Copyright © 2014 Albuquerque Journal
Medical workers at Christus St. Vincent Regional Medical Center in Santa Fe faced a potential crisis last week – and experienced the quick spread of fear – after paramedics delivered to the emergency room a sick patient who had recently traveled to Africa.
TV news stations were soon airing reports that the hospital was treating a patient who could be infected with the Ebola virus. The state Department of Health reported later that day that the patient’s travel history ruled out the possibility of Ebola infection.
False alarm or not, it rattled hospital staff and patients. Some patients told staff they wanted out of the hospital, said Fonda Osborn, a union representative for nurses at St. Vincent.
“The fear – it was all through the hospital,” Osborn said. “Everybody is afraid and, of course, nurses are afraid, too. This is a deadly disease.”
An announcement Wednesday that a second nurse at Texas Health Presbyterian Hospital had become infected with Ebola virus after providing care to a man who died of the illness has prompted health officials and hospitals across the country to review preparedness and adjust protocols for treating Ebola patients.
Officials at several of the state’s largest medical systems say personnel at hospitals, clinics and emergency medical services have the equipment and training they need to safely treat a patient infected with Ebola.
Infection control specialists at University of New Mexico Hospital and Presbyterian Healthcare Services say their hospitals have isolation units, where an infected person could be safely treated.
Dr. Bob Bailey, associate dean for clinical affairs at the UNM School of Medicine, said UNMH staff is equipped and trained to use a variety of infection-control techniques. The hospital also closely watches new guidelines emerging from the U.S. Centers for Disease Control and Prevention in response to events in Texas, he said.
UNMH developed a series of infection-control protocols in response to the 2009-10 flu pandemic and is “tweaking that to manage Ebola,” he said.
Bailey listed the hospital’s inventory of personal protection equipment, which includes boots, leggings, gowns, hoods, masks, face shields and Tyvek suits – a tough, synthetic jumpsuit impermeable to liquids.
How it’s transmitted
The Ebola virus is transmitted by direct contact with bodily fluids, including blood, feces and vomit.
Nursing and medical staff also get training on the use of powered air-purifying respirators, which deliver filtered air through a hose and mask, he said.
UNMH recently adapted its infection-control protocol to include a “buddy system” that requires a second person to watch staff remove protective equipment, he said.
The training and experience of staff in the use of personal protection equipment varies by department.
UNMH had an Ebola scare in August, when a 30-year-old woman with flu-like symptoms was admitted to UNMH after she returned from Sierra Leone, one of three West African countries associated with an Ebola outbreak. Testing determined that she was not infected with the virus.
In general, staff in UNMH’s emergency department and medical intensive care unit most commonly use protective equipment, Bailey said.
UNMH’s emergency department has a decontamination unit, which is typically used for treating people contaminated by chemicals or radiation.
“Our ER people often use personal protective equipment because of ” the decontamination unit, Bailey said.
A suspected Ebola patient would enter the hospital through the decontamination unit, which can be disinfected after the patient’s transfer to a room in medical ICU, Bailey said.
Medical ICU rooms are large and have outer rooms where medical personnel could put on and remove protective equipment, he said.
“The staff (in medical ICU) are used to personal protective equipment, and they’re used to one-on-one nursing, which is what you do with Ebola patients,” he said.
Dr. David Stryker, medical director for infection control for Presbyterian Hospital, said emergency room staff are equipped with Tyvec suits, leggings, masks, face shields and robust gloves.
The hospital has also ordered hoods that cover the neck and shoulders, he said.
“We will be doing a lot of hands-on training,” Stryker said. “Ramping that up takes a little bit of time.”
NM nurses concerned
New Mexico nurses have raised concerns about the safety of medical professionals who would provide front-line care if someone infected with the virus turns up at a hospital here.
“It’s important to us to know that the hospitals actually have the plan, have the appropriate equipment for the staff and are prepared,” said Lorie MacIver, president of the National Union of Hospital and Health Care Employees, Local 119.
MacIver sent a letter to officials at UNMH, asking for a meeting to discuss the hospital’s preparedness for treating Ebola patients.
“As you are aware, there were two (registered nurses) in Texas who contracted the disease while attending to the health care needs of a patient with Ebola,” the letter said.
The Dallas nurses, Amber Joy Vinson and Nina Pham, were diagnosed with Ebola after they worked at the side of Thomas Eric Duncan, who died Oct. 8 at Texas Health Presbyterian Hospital, six days after he became the first patient diagnosed in the U.S. with the viral illness.
“It is critical that all members of the health care team have the appropriate knowledge, education and personal protective equipment necessary” to ensure safety for workers and the public, the letter said.
MacIver said the union will ask for meetings with management at each of the five hospitals they represent, which include UNMH, St. Vincent, and hospitals in Las Vegas, Los Alamos and Taos. The union has about 1,600 members in a variety of health professions.
Jeff Dye, president and CEO of the New Mexico Hospital Association, said developing protocols for hospitals across the state is a moving target, with CDC guidelines changing in response to events in Texas.
“Every hospital, whatever its size, needs to be prepared to take whatever patient comes its way,” Dye said.
The association’s 44 member hospitals plan a conference call with the state Department of Health on Monday to discuss the most recent CDC guidelines for protective gear and training, he said.
Guidelines issued to date offer “room for interpretation” about how hospitals can best prepare and protect staff, he said.
“We understand the CDC is making an effort to standardize some of those personal protection equipment issues and leave less up to interpretation,” Dye said.
Protocol for medical clinics, where staff rarely use robust protective gear, generally calls for isolating patients and seeking guidance from the state Department of Health and hospital officials, Stryker and Bailey said.
Clinic staff “all have protective equipment, and we are increasing the amount and level of it as we can,” Stryker said.
But simply providing protective gear without training staff isn’t enough.
“Just having the tools there without people knowing how to take it off and put it on isn’t all that useful,” he said.
Staff at urgent care clinics typically have more training and experience with using protective gear, Stryker said.
DOH on alert
The New Mexico Department of Health urges medical personnel to contact the agency if any suspicion arises that a patient could be infected, said Dr. Joan Baumbach, the state’s deputy epidemiologist.
“We in New Mexico have been particularly cautious because we want people to call us even if someone doesn’t have a fever,” Baumbach said.
The Health Department has circulated a screening tool developed by the CDC intended to help medical personnel identify people with possible infections.
The key indications are fever and recent travel to Sierra Leone, Liberia or Guinea, where more than 4,500 people have died and at least 9,000 are infected with Ebola virus.
“People are definitely practicing and reviewing their policies and procedures,” Baumbach said. “It’s going on at a lot of levels.”