New pivot in Ebola protocol

A new guideline for health care workers is coming from the CDC: Protect all skin from exposure to the virus. 
A new guideline for health care workers is coming from the CDC: Protect all skin from exposure to the virus. 
Published Oct. 20, 2014

ATLANTA — Revised guidance for health care workers treating Ebola patients will include using protective gear "with no skin showing," a top federal health official said Sunday, and the Pentagon announced it was forming a team to assist medical staff in the United States, if needed.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said those caring for an Ebola patient in Dallas were vulnerable because some of their skin was exposed.

The Centers for Disease Control and Prevention is working on revisions to safety protocols. Earlier ones, he said, were based on a World Health Organization model in which care was given in more remote places, often outdoors, and without intensive training for health workers. "So there were parts about that protocol that left vulnerability, parts of the skin that were open," Fauci said.

The CDC guidance was expected as early as Saturday, but has been pushed back as it goes through review by experts and government officials.

Health officials had previously allowed hospitals some flexibility to use available covering when dealing with suspected Ebola patients. The new guidelines are expected to set a firmer standard: calling for full-body suits and hoods that protect workers' necks, setting rigorous rules for removal of equipment and disinfection of hands, and calling for a "site manager" to supervise the putting on and taking off of equipment.

The guidelines are also expected to require a "buddy system," in which workers check one another as they come in and go out, according to an official who spoke to the Associated Press but not authorized to discuss them before their release.

Hospital workers also will be expected to exhaustively practice getting in and out of the equipment, the official said.

Fauci, who appeared on five Sunday news shows, said, "Very clearly, when you go into a hospital, have to (put a breathing tube into) somebody, have all of the body fluids, you've got to be completely covered. So that's going to be one of the things … to be complete covering with no skin showing whatsoever."

The American Nurses Association and other groups have called for better guidance that sets clearer standards on what kind of equipment, how to put it on and how to take it off.

"We're disappointed that the recommendations are still not available," association president Pamela Cipriano said. "Having a lag in official direction from the CDC doesn't instill the greatest confidence in their ability to rapidly respond."

Cipriano said she understands the guidance will also include a call for anterooms, apart from the patient room, where protective equipment must be put on and taken off.

The push stems from the infection of two nurses at a Dallas hospital who treated an Ebola-infected patient, Thomas Eric Duncan, a Liberian who was the first person diagnosed with the virus in the United States.

The nurses, Nina Pham and Amber Joy Vinson, were diagnosed with Ebola less than a week later. Officials say how they were infected remains a mystery.

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Vinson's family issued a statement Sunday rejecting claims that the nurse had acted carelessly by flying from Dallas to Ohio, then back to Dallas, after treating Duncan. "Suggestions that she ignored any of the physician- and government-provided protocols recommended to her are patently untrue and hurtful," the family wrote.

Also Sunday, the Pentagon announced that Defense Secretary Chuck Hagel had ordered the formation of a 30-member support team from across the services to assist civilian medical professionals in the United States if needed to treat Ebola. So far, three cases have been confirmed in the United States.

The team was to be formed by Northern Command's commander, Gen. Chuck Jacoby, and was to consist of 20 critical care nurses, five doctors trained in infectious disease and five trainers in infectious disease protocols. Once formed, the team would undergo up to a week of specialized training in infection control and personal protective equipment at Fort Sam Houston in San Antonio, Texas, then remain in "prepare to deploy" status for 30 days.

The team would not be sent to West Africa or other overseas locations, and would "be called upon domestically only if deemed prudent by our public health professionals," Pentagon press secretary Rear Adm. John Kirby said in a statement Sunday.

Ebola's incubation period is 21 days, and Fauci noted that mark was being reached Sunday for Texas Health Presbyterian Hospital workers who first treated Duncan.

It was also reached by Duncan's fiancee, Louise Troh, who nursed him in their apartment and who was put under state-ordered quarantine. Her 13-year-old son and two young men who shared the apartment are also being cleared.

Duncan was seen at the hospital on Sept. 26 and sent home with antibiotics. He returned by ambulance and was admitted Sept. 28, and died of Ebola on Oct. 8.

The head of the group that runs the Texas hospital apologized in full-page ads in Dallas newspapers on Sunday, saying that the hospital "made mistakes in handling this very difficult challenge."

Barclay Berdan, chief executive of the Texas Health Resources, which operates a network of 25 hospitals, said in an open letter that hospital officials were deeply sorry for having misdiagnosed symptoms shown by Duncan.

Meanwhile, a cruise ship carrying a Dallas health care worker who was being monitored for Ebola returned to port after a seven-day trip in which passengers had their vacations briefly disrupted with an infectious disease scare.

The health care worker, a lab supervisor who handled a specimen from Duncan, showed no symptoms during the cruise but self-quarantined out of caution. Carnival Cruise Lines said it was informed by health authorities Sunday morning that she tested negative for Ebola. Vicky Rey, vice president of guest care for the cruise line, said the woman and her husband drove home after arriving in Galveston, Texas.

Information from the New York Times was used in this report.