/15) on NYTimes]

また、CDCはモニタリング対象者の航空機などの公共交通機関の利用に関して、ゆるい対応をしていた。エボラに感染した2人目の看護師Amber Vinsonがエボラ陽性判定を受ける24時間前に、ClevelandからDallasへの航空機に搭乗する前にCDCに問い合わせたが、CDCは搭乗に問題はないと回答していた。
Before she boarded that flight, the woman, identified by Ohio officials as Amber Joy Vinson, 29, informed the Centers for Disease Control and Prevention that she was running a temperature of 99.5 degrees, a federal official told The Washington Post.

That was below the 100.4-degree- threshold in CDC guidelines for screening travelers who have been in Ebola-affected countries, and which triggers a secondary screening. The CDC did not prohibit Vinson from traveling on the plane back to Dallas, said the official ...

オハイオ州当局者がAmber Joy Vinson(29)であることを確認している女性が航空機に搭乗する前に、体温が99.5F(37.5℃)であることをCDCに連絡していたと、連邦政府当局者がWashington Postに述べた。それは、第2次スクリーニングを実施する基準でもある、エボラ感染地域からの旅行者のスクリーニングのCDCガイドラインの閾値100.4F(38℃)以下だった。CDCはVinson看護師がDallasへ航空機で帰ることを認めたと、連邦政府当局者が述べた。

But on Wednesday, CDC Director Thomas Frieden said that Vinson should not have been flying anywhere given her possible exposure to Ebola at her workplace, Texas Health Presbyterian Hospital Dallas ...

しかし、2014/10/15に、CDCのThomas Friedenセンター長は、Vinsonは職場Texas Health Presbyterian Hospital Dallasでエボラに触れた可能性があるので、航空機に搭乗すべきではなかったと述べていた。

[Mark Berman, Lena H. Sun and Joel Achenbach: "Health-care worker with Ebola was allowed to fly despite slight fever" (2014/10/15) on WashingtonPost]
さらに、Texas Health Presbyterian Hospital Dallasの別の医療従事者が旅行に出かけていることがわかった。
Meanwhile, a different Dallas hospital worker who may have handled Duncan's fluid samples has been quarantined on a cruise ship in Belize ...

Though the employee did not have direct contact with Duncan, he or she "may have had contact with his specimen," the U.S. State Department said Friday.

A doctor at the cruise ship has declared the worker symptom-free and in good health, but the worker will remain under isolation as a precaution, it said.
It's been 19 days since the worker handled Duncan's fluid samples -- two days shy of the 21-day incubation period for Ebola.

The Texas Health Presbyterian Hospital worker boarded the commercial cruise ship Sunday from Galveston, Texas.

At the time, the Centers for Disease Control and Prevention had not updated its monitoring requirements, and required only self-monitoring, said Jen Psaki, a spokeswoman for the State Department.



Texas Health Presbyterian Hospitalの従業員は2014/10/12にテキサス州Galvestonから民間クルーズ船で出航していた。その時点ではCDCはモニタリング要件を改定しておらず、セルフモニタリングのみが義務付けられていたと、国務省広報担当Jen Psakiが述べた。

[Jason Hanna, Faith Karimi and Greg Botelho:"Amid Ebola fears, cruise ship quarantines worker, airline contacts travelers" (2014/10/17) on CNN]

. No individual who entered the first Ebola patient’s room can travel by commercial transportation until 21 days after that individual’s last exposure. These individuals should not travel by commercial conveyances (e.g. airplane, ship, long-distance bus, or train). Local use of public transportation (e.g. taxi, bus) by asymptomatic individuals should be discussed with the public health authority.

2. All HCW involved in the direct care of the first Ebola patient must be monitored twice a day with one of the monitoring sessions being a face to face encounter. As part of that monitoring, each HCW’s temperature will be checked twice a day;

3. No individual HCW who entered the first Ebola patient’s room can go to any location where members of the public congregate which includes but is not limited to, restaurants, grocery stores, theaters, or other places where the public may be in attendance or gather, throughout the entire 21 day time period that follows the individual’s last exposure.

4. All HCWs who provided direct care in the first Ebola patient’s room will be given the opportunity to stay at Presbyterian Hospital on a non-admission status in order to
facilitate monitoring; and

5. Any HCW that does not adhere to monitoring or any of these other measures may be subject to a communicable disease control order.

