When Thomas Duncan, the first person to be diagnosed with Ebola in the U.S. was admitted to Texas Health Presbyterian Hospital, the nurses and doctors who took over his care became the frontline in the battle with the virus. According to the Centers for Disease Control (CDC), proper infection control procedures should have protected those health care workers from getting infected, and should have stopped the virus from spreading any further than Duncan and anyone he may have had direct contact with before falling ill.
But they didn’t. Nina Pham, one of the nurses assigned to care for Duncan before he died, tested positive for Ebola on Oct 13. Initially, CDC director Dr. Tom Frieden attributed the infection to a “breach in protocol.”
“That infuriated me,” says Karen Higgins, co-president of National Nurses United (NNU) and a nurse at Boston Medical Center. “What it should have been attributed to was a breakdown in the system. It never should have been stated. Instead, we should figure out what the problem was and fix it, not say that it was her fault that she didn’t follow protocol and that’s why it happened.”
CDC has since acknowledged that they and the Texas health department are still investigating how the infection occurred, but according to the nurses’ group, there are serious gaps in the country’s preparedness for treating Ebola patients. For one, there is no standard protocol for what a hospital needs to have in place and how a hospital should handle an Ebola case. The CDC has published guidelines on its website, but it’s up to each hospital to decide how to implement those recommendations. And according to a recent survey of more than 2,200 nurses in 46 states, those policies vary widely and are haphazard. Eighty five percent of the nurses questioned felt their hospitals had not provided education about Ebola in a format in which they could ask questions and learn more about best practices for protecting themselves, the patient and their communities. Most were directed to a video or website or handed a piece of paper informing them of Ebola’s symptoms and urging them to ask patients with fevers about their recent travel history. Some were provided a Hazmat suit in the breakroom and told to try it on if they had time. Most said their hospitals did not have Hazmat suits for the nurses. Forty percent of them said their hospitals did not have enough protective equipment, including face shields or the fluid-barrier gowns that are required when treating infectious patients. “Are we prepared for infectious diseases? Yes we are. Are we prepared for Ebola? No we are not,” says Higgins.
The fact that two hospitals in the U.S.—Emory University Hospital and Nebraska Medical Center—successfully treated Ebola patients without any spread of the virus supports Frieden’s conviction that it’s possible to contain Ebola and protect health care workers.
But in order to do that, the NNU says a strong mandate is needed from the CDC and public health departments that specifies exactly what type of equipment health care providers should be wearing, how they should put the equipment on and take it off, and how they should dispose of them once they have been contaminated. That’s especially important if the CDC expects every hospital to be able to properly care for Ebola patients, something that Frieden says is possible. “We are challenging the CDC and saying we are past the time of guidelines and recommendations,” says Higgins. “What we need are standards, high standards of care. Say that this is now what is expected of your equipment, the right gloves, the right outfits, masks and covers.”
Specifically, the nurses want Hazmat suits for anyone who will be treating an Ebola patient. Health departments and the CDC have been reluctant to mandate these, since putting them on or taking them off improperly may put health care workers at greater risk of contamination. But with training, the nurses say, the suits could prevent further spread of the virus, like what happened in Dallas. “The equipment is one thing, but training has to be the second part,” says Higgins. “And not just a web site or a video, but people working with people one on one to make sure everyone understands what they are doing, how to get in and out of the equipment, and how to do it right.”
At Boston Medical Center, hospital staff have recognized that current procedures aren’t enough, and in the past week have increased hands-on training and drills to make sure health care workers are prepared to properly handle an Ebola patient, should one walk through the door. Those procedures include making sure that anyone gowning to go into an infectious patient’s room has a buddy to observe or gown with them, and point out any missed steps or improperly worn protective gear.
Waste from a potential Ebola patient is also getting the same stepped-up vigilance. Previously, the waste wasn’t given any additional care beyond the usual treatment for hazardous materials—a separate bin and a separate removal process that generally ended in incineration. But now, the hospital is requiring any Ebola material to be double or triple bagged and put in a separate box to be removed by a properly trained hazardous waste management team who will dispose of it in the right way to prevent further contamination.
For now, the nurses aren’t confident that they are able to properly protect themselves and their community from Ebola, but they’re convinced that with the proper equipment and training, they can be. “This is our test and we need to do it right,” says Higgins. “We feel extremely upset that any [healthcare worker] got infected. Hopefully she will be fine, but we don’t want to have to face another person or family that ends up getting infected because we are not as good as we should be in treating patients.”