The government reinforced its approach to the threat after the Ebola virus was transmitted to two nurses at Texas Health Presbyterian Hospital Dallas who treated Ebola patient Thomas Eric Duncan, the Liberian man who was the first person to be diagnosed with the disease in the U.S.
“This is the level of protection that I and other colleagues in the field had been calling for even prior to the (Ebola) transmissions that were the unfortunate consequence of having that first index case who presented from Liberia,” said Dr. Dan Hanfling, contributing scholar at the University of Pittsburgh Medical Center's Center for Health Security.
The agency previously advised healthcare workers to wear a minimum of gloves, a fluid-resistant gown and eye protection.
Frieden said Monday that “we may never know exactly how” nurses Nina Pham, 26, and Amber Vinson, 29, got infected but that those cases demonstrated that the CDC's previous guidelines—which were based on the experience of healthcare workers in Africa—were insufficient because of the more aggressive nature of care provided in the U.S. “The way care is given in this country is riskier than in Africa. There's more hands-on nursing care, and there are more high-risk procedures.”
The new guidelines place heightened emphasis on rigorous training on the procedures for applying and removing protective equipment, which Hanfling said is particularly important.
“The procedure that is required to take off the PPE is that which is most fraught with potential complications,” Hanfling said. “It requires very close attention to detail and something that requires muscle memory.”
The overhauled standards, however, raise new questions about the financial impact of preparing for the possibility of handling a patient infected with the virus. Facilities must invest more in protective equipment as well as the training to ensure any employees who interact with such a patient are fluent in the protocols.
“When we decided last week to exceed what was then the recommendations for personal protective equipment, we put in a order for about $100,000 worth of the jumpsuits, hoods and breathing devices,” said Dr. Lee Norman, chief medical officer at University of Kansas Hospital. “And that was just to get through what we thought would be a two-week period of time with one patient.”
Norman said the Kansas hospital made other investments as well, such as installing a new air system in the three rooms designated to treat Ebola patients, although he acknowledged that hospital would be hard pressed to provide care for more than one at a time given the amount of equipment needed and medical waste produced with the treatment of just one patient. “We almost need just one room for equipment storage and waste management,” he said.
But Dr. Ashish Jha, professor of international health at Harvard University, counters that the alternative to spending on preparation could be much worse. “It will cost money to prepare for this,” Jha said. “It will be really, really expensive to be unprepared if an Ebola patient shows up.”
Follow Steven Ross Johnson on Twitter: @MHsjohnson