[Movement of Persons with Possible Exposure to Ebola (2014/10/16) by Texas Department of State Health Services (text by LA Times/a>)]


米国ダラスのエボラ感染 Update 2014/10/15

リベリアからDallasに来たエボラ感染者Duncan氏が入院したTexas Health Presbyterian Hospitalで治療に参加した医療従事者に新たに感染が確認された。この2人目の感染者も看護師(29)で、保健省広報担当Carrie Williamsによれば、発熱を申告した2014/10/14に隔離された。

The Centers for Disease Control and Prevention (CDC) also said that the 29-year-old nurse, Amber Vinson, flew on a commercial flight from Cleveland, Ohio to Dallas with a low-grade temperature a day before she was diagnosed. While in Ohio, she also reportedly travelled from Cleveland to Akron.
Dr Tom Frieden, the CDC director, conceded on Wednesday that Vinson should not have been allowed to take the flights to Ohio. “We will, from this moment forward, ensure that no other individual who is being monitored for exposure undergoes travel in any way other than controlled movement,” Frieden said.

CDCによれば、29歳のAmber Vinsonはエボラと診断される前日に、微熱状態で、民間航空でオハイオ州ClevelandからDallasに移動していた。伝えられるところによれば、彼女はオハイオ州では、CelvelandからAkronに旅行していた。
CDCセンター長Dr. Tom Friedenは2014/10/15に、感染者Vinson看護師がオハイオへ旅行すべきではなかったと述べた。「今後一切、エボラ感染者と接触してモニタリング対象となっている者が、コントロール下をのぞく、いかなる方法によっても、確実に旅行させないようにする」

[Lauren Gambino: "Second Texas nurse with Ebola to be transferred to special facility" (2014/10/15) on theguardian]
Amber Vinson看護師は、米国の4つあるバイオコンテイメント施設の一つであるEmory University hospitalに送られる。
The US secretary of health and human services, Sylvia Burwell, said that Vinson will be transported to Emory University hospital in Atlanta, which has successfully treated two Ebola patients and is caring for a third, an unidentified American doctor who contracted the disease while working in the Sierra Leone.
Pham was in “improved condition” Wednesday, according to Frieden, while Vinson was “ill but clinically stable”.
[Lauren Gambino: "Second Texas nurse with Ebola to be transferred to special facility" (2014/10/15) on theguardian]

  • St. Patrick's Hospital, Missoula, Montana
  • Nebraska Medical Center, Omaha, Nebraska
  • NIH Clinical Center, Bethesda, Maryland
  • Emory University Hospital, Atlanta, Georgia


一方、感染原因は特定されていないが、The National Nurses Union(全米看護師協会)によれば、Texas Health Presbyterian Hospitalでは、防護装備の手袋をテープ止めしていなかったり、首が露出していたりした。

More ABC news videos | ABC Health News
これらが事実であれば、Texas Health Presbyterian Hospitalは費用をけちって、スタッフや入院患者への感染リスクを高めてしまっていたことになる。

そのような状況なら、最初の感染者Duncan氏も、Emory University Hospitalに送るべきだったとの関係者意見も頷ける:
"If we knew then what we know now about this hospital's ability to safely care for these patients, then we would have transferred him to Emory or Nebraska," the official told CNN senior medical correspondent Elizabeth Cohen. "I think there are hospitals that are more than ready, but I think there are some that are not."

[Josh Levs and Holly Yan:"CDC: U.S. health worker with Ebola should not have flown on commercial jet" (2014/10/15) on CNN]

posted by Kumicit at 2014/10/16 09:09 | Comment(0) | TrackBack(0) | Disease | このブログの読者になる | 更新情報をチェックする


米国ダラスのエボラ感染 Update 2014/10/14

CDCセンター長Dr. Thomas R. Friedenによれば、リベリアからダラスに来て死亡したエボラ感染者Duncan氏及び彼から感染した看護師に接触してモニタリング対象となっているのは125名である。
“There were 76 people who had some level of contact and therefore are being actively monitored,” Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said at a news conference, where he detailed plans for the agency response to the virus, including the use of rapid response teams.
The total number of people being monitored is now 125, health officials said, including 48 who have been watched for more than two weeks after coming into contact with Mr. Duncan before he was admitted to Texas Health Presbyterian Hospital on Sept. 28.
All but one of the 76 added to the monitoring list are health care workers who cared for Mr. Duncan, handled blood samples or were simply in the same room before he died, Dr. Frieden said. The other person being monitored had contact with the nurse.

How Ms. Pham contracted the virus remained unclear, Dr. Frieden said. “We have not yet identified a specific interaction.”

「現在、合計125名がモニタリング中であり、うち48名は、Duncan氏がTexas Health Presbyterian Hospitalに2014/09/28に入院する前に接触後、2週間以上モニタリングされている。

[JACK HEALY and TIMOTHY WILLIAMS: "76 People in Texas Being Monitored for Signs of Ebola" (2014/10/14) on NYTimes]
さらに、今後の米国の病院におけるエボラ対応について、CDCセンター長Dr. Thomas R. Friedenは...
DALLAS − As a 26-year-old Dallas nurse lay infected in the same hospital where she treated a dying Ebola patient last week, government officials on Monday said the first transmission of the disease in the United States had revealed systemic failures in preparation that must “substantially” change in coming days.

