[kyro]

More people should understand that hospitals are messy. Really messy. From wiping vomit to feces to rolling over patients to changing chucks to wiping down monitor cables to handling bottles of saline that you may inadvertently leave out in the open for others to touch to not disposing spare gauze that may be contaminated to forgetting to wipe down your stethoscope to tearing your gown off as you rush to see another patient, etc etc etc. There are any number of people going in and out of a patient's room, performing a wide array of tasks, handling an even wider array of objects. Add to that the often hurried nature of hospitals and you get an environment prone to breaches of protocol.

I say this not to incite panic, but to provide insight that many might not have. It is more likely that during the thousands of interactions that this patient saw, the messiness led to a breach, instead of the virus infecting via a vector we've not yet realized.

[wozniacki]

  More people should understand that hospitals are messy.

American hospitals are messy. It gives me no pleasure to uniquely qualify that. The fact is that, the more you read on the topic, the more you will learn that this is an uniquely American thing, at least among the industrialized advanced nations.

If you exclude the Cleveland Clinics, Cedar Sinais, Beth Israels & Stanford Meds of the hospital world, most American hospitals are woefully bad for patients, in terms of HAI rates(Hospital Acquired Infections).

Buried in a pile of books, surveys and studies during the passing of the Affordable Care Act (ACA) a few years ago, was an eminently readable book called

  Catastrophic Care: How American Health Care Killed
  My Father--and How We Can Fix It by David Goldhill. 

In 2007, David Goldhill's father, in good overall health, checked into the hospital with a minor case of pneumonia. Within a few days, he developed sepsis, then a wave of secondary infections. A few weeks after entering the hospital and the day after his 83rd birthday, he died.

Here's an Atlantic piece by Mr. Goldhill

http://www.theatlantic.com/magazine/archive/2009/09/how-amer...

A Reason TV discussion with him

https://www.youtube.com/watch?v=GvSa9nC4JcQ

I think his points are still relevant, even after the passage of the ACA.

In a few years, I am certain that we will have to revisit the issue of how little we get as consumers of healthcare in America, for how much we spend as a nation, all over again.

[tezza]

Um, it's not just the USA:

http://www.dailymail.co.uk/news/article-1327766/Mid-Stafford...

1200 dead because of avoidable cleanliness problems

[wpietri]

Yeah, when my mom was dealing with a brain tumor, she was treated at both her local hospital and a more distant university hospital (University of Michigan). The difference in quality between the two was jaw-dropping to me.

If anybody has a link for stats comparing local hospitals in the US versus Europe, I would love to read them.

[click170]

It's amazing how dangerous hospitals actually are, though it's also important to note that everyone working there is doing their best to keep your loved ones alive but at the end of the day, accidents will happen whenever and where ever they are allowed to.

I've had 2 relatives who were submitted to different local hospitals for different things, but they both contracted secondary infections, which nearly killed one of them.

At the end of the day, we should feel lucky that a complete stranger made an honest effort to help you or your loved one in their time of need, and not focus exclusively on the complications and accidents that may have happened along the way.

To anyone who works in healthcare, if you don't already, I would strongly encourage the use of checklists for any and every important task. Checklists save lives. [0]

[0] http://www.who.int/bulletin/volumes/86/7/08-010708/en/

http://news.bbc.co.uk/2/hi/health/7825780.stm

http://www.hsph.harvard.edu/news/magazine/fall08checklist/

Edit: Typo.

Edit 2: These hospital visits were covered by Canadian healthcare so we didn't have to pay hundreds of thousands of dollars. I can see how it would be very difficult to overlook complications and accidents when the bill will likely bankrupt you.

[kibibyte]

For further reading on the subject, I recommend taking a look at The Checklist Manifesto (http://amzn.com/0312430000), written by Atul Gawande, one of the doctors mentioned in the articles.

[wpietri]

For those skeptical of checklists as a symptom of bureaucracy, I wanted to suggest a distinction between top-down (or controlling) bureaucracy and bottom-up (or supportive) bureaucracy.

For the first 10 years or so of my working life, my only experience of paperwork was top-down controlling bullshit. Pointless timesheets. Useless reports. Data collected and never looked at again. It was managers imposing mandates in ways that rarely helped the business, and often hurt it.

But in getting into the Lean movement, I came to realize there's another approach. If you are a team that wants to do well, there's only so far you can go on implicit work practices. Eventually variation becomes the biggest barrier to improvement. The solution is to collaboratively create a standard way of getting a job done. With variation minimized, you can then start to rigorously test improvements, increasing quality and reducing waste.

This is easiest to see when you're working solo. A while back I was struggling to go running in the mornings. I was always forgetting something: keys, money, headphones. Now near the door is a simple list I can run down to make sure I have everything. Less stress, less wasted time in the mornings, more runs. I love it.

But groups can do the same thing. Can and should, really. Top-down imposition of quality practices rarely works. The people doing the work are the best ones to create and tune the way a job gets done. Might as well do it before some manager gets a bright idea and inflicts the wrong approach on you.

[jeffdavis]

First, everyone was saying that only backwards people doing backwards things in backwards places could possibly get Ebola (paraphrasing; and I am not condoning the message, just repeating it).

Now, we see that Western medical workers with education, resources, and the focus of single patients in Western hospitals are catching it. And now I feel like the message is shifting toward something like: "It's impossible for doctors to do their job without a high risk of transmitting Ebola, and even if the protocols work, it's impossible to follow them. But still: Ebola is nothing to worry about, and any significant response is counterproductive panic."

I don't know whether that's what you're saying or not. But I am done hearing about how Ebola is not really a problem[1][2]. We just don't know anywhere near enough to be confident that it won't spread.

Even if you grant that modern rich areas can control it, that still leaves an awful lot of people exposed.

[1] https://news.ycombinator.com/item?id=8161937 [2] https://news.ycombinator.com/item?id=8429867

[wellboy]

Having worked in a hospital for a whole year I can agree. Hospitals are the perfect example for something that you thought as a kid would be handled by ultra-smart people, doctors who love their jobs and who know best how to take care of patients.

Then when you grow older you realise that just like in every aspect of the world, everything is super messy and no one, except for a very few, know what they're doing.

[thathonkey]

Not to mention HCWs are the ones treating patients at their most infectious stage. As the viral load increases, so do the odds of transmission. Unfortunately it sounds like this was probably the result of improper PPE doffing :(

It depends when she became infected though - was it Duncan's first visit or after they admitted him as an Ebola patient? I'm not sure if this has been established yet or if so, can't find a good source.

One thing is for sure, that hospital is going to get the SHIT sued out of it.

[clumsysmurf]

> More people should understand that hospitals are messy.

Thats why its nice to live in a place that requires HAI (Healthcare Acquired Infections) to be reported. In the state I live in (US/AZ), this is only voluntary for the hospitals. As a patient, it makes it almost impossible to make an educated decision on what facilities to avoid.

[photorized]

looks like During Duncan's first visit, he wasn't being treated as an Ebola patient (he was given antibiotics and painkillers, and sent home). Once he was readmitted - that's a different story, but his initial interactions could have infected a lot of people.

[bdunbar]

Story on CNN reports the nurse treated the man during his second visit, when they knew he was infected.