Jennifer
His Fuckdoll
- Joined
- Mar 11, 2014
- Posts
- 7,238
Also...YAY! You quoted!!!
I had a good teacher!
Please don't go anywhere-I will need you when I can put up an AV!
Your Ebola Education Thread
- Thread starter snugglestruggle
- Start date
I had a good teacher!
Please don't go anywhere-I will need you when I can put up an AV!
Ishmael
Literotica Guru
- Joined
- Nov 24, 2001
- Posts
- 84,005
Probably so, but we have found out yesterday that those much vaunted CDC 'protocols' for dealing with such highly infectious patients is in reality non-existent.
Ishmael
RobDownSouth
No Kings
- Joined
- Apr 13, 2002
- Posts
- 77,887
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
- Posts
- 19,620
RobDownSouth
No Kings
- Joined
- Apr 13, 2002
- Posts
- 77,887
FYP, YW
You really miss your glory days as elementary school hall monitor, dontcha?
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
- Posts
- 19,620
You really miss your glory days as elementary school hall monitor, dontcha?
I was damned good at it, too. Much better than you were at being a bully.
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
- Posts
- 19,620
V. Transmission-Based Precautions
In addition to consistent use of Standard Precautions, additional precautions may be warranted in certain situations as described below.
A. Identifying Potentially Infectious Patients
Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhea, rash, respiratory symptoms, draining wounds or skin lesions)
If patient calls ahead:
Have patients with symptoms of active infection come at a time when the facility is less crowded, if possible
Alert registration staff ahead of time to place the patient in a private exam room upon arrival if available and follow the procedures pertinent to the route of transmission as specified below
If the purpose of the visit is non-urgent, patients are encouraged to reschedule the appointment until symptoms have resolved
Top of Page
B. Contact Precautions
Apply to patients with any of the following conditions and/or disease:
Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids
Presence of generalized rash or exanthems
Prioritize placement of patients in an exam room if they have stool incontinence, draining wounds and/or skin lesions that cannot be covered, or uncontrolled secretions
Perform hand hygiene before touching patient and prior to wearing gloves
PPE use:
Wear gloves when touching the patient and the patient’s immediate environment or belongings
Wear a gown if substantial contact with the patient or their environment is anticipated
Perform hand hygiene after removal of PPE; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus)
Clean/disinfect the exam room accordingly (refer to Section IV.F.4.)
Instruct patients with known or suspected infectious diarrhea to use a separate bathroom, if available; clean/disinfect the bathroom before it can be used again (refer to Section IV.F.5. for bathroom cleaning/disinfection)
Top of Page
C. Droplet Precautions
Apply to patients known or suspected to be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:
Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)
Bordetella pertusis
For first 24 hours of therapy: Neisseria meningitides, group A streptococcus
Place the patient in an exam room with a closed door as soon as possible (prioritize patients who have excessive cough and sputum production); if an exam room is not available, the patient is provided a facemask and placed in a separate area as far from other patients as possible while awaiting care.
PPE use:
Wear a facemask, such as a procedure or surgical mask, for close contact with the patient; the facemask should be donned upon entering the exam room
If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles (or face shield in place of goggles) should be worn
Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette
Clean and disinfect the exam room accordingly (refer to Section IV.F.4.)
Top of Page
D. Airborne Precautions
Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:
Tuberculosis
Measles
Chickenpox (until lesions are crusted over)
Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)
Have patient enter through a separate entrance to the facility (e.g., dedicated isolation entrance), if available, to avoid the reception and registration area
Place the patient immediately in an airborne infection isolation room (AIIR)
If an AIIR is not available:
Provide a facemask (e.g., procedure or surgical mask) to the patient and place the patient immediately in an exam room with a closed door
Instruct the patient to keep the facemask on while in the exam room, if possible, and to change the mask if it becomes wet
Initiate protocol to transfer patient to a healthcare facility that has the recommended infection-control capacity to properly manage the patient
PPE use:
Wear a fit-tested N-95 or higher level disposable respirator, if available, when caring for the patient; the respirator should be donned prior to room entry and removed after exiting room
If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles or face shield should be worn
Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and/or body fluids and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients , and practice respiratory hygiene and cough etiquette
Once the patient leaves, the exam room should remain vacant for generally one hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly*
If staff must enter the room during the wait time, they are required to use respiratory protection
*Francis J. Curry National Tuberculosis Center, FAQ: “How long does it take to clear the air in an isolation or high-risk procedure room?” Adobe PDF file [PDF - 461 KB]External Web Site Icon
CDC 2007 Guideline for Isolation Precautions
CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 Adobe PDF file [PDF - 1.80 MB]
In addition to consistent use of Standard Precautions, additional precautions may be warranted in certain situations as described below.
