ARE U.S. HOSPITALS PREPARED FOR POSSIBLE EBOLA BATTLE?

Original Story: usatoday.com

The fact that Dallas health care worker Nina Pham contracted Ebola even though she wore protective gear while treating Thomas Eric Duncan, the first person diagnosed with the deadly disease in the USA, is spurring demands for better training of health care workers and prompting calls for all U.S. Ebola patients to be cared for at one of the nation's four specially designed hospitals with biocontainment units.

But officials from two of those facilities say the super-hospitals won't be able to handle all future Ebola patients. Every hospital in the USA needs to be prepared to diagnose and treat patients with Ebola, said Bruce Ribner, medical director of the infectious disease unit at Emory University Hospital in Atlanta,which treated the first two Ebola patients in the USA, who contracted the disease in West Africa.

"It's not going to be possible, if this outbreak continues in West Africa, for a select number of institutions to care for patients," Ribner said.

Altogether, those four hospitals can accommodate just 8-13 patients, said Phil Smith, medical director of the biocontainment unit at Nebraska Medical Center in Omaha, which has treated a U.S. missionary and is treating a television news cameraman, both of whom contracted the virus in West Africa. He said Nebraska has 1-2 Ebola beds, Emory 2 beds, St. Patrick Hospital in Montana 1-2 beds and the National Institutes of Health in Maryland 4-7 beds. "But I don't know if they (NIH) have the staffing," he said.

Smith said the U.S. State Department decides which patients get beds at the four biocontainment units.

The nation's largest nurses' organization says most registered nurses at hospitals around the USA have not been given adequate training to handle an Ebola patient. Many hospitals have been slow to provide the proper training because it's expensive, said Charles Idelson, spokesman for National Nurses United, which has 185,000 members.

"Part of the problem with relying on the CDC (Centers for Disease Control and Prevention) is that they don't have an enforcement mechanism," he said. "What we see happening is the CDC can issue a thousand guidelines, but hospitals can choose to follow or not follow whatever guidelines they want. That's been a major roadblock to developing a national coordinated response to Ebola. For weeks, we heard assurances that the hospitals were prepared."

But he says his group's survey of more than 2,100 registered nurses at more than 750 facilities in 46 states and Washington, D.C., found that just 15% had received Ebola education where nurses had the ability to interact and ask questions. "What's happening is they're being given a CDC handout and directed to the CDC's website," he said.

The Society for Healthcare Epidemiology of America, which represents more than 2,000 physicians and other health care professionals, says the current Ebola outbreak "illustrates the need for increased funding for hospital epidemiology and infection prevention programs worldwide. ... The complexity of ensuring 100% adherence to infection control practices, particularly around personal protective equipment (PPE), points to the need for improved training of health care workers across all practice settings."

Pennsylvania Sen. Bob Casey, a Democrat, is calling for additional funding for a hospital preparedness program that has been cut by 50% since 2003. "We have to ensure that hospitals and medical facilities have the resources they need to protect public health," Casey said.

CDC director Thomas Frieden said Monday that the agency will "work with hospitals throughout the country to 'Think Ebola' in someone with a fever or other symptoms who has had travel to any of the three (West African) countries in the previous 21 days."

"We will be looking over the coming days at how we can increase training and increase training materials and availability, most urgently for the health care workers caring for the patient in Dallas, but also more generally throughout our health care system."

It's important for hospitals across the nation to be prepared and equipped to handle a potential Ebola patient because people on flights from Africa can end up in many U.S. cities, Smith said. "Every hospital, even small hospitals, have to have a plan in place to deal with a person who may just show up," he said.

He and other experts say that prepping to treat Ebola patients is costly. "I don't know the cost, except it's going to be expensive," Smith said. "Even for a smaller hospital, you need (an Ebola) dedicated staff, special nurses, a special area with a closed door between the surrounding area. Special security. Special waste handling. Every hospital that commits to prepare is going to have to spend a fair amount of money."

Ambreen Khalil, an infectious disease specialist at Staten Island University Hospital in Staten Island, N.Y., says the hospital is in the process of changing its protocol for removing PPEs. "Our protocols now require someone to observe removal of the equipment," she said. "If you don't peel it off very systematically, like layer by layer, and ensure your skin does not ever make contact with the garment, if you don't do that, you can still get Ebola.

"It is definitely challenging," she said.

Michael Guttenberg, chairman of emergency medicine at Forest Hills Hospital in Forest Hills, N.Y., said the most critical step in preparing for an Ebola patient is having a gatekeeper who can recognize such a person. "They have to have in place a person for identifying people who are potentially at risk," he said. "Essentially, they have to have at the front door a mechanism to identify patients who may be at risk."

In addition, hospitals have to partner with emergency medical services in their community so EMS workers can identify at-risk patients before they arrive at the emergency room. There are additional protocols: ensuring the safety of staff, visitors and patients; setting up an isolation room, and training staff in putting on and taking off the personal protective equipment worn when interacting with an Ebola patient.

Guttenberg said that removing the gear, especially, is a precise, exacting process that can take 6-10 minutes. "If there's any soiling of the outer garment, and if they remove it incorrectly and the outer garment comes into contact with their mucous membranes or their skin, that's where the risk lies for health care workers," he said.

There are protocols for contacting the local health department or the CDC to discuss a potential Ebola patient and determine if the patient is high risk. "If the patient is at high risk, the CDC or health department will ask for certain blood tests," he said. "You hold off on blood work until you talk with the health department or CDC, to limit the amount of needle pricks and possible exposure."

There also are protocols for moving an Ebola patient through the hospital; limiting visitors; cleaning equipment, and properly disposing of dirty linens and body waste.

"Hospitals with good infectious disease control programs in place will find this much easier to accomplish," he said. "A lot of this is just enhancement to what we do fairly routinely."

Guttenberg believes that about 50% of the nation's 4,500-5,000 hospitals are prepared to handle a single Ebola patient. "Very, very few of them could handle multiple patients," he said.