“We have to rethink the way we address Ebola infection control, because even a single infection is unacceptable,” Thomas Frieden, director of the Centers for Disease Control and Prevention, said in a news conference.

「今回の感染は、準備における組織的失敗を明らかにしており、今後、これを徹底的に修正しなければならない。1回の感染も許容できないので、エボラ感染コントロールの方法を再考する必要がある。」と2014/10/13の記者会見でDr. Thomas R. Friedenは述べた。

[my Ellis Nutt, Mark Berman and Brady Dennis: "CDC chief: After Dallas nurse’s Ebola infection, U.S. must ‘rethink’ protocols" (2014/10/13) on WashingtonPost]
一方、ABCnewによれば、感染したPham看護師への治療には、2か月前にエボラから回復した医師Dr. Kent Brantlyの血液が使われる。
Pham has received a potentially life-saving transfusion from Dr. Kent Brantly, the missionary doctor who beat the virus two months ago, ABC News has learned.

Brantly flew to Dallas on Sunday, one day after Pham tested positive for the virus, sources said. He donated his blood, packed with antibodies that should fight the disease.

Jeremy Blume, a spokesman for the nonprofit medical mission group Samaritan's Purse, confirmed that the plasma donation came from Brantly. The missionary had received an experimental treatment and fought off the virus, and has donated blood for transfusions for three others, including Pham.

[Dallas Nurse Battling Ebola Says She's 'Doing Well' (2014/10/14) on abdnews]

このような米国内感染に関して、National Nurses UnitedのRose Ann DeMoro代表は、看護師に最先端の装備器具を使えるようにしなければならないと述べた。
It is long past time to stop relying on a business-as-usual approach to a virus that has killed thousands in West Africa and has such a frighteningly high mortality rate. There is no margin for error. That means there can be no standard short of optimal in the protective equipment, such as hazmat suits, given to nurses and others who are the first to engage patients with Ebola-like symptoms. All nurses must have access to the same state-of-the-art equipment used by Emory University Hospital staff when they transported Ebola patients from Africa, but too many hospitals are trying to get by on the cheap.

In addition, hospitals and other frontline providers should immediately conduct hands-on training and drills so that personnel can practice, in teams, vital safety procedures such as the proper way to put on and remove protective equipment. Hospitals must also maintain properly equipped isolation rooms to ensure the safety of patients, visitors and staff and harden their procedures for disposal of medical waste and linens.

西アフリカで数千名を死に至らしめ、高い致死率をもつウィルスに対して、通常モードでアプローチするのは、ずっと前に終わっていなければならなかった。エラーのマージンはない。これは、エボラ様症状を示す患者に最初に接触する看護師などに貸与する防護スーツのような防護器具に関して、最適下限基準はありえないことを意味する。全看護師には、アフリカからエボラ感染者が搬送されたEmory Hospitalのスタッフが使った最先端の装備器具を使えるようにしなければならない。しかし、非常に多くの病院が安物で済ませようとしている。


[RoseAnn DeMoro (executive director of National Nurses United): "U.S. hospitals not prepared for Ebola threat" (2014/10/13) on WashingtonPost]

一方、感染者Duncan氏が入院し、Pham看護師が感染したTexas Health Presbyterian Hospitalはスタッフ890名、ベッド数255の大病院で評価も高かった。しかし、その病院をもってしても、USATodayによれば、エボラ感染という事態においては、事実把握と発表に混乱を繰り返していた。
In an Oct. 2 statement, the hospital said Duncan had a temperature of "100.1" and that his symptoms were "not severe." But medical records later provided to the Associated Press showed that Duncan had a fever of 103 and that he had reported having "severe pain." Staffers marked his fever with an exclamation point on his records, the Associated Press reported.

2014/10/02の声明で、病院側はDuncan氏の体温は100.1F(37.83℃)であり、症状は重篤ではなかったとしていた。しかし、後日Associate Pressに提供された医療記録によれば、Duncan氏の体温は103F(39.44℃)であり、本人は「強い痛み」を訴えていた。病院スタッフはDuncan氏の体温を「!」つきで記録していた。
Answering questions about Duncan's initial visit, hospital officials first blamed a flaw in the electronic health records system for not allowing the information from the nurse treating Duncan to reach the appropriate doctors. A day later, they corrected that statement, saying there was no flaw.


