Ebola Protocol Breach Raises Questions About Where to Treat Patients

PHOTO: Health care workers display protective gear inside an isolation room as part of a media tour of the emergency department of Bellevue Hospital in New York City, Oct. 8, 2014. PlayAdrees Latif/Reuters
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The protocol breach at a Texas hospital being blamed for a health care worker being infected with Ebola, the first person to contract the disease in the United States, raised concerns about whether hospitals are prepared to treat the virus.

The health care worker was among the Texas Health Presbyterian Hospital staff who treated Thomas Eric Duncan, the first person disagnosed with Ebola in the United States. The hospital is not one of the four in the U.S. with units specialized to handle diseases like Ebola.

"The comments from CDC [the Centers for Disease Control and Prevention] early on that this could be done in any hospital that is used to doing isolation just doesn't ring true to me," ABC News chief health and medical editor Dr. Richard Besser said.

"Groups like Doctors Without Borders, they have incredible training in this, and they practice it, and it's the practicing that ensures that you don't have a slip-up," he said. "For our first patient in America to lead already to a health care worker getting sick really raises a concern to me."

According to National Nurses United, the largest registered nurse union, surveys of their membership indicate that most nurses feel hospital administrations have not communicated adequately with staff about Ebola response plans.

"Reports of the infection of a nurse at the same hospital where the first U.S. patient, Thomas Eric Duncan died in Dallas only heightens the concerns for registered nurses and other frontline hospital personnel who would be among the first to respond and interact with other patients about whether their hospital is doing enough to protect health workers as well as patients and the general public," NNU Executive Director Rose Ann DeMoro said Sunday.

So far, the only two cases of Ebola that have been diagnosed in the United States have been treated at Texas Health Presbyterian.

The decision to not transfer Thomas Earl Duncan, who died of Ebola last week, to a specialized care facility was criticized by members of his family.

The CDC has not said if the patient diagnosed with Ebola Sunday will be transferred to one of four centers across the country where health care workers are trained to specialize in treating highly infectious diseases.

"We are going to look at all opportunities to improve the level of safety and to minimize risk," CDC Director Tom Frieden said at a press conference.

While he did not rule out transferring patients to specialized centers, Frieden said that all hospitals should be prepared to safely treat Ebola.

"We do want hospitals to have the ability to rapidly consider, isolate, and diagnose people who may have Ebola," he said.

Even before Sunday's announcement, hospitals from New York to Iowa to California have taken steps to try to prepare for possible Ebola cases.

Some hospitals are sending memos to staff, and others are running all-out drills, many of them following guidelines from the U.S. CDC, to make sure staff members know everything from how to identify possible Ebola patients to how to get out of protective gear without contaminating themselves.

All the U.S. citizens who contracted Ebola in Liberia and were brought to the United States were transported to the Nebraska Biocontainment Patient Care Unit, in Omaha, and to the specialized unit at Emory University Hospital in Atlanta.

Two more centers that are specialized to treat diseases like Ebola are at the National Institutes of Health in Bethesda, Md., and St. Patrick Hospital in Missoula, Mont.

The protocols put in place at Texas Health Presbyterian have been used for decades to treat Ebola, according to Frieden, and can be used in other hospitals.

But Frieden conceded that the same kind of protocol breach that led to the infection announced Sunday could have occurred to other hospital workers at Texas Health Presbyterian.

"Unfortunately it is possible in the coming days that we will see additional cases of Ebola," Frieden said. "Because the health care workers who cared for this individual [Duncan] may have had a breach of the same nature of the individual who appears now to have a preliminary positive test."

What exactly the protocol breach was has not been identified.

The female health care worker was interviewed by investigators after she was diagnosed with Ebola, but she could not identify when the breach occurred, Frieden said.

Frieden recommended that hospitals appoint individuals to oversee medical staff and ensure that all safety protocols prescribed by the CDC in treating Ebola are followed.

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