One of the main issues with this is that despite the recent onslaught of coverage in the media over Ebola, it truly is seen as a third-world issue, and US hospitals are generally more inclined to put their resources into areas where they know for sure a condition exists because it’s common to the population or the region. Think influenza in the wintertime in the Northeast.
Most hospitals already have systems in place for dealing with influenza outbreaks. They rely on these systems in the treatment of all highly contagious diseases, few if any of which have the death rate that Ebola has. As Dr. David Klocke, chief medical officer for Regional Health hospitals in South Dakota, explains, “We really are in general very well prepared to deal with dangerous microorganisms anyway.”
Some might take the above statement as comforting, but I look at it and wonder if there’s an aspect of arrogance in it. Is Dr. Klocke saying that his medical center can handle a community-wide Ebola outbreak? Given the circumstances, it would be a miracle if even the CDC could do so.
Going forward, we must do what can be done. Hospitals should be more vigilant about having nationally standardized practices in place for treating Ebola, and build a stockpile of materials that would make their efforts more successful.
WHOSE RESPONSIBILITY?
In the case of Texas Presbyterian, National Nurses United believes that procedures and protocols were definitely ignored or followed incorrectly. Although human error occurred, they feel that poor planning and mismanagement are the culprits that put the nurses who were infected at risk.
Management disagrees. A spokesperson for the hospital, Wendell Watson, made a statement that “Patient and employee safety is our greatest priority, and we take compliance very seriously” and that the hospital would “review and respond to any concerns raised by our nurses and all employees.”
The Centers for Disease Control and Prevention stated that some breach of protocol probably sickened Nurses Pham and Vinson. National Nurse United claimed that protocols were either non-existent or were changed constantly after Thomas Duncan was admitted. Further investigation reveals other alarming allegations of protocol breaches, most by the hospital.
Ms. Pham was reportedly there from the beginning of his illness and treated Duncan throughout the course of his battle in the hospital’s intensive care unit. Reportedly, “Duncan’s medical records make numerous mentions of protective gear worn by hospital staff, and Pham herself notes wearing the gear in visits to Duncan’s room. But there is no indication in the records of her first encounter with Duncan, on September 29, that Pham donned any protective gear.”
How is that possible? How could Ebola not have been suspected as the cause of illness for a Liberian national who had traveled from Liberia shortly before ending up in that Texas emergency room?
According to National Nurses United, nurses from Texas Presbyterian have alleged that Duncan’s “lab samples were allowed to travel through the hospital’s pneumatic tubes, possibly risking contaminating of the specimen-delivery system [and] that hazardous waste was allowed to pile up to the ceiling.”
TIP
There are no community-wide Ebola outbreaks here at present, and we can, under strong leadership, become capable of containing the disease in West Africa while protecting home territory. It will take a lot of humanitarian aid and tough, but logical, decision making.
It apparently wasn’t for several days that protective gear, including shoe coverings, had been mandated for use in Duncan’s care—that apparently there were a number of loose protocols and “recommendations” but very few essential hospital mandates.
Finally, several days into the ordeal, one of the nurses noted: “RN entered room in Tyvek suits, triple gloves, triple boots, and respirator cap in place.” But what about all those days before? What kind of protections and precautions had been in place? The documentation is sparse.
It has been rumored that the staff at the hospital has been threatened with firings for speaking to the press, so it’s hard to know if the public at large will ever know the real truth about how Duncan’s care had been managed or mismanaged.
So who’s at fault?
The medical staff may have committed errors in the donning and doffing of protective gear, if it was given to them in the first place. I have put on and taken off these outfits myself, and believe me when I tell you that there is a learning curve. A wrong move could easily mean contamination. Humans aren’t perfect, and mistakes happen, but I believe in my heart that nurses are heroes and the heart and soul of the field of health care. I have seen what they do day in and day out, and I will admit to you, as a physician, that I couldn’t do it.
The hospital has a burden of blame to bear, as it was clearly unprepared for dealing with the Ebola patient. It didn’t have the equipment, the advanced training, and the policies in place that would have made the unit an effective team. To put it simply, the hospital was in over its head.
The blame falls, therefore, where the buck stops, and that’s at the very top of our medical administration. Our top health officials have told us so often that we have nothing to worry about. We expect that we are up for any challenge because we are told that lie daily. I hoped that the high technology and vast resources in the United States would trump human error, disorganization, and yes, arrogance.
I was wrong. There are, indeed, circumstance for which we are unprepared, and woefully so. Our medical directors at the national level have failed to make us ready for the challenge of a deadly and contagious disease like Ebola. They have put considerations that may be political into an arena that should be apolitical. They have forgotten their duty to preserve the health of US citizens.
Yet, if any nation can rise to the challenge, we can. There are no community-wide Ebola outbreaks here at present, and we can, under strong leadership, become capable of containing the disease in West Africa while protecting home territory. It will take a lot of humanitarian aid and tough, but logical, decision making.
To be fair, there has been some action on the part of the government. The CDC has sent a team to evaluate the systems in place at Texas Presbyterian to ensure the proper protocols are in place for the treatment of those affected as well as future cases. Among team members deployed to the hospital are experts in infection control, Ebola virus control and infectious diseases, laboratory science, personal protective equipment, hospital epidemiology, and workplace safety—and all members of the team have had specific experience with Ebola management, working with organizations including Doctors Without Borders.
Their investigation, which is pertinent to hospitals yet to have Ebola cases come in, has a number of focuses, including to evaluate how personal protective equipment (PPE) is being used and how it is being put on and taken off; what medical procedures were done on Mr. Duncan that may have exposed the health-care worker; the decontamination processes for workers leaving the isolation unit; ensuring oversight and monitoring of all infection control practices, particularly putting on and taking off PPE, at each shift in each location where this occurs should be implemented; and what enhanced training and/or changes in protocol may be needed.
From their evaluation of how things had been handled at Texas Presbyterian, by pinpointing what went wrong and how to correct it, the hope is that the team will be able to establish better, more specific guidelines for other hospitals to follow should an outbreak occur in other facilities.