Lack of training, safety at Texas hospital where nurses contracted Ebola

By Kate Randall
17 October 2014

The US National Institutes of Health (NIH) said Thursday that the first Texas nurse infected with Ebola at a Dallas hospital was being transferred to a specialized NIH unit in Maryland. Federal health officials appeared Thursday before a US House Energy and Commerce Committee hearing on the government’s response to the Ebola crisis.

The nurse, Nina Pham, who is reportedly in stable condition, was part of the medical team at Texas Health Presbyterian Hospital that cared for Thomas Eric Duncan, a Liberian, who died October 8 of Ebola. He was initially turned away from the hospital despite having a fever and other symptoms and telling staff he had recently arrived from West Africa.

At Thursday’s hearing, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, said that the Dallas hospital is straining under the effort to monitor dozens of healthcare workers who may have been exposed to the virus.

On Wednesday, it was revealed that another nurse on the deceased Ebola patient’s treatment team, Amber Vinson, was also infected with the deadly virus. Vinson was transferred to Emory University Hospital in Atlanta for treatment Wednesday night. Vinson traveled on a commercial flight from Cleveland to Dallas the day before she showed Ebola symptoms, despite having a slightly elevated temperature.

At Thursday’s Congressional hearing, Centers for Disease Control (CDC) director Thomas Frieden confirmed under questioning that Vinson had in fact contacted the CDC before she boarded the plane. A federal official said Wednesday that Vinson told the CDC her temperature was 99.5 degrees Fahrenheit (37.5 Celsius), but “was not told not to fly” because this was below the CDC’s threshold of 100.4 F (38 C).

Dr. Daniel Varga, chief clinical officer and senior vice president of Texas Health Resources, the medical group overseeing Texas Health Presbyterian Hospital, appeared at the hearing by video from Texas. In prepared remarks, he said, “Unfortunately, in our initial treatment of Mr. Duncan, despite our best intentions and a highly skilled medical team, we made mistakes.”

Varga added, “We did not correctly diagnose his symptoms as those of Ebola. And we are deeply sorry.” Texas Health Presbyterian’s handling of both Duncan and Pham’s cases came under fire Wednesday from registered nurses at the hospital.

Speaking anonymously out of fear of retaliation from the hospital, the RNs spoke through a blog post on the National Nurses United union web site “about the protocols that were followed and what they view were confusion and frequently changing policies and protocols that are of concern to them, and to our organization as well.”

The nurses described how they had been instructed by hospital administrators to provide care for Duncan with part of their faces and necks exposed, forcing them to resort to wrapping medical tape around their exposed skin. They also said Duncan was left for hours in a common waiting area with other patients, and that nurses who had treated him with inadequate protection were then told to visit other patients, potentially infecting them.

One of the nurses came forward publicly Thursday morning, confirming these accusations of the breakdown of safety and protocol at the hospital. In an interview on NBC’s “Today” show, Brianna Aguirre stated, “I can no longer defend my hospital.” She said, “I watched them violate basic principles of nursing.” Aguirre appeared alongside her attorney, who described her as a whistleblower.

She said there was no preparedness for Ebola at Texas Health Presbyterian. “They gave us an optional seminar to go to,” she said, but it was “just information, not hands on. It wasn’t even suggested we go.” She said it took three hours for the hospital to contact the CDC to let them know they were suspicious that they had an Ebola patient.

She was not involved in Duncan’s case, but did take care of Pham. She was outraged by the insufficient protective gear provided to nurses and other healthcare workers. “I’ll be honest. I threw a fit. I just couldn’t believe it,” she said. “In the second week of an Ebola crisis at my hospital, the only gear they were offering us at that time…is gear that is allowing our necks to be uncovered?”

“Why would I be wearing three pairs of gloves, three pairs of booties, a plastic suit covering my entire body and then leave my neck hanging out this much so that something can potentially go close to my mouth or nose?” she asked. The Ebola virus is transmitted through the bodily fluids of an infected patient, often through touching the mouth, nose or open wound with the fluids.

Aguirre also said that garbage cans with infected waste were piled “to the ceiling” for hours, both in patient’s rooms and in hallways, with hospital workers freely passing through and then moving on to treat other patients.

A mother of a seven-year-old and a 10-year-old, Aguirre says she fears the fallout for speaking out about “the best job I ever had,” but felt she had to come forward. “I’m the breadwinner of my family. I’m terrified. I’m just like the majority of middle class, working class people,” she said. “I’m just a couple of paychecks from not being able to pay my mortgage and I’m terrified about that.”

The concerns of healthcare workers like Brianna Aguirre for the safety of patients at America’s hospitals were far from the minds of those questioning the healthcare officials Thursday on Capitol Hill. Representative Tim Murphy, a Pennsylvania Republican, opened the hearing stating, “Mistakes have been made. Trust and credibility of the administration and government are waning. That trust must be restored.”

Viewing the Ebola crisis through the narrow lens of the national ruling elite, a number of those on the Congressional panel pressed for the US borders to be closed to travelers from West Africa. This is despite the warnings of health experts that such an action would cause the economic collapse of these countries, vastly worsening the epidemic and making its global spread more likely.

Frieden responded, “As the director of CDC, one of the things I fear about Ebola is that it could spread more widely in Africa. If this were to happen, it could become a threat to our health system and the health care we give for a long time to come.”

On Monday, World Health Organization Director-General Dr. Margaret Chan defined the ongoing Ebola epidemic as “unquestionably the most severe acute public health emergency in modern times.”

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