How Long Has It Been Since Anything Was Said About Ebola? Fresh From the CDC In Atlanta: CDCEbola (Ebola Virus Disease)U.S. Healthcare Workers and SettingsPersonal Protective Equipment (PPE)


CDCEbola (Ebola Virus Disease)U.S. Healthcare Workers and SettingsPersonal Protective Equipment (PPE)
For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who Are Clinically Stable and Do Not Have Bleeding, Vomiting, or Diarrhea
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html

Who this is for: Healthcare providers in the U.S. evaluating PUIs for Ebola who are clinically stable AND do not have bleeding, vomiting, or diarrhea

What this is for: Provides guidance on the processes for donning and doffing PPE for healthcare workers and staff who are evaluating a PUI who is clinically stable and does not have bleeding, vomiting, or diarrhea

How to use this, how it relates to other guidance documents: Use this guidance with frontline and assessment healthcare facilities described in Interim Guidance for U.S. Hospital Preparedness for Patients Under Investigation (PUIs) or with Confirmed Ebola Virus Disease (EVD): A Framework for a Tiered Approach. It offers step-by-step processes for donning and doffing PPE described in Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease (EVD). These procedures do NOT apply to healthcare workers caring for patients with confirmed Ebola or to healthcare workers caring for PUIs who have bleeding, vomiting, diarrhea, or who are clinically unstable and/or will require invasive or aerosol-generating procedures (e.g., intubation, suctioning, active resuscitation). In those cases, use the Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE.

http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/hospitals.html

http://www.cdc.gov/vhf/ebola/healthcare-us/emergency-services/emergency-departments.html

http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html

Recommended PPE:

While evaluating and managing PUIs who are clinically stable and do not have bleeding, vomiting, or diarrhea, healthcare providers should at a minimum wear:

Single-use (disposable) fluid-resistant gown that extends to at least mid-calf or single-use (disposable) fluid-resistant coveralls without integrated hood
Single-use (disposable) full face shield
Single-use (disposable) facemask
Single-use (disposable) gloves with extended cuffs. Two pairs of gloves should be worn. At a minimum, outer gloves should have extended cuffs.
In this guidance, fluid-resistant means a gown that has demonstrated resistance to water or a coverall that has demonstrated resistance to water or synthetic blood. The specific test methods that assess resistance are listed in Table 1. When purchasing gowns and coveralls, facilities should follow specifications in this table to ensure they select recommended gowns and coveralls.

Table 1. Specifications for fluid-resistant gowns and coveralls
Gown Coverall
Fluid-resistant
Surgical or isolation* gown that passes:

ANSI/AAMI PB70 Level 3 requirements
or
EN 13795 high performance surgical gown
Coverall* made of fabric that passes:

AATCC 42 ≤ 1 g and AATCC 127 ≥ 50 cm H20 or EN 20811 ≥ 50 cm H20
or
ASTM F1670 (13.8kPa)
or
ISO 16603 ≥ 3.5 kPa
*Testing by an ISO 17025 certified third party laboratory is recommended

For more details, refer to technical document Considerations for Selecting Protective Clothing used in Healthcare for Protection against Microorganisms in Blood and Body Fluids, which provides a more detailed explanation of the scientific evidence and national and international standards, test methods, and specifications for fluid-resistant and impermeable protective clothing used in health care settings.

http://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html

http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html

Facilities should ensure that healthcare providers are trained and able to demonstrate competency in donning and doffing recommended PPE before being allowed to care for PUIs. Facilities should also designate areas for PPE donning and doffing as specified below (for more information, refer to the Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE.

Ensure that areas for donning and doffing are separate from the patient care area (e.g., patient’s room) and that there is a predominantly one-way flow of movement of healthcare providers from the donning area to the patient care area or room to the doffing area.
Confirm that the doffing area is large enough to allow freedom of movement for safe doffing, has space for waste containers, a new glove supply, and alcohol-based hand rub (ABHR) for use during the doffing process.
Donning PPE

Donning PPE – This donning procedure applies to PPE recommended for evaluating and managing PUIs who are clinically stable and do not have bleeding, vomiting, or diarrhea. There is a lower risk of splashes and contamination in these situations. An established protocol, combined with proper training of the healthcare worker (HCW), helps to facilitate compliance with PPE guidance.

