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