In the event that another person in the United States tests positive for Ebola, they could be re-routed to one of a handful of hospitals that are specifically equipped and trained to deal with deadly viruses like Ebola, confirmed Centers for Disease Control and Prevention director Dr. Tom Frieden during a press conference on Oct. 20.
“There’s a need for specialized centers when there is a patient with confirmed Ebola, or a number of patients if that were to happen in the future,” said Frieden, though he did not specify which hospitals would be among the designated group. “We need to increase the margin of safety.”
So far during this outbreak, only four hospitals across the United States have experience treating Ebola patients: Nebraska Medicine, Emory University Hospital, the National Institutes of Health Clinical Center and Texas Health Presbyterian Hospital Dallas.
“There are many hospitals in the country that are already in the process of becoming proficient in care of patients with Ebola,” said Frieden. “We’re focusing first on Dallas, where they’ve been dealing with Ebola, and in case there are additional cases that arise there, they’ll be ready to care for them.”
In addition to announcing the hospital plan, Frieden also confirmed significant changes to safety protocol for U.S. health workers who are caring for Ebola patients. The changes were reached by consensus among “all people in the U.S. with experience with Ebola,” as well as Doctors Without Borders (MSF).
The changes include: rigorous and repeated training of the donning and doffing of personal protective equipment (PPE), to the point that the steps become “ritualized,” no skin exposure when PPE is worn, and a trained hospital staff monitor that oversees health workers putting on and removing PPE.
The CDC also now recommends that health workers wear a respirator — either an N95 respirator or powered air purifying respirator (PAPR) — while with the patient in his or her isolation unit. This doesn’t mean that the virus is airborne, Frieden explained, but that procedures that are undertaken in the U.S., like intubation or suctioning — procedures that require close contact with the nose and mouth of patients — may pose a higher risk to health workers than the supportive care measures conducted in West Africa.
The CDC has faced increased scrutiny and criticism over their recommended safety protocols after Texas Health nurses Nina Pham and Amber Joy Vinson contracted Ebola from Thomas Eric Duncan, the first person to be diagnosed with the virus in the U.S. Pham was later transferred to NIH Clinical Center for Ebola treatment, while Vinson was transferred to Emory University Hospital. These changes are in a response to Pham and Vinson’s positive diagnoses, said Frieden.
“We may never know exactly how [transmission] happened, but the bottom line is that the guidelines didn’t work for that hospital,” said Frieden. “Dallas shows that taking care of Ebola is hard.”