A. Identifying Potentially Infectious Patients
Facility staff remain alert for any patient arriving with symptoms of an active infection (e.g., diarrhea, rash, respiratory symptoms, draining wounds or skin lesions)
If patient calls ahead:
Have patients with symptoms of active infection come at a time when the facility is less crowded, if possible
Alert registration staff ahead of time to place the patient in a private exam room upon arrival if available and follow the procedures pertinent to the route of transmission as specified below
If the purpose of the visit is non-urgent, patients are encouraged to reschedule the appointment until symptoms have resolved
Top of Page
B. Contact Precautions
Apply to patients with any of the following conditions and/or disease:
Presence of stool incontinence (may include patients with norovirus, rotavirus, or Clostridium difficile), draining wounds, uncontrolled secretions, pressure ulcers, or presence of ostomy tubes and/or bags draining body fluids
Presence of generalized rash or exanthems
Prioritize placement of patients in an exam room if they have stool incontinence, draining wounds and/or skin lesions that cannot be covered, or uncontrolled secretions
Perform hand hygiene before touching patient and prior to wearing gloves
PPE use:
Wear gloves when touching the patient and the patient’s immediate environment or belongings
Wear a gown if substantial contact with the patient or their environment is anticipated
Perform hand hygiene after removal of PPE; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea (e.g., Clostridium difficile, norovirus)
Clean/disinfect the exam room accordingly (refer to Section IV.F.4.)
Instruct patients with known or suspected infectious diarrhea to use a separate bathroom, if available; clean/disinfect the bathroom before it can be used again (refer to Section IV.F.5. for bathroom cleaning/disinfection)
Top of Page
C. Droplet Precautions
Apply to patients known or suspected to be infected with a pathogen that can be transmitted by droplet route; these include, but are not limited to:
Respiratory viruses (e.g., influenza, parainfluenza virus, adenovirus, respiratory syncytial virus, human metapneumovirus)
Bordetella pertusis
For first 24 hours of therapy: Neisseria meningitides, group A streptococcus
Place the patient in an exam room with a closed door as soon as possible (prioritize patients who have excessive cough and sputum production); if an exam room is not available, the patient is provided a facemask and placed in a separate area as far from other patients as possible while awaiting care.
PPE use:
Wear a facemask, such as a procedure or surgical mask, for close contact with the patient; the facemask should be donned upon entering the exam room
If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles (or face shield in place of goggles) should be worn
Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients, and practice respiratory hygiene and cough etiquette
Clean and disinfect the exam room accordingly (refer to Section IV.F.4.)
Top of Page
D. Airborne Precautions
Apply to patients known or suspected to be infected with a pathogen that can be transmitted by airborne route; these include, but are not limited to:
Tuberculosis
Measles
Chickenpox (until lesions are crusted over)
Localized (in immunocompromised patient) or disseminated herpes zoster (until lesions are crusted over)
Have patient enter through a separate entrance to the facility (e.g., dedicated isolation entrance), if available, to avoid the reception and registration area
Place the patient immediately in an airborne infection isolation room (AIIR)
If an AIIR is not available:
Provide a facemask (e.g., procedure or surgical mask) to the patient and place the patient immediately in an exam room with a closed door
Instruct the patient to keep the facemask on while in the exam room, if possible, and to change the mask if it becomes wet
Initiate protocol to transfer patient to a healthcare facility that has the recommended infection-control capacity to properly manage the patient
PPE use:
Wear a fit-tested N-95 or higher level disposable respirator, if available, when caring for the patient; the respirator should be donned prior to room entry and removed after exiting room
If substantial spraying of respiratory fluids is anticipated, gloves and gown as well as goggles or face shield should be worn
Perform hand hygiene before and after touching the patient and after contact with respiratory secretions and/or body fluids and contaminated objects/materials; note: use soap and water when hands are visibly soiled (e.g., blood, body fluids)
Instruct patient to wear a facemask when exiting the exam room, avoid coming into close contact with other patients , and practice respiratory hygiene and cough etiquette
Once the patient leaves, the exam room should remain vacant for generally one hour before anyone enters; however, adequate wait time may vary depending on the ventilation rate of the room and should be determined accordingly*
If staff must enter the room during the wait time, they are required to use respiratory protection
*Francis J. Curry National Tuberculosis Center, FAQ: “How long does it take to clear the air in an isolation or high-risk procedure room?” Adobe PDF file [PDF - 461 KB]External Web Site Icon
CDC 2007 Guideline for Isolation Precautions
CDC Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 Adobe PDF file [PDF - 1.80 MB]
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
- Posts
- 19,620
Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
ShareShare
On August 1, 2014, CDC released guidance titled,”Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals.”
Ebola viruses are transmitted through direct contact with blood or body fluids/substances (e.g., urine, feces, vomit) of an infected person with symptoms or through exposure to objects (such as needles) that have been contaminated with infected blood or body fluids. The role of the environment in transmission has not been established. Limited laboratory studies under favorable conditions indicate that Ebolavirus can remain viable on solid surfaces, with concentrations falling slowly over several days.1, 2 In the only study to assess contamination of the patient care environment during an outbreak, virus was not detected in any of 33 samples collected from sites that were not visibly bloody. However, virus was detected on a blood-stained glove and bloody intravenous insertion site.3 There is no epidemiologic evidence of Ebolavirus transmission via either the environment or fomites that could become contaminated during patient care (e.g., bed rails, door knobs, laundry). However, given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity, higher levels of precaution are warranted to reduce the potential risk posed by contaminated surfaces in the patient care environment.
As part of the care of patients who are persons under investigation, or with probable or confirmed Ebola virus infections, hospitals are recommended to:
Be sure environmental services staff wear recommended personal protective equipment (PPE) including, at a minimum, disposable gloves, gown (fluid resistant/ impermeable), eye protection (goggles or face shield), and facemask to protect against direct skin and mucous membrane exposure of cleaning chemicals, contamination, and splashes or spatters during environmental cleaning and disinfection activities. Additional barriers (e.g., leg covers, shoe covers) should be used as needed. If reusable heavy-duty gloves are used for cleaning and disinfecting, they should be disinfected and kept in the room or anteroom. Be sure staff are instructed in the proper use of personal protective equipment including safe removal to prevent contaminating themselves or others in the process, and that contaminated equipment is disposed of appropriately. (see question 8).
