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RPT-US CDC head criticized for blaming "protocol breach" as nurse gets Ebola
(Repeating story to additional subscribers)
CHICAGO Oct 13 (Reuters) – Some healthcare experts are
bristling at the assertion by a top U.S. health official that a
“protocol breach” caused a Dallas nurse to be infected with
Ebola while caring for a dying patient, saying the case instead
shows how far the nation’s hospitals are from adequately
training staff to deal with the deadly virus.
Dr. Thomas Frieden, director of the U.S. Centers for Disease
Control and Prevention, made the declaration on Sunday at a news
conference and called for an investigation into how the
unidentified nurse became infected while caring for Liberian
national Thomas Eric Duncan, the first Ebola patient diagnosed
in the United States. Duncan died last week at
Texas Health Presbyterian Hospital.
Healthcare and infection control experts said that hospital
staff need to be coached through the stages of treating an Ebola
patient, making sure they have the right safety equipment and
know how to use it properly to prevent infection.
It was not immediately clear whether the Texas hospital
prepared its staff with simulation drills before admitting
Duncan, but a recent survey of nurses nationwide suggests few
have been briefed on Ebola preparations.
Officials at the hospital did not respond to requests for
comment.
Some experts also question the CDC’s assertion that any U.S.
hospital should be prepared to treat an Ebola patient as the
outbreak ravaging West Africa begins to spread globally. Given
the level of training required to do the job safely, U.S. health
authorities should consider designating a hospital in each
region as the go-to facility for Ebola, they said.
“You don’t scapegoat and blame when you have a disease
outbreak,” said Bonnie Castillo, a registered nurse and a
disaster relief expert at National Nurses United, which serves
as both a union and a professional association for U.S. nurses.
“We have a system failure. That is what we have to correct.”
More than 4,000 people have died in the worst Ebola outbreak
on record that began in West Africa in March.
In recent months, the CDC has published detailed guidelines
on how to handle various aspects of Ebola, from lab specimens
and infectious waste to the proper use of protective equipment.
How that information gets communicated to frontline workers,
however, varies widely, Castillo said.
In many cases, hospitals “post something on a bulletin board
referring workers and nurses to the CDC guidelines. That is not
how you drill and practice and become expert,” she said.
CDC spokesman Tom Skinner said the agency is still
investigating the case of the Dallas nurse, but stressed that
“meticulous adherence to protocols” is critical in handling
Ebola. “One slight slip can result in someone becoming
infected.”
Skinner said the CDC is going to step up its education and
training efforts on how to triage and handle patients, and may
consider designating specific hospitals in each region as an
Ebola treatment facility.
“We’ve been doing a lot over the past few months, but
clearly there is more to do,” he said. “The notion of possibly
transporting patients diagnosed with Ebola to these hospitals is
not something that is out of the question and is something we
may look into.”
Dr. Gavin Macgregor-Skinner, an expert on public health
preparedness at Pennsylvania State University, also disagreed
with the talk of a breach of protocol, saying it just puts the
onus on the nurse.
“I think that is just wrong,” said Macgregor-Skinner, who
helped the Nigerian government train healthcare workers when a
traveler from Liberia touched off an outbreak of Ebola this past
summer.
“We haven’t provided them with a national training program.
We haven’t provided them with the necessary experts that have
actually worked in hospitals with Ebola,” he added in reference
to U.S. hospital staff.
Legal experts said the Dallas nurse may be entitled to
compensation if the hospital carries workers’ compensation
insurance. If it doesn’t, she would have the right to sue the
hospital for damages under Texas law, said Jay Harvey, a lawyer
in Austin, Texas.
Her ability to show that the hospital was negligent by, for
example, not providing proper training, would be key to winning
such a suit, Harvey said.
Sean Kaufman, president of Behavioral-Based Improvement
Solutions in Atlanta, helped train healthcare staff at a special
isolation unit at Atlanta’s Emory University which treated U.S.
aid workers Dr. Kent Brantly and Nancy Writebol, the first two
Ebola patients to be treated on U.S. soil.
He would observe the nurses and doctors as they cared for
patients and keep detailed notes when someone would accidentally
touch their sleeve or mask with an infected glove.
He then helped coach them through the process of carefully
removing their infected gear. Facilities caring for Ebola
patients are encouraged to use a buddy system so that colleagues
are watching each other to make sure they don’t take risks.
“Doctors and nurses get lost in patient care. They do things
that put themselves at risk because their lens is
patient-driven,” Kaufman said. In Dallas, “I suspect no one was
watching to make sure the people who were taking care of the
patients were taking care of themselves,” he said.
CDC and Texas health officials said the nurse who became
infected had been wearing the recommended personal protective
gear for Ebola, which consists of gloves, a gown, a mask, and a
shield to protect the eyes from possible splatters from the
patient.
According to experts, that gear offers the minimum level of
protection. When an Ebola patient enters the latter stages of
the disease, as Duncan did, they become so-called fluid
producers, Kaufman said.
“Towards of end of the illness, the virus is trying to live
and thrive. It’s trying to get out of the person’s body. It’s
producing massive amounts of fluid,” he said.
At that point, caregivers need to add more layers of
protective gear, such as double gloves and a respirator or a
full bodysuit. Those kinds of decisions need to be made by
managers who are constantly assessing the risk to healthcare
workers, Kaufman said.
Macgregor-Skinner said all U.S. hospitals must be ready to
identify and isolate an Ebola patient, but should also be able
to turn to a regional facility that is better prepared to
receive them.
“Every hospital can then prevent the spread of Ebola, but
not every hospital in the U.S. can admit a patient in the
hospital for long-term care,” he said.
(Reporting by Julie Steenhuysen; Additional reporting by David
Ingram in New York; Editing by Michele Gershberg and Martin
Howell)
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