Ebola Virus: Texas Health Worker Tests Positive, CDC Confirms

A nurse who cared for the Ebola patient who died here last week tested positive for the disease, heightening concerns about the nation’s preparedness and protocols for containing its spread.
The nurse at Texas Health Presbyterian Hospital Dallas was isolated Friday night after reporting a low-grade fever, the Centers for Disease Control and Prevention said. Tests Saturday night and Sunday confirmed she had Ebola.

The diagnosis was disconcerting because the woman initially was considered to be at low risk. She was wearing protective gear while caring for Thomas Eric Duncan, the Liberian patient who died Wednesday after 10 days in the hospital.

Officials gave few details of how they believe she contracted the virus. CDC Director Tom Frieden called the infection a result of a “breach in protocol” at the hospital and said more cases may emerge. “Unfortunately, it is possible in the coming days that we will see additional cases of Ebola,” Dr. Frieden said in a news conference. “This is because the health-care workers who cared for this individual may have had a breach of the same nature.”

The infection is the first transmitted in the U.S. and the second outside of West Africa, following that of a nurse’s aide in Spain who had cared for a missionary repatriated from Leone. The missionary died.

The latest case has prompted a wider search for those possibly exposed. It also has underscored the need for hospitals to be meticulous about infection-control procedures.

President Barack Obama ordered that an inquiry into what went wrong at the hospital move as quickly as possible. Congressional Republicans said the administration must do more to reassure Americans they are safe.

Officials were at pains to reassure the public that the Ebola outbreak is manageable despite this latest case. “We are broadening our team in Dallas and working with extreme diligence to prevent further spread,” said David Lakey, commissioner of the Department of State Health Services.

Dr. Frieden said the search for people possibly exposed to Ebola will now expand to include contacts of the health-care workers who had contact with Mr. Duncan between Sept. 28 and Oct. 8, when he died. The CDC has sent additional resources to Texas to help with the investigation, he added.

Texas officials said only one person had close contact with the Dallas nurse since she developed symptoms, and that person has also been isolated as a precaution. The nurse was isolated within 90 minutes of reporting a low-grade fever Friday night, in contrast to three visits that the infected Spanish nurse’s aide, Romero, made to health-care providers before she was diagnosed and isolated last week.

Even so, the second Dallas Ebola case raises questions about how prepared U.S. hospitals are for the disease, outside of some specialized facilities. Among those are two high-tech units built for possible victims of highly infectious diseases or bioterror, which are at Emory University Hospital and Nebraska Medical Center, which have treated five Ebola patients evacuated from West Africa.

The Obama administration has taken steps to reduce the risk of transmission in the U.S. since Mr. Duncan was diagnosed, including implementing new screening for travelers arriving from West Africa, where more than 4,000 people have died of Ebola. Screening began Saturday at JFK Airport in New York and went smoothly, with some lessons learned, the CDC’s Dr. Frieden said. He said screening at four other airports is expected to begin Thursday.

The CDC issued guidance to U.S. hospitals for identifying and treating Ebola patients about 2 1/2 months ago, when the epidemic began escalating in West Africa and two American missionaries were evacuated to the U.S. The CDC has said it is stepping up outreach to educate hospitals on how to identify and treat the disease in the wake of a missed initial diagnosis of Mr. Duncan.

Some doctors have criticized the CDC guidance as confusing. One hospital system says it has gone beyond the guidance to use measures from the World Health Organization that include more hand-washing steps. The CDC said it is giving hospitals simplified versions of its guidance.

Dr. Frieden said Sunday that measures for containing Ebola are well known, but the nurse’s infection “tells us there is a need to enhance training and protocols.” Preventing transmission requires “scrupulous attention to infection control,” he said. “It’s hard to do it safely. Even a single lapse or breach can result in infection.”

He said that treating Ebola patients only in high-tech facilities isn’t the answer; rather, care in regular hospitals must be strengthened.

In searching for how the nurse caught Ebola, two areas disease investigators will scrutinize are how health-care workers carried out kidney dialysis and respiratory intubation provided to Mr. Duncan, Dr. Frieden said. He said that removing protective gear is also a “major potential area for risk” that will be examined.

The CDC recommended that the Dallas hospital name an individual to oversee infection control full time while the nurse is cared for, Dr. Frieden said.

The CDC recommends that workers caring for Ebola patients wear impermeable gowns, gloves, goggles or face shields and face masks—gear that Texas hospital officials said the now-infected nurse was wearing. The CDC recommends that when a patient is releasing large amounts of fluids, workers wear double layers of gloves, disposable shoe covers and leg covers.

Such gear is short of the full moon suits that health workers wear in Ebola treatment centers in Africa, where the risk is greater because there are so many patients. Emory doctors say their workers who treated Ebola patients in Atlanta have worn more gear than was necessary at times because full hoods were more comfortable than goggles.

Doctors say training is critical. The aid organization Doctors Without Borders puts health-care workers through intensive training before allowing them into treatment units in West Africa.

“There is a difference between being trained from some guidelines and getting trained by someone who actually has done it and has been through it,” said Joseph McCormick, regional dean of the University of Texas School of Public Health in Brownsville, who has helped contain other Ebola outbreaks in Africa.

Texas Health Presbyterian Hospital Dallas’s handling of Ebola needs to improve. “There needs to be more training and more planning,” he said. “There have been a whole series of mistakes.”

Dr. McCormick said he was deeply concerned that the nurse drove herself to the hospital, potentially putting herself and others at risk if she had an accident. He said the hospital should have had a team ready to pick up anyone who showed symptoms of the illness.

Phil Smith, medical director of the biocontainment unit at The Nebraska Medical Center, which is treating its second Ebola patient, said in an interview his unit has multiple safeguards to make sure doctors and nurses don and remove their protective gear safely. “Nobody dresses themselves,” he said. “When they come out, there is a checklist on the wall. First they take off three pairs of gloves. A person there watches them. I think that system of checks and balances has been valuable.”

Mount Sinai Health System in New York, which had several suspected cases of Ebola, though none confirmed, has gone beyond the CDC recommendations for taking off protective gear and is using the WHO protocol, which involves hand-washing at more stages.

“I don’t think [the CDC’s version] is inadequate,” said Brian Koll, executive director of infection prevention for the Mount Sinai system. “What I like about the WHO version is, every time you take off a piece of [personal protective gear], there’s a hand hygiene step built in.”

The CDC’s official poster outlining protective-gear removal has a note at the bottom telling workers to use hand hygiene immediately after removing all protective gear, but it doesn’t depict hand washing after every individual step. Mount Sinai has observers, with checklists, watching staffers remove their protective gear in the emergency department, and is considering doing so in other areas as well.

Two suspected cases at Mount Sinai’s Beth Israel hospital last week turned out to have malaria, but they had triggered the hospital’s Ebola-alert precaution system.

The level of precaution required is unique for Ebola, since an exposed patient could show up at any hospital in the U.S. and even a minor breach of precautions could spread the disease, said Paul Biddinger, medical director for emergency preparedness at Massachusetts General Hospital in Boston. Mass General hasn’t seen any suspected Ebola cases, but the staff has been doing infectious-disease drills, emphasizing the “donning and doffing” of protective gear with observers watching.

Corrections & Amplifications

The infection is the first transmitted in the U.S. and the second outside of West Africa, following that of a nurse’s aide in Spain who had cared for a missionary repatriated from Sierra Leone. The missionary died. An earlier version of this article incorrectly identified the missionary as a priest.

Source: Wall Street Journal
United States Of America 4684273863078216459

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