How did two nurses, both wearing protective gear, get Ebola in a Dallas hospital? That's the frightening question behind the growing criticism of the CDC and Dallas's Texas Health Presbyterian hospital. Not to mention less-reasonable chatter, like demands for a travel ban, suggestions that Liberians are rushing U.S. borders for free medical care, and fears that the American Ebola cases are part of an elaborate conspiracy designed to enrich drug companies.
Although the CDC has said it spent months readying U.S. hospitals to handle potential Ebola cases, many healthcare workers around the country are now saying they are far from prepared to treat patients who have the virus.
We still don't know exactly how either of the Texas nurses, Nina Pham and Amber Vinson, contracted the disease. In a statement provided to a nurses' union, their co-workers in Dallas claimed that a number of things went wrong, including that the patient, Thomas Eric Duncan, was not immediately isolated, that the nurses lacked hands-on training, that hazardous waste had piled up around the hospital, and that their protective gear left parts of their bodies exposed.
On Friday, a Texas Health Presbyterian nurse, Briana Aguirre, told CNN that the only training she received was a one-time, optional seminar, and that her suit left her neck exposed.
The hospital has denied all of these statements and has said it was in compliance with CDC recommendations at all times.
Health officials say that hospital workers should have regular practice drills on how to take the protective clothing, hoods, and gloves on and off. It's important to "make sure we can open the supply closet, pull stuff out at 2 a.m. on a Sunday morning," Stephen Frum, a nurse at Medstar Washington Hospital Center in Washington, told WAMU.
In a Congressional hearing yesterday, Daniel Varga, the chief clinical officer for Texas Health Resources, the medical group that oversees Texas Health Presbyterian Hospital, said that the health workers treating Duncan were wearing the "level two" protective gear shown on this New York Times infographic.
However, he also said “shoe covers were added shortly thereafter,” implying that time had elapsed between when Duncan was admitted and when the foot protection was donned.
It would be one thing if Dallas was uniquely ill-equipped to handle Ebola. But increasingly, nurses' groups from around the country are saying that their members have received little training in how to process a suspected Ebola case.
In a recent survey of 2,000 nurses at more 750 facilities in 46 states, the Nurses United union found:
- 76 percent still say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
- 85 percent say their hospital has not provided education on Ebola with the ability for the nurses to interact and ask questions
- 37 percent say their hospital has insufficient current supplies of eye protection (face shields or side shields with goggles) for daily use on their unit; 36 percent say there are insufficient supplies of fluid resistant/impermeable gowns in their hospital
- 39 percent say their hospital does not have plans to equip isolation rooms with plastic covered mattresses and pillows and discard all linens after use; only 8 percent said they were aware their hospital does have such a plan in place
"We have heard consistently across the country that there are no protocols in place," Nurses United executive director RoseAnn DeMoro told reporters Wednesday. DeMoro also said that the situation could escalate to possible strikes if nurses don't receive better training and supplies soon.
Nurses from other unions have echoed those complaints. Mari Cordes, a nurse in Burlington, Vermont, and president of the Vermont Federation of Nurses & Health Professionals, said that her hospital, Fletcher Allen Health Care, has not conducted any trainings or advisories about Ebola.
"We have been told by Fletcher Allen that 'they' are planning, but ... hospital management has yet to meet with staff, and says that the earliest they could meet with us is October 31st," she said in an email. "The Ebola outbreak has been occurring for months."
Lynda Pond, a labor and delivery nurse in Springfield, Oregon and a member of the Oregon Nurses Association, said she doesn't feel adequately educated about Ebola and claimed that the primary communication she's received from her hospital about the issue was through a "blast email" on October 6. She asked that the name of her employer not be used.
Pond also expressed concern that the hospital's infrastructure isn't enough to fully protect nurses and disinfect contaminated gear:
None of [the rooms] have antechambers for donning and removing isolation gear. A "cart" with paper gowns, gloves, and non-specific masks is parked outside the door. The nurse [puts on] gowns and gloves outside the room, enters the room, provides care and removes the equipment at the door prior to exiting, placing it in a garbage bin inside the room ... To my knowledge there is not adequate supply of full hazmat suits, there are not instructions for gloving, taping and gloving again. Nor are there leggings or shoe covers as part of the standard isolation gear.
"As it is," she added, "staffing is so short, our patient population so sick, that the nurses are doing all they can to take care of what they have. Ebola is a sideline conversation."
The CDC is taking measures to address some of these problems, like announcing this week that a new "Ebola response team" will be flown to any American hospital that has a confirmed Ebola case to help with patient care and worker protection.
Still, not every Ebola case has been immediately identified as such—Duncan was sent home the first time he tried to go to the hospital—and the blood tests sometimes take days to process.
Nurses might, understandably, be hyper-sensitive to the Ebola threat right now. If two of their own had not fallen ill, it's unlikely that the gaps in training and equipment would be drawing so much scorn.
But assuming the U.S. won't ever see a true "outbreak" of Ebola, which it likely won't, the apparent oversights among hospitals are worrying for other reasons.
The West African Ebola outbreak has highlighted the fact that we live in an increasingly globalized world, and that rare and dangerous pathogens can make their way across oceans with relative ease. It's not a leap to think that tuberculosis, antibiotic-resistant strep, or even rare flus could similarly wreak havoc on healthcare systems in future years. Judging by the situation in Dallas, it looks like America's defenses against infectious diseases are only as strong as our weakest hospitals.
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