Remove Personal Clothing and Items: The HCW should wear surgical scrubs (or disposable garments) and dedicated washable (plastic or rubber) footwear. No personal items (e.g., jewelry [including rings], watches, cell phones, pagers, pens) should be worn under PPE or brought into the patient room. Long hair should be tied back. Eye glasses should be secured with a tie.

Inspect PPE Prior to Donning: Visually inspect the PPE ensemble to ensure that it is in serviceable condition (e.g., not torn or ripped), that all required PPE and supplies are available, and that the sizes selected are correct for the HCW.
Perform Hand Hygiene: Perform hand hygiene with alcohol-based hand rub (ABHR). When using ABHR, allow hands to dry before moving to next step.
Put on Inner Gloves: Put on first pair of gloves.
Put on Gown or Coverall: Put on gown or coverall. Ensure gown or coverall is large enough to allow unrestricted movement. Ensure cuffs of inner gloves are tucked under the sleeve of the gown or coverall.
Put on Facemask: Put on facemask.
Put on Outer Gloves: Put on second pair of gloves (with extended cuffs). Ensure the cuffs are pulled over the sleeves of the gown or coverall.
Put on Face Shield: Put on full face shield over the surgical facemask to protect the eyes, as well as the front and sides of the face.
Verify: After completing the donning process, the integrity of the ensemble should be verified by the HCW (e.g., there should be no cuts or tears in the PPE). The HCW should be comfortable and able to extend the arms, bend at the waist, and go through a range of motions to ensure there is sufficient range of movement while all areas of the body remain covered. A mirror in the room can be useful for the HCW while donning PPE.
Doffing PPE

Doffing PPE – PPE is doffed in the designated PPE removal area in the healthcare facility. As with all PPE doffing, meticulous care should be taken to avoid self-contamination. Place all PPE waste in a leak-proof infectious waste container.

1. Inspect: Inspect the PPE for visible contamination, cuts, or tears before starting to remove. If any PPE is visibly contaminated, disinfect by using an *EPA-registered disinfectant wipe.
http://www.epa.gov/oppad001/list-l-ebola-virus.html
If the facility conditions permit and appropriate regulations are followed, an *EPA-registered disinfectant spray can be used, particularly on contaminated areas.

2. Disinfect and Remove Outer Gloves: Disinfect outer-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard outer gloves, taking care not to contaminate inner gloves when removing the outer gloves. Dispose of outer gloves into the designated leak-proof infectious waste container.
http://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/hospitals.html

3. Inspect and Disinfect Inner Gloves: Inspect the inner gloves’ outer surfaces for visible contamination, cuts, or tears. If an inner glove is visibly soiled, then disinfect the glove with either an *EPA-registered disinfectant wipe or ABHR, remove the inner gloves, perform hand hygiene with ABHR on bare hands, and don a new pair of gloves. If a cut or tear is seen on an inner glove, immediately review occupational exposure risk per hospital protocol. If there is no visible contamination and no cuts or tears on the inner gloves, then disinfect the inner-gloved hands with either an *EPA-registered disinfectant wipe or ABHR.

4. Remove Face Shield: Remove the full face shield by tilting the head slightly forward, grabbing the rear strap and pulling it over the head, gently allowing the face shield to fall forward. Avoid touching the front surface of the face shield. Discard the face shield into the designated leak-proof infectious waste container.

5. Disinfect Inner Gloves: Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR.

6. Remove Gown or Coverall: Remove and discard.
(a) Depending on gown design and location of fasteners, the HCW can either untie fasteners or gently break fasteners. Avoid contact of scrubs or disposable garments with outer surface of gown during removal. Pull gown away from body, rolling inside out and touching only the inside of the gown.
(b) To remove coverall, tilt head back to reach zipper or fasteners. Unzip or unfasten coverall completely before rolling down while turning inside out. Avoid contact of scrubs with outer surface of coverall during removal, touching only the inside of the coverall. Dispose of gown or coverall into the designated leak-proof infectious waste container.

7. Disinfect and Change Inner Gloves: Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR.
(a) Remove and discard gloves, taking care not to contaminate bare hands during removal process.
(b) Perform hand hygiene with ABHR.
(c) Don a new pair of inner gloves.

8. Remove Surgical Facemask: Remove the surgical facemask by tilting the head slightly forward, grasping first the bottom tie or elastic strap, then the top tie or elastic strap, and remove the front of the surgical facemask without touching it. Discard the surgical face mask into the designated leak-proof infectious waste container.

