Wednesday, October 15, 2014


Dallas nurses describe Ebola hospital care: 'There was no protocol'

A Liberian man who arrived by ambulance at a Dallas hospital with symptoms of Ebola sat for "several hours" in a room with other patients before being put in isolation, and the nurses who treated him wore flimsy gowns and had little protective gear, nurses alleged Tuesday as they fought back against suggestions that one of their own had erred in handling him.

The statements came as Nina Pham, a 26-year-old nurse at Texas Health Presbyterian Hospital in Dallas, fought off the Ebola virus after contracting it from the Liberian, Thomas Eric Duncan. The statements by the Dallas hospital nurses were read by representatives of the Oakland-based group National Nurses United.

RoseAnn DeMoro, executive director of National Nurses United, said the nonunionized Texas nurses could not identify themselves, speak to the media independently or even read their statements over the phone because they feared losing their jobs. In a conference call, questions from the media were relayed to the unknown number of nurses by National Nurses United representatives, and the responses were read back to reporters.

DeMoro said all of the nurses had direct knowledge of what had transpired in the days after Duncan arrived at the hospital on Sept. 28.

Among other things, they said that Duncan "was left for several hours, not in isolation, in an area where other patients were present."

When a nurse supervisor demanded that he be moved into isolation, the supervisor "faced resistance from other hospital authorities," the nurses said.

They described a hospital with no clear guidelines in place for handling Ebola patients, where Duncan's lab specimens were sent through the usual hospital tube system "without being specifically sealed and hand-delivered. The result is that the entire tube system, which all the lab systems are sent, was potentially contaminated," they said.

"There was no advanced preparedness on what to do with the patient. There was no protocol; there was no system. The nurses were asked to call the infectious disease department" if they had questions, they said.

The nurses said they were essentially left to figure things out for themselves as they dealt with "copious amounts" of body fluids from Duncan while wearing gloves with no wrist tapes, gowns that did not cover their necks, and no surgical booties. Protective gear eventually arrived, but not until three days after Duncan's admission to the hospital, they said.

The nurses' allegations conflict with what hospital officials have been saying since Duncan's admission: that they have strict protocols in place for handling such patients and that a mistake led to Pham becoming infected while she treated him.

The hospital released the following statement after the nurses' comments:

"Patient and employee safety is our greatest priority and we take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting. Our nursing staff is committed to providing quality, compassionate care, as we have always known, and as the world has seen firsthand in recent days. We will continue to review and respond to any concerns raised by our nurses and all employees."

DeMoro said the nurses came forward and asked Nurses United to publicize their statements out of anger they were being blamed for what had happened to their colleague.

The nurses statements come as an additional 76 healthcare workers who were involved in the treatment of Duncan are being watched for symptoms of Ebola and as the U.S. Centers for Disease Control and Prevention pledged to improve its response to hospitals in the event of more Ebola cases.

The new group is in addition to the 48 people who have been monitored since Duncan was first diagnosed with Ebola symptoms after arriving in Dallas last month, Dr. Thomas Frieden, the director of the CDC, told reporters in a conference call Tuesday. No one in the original group, which includes family and friends of Duncan, has developed Ebola symptoms, and they now are two-thirds of the way through the period of greatest risk of becoming infected.

Frieden also announced the creation of a rapid response team that could be sent to any hospital where an Ebola case arises. The team would also work to protect healthcare workers.

Frieden said he wished he had sent such a team to Texas Health Presbyterian Hospital, where Duncan was treated and died last week.

"We did send some expertise in infection control," Frieden told reporters earlier in the day. "But I think we could, in retrospect, with 20/20 hindsight, have sent a more robust hospital infection control team and been more hands-on with the hospital from Day One about exactly how this should be managed."

Pham's condition was upgraded Tuesday to good. Officials are investigating how she became infected but have not yet identified a specific error in protocol, he said.

Frieden said there was only one known contact for the nurse and that person was in isolation but has not developed any symptoms.

A spokeswoman for the eye care company Alcon confirmed the contact was one of its employees.

