Why are healthcare workers getting infected with Ebola? We were not prepared
Friday, October 17, 2014
Thomas Eric Duncan, the first Ebola patient diagnosed in the United States, died Oct. 8. Shortly after, a nurse named Nina Pham was diagnosed with the Ebola virus, followed this week by a second nurse who is also infected.
With the current infections of two direct caregivers, questions have surfaced regarding the preparedness of our hospitals and healthcare staff in the United States.
As of this article, there have been no reports of the mode of transmission and/or contamination of the two healthcare workers. When Pham was diagnosed, the CDC was quick to blame the nurse for not following protocols. That was followed by the statement that the protocols were being evaluated. This raised the question that if the protocol was sufficient and the nurse was "to blame for her infection," why the sudden need to change the protocols?
As damage control continued, reports began surfacing that inadequate personal protective equipment was in use during the care and treatment of Duncan, the first infected patient in Dallas. The hospital maintains that they followed the CDC's protocols, but reports still continue to surface saying that waste is not being contained and evacuated as would be expected and that Duncan's infected blood was transported through the hospital’s tube system, instead of being hand-delivered.
These examples represent the lack of respect for this virus and its potential for infection and possible mortality.
More importantly, it demonstrates the lack of preparedness for our local community hospitals. Tom Frieden, the director of the CDC, has been saying for weeks that America was prepared for Ebola. As we have learned from Dallas, this clearly is not the case.
Texas Health Presbyterian Hospital could have been any hospital in America. It was caught off guard and will hopefully be an example to the rest of the healthcare community so our mistakes are not repeated. In a statement prepared for the House of Representatives subcommittee hearings on Oct. 16, Daniel Varga, the chief clinical officer for Texas Health Resources, admitted that the hospital made mistakes for which they are "deeply sorry."
All of the infected patients who have been transported back to the U.S. have been cared for in highly sophisticated biocontainment units. Once Duncan was initially diagnosed, he should have been immediately transported to an appropriate facility.
In these facilities, the staff are highly trained and supported. They have done drills and practiced how to care and manage these types of patients. To expect the average community hospital to safely and appropriately care for such a highly infectious patient is not logical or reasonable. Moving forward, protocols need to include transport to the nearest capable facility.
Unfortunately, the lives of two nurses now hang in the balance. They found themselves at the crossroads of poor decision-making and policy-protecting, and they did what healthcare professionals do each day — take care of their patients the best way they know how.
Unfortunately, the system as a whole failed them — not just their hospital for its lack of preparedness, but also the CDC support staff that was supposed to give them guidance and support. Sadly, this could have happened at any hospital.
According to current estimates, 400 healthcare workers globally have been infected, and 230 have died. This high rate of transmission is related to poor protective equipment in vulnerable countries. Nurses are especially vulnerable as they provide the basic care needed by these patients.
Unfortunately, as the patients worsen, they become more infectious, while also requiring more care due to the excessive vomiting and diarrhea that typically occurs. This high rate of exposure, coupled with poor protection, is placing healthcare workers directly in harm's way.
Clearly, lessons have been learned thus far. In a video released on Oct. 16 of Pham just prior to her transport to the NIH facility in Maryland, the staff is clearly well protected and now appear to be wearing respirators as is recommended.
According to all previous reports, including a brave nurse who came forward, this was not the case in the early days of Duncan's admission. The healthcare workers apparently received no training on the seriousness of the situation, nor were they provided with adequate protective equipment leaving them exposed.
Please, take the time to educate yourself on this disease, especially if you are a healthcare provider. The Nebraska Medical Center, which has successfully cared for two infected Ebola patients, is doing a wonderful service in providing complete transparency in how they care for these patients. You can find a video about how to properly don and doff your protective equipment safely on their website.
Although the likelihood of any of us caring for an infected patient is slim, for the sake of our patients, our families and the public we must be educated and prepared. The only way we are going to tackle and contain this is with vigilance. And that starts with us.
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