Nurses group slams Dallas hospital for sloppy Ebola care

A national nurses group says a Dallas hospital's handling of the nation's first Ebola case was sloppy, putting health care workers and patients at risk of infection from the deadly virus.

At a news conference Wednesday, leaders of National Nurses United recited examples of how they say Texas Health Presbyterian Hospital Dallas mishandled the care of Thomas Eric Duncan, the first person with Ebola diagnosed in the USA.

The group called on President Obama to use his executive authority to issue uniform standards for treating Ebola patients.

Two health care workers in Dallas who cared for Duncan before he was diagnosed with Ebola have been diagnosed with the virus. A Spanish nurse caring for an Ebola patient in Madrid also has been diagnosed with Ebola.

In Dallas, nurses assigned to care for Duncan, who died last week, weren't given proper training or proper personal protective equipment, said Deborah Burger, co-president of the nursing group, who said she has spoken with nurses at Texas Presbyterian. Those nurses also were assigned to care for other patients, potentially exposing them to Ebola, she said. Duncan was left in an area with other patients for hours after he was diagnosed rather than immediately isolated, she said.

Blood samples taken from Duncan were sent through the hospital's general tube delivery system, rather than hand-delivered to a lab, Burger quoted the nurses as saying. That could potentially contaminate the entire tube system, which could infect blood shipped around the hospital.

The hospital failed to promptly remove waste contaminated with Ebola, which was stacked "to the ceilings," Burger said.

"We want to make sure this does not happen ever again," Burger said.

Wendell Watson, a spokesman for the Dallas Hospital, said in a written statement said. "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."

In the future, the Centers for Disease Control and Prevention will send "go teams" of Ebola experts to any hospital with an Ebola case within hours of the diagnosis, Thomas Frieden, the agency's director, said.

Frieden said CDC staff members observed problems at the Dallas hospital.

"Some health care workers were putting on three or four layers of personal protective equipment," known as PPE, Frieden said. "Other things were done, such as taping part of the gear in the belief that this would be more protective."

Workers were operating in good faith, Frieden said, but, "By putting on more layers of gloves and other layers of clothing, it becomes much harder to put them on and much harder to take them off. So the risk of contamination gets much higher."

Following a routine procedure reduces the risk of infection, Frieden said. "Health care workers who are using familiar PPEs in familiar ways are more likely to do it right," he said.

The nursing group released results of a survey of nurses nationwide in which 85% said their hospital has not provided education on Ebola in a way that lets nurses interact and ask questions.

In the survey, 40% said their hospital has insufficient current supplies of eye protection, including face shields or side shields with goggles; 38% said there are insufficient supplies of fluid resistant/impermeable gowns in their hospital.

In the letter to Obama, the nursing group asked that all hospitals follow the guidelines used at the Nebraska Medical Center in Omaha, one of four in the USA designed to treat patients with the most dangerous infectious diseases. That hospital treated and released Richard Sacra, a medical missionary who contracted Ebola while working in Liberia, and is currently treating Ashoka Mukpo, a freelance cameraman for NBC News who was covering the epidemic.

Among their demands, the nurses asked for full-body hazardous-material suits that meet certain high standards.

Nurses caring for patients with Ebola are "our first line of defense," the group wrote to Obama. "We would not send soldiers to the battlefield without armor and weapons."

The group added, "Not one more patient, nurse, or health care worker should be put at risk due to a lack of health care facility preparedness. The United States should be setting the example on how to contain and eradicate the Ebola virus."

Some groups have a good track record of safely caring for Ebola patients.

Doctors Without Borders has had 21 Ebola infections among its staff of 3,000 in Liberia, Sierra Leone and Guinea. Twelve of its workers have died, six have recovered and three are in isolation.

Very few of those infections occurred in the hospital, spokesman Michael Goldfarb said.

"The vast majority of cases occurred outside (its) medical structures, among local/national staff members," Goldfarb says. "While there isn't zero risk of exposure in our health facilities, the main threat to our staff lies in the communities they return to after working hours."

According to the World Health Organization, at least 8,997 people have been infected with Ebola and 4,493 have died. Those numbers most likely underestimate the epidemic's true reach because many overwhelmed health workers are no longer able to keep up with regularly reporting new cases and deaths.

According to WHO, 236 of 427 health care workers infected with Ebola have died.

Ebola does not spread through the air and can be transmitted only through close contact with the bodily fluids of someone who is showing symptoms of Ebola, according to the CDC. In the early stages of the disease, people are not very contagious because their bodies have relatively low levels of virus. That means that the general population is not at high risk from casual contact with Ebola patients.

Health workers, however, are at extremely high risk of Ebola, because the virus makes many copies of itself as the disease progresses, says infectious disease expert Peter Hotez. People with late stages of Ebola often bleed profusely and vomit blood, making them contagious to those caring for them, such as health workers or family members, who take care of many Ebola patients in West Africa.

Some scientists are urging health officials to acknowledge what they don't know. At a meeting on Ebola on Tuesday, one infectious disease researcher told an audience at Johns Hopkins University in Baltimore that scientists should get comfortable with uncertainty and be honest with the public about gaps in knowledge about Ebola.

"We're making this up as we go," said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. "We have to be mindful that we're making it up. One of the worst enemies we can have today is dogma."

Osterholm said he's concerned about migrant workers spreading Ebola to new parts of West Africa. Many men and teenage boys work at home in the summer while harvesting crops but leave their home country to take temporary jobs in October.

"The rest of Africa is a tanker truck waiting for a match to hit it," Osterholm said.