"An Alcon associate was admitted to Texas Health Presbyterian Hospital on Sunday, Oct. 12, and is being monitored for potential signs and symptoms of the Ebola virus, based on the Centers for Disease Control and Prevention protocol. This measure was taken due to the fact that the associate was in contact with the Texas Health Presbyterian healthcare worker who has recently tested positive for the virus. The Alcon associate has not shown any signs or symptoms of the Ebola virus," said spokeswoman Elizabeth Harness Murphy.

Tensions have been increasing among healthcare workers since Pham contracted the virus.

"We understand there is a lot of anxiety among" healthcare workers, Texas Health Commissioner David Lakey told reporters at the same briefing.

The latest group to be monitored comes as officials said they have cast a wide net: 76 people who may have had contact with Duncan or his blood products. Ebola is spread through direct contact with a symptomatic person or his bodily fluids.

Frieden said the stepped-up response team would include some of the world's leading experts in how to care for Ebola patients and protect healthcare workers. The new team would examine the facilities, as well as help train healthcare workers on the use of protective equipment and other issues such as hazardous waste management.

Pham's infection has worried nurses around the country, said DeMoro of National Nurses United.

About 6,000 nurses have signed up for the conference call Wednesday on hospital preparedness in dealing with Ebola, she said.

"From what we know inside the Dallas hospital, it's what we expect from almost every hospital in the United States: lack of preparedness, inappropriate equipment. It was chaos, rather than systematic patient care under an Ebola plan," she said before the CDC announcement of a new team.

"Every hospital in the country could be Dallas."

Meanwhile, Pham said she was "doing well" in isolation and is being well cared for by the hospital.

"I'm doing well and want to thank everyone for their kind wishes and prayers," Pham said in a statement released at her request by the hospital. "I am blessed by the support of family and friends and am blessed to be cared for by the best team of doctors and nurses in the world here at Texas Health Presbyterian Hospital Dallas."

The cost of treatment will be covered and will not be a financial burden for Pham or her family, the hospital said later in the day. Pham's friends have set up a website:, to help raise money for other expenses, the hospital said.

While officials continue to cope with the Texas cases, the World Health Organization warned Tuesday that new cases of Ebola could skyrocket to 10,000 a week.

At a news conference in Geneva, the WHO's assistant director-general, Bruce Aylward, said that by December, he envisions 5,000 to 10,000 Ebola cases a week in Guinea, Liberia and Sierra Leone, the West African countries hit hardest by the outbreak.

As of Tuesday, Aylward said, there had been 8,914 Ebola cases and 4,447 deaths as a result of the virus, which was first reported in the region in March.

He cautioned against assuming that the outbreak has slowed down.

"Quite frankly, it's too early to say," Aylward said, adding that numbers can fluctuate because of lags in reporting and high caseloads. "People may draw the wrong conclusion that this is coming under control."

Still, he told reporters that in an encouraging development, certain hard-hit areas such as Liberia's Lofa County and Kenema, Sierra Leone, are seeing a slowing of new cases, which epidemiologists believe is a result of greater awareness and a stepped-up response.

Nevertheless, about 70% of patients in the three affected countries are dying of the Ebola virus, significantly higher than the previously estimated 50% mortality rate.

Meeting with military leaders from other nations, President Obama urged them to do more to fight Ebola.

"As I've said before, and I'm going to keep on repeating until we start seeing more progress, the world as a whole is not doing enough," Obama said, calling the outbreak a humanitarian crisis that threatens hundreds of thousands of people.

The U.S., he said, is making strides in getting aid to the outbreak in West Africa as well as working to figure out how the nurse in Dallas contracted Ebola.

"We have the public health infrastructure and systems and support that make an epidemic here highly unlikely, but obviously, one case is too many, and we've got to keep on doing everything we can, particularly to protect our healthcare workers because they're on the front lines in battling this disease," he said.
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The idea behind the text.
Respect for the truth is almost the basis of all morality.
Nothing can come from nothing.

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