That statement also said Duncan was confirmed to have Ebola on Sept. 29, later corrected to Sept. 30.


On Sunday, as news of Pham's condition was made public, the hospital announced that it would be diverting all emergency room visits to other area hospitals. At 7:20 p.m., it announced it was no longer diverting its emergency visits. "The department is appropriately staffed, and ambulances may begin bringing patients in for care immediately," it said.

Twenty-five minutes later, it reverted back to diversion status.


[Rick Jervis: "Dallas hospital stumbles in early response to Ebola" (2014/10/14) on USA Today]
Texas Health Presbyterian Hospitalの規模と評価からすれば、他の病院でも大して変わらないと考えておくべきだろう。

posted by Kumicit at 2014/10/15 19:40 | Comment(0) | TrackBack(0) | Disease | このブログの読者になる | 更新情報をチェックする



Depyed security personnel of the company ≪Falcon≫ tasked with securing the University of Cairo, intensely on the doors on the first day of the new academic year. and hired ≪Falcon≫ sniffer dogs to inspect the cars and make sure they are free of explosives, other than portals to make sure not to carry any student for firearms or white and flammable materials. officers also used the company's security, detection devices for separate waste to inspect the cars and the walls and doors of the university, for fear of violence in the first days of the study. comes in conjunction condensation security by the police forces in the field of the Renaissance and the door of the Faculty of Commerce. [translated by google translate]


[cairoportal 2014/10/11 via asmaaghazall via nofrills]
新学期の開始とともに爆発物や銃器の持ち込みをゲートで検査するのに、探知犬とともに"だうじんぐマシン"が使われているという報道。これを行っているのはFalcon Group Internationalの警備サービスであり、当該サイトにある、それらしい記述は...
Security surveillance equipments
-Metal and explosive materials detectors (x-rays, walk through gates, hand held, etc)
-Voice and video surveillance (Bugs, spy cam and microphones.etc)
-Intrusion systems
-Radio and GSM surveillance

[Falcon Group - Technical System & Security]
"hand held"な"metal and explosive material detectors"とあり、これが"だうじんぐマシン"ぽい。


ههههههههههههههه هههههههههه هههههههههه هههههههههه هههههههههه هههههههههه هههههههههه هههههههههه هههههههههه هههههههه

Hahahahahahahah Hahahahaha Hahahahaha Hahahahaha Hahahahaha Hahahahaha Hahahahaha Hahahahaha Hahahahaha ĺĺĺĺĺĺĺĺ



posted by Kumicit at 2014/10/13 12:23 | Comment(0) | TrackBack(0) | Others | このブログの読者になる | 更新情報をチェックする



2014年10月12日付のテキサス州保健局のリリースによれば、リベリアからダラスに来て死亡したエボラ感染者Duncan氏の看護にあたっていたTexas Health Presbyterian Hospitalの医療従事者1名が、10月10日に発熱を訴えて隔離され、10月11日にエボラ陽性判定が出た。
[Texas Patient Tests Positive for Ebola - News Release (2014/10/12) on Texas State]

Texas Patient Tests Positive for Ebola

A health care worker at Texas Health Presbyterian Hospital who provided care for the Ebola patient hospitalized there has tested positive for Ebola in a preliminary test at the state public health laboratory in Austin. Confirmatory testing will be conducted by the Centers for Disease Control and Prevention in Atlanta.

The health care worker reported a low grade fever Friday night and was isolated and referred for testing. The preliminary ​test result was received late Saturday.

Texas Health Presbyterian Hospitalでエボラ患者の看護にあたっていた医療従事者が、オースチンの州公衆衛生ラボの初期検査でエボラ陽性と判定された。確認検査がアトランタのCDCで実施される。


"We knew a second case could be a reality, and we've been preparing for this possibility," said Dr. David Lakey, commissioner of the Texas Department of State Health Services. "We are broadening our team in Dallas and working with extreme diligence to prevent further spread."

Health officials have interviewed the patient and are identifying any contacts or potential exposures. People who had contact with the health care worker after symptoms emerged will be monitored based on the nature of their interactions and the potential they were exposed to the virus.

Ebola is spread through direct contact with bodily fluids of a sick person or exposure to contaminated objects such as needles. People are not contagious before symptoms such as fever develop.

「二人目の感染者が出る可能性があることはわかっており、我々はその可能性を想定して準備してきた。我々はダラスのチームを拡大し、さらなる感染拡大を防止すべき全力を挙げている」とテキサス州保健局のDr David Lakey局長は述べた。



posted by Kumicit at 2014/10/12 20:16 | Comment(0) | TrackBack(0) | Disease | このブログの読者になる | 更新情報をチェックする