CDC Urges All US Hospitals To 'Think Ebola'
NEW YORK (CBSNewYork/AP) -- Federal health authorities are telling the nation's hospitals to "think Ebola.''
Centers for Disease Control and Prevention Director Dr. Tom Frieden is urging hospitals to watch for patients with fever or symptoms of Ebola who have traveled from the three Ebola-stricken African nations in the past 21 days.
He spoke Monday after a nurse in Dallas became the first person to catch the disease within the United States. She had treated a Liberian man who died at the hospital after bringing the disease from Liberia.
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Frieden said Sunday there had been a breach of protocol that led the worker to become infected while treating patient Thomas Eric Duncan, but officials are not sure what occurred. Frieden suspects the nurse might have touched contaminated protective gear.
"A breach in protocol may be that the protocol's fine, they were not trained properly," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Duncan, who traveled from Liberia to visit family, did not get sick until he arrived in the U.S. He died Wednesday.
The nurse, 26-year-old Nina Pham, has not been able to point to how the breach might have occurred. She wore a gown, gloves, mask and shield while she cared for Duncan during his second visit to Texas Health Presbyterian Hospital, said Dr. Daniel Varga of Texas Health Resources, which runs the hospital.
Hazmat teams have decontaminated Pham's Dallas apartment, and health officials alerted neighbors with a reverse 911 call, CBS 2's Matt Kozar reported.
"We have to rethink the way we address Ebola infection, because even a single infection is unacceptable," Friedan said.
Officials are monitoring 50 people who nurse Pham had contact with prior to contracting Ebola.
The CDC is now monitoring all hospital workers who treated Duncan. Frieden said he wouldn't be surprised if another hospital worker who cared for him when he was very sick becomes ill. Ebola patients become more contagious as the disease progresses.
"Unfortunately, it is possible in the coming days that we will see additional cases of Ebola," Frieden said. "This is because the health care workers that cared for this individual may have had a breach of the same nature."
Hazmat crews spent hours cleaning Pham's Dallas apartment. Her husband has also been placed in hospital isolation to be observed for possible exposure.
Her neighbors said they are nervous.
"I'm definitely going to be taking more precautions," Kara Utley said. "It's something that's very scary. It's creepy that it's just a few houses down."
Pham's father says she's in fine spirits and is in stable condition -- only suffering from a fever.
Of the six Ebola patients treated in the U.S. before Pham's case, Duncan was the only one not treated at one of the specialized units in several hospitals around the country set up to deal with high-risk germs.
Frieden has said that any U.S. hospital with isolation capabilities can care for an Ebola patient. But his stance seemed to soften Sunday, when asked at a news conference whether officials now would consider moving Ebola patients to specialized units.
"We're going to look at all opportunities to improve the level of safety and to minimize risk, but we can't let any hospital let its guard down,'' because Ebola patients could turn up anywhere, and every hospital must be able to quickly isolate and diagnose such cases, he said.
But once that is done, "then thinking about what the safest way is to provide that care, that's something that we'll absolutely be looking at,'' he said.
CBS 2's Dr. Max Gomez said Ebola can be prevented from spreading in the U.S., but it takes strict adherence to infection control protocols.
The first step is an isolation room. Next, there's protective gear. The gear is especially important for anyone cleaning up bodily fluids or performing a procedure on a patient -- dialysis, drawing blood, inserting IVs or breathing tubes or cleaning bed pans.
Taking the protective gear off is by far the hardest part of the infection control protocols because it might contain infectious bodily fluids.
"If while removing the suit, you accidentally touch something on the outside of the suit or your gloves with your hands or some other part of your skin, then the virus can be on you, and that's how the virus can be transmitted," said Dr. Mark Jarrett of North Shore-LIJ Health System.
There also must be a route of entry, such as an open cut, scrape or touching the eyes, nose or mouth, Gomez said.
The protective exact gear can vary. A hazardous material-type suit usually includes a gown, two sets of gloves, a face mask, and an eye shield. There are strict protocols for how to use it correctly.
"When you put on your garb and you take off your garb, it's a buddy system,'' with another health worker watching to make sure it's done right, said Dr. Dennis Maki, a University of Wisconsin-Madison infectious disease specialist and former head of hospital infection control.
In Dallas, the investigation is focusing on two areas: how the gear was removed and the intensive medical procedures Duncan received, which included kidney dialysis and a breathing machine. Both involve inserting tubes into blood vessels or an airway. That raises the risk a health worker will have contact with the patient's bodily fluids, which is how Ebola spreads.
Some of the gear the health worker takes off might brush against a surface and contaminate it. New data suggest that even tiny droplets of a patient's body fluids can contain the virus, said Maki.
"I can have on the suit and be very careful, but I can pick up some secretions or body fluids on a surface'' and spread it that way, he said.
The case in Dallas heightens concern for health workers' safety, and nurses at many hospitals "are alarmed at the inadequate preparation they see,'' says a statement from Rose Ann DeMoro, executive director of the union, National Nurses United.
"The hospitals are not providing the training that we need nor are they providing the personal protection we need to keep our patients, ourselves, our families and our communities safe," said Katy Roemer with National Nurses United.
Here at home, the New York State Nurses Association said it is concerned that hospital workers, instead of hospital protocols, are being blamed for spreading Ebola.
Lisa Baum, who is in charge of health and safety for the union, said 200 hospitals that members work in are being asked to prove that they can handle the disease.
"We are requesting a written protocol that includes information on triage procedures, personal protection equipment for staff, training, waste handling," she told 1010 WINS' Mona Rivera.
Baum told WCBS 880's Marla Diamond she believes some hospitals are more ready than others.
"We are in the process of trying to get all of the information from all of the hospitals to make sure that they are adequately prepared," she said.
Mayor Bill de Blasio said New York City's health care system has been preparing for weeks for any Ebola cases with an emphasis on safety.
De Blasio emphasized Monday that there are no known cases of Ebola in New York City, but he said that Bellevue Hospital Center is in a "high state of readiness,'' just in case.
"We are ready for anything,'' he said.
In a statement Sunday, Health Commissioner Dr. Mary Bassett and Health and Hospitals Corp. President Dr. Ram Raju said state and local health officials have been working closely with hospitals and first responders to make sure they have adequate supplies, equipment, training and protocols to care for any potential Ebola patients.
"Meticulous adherence to these guidelines, established in accordance with CDC guidance, will keep health workers involved in direct care for patients with Ebola safe from infection," the statement said.
The CDC says training at the Texas hospital has been ramped up. The agency also now recommends the hospital minimize the number of people caring for an Ebola patient, perform only procedures essential to support the patient's care and name a full-time infection control supervisor while any Ebola patient is being cared for.
Frieden also said the agency was taking a new look at personal protective equipment, "understanding that there is a balance and putting more on isn't always safer, it may make it harder to provide effective care.''
Meanwhile, the White House said President Barack Obama also wants an update on steps underway to ensure the national health system is prepared to deal with the disease. Obama was meeting with senior officials Monday afternoon, the White House said.
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