Use 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) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.
Avoid contamination of reusable porous surfaces that cannot be made single use. Use only a mattress and pillow with plastic or other covering that fluids cannot get through. Do not place patients with suspected or confirmed Ebola virus infection in carpeted rooms and remove all upholstered furniture and decorative curtains from patient rooms before use.
To reduce exposure among staff to potentially contaminated textiles (cloth products) while laundering, discard all linens, non-fluid-impermeable pillows or mattresses, and textile privacy curtains into the waste stream and disposed of appropriately.
The Ebola virus is a classified as a Category A infectious substance by and regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180). Any item transported offsite for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, and used health care products (such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, used Personal Protection Equipment (gowns, masks, gloves, goggles, face shields, respirators, booties, etc.) or byproducts of cleaning) contaminated or suspected of being contaminated with a Category A infectious substance.6, 7 (see question 8).
Frequently Asked Questions
1. How can I determine whether a particular EPA-registered hospital disinfectant is appropriate for use in the room of a patient with suspected or confirmed Ebola virus infection?
Begin by looking at the product label or product insert or, if these are not available, search the EPA search engine for this information. Users should be aware that an 'enveloped' or 'non-enveloped virus' designation may not be included on the container label. Instead check the disinfectant's label for at least one of the common non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus).
2. Are there special instructions for cleaning and disinfecting the room of a patient with suspected or confirmed Ebola virus infection?
Daily cleaning and disinfection of hard, non-porous surfaces (e.g., high-touch surfaces such as bed rails and over bed tables, housekeeping surfaces such as floors and counters) should be done.4 Before disinfecting a surface, cleaning should be performed. In contrast to disinfection where products with specific claims are used, any cleaning product can be used for cleaning tasks. Use cleaning and disinfecting products according to label instructions. Check the disinfectant's label for specific instructions for inactivation of any of the non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) follow label instructions for use of the product that are specific for inactivation of that virus. Use disposable cleaning cloths, mop cloths, and wipes and dispose of these in leak-proof bags. Use a rigid waste receptacle designed to support the bag to help minimize contamination of the bag's exterior.
3. How should spills of blood or other body substances be managed?
The basic principles for blood or body substance spill management are outlined in the United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standards (29 CFR 1910.1030).5 CDC guidelines recommend removal of bulk spill matter, cleaning the site, and then disinfecting the site.4 For large spills, a chemical disinfectant with sufficient potency is needed to overcome the tendency of proteins in blood and other body substances to neutralize the disinfectant's active ingredient. An EPA-registered hospital disinfectant with label claims for non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) and instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids should be used according to those instructions.
4. How should disposable materials (e.g., any single-use PPE, cleaning cloths, wipes, single-use microfiber cloths, linens, food service) and linens, privacy curtains, and other textiles be managed after their use in the patient room?
These materials should be placed in leak-proof containment and discarded appropriately. To minimize contamination of the exterior of the waste bag, place this bag in a rigid waste receptacle designed for this use. Incineration or autoclaving as a waste treatment process is effective in eliminating viral infectivity and provides waste minimization. If disposal requires transport offsite then this should be done in accordance with the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180).6, 7 Guidance from DOT has been released for Ebola.7
5. Is it safe for Ebola patients to use the bathroom?
Yes. Sanitary sewers may be used for the safe disposal of patient waste. Additionally, sewage handling processes (e.g., anaerobic digestion, composting, and disinfection) in the United States are designed to inactivate infectious agents.
6. How long does the Ebola virus persist in indoor environments?
Only one laboratory study, which was done under environmental conditions that favor virus persistence, has been reported. This study found that under these ideal conditions Ebola virus could remain active for up to six days.1 In a follow up study, Ebolavirus was found, relative to other enveloped viruses, to be quite sensitive to inactivation by ultraviolet light and drying; yet sub-populations did persist in organic debris.2
In the only study to assess contamination of the patient care environment during an outbreak, conducted in an African hospital under "real world conditions", virus was not detected by either nucleic acid amplification or culture in any of 33 samples collected from sites that were not visibly bloody. Virus was detected on a blood-stained glove and bloody intravenous insertion site by nucleic acid amplification, which may detect non-viable virus, but not by culture for live, infectious virus.3 Based upon these data and what is known regarding the environmental infection control of other enveloped RNA viruses, the expectation is with consistent daily cleaning and disinfection practices in U.S. hospitals that the persistence of Ebola virus in the patient care environment would be short – with 24 hours considered a cautious upper limit.
7. Are wastes generated during delivery of care to Ebola virus-infected patients subject to select agent regulations?
As long as facilities treating Ebola virus-infected patients follow the CDC's Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals; waste generated during delivery of care to Ebola virus-infected patients would not be subject to Federal select agent regulations (See the exclusion provision 42 CFR § 73.3(d)(1)). However, this would not apply to any facility that intentionally collected or otherwise extracted the Ebola virus from waste generated during the delivery of patient care.
8. Are wastes generated during delivery of care to Ebola virus-infected patients subject to any special transportation requirements?
