Are U.S. Hospitals Prepared for Ebola?

By Steven Reinberg

HealthDay Reporter

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, while a second, as yet unnamed, female worker with Ebola 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.

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. "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.

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.

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