​Texas hospital pushes back against nurses' claims on Ebola protocols

A Texas hospital where the nation's first fatal Ebola victim was treated has responded to complaints levied by nurses and the CDC about a failure to follow protocols, which is being blamed for the infection of two health care workers.

On Wednesday, representatives of National Nurses United, citing anonymous health care workers at Texas Health Presbyterian Hospital Dallas, said that hospital officials did not know the proper protocol for dealing with Thomas Eric Duncan, who died on October 8, and that a nurse supervisor who had demanded that he be moved to an isolation unit faced resistance from other hospital authorities.

There were also complaints that protective gear provided to nurses was incomplete or ill-fitting and left areas exposed, and that Duncan's lab specimens potentially contaminated the hospital's entire specimen processing system.

Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, also said that breaches of protocols led to the infection of the two nurses, but added that nurses were wearing too much protective gear, increasing the difficulty of suiting up properly and increasing the risk of contamination while undressing.

On Thursday, the hospital said that nurses union's assertions "do not reflect actual facts learned from the medical record and interactions with clinical caregivers."

The hospital said that CDC guidelines were followed, and that additional guidance and clarity was sought.

In a statement, the hospital said that nurses caring for Duncan wore protective gear consistent with CDC guidelines, including shoe covers, face shields, and an optional N-95 mask, and that when nurses complained isolation suits left the skin on their necks exposed, the hospital ordered hoods be worn.

The hospital admitted that some Tyvek suits were too large. "We have since received smaller sizes, but it is possible that nurses used tape to cinch the suits for a better fit," the statement said.

The hospital also said that when Duncan returned to the hospital for his second visit, the tube system was not used for transporting his lab specimens. "His specimens were triple-bagged, placed in a container, and placed into a closed transport container and hand-carried to the lab utilizing the buddy system," the statement said.

The federal government is ramping up its response to the Ebola crisis after a second Dallas nurse became ill and it was disclosed that she had been cleared to fly a day before her diagnosis.

While Ebola patients are not considered contagious until they have symptoms and only two persons have been known to contract the disease in the U.S., the revelations Wednesday raised new alarms about whether hospitals and the public health system are equipped to handle the deadly disease.

Federal health officials were being called to testify before a congressional committee Thursday to explain where things went wrong.

President Barack Obama directed his administration to respond in a "much more aggressive way" to oversee the Dallas cases and ensure the lessons learned there are transmitted to hospitals and clinics across the country. For the second day in a row he canceled out-of-town trips to stay in Washington and monitor the Ebola response.

The CDC's Dr. Frieden said nurse Amber Joy Vinson never should have been allowed to fly on a commercial jetliner because she had been exposed to the virus while caring for an Ebola patient who traveled to the U.S. from Liberia.

Vinson was being monitored more closely since another nurse, Nina Pham, also involved in Thomas Eric Duncan's care was diagnosed with Ebola.

Still, a CDC official cleared Vinson to board the Frontier Airlines flight from Cleveland to the Dallas area. Her reported temperature -- 99.5 degrees -- was below the threshold set by the agency and she had no symptoms, according to agency spokesman David Daigle.

Vinson was diagnosed with Ebola a day after the flight, news that sent airline stocks falling amid fears it could dissuade people from flying. Losses between 5 percent and 8 percent were recorded before shares recovered in afternoon trading.

Frontier has taken the aircraft out of service. The plane was flown Wednesday without passengers from Cleveland to Denver, where the airline said it will undergo a fourth cleaning, including replacement of seat covers, carpeting and air filters.

Customs and health officials at airports in Chicago, Atlanta, the Washington suburbs and Newark, New Jersey, were scheduled to start taking the temperatures of passengers from the three hardest-hit West African countries Thursday. The screenings, using no-touch thermometers, started Saturday at New York's Kennedy International Airport.

Even as the president sought to calm new fears about Ebola in the U.S., he cautioned against letting them overshadow the far more urgent crisis unfolding in West Africa, where Ebola has killed more than 4,000.

Underscoring his emphasis on international action, Mr. Obama called European leaders Wednesday to discuss better coordination in the fight against Ebola in the countries of Sierra Leone, Liberia and Guinea and to issue a call for more money and personnel to "to bend the curve of the epidemic." British Prime Minister David Cameron's office said he offered to consult with the Italians to add treatment beds in Sierra Leone.

On Thursday, Chinese President Xi Jinping pledged continued support for the fight against Ebola in West Africa, but made no specific new aid offers. China last month pledged $33 million in assistance to Liberia, Sierra Leone and Guinea and dispatched doctors and medical supplies.

And France said that on Saturday, it will begin screening passengers who arrive at Paris' Charles de Gaulle airport on the once-daily flight from Guinea's capital.

But it was Wednesday's development in Dallas that captured political and public attention in the United States.

Duncan, who traveled to the U.S. from Liberia, originally was sent home when he went to the Dallas hospital's emergency room, only to return much sicker two days later. He died of Ebola on Oct. 8.

Republican lawmakers, including House Speaker John Boehner, increased calls for travel bans or visa suspensions from the West African countries where the disease has spread and urged the administration to take other measures to secure the transportation system.

The oversight subcommittee of the House Energy and Commerce Committee scheduled a Thursday hearing on Ebola with Frieden and Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

In prepared testimony, Fauci said Duncan's death and the infections of the two Dallas nurses and a nurse in Spain "intensify our concerns about this global health threat." He said two Ebola vaccine candidates were undergoing a first phase of human clinical testing this fall. But he cautioned that scientists were still in the early stages of understanding how Ebola infection can be treated and prevented.

Medical records provided to The Associated Press by Duncan's family showed Vinson inserted catheters, drew blood and dealt with Duncan's body fluids. Late Wednesday, she arrived in Atlanta to be treated at Emory University Hospital, which has already treated three Americans diagnosed with the virus.

Even though Vinson did not report having a fever until the day after she returned home, Frieden said she should not have boarded a commercial flight.

From now on, Frieden said, no one else involved in Duncan's care will be allowed to travel "other than in a controlled environment." He cited guidelines that permit charter flights or travel by car but no public transportation.

On its website, the CDC says all people possibly exposed to Ebola should restrict their travels -- including by avoiding commercial flights -- for 21 days.

President Obama sought to ease fears in the U.S., urging a stepped-up response even as he stressed that the danger in the United States remained a long shot.

"We want a rapid response team, a SWAT team essentially, from the CDC to be on the ground as quickly as possible, hopefully within 24 hours, so that they are taking the local hospital step by step though what needs to be done," he said.

But he also noted that the Ebola is not an airborne virus like the flu and thus is more difficult to transmit.

He made the point of noting that when he visited with health care workers who had attended to Ebola patients at Emory University Hospital in Atlanta, he hugged and kissed them without fear of infection.

"They followed the protocols, they knew what they were doing," he said. "I felt perfectly safe doing so."