Some US healthcare experts are bristling at the assertion by a top health official in the country that a “protocol breach” caused a Dallas, Texas, nurse to be infected with Ebola while caring for a dying patient, saying the case instead shows how far US hospitals are from adequately training staff to deal with the deadly virus.
US Centers for Disease Control and Prevention (CDC) Director Thomas Frieden 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 US.
Duncan died last week at Texas Health Presbyterian Hospital.
Photo: Reuters
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 US hospital should be prepared to treat an Ebola patient. Given the level of training required to do the job safely, US 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 US 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.
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.
However, how that information gets to frontline workers varies widely, Castillo said.
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.
“We’ve been doing a lot over the past few months, but clearly there is more to do,” she 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.”
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 US hospital staff.
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 US aid workers Kent Brantly and Nancy Writebol, the first two Ebola patients to be treated on US soil.
Macgregor-Skinner said all US 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 US can admit a patient in the hospital for long-term care,” he said.
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