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Are U.S. Hospitals Prepared for Ebola?

After 2nd health worker at Dallas hospital is diagnosed with the virus, experts say more vigilance is needed

WEDNESDAY, Oct. 15, 2014 (HealthDay News) -- With two confirmed cases of Ebola contracted by health care workers now being reported at a Dallas hospital, medical centers across the country are scrambling to ensure that their infection-control measures will protect staff and the public.

But are staffers at most centers equipped and experienced enough to handle the threat of infection from this largely new and highly lethal virus?

Dr. William Fischer spent several months working with the medical aid agency Doctors Without Borders in Guinea, one of three West African nations struggling with the Ebola epidemic. He believes that most people working at Ebola treatment units do try and take the steps necessary to keep themselves safe.

But errors -- such as some break in protocol that may have led to the infection of the two workers at Texas Health Presbyterian Hospital -- are always possible, he said.

Both of the infected health care workers were among dozens who helped care for Ebola-infected Liberian national Thomas Eric Duncan, who died of the illness at the hospital last Wednesday.

Nurse Nina Pham, 26, was diagnosed with Ebola over the weekend and is currently being cared for in isolation at the Dallas medical center. A second nurse, Amber Joy Vinson, 26, was diagnosed late Tuesday and is also in an isolation ward.

Breaches in protocol may have happened at the Dallas hospital, but "could have happened anywhere," according to Fischer, an assistant professor of medicine at the University of North Carolina School of Medicine.

"What we have to do right now is change the game -- the way you change the game is to dramatically increase vigilance," he said. "That's the most important step."

One key point of potential weakness occurs the moment an infected and symptomatic person presents themselves at a hospital ER waiting room.

The first step is to ensure that doctors and other health care workers are trained to quickly spot patients who might be infected with Ebola, according to experts. But even in the absence of a diagnosis, certain steps -- including the use of certain protective gear -- is key.

As reported by The New York Times, the nurses' union National Nurses United issued a statement Tuesday night, citing a statement prepared by nurses at Texas Health Presbyterian Hospital who asked to remain nameless. The Dallas nurses said that when Duncan arrived by ambulance at the hospital with symptoms of Ebola on Sept. 28, he "was left for several hours, not in isolation, in an area where other patients were present."

When a nurse supervisor demanded that Duncan be relocated to an isolation unit she "faced resistance from other hospital authorities," the statement said, according to the Times.

Furthermore, nurses who first dealt with Duncan wore only standard hospital gowns that "still exposed their necks, the part closest to their face and mouth," the nurses said in the statement, the newspaper reported. "They also left exposed the majority of their heads and their scrubs from the knees down. Initially they were not even given surgical bootees nor were they advised the number of pairs of gloves to wear."

All of this took place while Duncan was vomiting and had diarrhea, the statement said, and while nurses continued to minister to other patients, according to the statement.

Ebola is transmitted through direct contact with bodily fluids such as vomit, blood and feces.

Use of proper protective clothing, "whether recommend by the CDC [U.S. Centers for Disease Control and Prevention] or WHO [World Health Organization], are all probably effective" in blocking Ebola transmission, Fischer said.

The point at which the risk of infection is highest is while taking off the protective mask, gloves, gowns and boots.

Katy Roemer, a spokesperson for National Nurses United, told HealthDay that better training could have helped minimize the risk to staff and other patients in Dallas. However, one survey of nurses conducted by her organization found that 76 percent said they have had no training on admitting Ebola patients, she said.

"Men and women who are putting their lives on the line to take care of these people deserve the highest level of protection and training so we can be safe," Roemer said.

Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City, agreed that most protocols for treating Ebola patients call for a gown that is impervious to blood, vomit, diarrhea and other body fluids, double gloves, a face mask and protective boots.

But using this equipment is something that needs to be practiced, he said. "It's a team thing. There are people telling you what to do -- there are spotters watching," Glatter said.

Fischer agreed. He said that risks to hospital staff can be minimized, but practice and repetition are key. This starts by adhering to strict rules, especially when it comes to taking off potentially soiled gear the same way every time.

He noted that the medical relief agency Doctors Without Borders also insists that someone tell health care workers how to safely remove the equipment -- each time they do so.

"It's a ritualized process," Fischer explained. "It's somebody's sole purpose to tell you what to do whether it's the first time or the hundredth time."

These precautions are essential, Fischer said, because unlike other infectious diseases, such as flu and multidrug-resistant tuberculosis and even HIV, Ebola can be easily passed through direct contact.

Still, David Sanders, an associate professor of biological sciences at Purdue University who has been working on Ebola for a decade, doesn't think that all hospitals are prepared -- or need to be prepared -- to deal with the specialized isolation procedures that Ebola patients require.

Instead, he advocates that Ebola patients who are seen at hospitals not fully equipped and trained to deal with the virus should be immediately transferred to hospitals that are prepared.

"We know we can do this with safety, but it's a matter of training," Sanders said.

Right now, Sanders said, the CDC is asking all U.S. hospitals to be prepared to deal with Ebola patients.

"I do not think that most places have the training. They may have the infection-control equipment, but they don't have the training to deal with this type of infectious disease," he said.

"We really need a much more focused effort than we have seen so far," Sanders said.

In a statement released Wednesday morning, the CDC said that it would ramp up its efforts to help staff at the Dallas hospital and any other medical center in the United States that believes it might have a case of Ebola on its hands.

The agency said it is now "establishing a dedicated CDC response team that could be on the ground within a few hours at any hospital with a confirmed patient with Ebola. The CDC Response Team would provide in-person, expert support and training on infection control, healthcare safety, medical treatment, contact tracing, waste and decontamination, public education and other issues."

The specialized team would also "help ensure that clinicians, and state and local public health practitioners, consistently follow strict standards of protocol to ensure safety of the patient and health care workers," the agency said.

Speaking to reporters on Tuesday, Dr. Tom Frieden, CDC director, said, "I wish we had put a team like this on the ground the day the first patient was diagnosed [in Dallas]. That might have prevented [the hospital worker] infection."

For his part, Sanders said that, given the growing size of the Ebola epidemic in Africa, sporadic cases of Ebola are likely to be seen in the United States. That means that the best way to shield Americans from the infection is to suppress it in Africa, he said.

More information

For more information on Ebola, visit the World Health Organization.

SOURCES: William Fischer, M.D., assistant professor of medicine, University of North Carolina School of Medicine, Chapel Hill; David Sanders, Ph.D., associate professor, biological sciences, Purdue University, West Lafayette, Ind.; Katy Roemer, R.N., spokesperson, National Nurses United; Robert Glatter, M.D., emergency medicine physician, Lenox Hill Hospital, New York City; The New York Times; Oct. 15, 2014, statement, U.S. Centers for Disease Control and Prevention
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