Last week the Ebola virus spread from a Dallas, Texas patient to his nurse. This week some caregivers are asking if their hospital is prepared to keep them safe.
Friday, the New Jersey Health Commissioner sent a letter to acute care hospitals in the Garden State asking them to conduct drills by Oct. 17 — and get ready for the possibility that a patient with Ebola will come through the door.
Patricia Eakin, an emergency room nurse, and president of the Association of Staff Nurses and Allied Professionals, says hospitals are scrambling to figure out how to care for a person with the Ebola virus.
Eakin says regional public health officials should designate a single treatment center for most Ebola cases in the region, and then send extra help to that location — to make sure health workers have the space and facilities they need.
“Seems to me it would be safer for everybody and wouldn’t require the number of resources in every single hospital to get ready for these patients,” Eakin said.
Her group outlined a series of suggestions.
“These recommendations are not a wish list; they are an absolute minimum needed to keep the contagion from spreading and to keep the dedicated nurses and other personnel caring for infected patients safe,” Eakin said in a press statement.
There is some precedent for concentrating similar cases at one or two locations during a health crisis. Philadelphia infectious disease physician Esther Chernak says that approach probably works best in a country where the government runs the entire health system.
In Canada, during the severe acute respiratory syndrome (SARS) epidemic in certain medical centers became known as SARS hospitals. There’s a level of proficiency — an economy of scale that comes with taking care of many patients with the same concern, Chernak said.
Nonetheless, Chernak said every health care center, big or small, needs basic safety protocols.
“People go wherever is convenient for them when they need help — even to their local urgent care clinic,” she said.
“All of our hospitals in New Jersey need to be ready to manage a potential case of an individual that would appear at their doorstep with Ebola,” said New Jersey Health Commissioner Mary O’Dowd. “All hospitals need to understand that when they are doing triage they need evaluate travel history for any patient that is exhibiting symptoms that are consistent with Ebola.”
Health screening is set to start at Newark airport this week. University Hospital in Newark said it’s ready to accept potential patients.
The hospital has a memorandum of agreement with the Centers for Disease Control and Prevention “to detain, isolate and quarantine individuals who are reasonably believed to be infected with Ebola or any communicable disease” said Tiffany Smith, the hospital’s manager of communications.
Patricia Eakin says she wasn’t surprised when she learned that the Dallas nurse contracted Ebola.
“We’ve been hearing all along that that this illness is very dangerous to health care workers,” Eakin said.
“Even before I heard about the nurse being infected, I thought, that’s going to be a high risk situation,” Esther Chernak said.
In the last days of his life, Thomas Duncan, the first person to be diagnosed with Ebola in the United States, was on a ventilator and needed dialysis for kidney failure.
A person on dialysis has his blood cycled through a machine to remove impurities.
“There’s lots of areas where there’s potential blood exposures,” Chernak said.
A patient on mechanical ventilation has a tube in his throat.
“There’s lots of secretions. Someone is suctioning out those secretions and caring for the tube,” said Chernak, an associate research professor at the Drexel School of Public Health.
Personal Protective Equipment
The CDC is investigating but it’s not clear how the infection spread from patient to nurse in Dallas. Some experts say the incident is a wake up call about the importance of personal protective equipment.
Aline Holmes leads clinical affairs at the New Jersey Hospital Association and is a registered nurse.
She says the protective clothing required for Ebola is like wearing a bulky sweater — backward — and then having to wiggle out of all that gear, safely while wearing two pairs of gloves.
“You have to untie the gown in the back, and then you have to bring it forward over your shoulders, pull your arms out of it, and make sure you don’t touch any part of the outside of the gown,” Holmes said.
There are lots of opportunities to make a small mistake, Holmes says, if a health worker is not well trained.
Director of the Wistar Institute’s Vaccine Center Hildegund Ertl says doctors and nurses deal with contagious illness everyday, but rarely a virus as deadly as Ebola.
“It’s not particularly spreadable, it’s not as spreadable as influenza virus, or measles virus,” Ertl said. “Ebola really requires close contact with the patient.”
Scientists at high-security research labs practice frequently to prevent spreading a virus like Ebola, but Ertl says that level of training doesn’t happen so often at a typical American hospital.
“If you’ve never had a case like this and your hospital doesn’t train you, chances are you don’t think about it,” she said.
Some medical centers employ a buddy system to help workers doff (remove) their gear safely.
“Another colleague is observing them and making sure they are taking all the correct and exact steps to prevent self-contamination when they remove it,” Chernak said.
Can workers say ‘no’ to providing care?
Eakin said she’s heard from front-line health care workers who worry they haven’t had the appropriate practice and training.
“When I talked to medics from the Philly Fire Department — I work in an E.R. and obviously medics bring us our patients. They tell me they haven’t had any trainin g— they don’t have masks, they don’t have suits, they haven’t been trained to screen for Ebola. They have a piece of paper that gives them some instructions, but that’s it in terms of training and policy,” Eakin said.
Holmes, with the New Jersey Hospital association said she hasn’t heard of any health workers who aren’t showing up at work because of concerns around Ebola. Surely some doctors and nurses are concerned she said professionals are taking a ‘wait and see’ stance while the CDC’s investigation continues.
WHYY asked New Jersey’s health commissioner and local hospitals if workers have a right to refuse to care for a patient.
“Generally speaking health care professionals — in a health care setting — are required to perform within the scope of their practice, there are very limited statutory exceptions,” O’Dowd said. “There are boards of medicine and nursing that have jurisdiction over professional responsibility in individual practice, and we are working hard with our health care providers to ensure that they feel that they have the appropriate training and preparedness.”
By email, Penn Medicine’s Senior Vice President for Public Affairs Susan Phillips said: “The safe and appropriate care of each and every patient regardless of their diagnosis is our first responsibility. Our staff are well trained in isolation practices and if needed, special protective equipment is readily available.”
“Should a situation arise where staff do not feel able to provide appropriate care to a patient, we will review their concerns and take any needed action that would be in the best interest of both our patients and staff.”