Yes, wastes contaminated or suspected to be contaminated with Ebola virus must be packaged and transported in accordance U.S. DOT Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180).6, 7
Once a patient with suspected Ebola Virus Disease (e.g., Patients under investigation) is no longer suspected to have Ebola Virus disease (EVD) or has ruled out for EVD, their waste materials no longer need to be managed as if contaminated with Ebola Virus.
References
Sagripanti JL, Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces. Arch Virol 2010; 155:2035-2039
Sagripanti JL, Lytle DC. Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Arch Virol 2011; 156:489–494
Bausch DG et al. Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. J Infect Dis 2007; 196:S142–7
CDC Guidelines for Environmental Infection Control in Healthcare Facilities[PDF - 249 pages] (see: Environmental Surfaces Section).
OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030
DOT. Guidance for Transporting Ebola Contaminated Items, a Category A Infectious Substance
DOT. Hazardous Materials Regulations [49 CFR Parts 100-1999; 49 CFR 172.700; 49 CFR 173.134(a)(5))
ShareShare
On August 1, 2014, CDC released guidance titled,”Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals.”
Ebola viruses are transmitted through direct contact with blood or body fluids/substances (e.g., urine, feces, vomit) of an infected person with symptoms or through exposure to objects (such as needles) that have been contaminated with infected blood or body fluids. The role of the environment in transmission has not been established. Limited laboratory studies under favorable conditions indicate that Ebolavirus can remain viable on solid surfaces, with concentrations falling slowly over several days.1, 2 In the only study to assess contamination of the patient care environment during an outbreak, virus was not detected in any of 33 samples collected from sites that were not visibly bloody. However, virus was detected on a blood-stained glove and bloody intravenous insertion site.3 There is no epidemiologic evidence of Ebolavirus transmission via either the environment or fomites that could become contaminated during patient care (e.g., bed rails, door knobs, laundry). However, given the apparent low infectious dose, potential of high virus titers in the blood of ill patients, and disease severity, higher levels of precaution are warranted to reduce the potential risk posed by contaminated surfaces in the patient care environment.
As part of the care of patients who are persons under investigation, or with probable or confirmed Ebola virus infections, hospitals are recommended to:
Be sure environmental services staff wear recommended personal protective equipment (PPE) including, at a minimum, disposable gloves, gown (fluid resistant/ impermeable), eye protection (goggles or face shield), and facemask to protect against direct skin and mucous membrane exposure of cleaning chemicals, contamination, and splashes or spatters during environmental cleaning and disinfection activities. Additional barriers (e.g., leg covers, shoe covers) should be used as needed. If reusable heavy-duty gloves are used for cleaning and disinfecting, they should be disinfected and kept in the room or anteroom. Be sure staff are instructed in the proper use of personal protective equipment including safe removal to prevent contaminating themselves or others in the process, and that contaminated equipment is disposed of appropriately. (see question 8).
Use 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) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and non-enveloped viruses.
Avoid contamination of reusable porous surfaces that cannot be made single use. Use only a mattress and pillow with plastic or other covering that fluids cannot get through. Do not place patients with suspected or confirmed Ebola virus infection in carpeted rooms and remove all upholstered furniture and decorative curtains from patient rooms before use.
To reduce exposure among staff to potentially contaminated textiles (cloth products) while laundering, discard all linens, non-fluid-impermeable pillows or mattresses, and textile privacy curtains into the waste stream and disposed of appropriately.
The Ebola virus is a classified as a Category A infectious substance by and regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180). Any item transported offsite for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, and used health care products (such as soiled absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, used Personal Protection Equipment (gowns, masks, gloves, goggles, face shields, respirators, booties, etc.) or byproducts of cleaning) contaminated or suspected of being contaminated with a Category A infectious substance.6, 7 (see question 8).
Frequently Asked Questions
1. How can I determine whether a particular EPA-registered hospital disinfectant is appropriate for use in the room of a patient with suspected or confirmed Ebola virus infection?
Begin by looking at the product label or product insert or, if these are not available, search the EPA search engine for this information. Users should be aware that an 'enveloped' or 'non-enveloped virus' designation may not be included on the container label. Instead check the disinfectant's label for at least one of the common non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus).
2. Are there special instructions for cleaning and disinfecting the room of a patient with suspected or confirmed Ebola virus infection?
Daily cleaning and disinfection of hard, non-porous surfaces (e.g., high-touch surfaces such as bed rails and over bed tables, housekeeping surfaces such as floors and counters) should be done.4 Before disinfecting a surface, cleaning should be performed. In contrast to disinfection where products with specific claims are used, any cleaning product can be used for cleaning tasks. Use cleaning and disinfecting products according to label instructions. Check the disinfectant's label for specific instructions for inactivation of any of the non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) follow label instructions for use of the product that are specific for inactivation of that virus. Use disposable cleaning cloths, mop cloths, and wipes and dispose of these in leak-proof bags. Use a rigid waste receptacle designed to support the bag to help minimize contamination of the bag's exterior.
3. How should spills of blood or other body substances be managed?
The basic principles for blood or body substance spill management are outlined in the United States Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standards (29 CFR 1910.1030).5 CDC guidelines recommend removal of bulk spill matter, cleaning the site, and then disinfecting the site.4 For large spills, a chemical disinfectant with sufficient potency is needed to overcome the tendency of proteins in blood and other body substances to neutralize the disinfectant's active ingredient. An EPA-registered hospital disinfectant with label claims for non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) and instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids should be used according to those instructions.
