Health Officials Reviewing Ebola Treatment Procedures at Dallas Hospital

CDC will be 'doubling down' on education and training for all U.S. hospitals

Monday, October 13, 2014

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MONDAY, Oct. 13, 2014 (HealthDay News) -- Federal and local health officials said Monday that they were re-examining infection-control efforts at the Dallas hospital where a nurse contracted Ebola while caring for America's first diagnosed victim of the deadly disease.

The goal: To see if further refinements are needed on the so-called "infection-control protocols" designed by the U.S. Centers for Disease Control and Prevention for treating Ebola patients.

However, CDC officials insisted that their infection-control guidelines have proven effective when treating Ebola patients in the past.

Officials are examining every step at which a health care worker at Texas Health Presbyterian Hospital could be exposed to Ebola while treating an already infected patient, CDC Director Dr. Thomas Frieden said during a late-morning news briefing.

Nurse Nina Pham currently is in stable condition after being exposed to Ebola while caring for Liberian national Thomas Eric Duncan. USA Today reported her identity Monday after confirming it with family members.

Duncan died Oct. 8 at Texas Health Presbyterian Hospital. Two days later, Pham reported to the hospital with a fever. She tested positive for Ebola late Saturday night, becoming the first person known to contract Ebola inside the United States.

Pham's case "does tell us that there were risks to that individual and potentially to others, so we are intensively monitoring that so we can break the chain of transmission there," Frieden said.

CDC officials in Texas also are conducting an extensive investigation to determine how many other health care workers might have been exposed to Ebola while treating Duncan, he added.

Meanwhile, President Barack Obama was meeting Monday afternoon with senior administration officials on the government's response to Ebola now that the Texas nurse contracted the disease, according to the Associated Press.

Ebola patients are not contagious until they show symptoms such as fever, vomiting and diarrhea, according to the CDC.

"The teams on the ground are going through in great detail what kind of contact people had and what kind of care they gave on which days, so we can really develop a map of what the potential exposures are," Frieden said.

The CDC hopes to release by Tuesday the number of health care workers who will need to be monitored for 21 days because of potential exposure during Duncan's care, to see if they develop any symptoms of Ebola.

That pool of potential hospital exposures is on top of the 48 people already under observation because of confirmed or suspected contact with Duncan after he fell ill and became contagious before he entered the hospital on Sept. 28. None of those people has yet shown any symptoms of Ebola, officials said.

Only one person appears to have been in contact with Pham after she developed a fever, and that person is being monitored, Freiden noted.

Frieden reiterated that the CDC believes that its Ebola infection-control procedures are effective in preventing exposure to the deadly virus that has been ravaging the West African nations of Guinea, Liberia and Sierra Leone since the spring.

"We've already cared for other patients with Ebola in this country without infections," he said, referring to several American aid workers who were brought home from West Africa for medical care after contracting the virus abroad. "Doctors Without Borders and others, including ourselves, have cared for patients for decades without infections, so we know how to stop Ebola."

But public health officials are examining the steps taken at Texas Health Presbyterian to see if the guidelines can be improved, Frieden said.

Those steps, he said, include:

Reviewing how hospital staff handle and apply protective gear, and retraining workers how to do it safely.
Requiring a "buddy system," in which someone donning protective equipment has a colleague watching to make sure it's done right.
Weighing more liberal use of an antiviral agent that now is sprayed over the gloves of workers as they leave the isolation ward.
Considering different types of protective equipment to figure out which are easiest to put on and take off.

Officials are particularly focusing on the risks that health care workers face when coming out of an isolation ward wearing potentially contaminated protective gear.

"One thing we've found is that sometimes health care workers may think more is better, so they may put on additional sets of gloves or additional coverings," Frieden said. "That may actually end up paradoxically making things less, rather than more, safe because it is so difficult to remove those layers."

In the days to come, the CDC will be "doubling down" on education and training in infection control and diagnosis of Ebola in all U.S. hospitals, Frieden said.

"It's very important that every hospital be prepared to diagnose someone with Ebola," he said, noting that anyone who has a fever or other symptoms should be grilled about their travel history, and isolated if they've been to Guinea, Liberia or Sierra Leone within the past three weeks.

In a statement Sunday, Obama called on federal authorities to "take immediate additional steps to ensure hospitals and health care providers nationwide are prepared to follow protocols should they encounter an Ebola patient."

Officials decontaminated Pham's apartment on Sunday, but were expected to go back Monday to do additional cleaning, said Dr. David Lakey, commissioner of the Texas Department of State Health Services.

She also has a dog, he added, and officials are trying to determine where to keep the animal and monitor it for Ebola exposure.

According to USA Today, Pham graduated from Texas Christian University's nursing program in 2010.

The Ebola epidemic in West Africa is the worst outbreak ever of the disease. So far, an estimated 8,000 people have become infected and an estimated 3,880 people have died in Guinea, Liberia and Sierra Leone, according to the World Health Organization.

SOURCES: Oct. 13, 2014, news briefing, Tom Frieden, M.D., M.P.H, director, U.S. Centers for Disease Control and Prevention, and David Lakey, M.D., commissioner, Texas Department of State Health Services; USA Today; Associated Press

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