9. Disinfect and Remove Inner Gloves: Disinfect inner-gloved hands with either an *EPA-registered disinfectant wipe or ABHR. Remove and discard gloves, taking care not to contaminate bare hands during removal process. Dispose of inner gloves into the designated leak-proof infectious waste container.

10. Perform Hand Hygiene: Perform hand hygiene with ABHR.

11. Inspect: The HCW should inspect for any contamination of the surgical scrubs or disposable garments. If there is contamination, shower immediately, and then immediately inform the infection preventionist or occupational safety and health coordinator or their designee.

*EPA-registered disinfectant wipe: Use a disposable wipe impregnated with a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus, adenovirus, poliovirus); see EPA list of Disinfectants for Use Against the Ebola Virus at http://www.epa.gov/oppad001/list-l-ebola-virus.html.

Tyson Causes The Death of Their Small Farmers

Manifest Injustice

Scott Edwards
Co-Director, Food & Water Justice Project

Rude Awakening in America’s Farmland
Posted: 11/13/2012 12:21 pm EST Updated: 01/13/2013 5:12 am EST

I’m an environmentalist. So when I think about our industrialized system of agriculture and the proliferation of mega-factory farms across the country, where giant companies like Perdue, Tyson, Smithfield and a handful of others dominate our increasingly fragile landscapes, my first thoughts go to the impacts on watersheds and airways. I tend to dwell on the unsustainability of hundreds of thousands of tons of chicken manure piled high in places like the Eastern Shore of Maryland, where the Chesapeake Bay is dying, or the millions of gallons of fetid hog waste lying in lagoons all across the eastern part of North Carolina, overflowing into the Neuse River every time it rains. But the other night I was told a story about an equally dark side of our…

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EPA river pollution cover-up to be exposed by private citizen science lab: lead, arsenic, cadmium and mercury tests offered by the Health Ranger, using Agilent ICP-MS instrumentation

Christian Patriots

(NaturalNews) The incompetence of big government never ceases to amaze me. The EPA — now known as the “Environmental POLLUTION Agency” — recently managed to spill 3 million gallons of toxic sludge into the Animas River. The actual composition of that toxic sludge is being kept a secret by the EPA, which is why I’m openly calling for anyone who has access to the river to send me a water sample so I can test it in my lab. (See below.)

The EPA, it turns out, needs to be kept honest by “citizen science.” In other words, when the EPA becomes a massive polluter and tries to cover it up, it’s up to science-based citizens to hold the EPA accountable by conducting honest, high-integrity private scientific testing that can’t be buried by the government and the media.

The total government cover-up of all this, quite predictably, is already well under…

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TOXIC SLUDGE IN CONTAMINATED RIVER REACHES NEW MEXICO, COMMUNITIES HAVE 90-DAY WATER SUPPLY

tomfernandez28's Blog

Estimated that over one million gallons of toxic waste has already found its way into the river
Toxic waste, including arsenic and lead, which seeped into a river in southwest Colorado, has now crossed the state border into New Mexico. More than 550 gallons per minute are entering the water flow system according to the Environmental Protection Agency, which caused the spill.

The agency says it should have the results of samples undergoing lab testing soon, so they can find out just how contaminated the river has become. Aside from lead and arsenic, federal officials say the spill also contains, cadmium, aluminum, copper and calcium.

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Officials in the cities of Aztec and Farmington say they have shut down the river’s access to water treatment plants, adding that the communities had a 90-day supply of water.

The Animas flows into the San Juan River in New Mexico, and the San Juan…

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UPDATE: 7 Dead, 86 Cases, 64 Hospitalized With Legionnaires’ Disease In NYC…

tomfernandez28's Blog

Screen Shot 2015-08-04 at 6.10.57 PM

Five more cases of Legionnaires’ disease have been added to the Bronx outbreak that has claimed seven lives and sickened more than six dozen people in the last three weeks, Mayor de Blasio said Tuesday. The number of those killed stands at seven.

The mayor’s briefing comes a day after the city announced an increase in the death toll and the number of cases at a packed town hall meeting at the Bronx Museum of the Arts, where hundreds of residents gathered to hear what state, city and local officials had to say about the deadly outbreak.

Eighty-six cases of the disease, a severe, often lethal, form of pneumonia spread through the air, have been reported in the south Bronx since July 10, city officials said Tuesday. That marked 40 new cases since Wednesday, when 46 cases were announced as health officials first discussed the outbreak…

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