Infectious disease experts confident in protocols, but taking precautions

Oct. 16, 2014 | by Barbara Grijalva

TUCSON, AZ (Tucson News Now) - After two U.S. health care workers have been diagnosed with Ebola, national nurses' groups are speaking out, saying their hospitals and staff are not properly prepared to handle Ebola patients.

More than 11,000 nurses from around the country took part in a conference call with National Nurses United on Oct. 15 to voice concerns that their hospitals are not prepared for Ebola.

Nurses on the call said 85 percent of hospitals have not provided education on Ebola, and that many simply refer healthcare workers to the website of the Centers for Disease Control and Prevention.

They sent a letter asking President Obama to use his executive authority and mandate uniform hospital standards.

In Tucson, the University of Arizona Medical Center has two hospital campuses. One has the only Level 1 trauma unit in Southern Arizona.

Tucson and Pima County have protocols in place for dealing with infectious diseases, but the Ebola concerns have them taking even more precautions.

Experts from UAMC convened what they call an Ebola Response Task Force in August.

Dr. Sean Elliott is the Medical Director for Infection Prevention for UA Health Network. He said hospitals are in communication with each other, sharing information.

He said on Monday, after the news broke about the first infected Dallas nurse, UA Health Network reconvened what's called a "hot wash," or a kind of debriefing involving "a multidisciplinary team with leaders from all over our network to identify unanswered questions. What are we not yet able to do comfortably?"

Elliott said, "Oh, we're actually able to do quite a lot comfortably and we've been doing it for a long time. But with new information we can answer those questions as well. What do with the medical waste? How do we transport the patient?

"So the public in Tucson and Pima County should be quite assured that we are ready for the highly unlikely event of an Ebola patient."

Elliott said mistakes are made when people become complacent and do not practice scenarios, such as an infectious disease outbreak.

He said it's also important to study what happened in Dallas that led to the two health care workers becoming infected.

"Where were the breaches in protocol, because this event did not happen in Atlanta when we had two health care coworkers transported back? This event has not happened in Nebraska where there currently is a patient hospitalized. So, what happened in Dallas and what can we do to avoid those challenges?" Elliott said.

One of Elliott's colleagues, Josh Gaither, is a University of Arizona emergency department physician and associate medical director for the University Campus Base Hospital.

He oversees the EMS functions of the hospital.

First responders, such as paramedics, likely would have the first contact with a possible Ebola patient.

Gaither said those pre-hospital providers are an important part of the system.

"So over the last two days actually we've sent a large amount of material from the CDC and from our own base hospital to educate our pre-hospital providers - our paramedics, our EMTs - in terms of what they need to do. What type of clothes do they need to put on. What do they have to worry about," Gaither said.

Gaither said a local fire department handled a recent situation as they should have.

"Well, I think our community is very prepared. In fact, one of our fire agencies took care of a patient that they were concerned could have had Ebola several weeks ago. They did a fabulous job. They used their personal equipment, just like they were supposed to. They called us. We were able to prepare for that patient. I have have no doubt in my mind that they will be able to manage the case again without any difficulty," Gaither said.

The patient did not have Ebola.

The decontamination rooms at UAMC's emergency department are used to control infection.

Isolating an Ebola patient from the rest of the hospital is key.

"They might come in by ambulance. They might come in through triage, but at no point do they enter the rest of the hospital space," Elliott said. "Typically, all interviews - all health care interviews - will occur in this room by health care personnel who've already gowned and gloved with personal protective equipment."

The health care workers take an extensive medical history from the patient, including information about whether the patient had recently traveled to West Africa or had contact with someone who made the trip.

"Identifying yes or no. Is this a true suspect Ebola patient by taking a very careful history. And if so, testing occurs in this room. Confirmation occurs in this room. And then the patient will be transported in an isolation tent to a specially prepared isolation room upstairs in the Diamond Tower," Elliott said.

Elliott said having an Ebola patient in Tucson is unlikely, but that experts continue to assess the situation in Dallas and elsewhere and make changes in Tucson's preparedness.

He said local hospital network representatives were set to meet with Pima County Health Department leaders on Oct. 16 to exchange ideas and compare notes. Elliott said communication is critical.

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