4. How should disposable materials (e.g., any single-use PPE, cleaning cloths, wipes, single-use microfiber cloths, linens, food service) and linens, privacy curtains, and other textiles be managed after their use in the patient room?
These materials should be placed in leak-proof containment and discarded appropriately. To minimize contamination of the exterior of the waste bag, place this bag in a rigid waste receptacle designed for this use. Incineration or autoclaving as a waste treatment process is effective in eliminating viral infectivity and provides waste minimization. If disposal requires transport offsite then this should be done in accordance with the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180).6, 7 Guidance from DOT has been released for Ebola.7
5. Is it safe for Ebola patients to use the bathroom?
Yes. Sanitary sewers may be used for the safe disposal of patient waste. Additionally, sewage handling processes (e.g., anaerobic digestion, composting, and disinfection) in the United States are designed to inactivate infectious agents.
6. How long does the Ebola virus persist in indoor environments?
Only one laboratory study, which was done under environmental conditions that favor virus persistence, has been reported. This study found that under these ideal conditions Ebola virus could remain active for up to six days.1 In a follow up study, Ebolavirus was found, relative to other enveloped viruses, to be quite sensitive to inactivation by ultraviolet light and drying; yet sub-populations did persist in organic debris.2
In the only study to assess contamination of the patient care environment during an outbreak, conducted in an African hospital under "real world conditions", virus was not detected by either nucleic acid amplification or culture in any of 33 samples collected from sites that were not visibly bloody. Virus was detected on a blood-stained glove and bloody intravenous insertion site by nucleic acid amplification, which may detect non-viable virus, but not by culture for live, infectious virus.3 Based upon these data and what is known regarding the environmental infection control of other enveloped RNA viruses, the expectation is with consistent daily cleaning and disinfection practices in U.S. hospitals that the persistence of Ebola virus in the patient care environment would be short – with 24 hours considered a cautious upper limit.
7. Are wastes generated during delivery of care to Ebola virus-infected patients subject to select agent regulations?
As long as facilities treating Ebola virus-infected patients follow the CDC's Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals; waste generated during delivery of care to Ebola virus-infected patients would not be subject to Federal select agent regulations (See the exclusion provision 42 CFR § 73.3(d)(1)). However, this would not apply to any facility that intentionally collected or otherwise extracted the Ebola virus from waste generated during the delivery of patient care.
8. Are wastes generated during delivery of care to Ebola virus-infected patients subject to any special transportation requirements?
Yes, wastes contaminated or suspected to be contaminated with Ebola virus must be packaged and transported in accordance U.S. DOT Hazardous Materials Regulations (HMR, 49 C.F.R., Parts 171-180).6, 7
Once a patient with suspected Ebola Virus Disease (e.g., Patients under investigation) is no longer suspected to have Ebola Virus disease (EVD) or has ruled out for EVD, their waste materials no longer need to be managed as if contaminated with Ebola Virus.
References
Sagripanti JL, Rom AM, Holland LE. Persistence in darkness of virulent alphaviruses, Ebola virus, and Lassa virus deposited on solid surfaces. Arch Virol 2010; 155:2035-2039
Sagripanti JL, Lytle DC. Sensitivity to ultraviolet radiation of Lassa, vaccinia, and Ebola viruses dried on surfaces. Arch Virol 2011; 156:489–494
Bausch DG et al. Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. J Infect Dis 2007; 196:S142–7
CDC Guidelines for Environmental Infection Control in Healthcare Facilities[PDF - 249 pages] (see: Environmental Surfaces Section).
OSHA Bloodborne Pathogen Standard 29 CFR 1910.1030
DOT. Guidance for Transporting Ebola Contaminated Items, a Category A Infectious Substance
DOT. Hazardous Materials Regulations [49 CFR Parts 100-1999; 49 CFR 172.700; 49 CFR 173.134(a)(5))
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
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and lastly:
Oh and notice the last part; evidently visitors just need a little education before visiting the infected patient.
For information on symptoms of Ebola Virus Disease infection and modes of transmission, see the CDC Ebola Virus Disease Website.
Key Components of Standard, Contact, and Droplet Precautions Recommended for Prevention of EVD Transmission in U.S. Hospitals
Component Recommendation Comments
Patient Placement
Single patient room (containing a private bathroom) with the door closed
Facilities should maintain a log of all persons entering the patient's room
Consider posting personnel at the patient’s door to ensure appropriate and consistent use of PPE by all persons entering the patient room
Personal Protective Equipment (PPE)
All persons entering the patient room should wear at least:
Gloves
Gown (fluid resistant or impermeable)
Eye protection (goggles or face shield)
Facemask
Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to:
Double gloving
Disposable shoe covers
Leg coverings
Recommended PPE should be worn by HCP upon entry into patient rooms or care areas. Upon exit from the patient room or care area, PPE should be carefully removed without contaminating one’s eyes, mucous membranes, or clothing with potentially infectious materials, and either
Discarded, or
For re-useable PPE, cleaned and disinfected according to the manufacturer's reprocessing instructions and hospital policies.
