Dallas Ebola case spurs concern about hospital readiness
A D.C.-area hospital admitted a patient with symptoms and a travel history associated with Ebola.
A CDC official said the agency realized that many hospitals remain confused and unsure about how they are supposed to react when a suspected patient shows up. The agency sent additional guidance to health-care facilities around the country this week, just as it has numerous times in recent months, on everything from training personnel to spot the symptoms of Ebola to using protective gear.
Emory University Hospital in Atlanta, which has treated several Ebola patients who were flown from West Africa, also has provided information and advice to dozens of hospitals, many of which are struggling with a lack of awareness about safety protocols and fear among some workers who feel ill-prepared. Washington-area health officials also said they are trying to identify gaps in their preparedness plans.
“It’s very important to remind the American people that the United States has the most capable infrastructure and the best doctors in the world, bar none,” said Lisa Monaco, assistant to the president for homeland security and counterterrorism. “The United States is prepared to deal with this crisis.”
In the District, a patient who had recently traveled to Nigeria arrived at Howard University Hospital overnight Thursday “presenting symptoms that could be associated with Ebola,” spokeswoman Kerry-Ann Hamilton said in a statement. The patient has been put into isolation, and the hospital has activated infection-control procedures, a spokeswoman said.
Just hours later, Shady Grove Adventist Hospital in Rockville, Md., confirmed that it was evaluating a patient who “presented with flu-like symptoms and a travel history that matches criteria for possible Ebola.” It said the patient was received “within the past 24 hours” and that hospital staff immediately implemented CDC’s guidelines for appropriate testing and care. Late Friday, however, the hospital confirmed that the patient was suffering from malaria and did not have Ebola.
Craig deAtley, administrator of the DC Emergency Healthcare Coalition, said the Dallas case is prompting health-care institutions across the country to look at their individual abilities to respond.
Facilities may not realize, for example, how much practical planning goes into training and staffing personnel, configuring isolation rooms, and determining what to do with dirty bedsheets and other waste, he and other officials said.
DeAtley said that officials are learning from the experiences of Emory University Hospital and the University of Nebraska Medical Center, which together treated several Americans with Ebola. In the process, and by also reviewing the missteps of Texas Health Presbyterian Hospital Dallas, officials are discovering logistical problems in key areas, he and others said.
Although the CDC has issued guidelines for keeping infected patients in isolation in special rooms, hospitals need to determine how big that room should be, he said. “Do I put the patient in a single room, or in a larger space that could accommodate laboratory equipment and medical care?”
At MedStar Washington Hospital Center, officials are in the process of training a team of nurses who would monitor all personnel going into and out of an infected person’s room to make sure they are following procedures for wearing and taking off protective gear.
Some health-care workers around the country have expressed concern about whether the facilities where they work haven’t provided sufficient training to handle Ebola patients.
“They have these protocols and policies in place, but they don’t actually make it down to the level where the nurse is providing that care,” said Deborah Burger, a registered nurse in California and co-president of National Nurses United, the largest nurses union in the country.
She cited a study that the union recently completed of nearly 700 registered nurses around the country, in which the vast majority said their hospital had not communicated any policy with them regarding the potential admission of Ebola patients. To the extent there had been training, the nurses said, it was largely conducted by computer and didn’t offer the chance to pose practical questions about how to provide such care. A third of the respondents said their facility lacked adequate supplies of protective gear.
Burger also pointed to one of the lapses cited in Dallas, when information about Duncan’s travel history apparently didn’t make it to doctors.
CDC officials acknowledged that widespread hospital awareness didn’t kick in until the recent case in Dallas.
“We let our guard down a little bit,” said Abbigail Tumpey, a CDC spokeswoman, referring to the country’s health-care systems. “We as a health-care system have to make sure not to let our guard down and be vigilant that patients with Ebola could show up at any U.S. health-care facility. . . . Now that we’ve seen this happen, we know now that we need to do more to make people feel prepared.”
She added, “We realized this week that this is a teachable moment, and despite the guidance we have sent out [to hospitals], people don’t necessarily understand how to implement it.”
One set of reminders to health personnel was to pay close attention to whether sick patients displayed the classic symptoms of Ebola, whether they had traveled to West Africa during the three weeks before falling ill and, if so, to isolate them in a private room with a private bathroom.
Emory University Hospital, which treated American missionaries Kent Brantly and Nancy Writebol, said it has received dozens of inquiries about medical procedures, personal protective gear and other topics, according to Bruce Ribner, one of the doctors who treated the two Americans.
At other facilities, such as New York’s Mount Sinai Hospital, everyone from security guards to doctors has been involved in repeated drills on how to respond to potential cases of Ebola. Those dry runs identified important holes, such as how the hospital shouldn’t use glass tubes to draw blood because they can break and cause injuries. It now uses plastic tubes.
“The major flaws that we really found were about communication,” said Brian Koll, chairman of the system’s health prevention committee. “We fully expected to see patients, just because of the interconnected world that we live in.”