Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, over the weekend said that not every hospital is properly equipped to deal with Ebola cases and that "much more stringent" guidelines are needed to protect health care workers and other patients from exposure.
Fauci's comments come nearly a week after two Texas Health Presbyterian Hospital nurses treating Thomas Eric Duncan, the first Ebola patient on U.S. soil, contracted the disease, heightening concerns about the U.S. health system's ability to contain its spread.
While the direct cause of the nurses' exposure is still unknown, Fauci in a statement last week said "an inadvertent, innocent breach of the protocol of taking care of a patient within the personal protective equipment" was to blame.
Fauci says CDC is working to identify the breach in question. However, some health care workers—including some colleagues of the infected nurses—say that the case doesn't highlight a protocol breach so much as a lack of adequate training for hospital workers. Infection control experts say hospital workers must be coached through treating Ebola cases.
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Fauci also says that CDC is working to improve its guidelines for hospitals.
According to Fauci, current guidelines for treating Ebola patients were developed by the World Health Organization (WHO) and allow workers treating the disease in Africa to have portions of their bodies exposed. However, he says the guidelines are intended for field workers were not doing "very invasive procedures," like those two high-risk" procedures carried out by Texas Health Presbyterian Hospital workers in an effort to save Duncan's life.
CDC spokesperson Abbigail Tumpey adds, "The original recommendations that we put out in August provided a lot of flexibility, [but] [w]hat we found in Dallas is that some of that adaptation could lead to potential confusion."
Tumpey says the "new recommendations are going to be much more specific." The agency is expected to release the revisions this week.
Four hospitals are ready, but space is limited
Any further cases in Dallas will be sent to one of the four hospitals considered well-equipped to handle the treatment of a patient with Ebola.
The four facilities have bio-containment units considered well-equipped for addressing Ebola infections. The hospitals are Emory University Hospital in Atlanta, NIH in Maryland, the University of Nebraska Medical Center, and St. Patrick Hospital in Montana. Three of those hospitals have already treated Ebola patients.
According to Emory spokesperson Holly Korschun, the hospital has space for three patients in its biocontainment unit. Workers at the hospital have been "trained in the use of personal protective equipment like full-body suits" and have conducted training drills for "a dozen different scenarios."
Sean Kaufman, a biosafety expert who helped care for the first two U.S. Ebola patients at Emory, says the hospital "did a lot of things right." He explains that the facility was "engineered properly" and the attending physicians had the best personal protective equipment ... outstanding standard operating procedures... [and] great administrative control."
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Meanwhile, NIH can treat two patients concurrently in its units. The University of Nebraska Medical Center could likely handle two to three patients, according to Christopher Kratochvil, the hospital's associate vice chancellor for clinical research.
The Montana facility—which has not yet treated an Ebola patient—has three patient rooms in its biocontainment unit, according to a 2010 article in Emerging Infectious Diseases.
Combined, just seven spots remain open at these facilities for any emerging cases.
Fauci says more preparation must be done in the event of an outbreak. In an interview with NBC News on Sunday, Fauci said, "We need to have more than just four [units] in which you have people who are pre-trained, so that you don't come in, and then that's the first time you start thinking about it."
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He added, "In case there are more cases, we want to make sure we have people who are pre-trained, pre-drilled over and over, and have the right protocol going" (Khazan, The Atlantic, 10/17; Weber et al., Bloomberg News, 10/19; Barnes, Wall Street Journal, 10/19; NBC News, 10/19; Langreth/Koons, Bloomberg News, 10/17; "World News," ABC News, 10/16).
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