Instructions for donning and removing PPE have been published
Hand hygiene should be performed immediately after removal of PPE
Patient Care Equipment
Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care
All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer's instructions and hospital policies
Patient Care Considerations
Limit the use of needles and other sharps as much as possible
Phlebotomy, procedures, and laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and medical care
All needles and sharps should be handled with extreme care and disposed in puncture-proof, sealed containers
Aerosol Generating Procedures (AGPs)
Avoid AGPs for patients with EVD.
If performing AGPs, use a combination of measures to reduce exposures from aerosol-generating procedures when performed on Ebola HF patients.
Visitors should not be present during aerosol-generating procedures.
Limiting the number of HCP present during the procedure to only those essential for patient-care and support.
Conduct the procedures in a private room and ideally in an Airborne Infection Isolation Room (AIIR) when feasible. Room doors should be kept closed during the procedure except when entering or leaving the room, and entry and exit should be minimized during and shortly after the procedure.
HCP should wear gloves, a gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit-tested N95 filtering facepiece respirator or higher (e.g., powered air purifying respiratory or elastomeric respirator) during aerosol generating procedures.
Conduct environmental surface cleaning following procedures (see section below on environmental infection control).
If re-usable equipment or PPE (e.g. Powered air purifying respirator, elastomeric respirator, etc.) are used, they should be cleaned and disinfected according to manufacturer instructions and hospital policies.
Collection and handling of soiled re-usable respirators must be done by trained individuals using PPE as described above for routine patient care
Although there are limited data available to definitively define a list of AGPs, procedures that are usually included are Bilevel Positive Airway Pressure (BiPAP), bronchoscopy, sputum induction, intubation and extubation, and open suctioning of airways.
Because of the potential risk to individuals reprocessing reusable respirators, disposable filtering face piece respirators are preferred.
Hand Hygiene
HCP should perform hand hygiene frequently, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves.
Healthcare facilities should ensure that supplies for performing hand hygiene are available.
Hand hygiene in healthcare settings can be performed by washing with soap and water or using alcohol-based hand rubs. If hands are visibly soiled, use soap and water, not alcohol-based hand rubs.
Environmental Infection Control Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
Safe Injection practices
Facilities should follow safe injection practices as specified under Standard Precautions.
Any injection equipment or parenteral medication container that enters the patient treatment area should be dedicated to that patient and disposed of at the point of use.
Duration of Infection Control Precautions
Duration of precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.
Factors that should be considered include, but are not limited to: presence of symptoms related to EVD, date symptoms resolved, other conditions that would require specific precautions (e.g., tuberculosis, Clostridium difficile) and available laboratory information
Monitoring and Management of Potentially Exposed Personnel
Facilities should develop policies for monitoring and management of potentially exposed HCP
Facilities should develop sick leave policies for HCP that are non-punitive, flexible and consistent with public health guidance
Ensure that all HCP, including staff who are not directly employed by the healthcare facility but provide essential daily services, are aware of the sick leave policies.
Persons with percutaneous or mucocutaneous exposures to blood, body fluids, secretions, or excretions from a patient with suspected EVD should
Stop working and immediately wash the affected skin surfaces with soap and water. Mucous membranes (e.g., conjunctiva) should be irrigated with copious amounts of water or eyewash solution
Immediately contact occupational health/supervisor for assessment and access to postexposure management services for all appropriate pathogens (e.g., Human Immunodeficiency Virus, Hepatitis C, etc.)
HCP who develop sudden onset of fever, intense weakness or muscle pains, vomiting, diarrhea, or any signs of hemorrhage after an unprotected exposure (i.e. not wearing recommended PPE at the time of patient contact or through direct contact to blood or body fluids) to a patient with EVD should
Not report to work or should immediately stop working
Notify their supervisor
Seek prompt medical evaluation and testing
Notify local and state health departments
Comply with work exclusion until they are deemed no longer infectious to others
For asymptomatic HCP who had an unprotected exposure (i.e. not wearing recommended PPE at the time of patient contact or through direct contact to blood or body fluids) to a patient with Ebola HF
Should receive medical evaluation and follow-up care including fever monitoring twice daily for 21 days after the last known exposure.
Hospitals should consider policies ensuring twice daily contact with exposed personnel to discuss potential symptoms and document fever checks
May continue to work while receiving twice daily fever checks, based upon hospital policy and discussion with local, state, and federal public health authorities.
Monitoring, Management, and Training of Visitors
Avoid entry of visitors into the patient's room
Exceptions may be considered on a case by case basis for those who are essential for the patient's wellbeing.
Establish procedures for monitoring managing and training visitors.
Visits should be scheduled and controlled to allow for:
Screening for EVD (e.g., fever and other symptoms) before entering or upon arrival to the hospital
Evaluating risk to the health of the visitor and ability to comply with precautions
providing instruction, before entry into the patient care area on hand hygiene, limiting surfaces touched, and use of PPE according to the current facility policy while in the patient's room
Visitor movement within the facility should be restricted to the patient care area and an immediately adjacent waiting area.
Visitors who have been in contact with the EVD patient before and during hospitalization are a possible source of EVD for other patients, visitors, and staff.
Oh and notice the last part; evidently visitors just need a little education before visiting the infected patient.
For information on symptoms of Ebola Virus Disease infection and modes of transmission, see the CDC Ebola Virus Disease Website.
