As of Monday afternoon, there was no word from the agency as to when the guidelines would be issued or why the new recommendations were not incorporated into the protocols before the virus arrived in the U.S. in late September. On its website, the section regarding personal protective equipment recommendations has been removed. The CDC did not provide a response to repeated requests in time for this story.
It's still unknown exactly how two nurses were infected at Texas Health Presbyterian Hospital Dallas, the facility that treated Ebola patient Thomas Eric Duncan.
“When you have patients here, we do things that are much more aggressive with patients – intubation, hemodialysis, - so the exposure level is a bit different,” Fauci said.
The revised guidelines are expected to include calls for more rigorous training of healthcare personnel in putting on and taking off PPE, as well as establishing a “buddy system” where workers watch each other entering and leaving isolation units to ensure that have followed proper protocol. Also, a “site manager” will be present to monitor personnel putting and taking off equipment.
The CDC has come under criticism for the way it has handled the cases of two nurses who contracted Ebola while treating patient Duncan at Texas Health Presbyterian Hospital Dallas. Last week the nurses' union National Nurses United, wrote a letter to President Barack Obama (PDF) asking him to mandate a national set of standards and protocols for hospitals that included supplying nurses with the kind of personal protective equipment used at the nation's four hospitals with biocontainment units for high-risk infectious diseases.
“The Ebola pandemic and the exposure of healthcare workers to the virus represent a clear and present danger to public health,” the letter read. “We know that without these mandates to healthcare facilities we are putting registered nurses, physicians and other healthcare workers at extreme risk.”
Previous CDC guidelines called for healthcare workers to wear a minimum of gloves, a fluid-resistant gown and eye protection. Additional protection, such as two sets of gloves, disposable shoe covers and leggings, were to be worn if a patient began bleeding, vomiting or had any other loss of bodily fluids, which are indicative with those in the latter stages of the disease.
The updated guidelines for healthcare workers are part of an overall strategy by CDC to ramp up its response to the disease in this country. Last week the agency announced it was creating an Ebola response team of infectious disease experts who would deploy in a matter of hours to any site throughout the country where a case of the disease had been confirmed.
Meanwhile momentum continues to build for dedicating certain hospitals to treat Ebola cases. On Sunday, Fauci called for more training of healthcare workers, and said the four hospitals in the country considered to be specially equipped to handle Ebola cases was probably not enough. A CDC official last week stated a plan could call for at least one Ebola-designated hospital in each state.
The New York City Health and Hospitals Corp., the largest public health system in the country, announced that it planned to designate Bellevue Medical Center as a site where all city hospitals can transfer Ebola patients. In Chicago, a spokesman with Rush University Medical Center confirmed the facility was among a number of sites being considered by state and federal health officials to potentially be designated to receive Ebola cases throughout the area.
Follow Steven Ross Johnson on Twitter: @MHsjohnson
