Report of Second Texas Nurse With Ebola Fans Hospital Safety Fears

Health officials from CDC and the state of Texas are reeling in the wake of today’s report that a second nurse at the Texas hospital that treated Ebola patient Thomas Eric Duncan has tested positive for the virus. The news came while health leaders were still trying to determine how 26-year-old nurse Nina Pham contracted Ebola while caring for the first patient diagnosed with the disease on US soil.

Top public health officials grasped for answers as fears grow that most hospitals would fare no better than Texas Presbyterian if a patient exhibiting Ebola symptoms landed in their emergency room. Meanwhile, reports of suspected Ebola cases that turned out to be false alarms have started to crop up, including one from Mobile, Alabama.

In an extraordinary admission, CDC Director Thomas Frieden, MD, MPH, yesterday said that that the agency should have moved more quickly to assist Texas Presbyterian Hospital after Mr Duncan tested positive for Ebola, and said CDC would now send teams to enforce patient care protocols as soon as a diagnosis is made. Mr Duncan died on October 8, 2014, more than a week after he returned to Texas Presbyterian’s emergency department (ED) after his symptoms worsened; Texas Presbyterian officials have come under fire for sending Mr Duncan home with antibiotics when he first appeared in their ED.

“Getting it right is really, really important because the stakes are so high,” Dr Frieden said during a news conference. “We could have sent a more robust hospital infection control team and been more hands on with the hospital from Day One about how this should be managed.”

That was little comfort to the leaders of National Nurses United (NNU), who yesterday held a press conference to decry what they called sloppy conditions at Texas Presbyterian. The nurses issued updated results from a survey of 2300 members, who report that most hospitals are not prepared to treat a patient with Ebola.

“There is no standard short of optimal in protective equipment and hands-on-training that is acceptable,” said RoseAnn DeMoro, executive director of NNU, the largest US organization of nurses.

ABC News reported a union statement that Mr Duncan was left in a nonquarantined zone for hours, and a nurse supervisor faced resistance from hospital leaders after demanding that Mr Duncan be moved to an isolation unit. Additionally, Mr Duncan’s lab specimens were through the hospital’s tube system, potentially contaminating the system, the nurses said. In response, Texas Presbyterian issued a statement that numerous steps were taken to ensure patient and worker safety, including annual training and a hotline to anonymously report problems.

According to the NNU survey:

• 85% of the respondents said their hospital has not provided education on Ebola with the ability for the nurses to interact and ask questions.
• 40% say their hospital has insufficient current supplies of eye protection (face shields or side shields with goggles) for daily use on their unit; 38% say there are insufficient supplies of fluid resistant/impermeable gowns in their hospital.
• 41% say their hospital does not have plans to equip isolation rooms with plastic covered mattresses and pillows and discard all linens after use; only 8% said they were aware their hospital does have such a plan in place.

The extraordinary challenge that healthcare workers face in treating Ebola patients was highlighted further in CDC’s Mortality and Morbidity Weekly Report, which yesterday included a paper on an Ebola treatment unit within a hospital in Monrovia, Liberia. Over 2 weeks in July 2014, 5 healthcare workers contracted the virus, and 2 died, even though none of the workers reportedly had any known protocol violations that exposed them to the virus.

Around the Web

Second Health Care Worker Tests Positive for Ebola at Dallas Hospital

CDC Should Have Been More Hands On With Dallas Ebola Case, Director Says

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Cluster of Ebola Cases Among Liberian and US Healthcare Workers: MMWR