Key Components of Standard, Contact, and Droplet Precautions Recommended for Prevention of EVD Transmission in U.S. Hospitals
Component Recommendation Comments
Patient Placement
Single patient room (containing a private bathroom) with the door closed
Facilities should maintain a log of all persons entering the patient's room
Consider posting personnel at the patient’s door to ensure appropriate and consistent use of PPE by all persons entering the patient room
Personal Protective Equipment (PPE)
All persons entering the patient room should wear at least:
Gloves
Gown (fluid resistant or impermeable)
Eye protection (goggles or face shield)
Facemask
Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body fluids, vomit, or feces present in the environment), including but not limited to:
Double gloving
Disposable shoe covers
Leg coverings
Recommended PPE should be worn by HCP upon entry into patient rooms or care areas. Upon exit from the patient room or care area, PPE should be carefully removed without contaminating one’s eyes, mucous membranes, or clothing with potentially infectious materials, and either
Discarded, or
For re-useable PPE, cleaned and disinfected according to the manufacturer's reprocessing instructions and hospital policies.
Instructions for donning and removing PPE have been published
Hand hygiene should be performed immediately after removal of PPE
Patient Care Equipment
Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care
All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer's instructions and hospital policies
Patient Care Considerations
Limit the use of needles and other sharps as much as possible
Phlebotomy, procedures, and laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and medical care
All needles and sharps should be handled with extreme care and disposed in puncture-proof, sealed containers
Aerosol Generating Procedures (AGPs)
Avoid AGPs for patients with EVD.
If performing AGPs, use a combination of measures to reduce exposures from aerosol-generating procedures when performed on Ebola HF patients.
Visitors should not be present during aerosol-generating procedures.
Limiting the number of HCP present during the procedure to only those essential for patient-care and support.
Conduct the procedures in a private room and ideally in an Airborne Infection Isolation Room (AIIR) when feasible. Room doors should be kept closed during the procedure except when entering or leaving the room, and entry and exit should be minimized during and shortly after the procedure.
HCP should wear gloves, a gown, disposable shoe covers, and either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection that is at least as protective as a NIOSH certified fit-tested N95 filtering facepiece respirator or higher (e.g., powered air purifying respiratory or elastomeric respirator) during aerosol generating procedures.
Conduct environmental surface cleaning following procedures (see section below on environmental infection control).
If re-usable equipment or PPE (e.g. Powered air purifying respirator, elastomeric respirator, etc.) are used, they should be cleaned and disinfected according to manufacturer instructions and hospital policies.
Collection and handling of soiled re-usable respirators must be done by trained individuals using PPE as described above for routine patient care
Although there are limited data available to definitively define a list of AGPs, procedures that are usually included are Bilevel Positive Airway Pressure (BiPAP), bronchoscopy, sputum induction, intubation and extubation, and open suctioning of airways.
Because of the potential risk to individuals reprocessing reusable respirators, disposable filtering face piece respirators are preferred.
Hand Hygiene
HCP should perform hand hygiene frequently, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves.
Healthcare facilities should ensure that supplies for performing hand hygiene are available.
Hand hygiene in healthcare settings can be performed by washing with soap and water or using alcohol-based hand rubs. If hands are visibly soiled, use soap and water, not alcohol-based hand rubs.
Environmental Infection Control Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus
Safe Injection practices
Facilities should follow safe injection practices as specified under Standard Precautions.
Any injection equipment or parenteral medication container that enters the patient treatment area should be dedicated to that patient and disposed of at the point of use.
Duration of Infection Control Precautions
Duration of precautions should be determined on a case-by-case basis, in conjunction with local, state, and federal health authorities.
Factors that should be considered include, but are not limited to: presence of symptoms related to EVD, date symptoms resolved, other conditions that would require specific precautions (e.g., tuberculosis, Clostridium difficile) and available laboratory information
Monitoring and Management of Potentially Exposed Personnel
Facilities should develop policies for monitoring and management of potentially exposed HCP
Facilities should develop sick leave policies for HCP that are non-punitive, flexible and consistent with public health guidance
Ensure that all HCP, including staff who are not directly employed by the healthcare facility but provide essential daily services, are aware of the sick leave policies.
Persons with percutaneous or mucocutaneous exposures to blood, body fluids, secretions, or excretions from a patient with suspected EVD should
Stop working and immediately wash the affected skin surfaces with soap and water. Mucous membranes (e.g., conjunctiva) should be irrigated with copious amounts of water or eyewash solution
Immediately contact occupational health/supervisor for assessment and access to postexposure management services for all appropriate pathogens (e.g., Human Immunodeficiency Virus, Hepatitis C, etc.)
HCP who develop sudden onset of fever, intense weakness or muscle pains, vomiting, diarrhea, or any signs of hemorrhage after an unprotected exposure (i.e. not wearing recommended PPE at the time of patient contact or through direct contact to blood or body fluids) to a patient with EVD should
Not report to work or should immediately stop working
Notify their supervisor
Seek prompt medical evaluation and testing
Notify local and state health departments
Comply with work exclusion until they are deemed no longer infectious to others
For asymptomatic HCP who had an unprotected exposure (i.e. not wearing recommended PPE at the time of patient contact or through direct contact to blood or body fluids) to a patient with Ebola HF
Should receive medical evaluation and follow-up care including fever monitoring twice daily for 21 days after the last known exposure.
Hospitals should consider policies ensuring twice daily contact with exposed personnel to discuss potential symptoms and document fever checks
May continue to work while receiving twice daily fever checks, based upon hospital policy and discussion with local, state, and federal public health authorities.
Monitoring, Management, and Training of Visitors
Avoid entry of visitors into the patient's room
Exceptions may be considered on a case by case basis for those who are essential for the patient's wellbeing.
Establish procedures for monitoring managing and training visitors.
Visits should be scheduled and controlled to allow for:
Screening for EVD (e.g., fever and other symptoms) before entering or upon arrival to the hospital
Evaluating risk to the health of the visitor and ability to comply with precautions
providing instruction, before entry into the patient care area on hand hygiene, limiting surfaces touched, and use of PPE according to the current facility policy while in the patient's room
Visitor movement within the facility should be restricted to the patient care area and an immediately adjacent waiting area.
Visitors who have been in contact with the EVD patient before and during hospitalization are a possible source of EVD for other patients, visitors, and staff.
RobDownSouth
No Kings
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- Apr 13, 2002
- Posts
- 77,887
I have this mental picture of you on the Safety Patrol, with your shiny little badge sitting in a desk at the end of the hallway, with the machine gun that sprayed rubber bullets at those kids who dared to run in the halls.
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
- Posts
- 19,620
Paint balls. no denying the paint. The little bitches and bastards in training never had a chance.
RobDownSouth
No Kings
- Joined
- Apr 13, 2002
- Posts
- 77,887
Pfft, so you're younger than I thought. Back then the Patrol used rubber bullets. Bastards hurt, too.
Bidin~Time
montani semper liberi
- Joined
- May 7, 2002
- Posts
- 19,620
I was always ahead of the curve.
They are changing the s&s that they have used to determine if a person is a potential carrier. No longer a temp of 101.5 but 100.4.
The second RN was told by CDC that 99.5 was okay to fly. But what was her baseline?
Fever is a crap indicator.
The second RN was told by CDC that 99.5 was okay to fly. But what was her baseline?
Fever is a crap indicator.
Jennifer
His Fuckdoll
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- Mar 11, 2014
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Yes, especially when the true and best temps are obtained from the rectum. Should we do rectal temps before or after the body scanner at the airports?
Only after they have been sent home once first....just to be sure they're really sick.
snugglestruggle
...
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- Oct 1, 2011
- Posts
- 7,373
BT, You Rock! That was some really good stuff you posted. Thank you for contributing.
It seems to me from listening to the press conferences the CDC is in hand wringing mode. They've been caught asleep at the wheel and it's very dangerous.
By that I mean What if _____ terrorist group see's how ill equipped we are to handle an outbreak of a few infected people, then gets the idea to send some volunteers to West Africa to get infected and then smuggles them into the country to spread Ebola. It would be as easy as smuggling drugs into the country.
It seems to me from listening to the press conferences the CDC is in hand wringing mode. They've been caught asleep at the wheel and it's very dangerous.
By that I mean What if _____ terrorist group see's how ill equipped we are to handle an outbreak of a few infected people, then gets the idea to send some volunteers to West Africa to get infected and then smuggles them into the country to spread Ebola. It would be as easy as smuggling drugs into the country.
Jennifer
His Fuckdoll
- Joined
- Mar 11, 2014
- Posts
- 7,238
BT, You Rock! That was some really good stuff you posted. Thank you for contributing.
It seems to me from listening to the press conferences the CDC is in hand wringing mode. They've been caught asleep at the wheel and it's very dangerous.
By that I mean What if _____ terrorist group see's how ill equipped we are to handle an outbreak of a few infected people, then gets the idea to send some volunteers to West Africa to get infected and then smuggles them into the country to spread Ebola. It would be as easy as smuggling drugs into the country.
This what happens when we have suits running the show who may have never done any real practice at the bedside. They are completely out of touch. If only nurses ran the world...we could have stopped this shit with a clipboard, pen, and whistle.
snugglestruggle
...
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TRUTH!
Also, has anyone seen hide or hair of the surgeon General? Correct me if I am wrong but isn't the S.G. the nations top Doc? Where is Obama getting his policy advice from a Magic 8 ball? Fortune cookies?
I thought you didn't have one.TRUTH!
Also, has anyone seen hide or hair of the surgeon General? Correct me if I am wrong but isn't the S.G. the nations top Doc? Where is Obama getting his policy advice from a Magic 8 ball? Fortune cookies?
RobDownSouth
No Kings
- Joined
- Apr 13, 2002
- Posts
- 77,887
TRUTH!
Also, has anyone seen hide or hair of the surgeon General? Correct me if I am wrong but isn't the S.G. the nations top Doc? Where is Obama getting his policy advice from a Magic 8 ball? Fortune cookies?
The Surgeon General position is vacant right now. The NRA has had conservative senators prevent his nomination from coming to a vote because he doesn't worship at the altar of Moar Guns.
Guns > Diseases
IrezumiKiss
Literotica Guru
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- Feb 11, 2007
- Posts
- 74,229
Meanwhile, you can keep on doing nothing but ramping up the end-of-America fear, panic and paranoia as usual until the next thing that make you piss your pants in the morning comes along to knock The Ebola® off the front page.
RobDownSouth
No Kings
- Joined
- Apr 13, 2002
- Posts
- 77,887
Meanwhile, you can keep on doing nothing but ramping up the end-of-America fear, panic and paranoia as usual until the next thing that make you piss your pants in the morning comes along to knock The Ebola® off the front page.
"It's an Extinction-Level Event™!!!" - SEVERUSMAX
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