In the wake of a Texas nurse contracting Ebola from a patient, New Jersey hospitals are ramping up drills and training to better prepare their staffs to prevent any spread of the virus in the state.
Healthcare workers have expressed concerns about what they should be doing to protect themselves and their patients, and groups representing nurses are calling for hospitals, the state Department of Health, and the federal Centers for Disease Control and Prevention to rethink Ebola safeguards.
The New Jersey State Nurses Association, the largest professional organization for nurses in the state, called for any confirmed Ebola patients to be taken to one of four federal bio-containment facilities -- the closest to New Jersey are at Fort Detrick in Maryland and the central location at CDC headquarters in Atlanta. Separately, the Health Professionals and Allied Employees union called on the state to designate one hospital in the state for confirmed cases.
The CDC announced yesterday that it’s established an Ebola response team that would be on the ground within hours anywhere in the country with a confirmed case. CDC Director Dr. Thomas Frieden said the CDC would consider moving patients to the bio-containment units.
State Nurses Association Executive Director Richard T. Ridge said nurses are concerned that the method by which the Dallas nurse became infected remains unknown
“My phone was ringing off the hook all weekend,” after the nurse’s infection was announced, Ridge said. “The nurse thinks that she followed everything” in CDC-established infection-prevention protocols.”
“Maybe there was a break, maybe not,” he said. “That’s what got everyone’s attention in nursing.”
Ridge emailed a newsletter to 80,000 healthcare professionals yesterday recommending that they use a respirator when treating patients suspected of having Ebola, a step beyond the current CDC guideline to use a facemask. That’s based on the possibility that the virus could be transmitted through airborne particles, which hasn’t occurred in Ebola’s history.
“It’s conjecture, but it’s better safe than sorry when you’re really dealing with these things,” said Ridge, noting that researchers with the Center for Infectious Disease Research and Policy at the University of Minnesota had raised the possibility of Ebola becoming airborne.
CDC officials have said they’re revisiting their protocols for protective gear. The state Department of Health has urged hospitals to follow CDC guidelines.
Ridge also noted that healthcare workers could be exposed when patients first enter the hospital.
“The initial symptoms of Ebola are really the symptoms an everyday cold -- a bad cold -- and that’s the challenge,” Ridge said, adding that taking the patient’s history, which may reveal travel to Ebola-struck countries in West Africa, is crucial.
Dr. Meika Roberson, chief medical officer and emergency medicine chief at CarePoint Health’s Hoboken University Medical Center, said hospitals must be ready to treat patients with Ebola well before they’re confirmed cases, since it takes three days to get test results for the virus.
She also noted that the CDC has said that the virus is spread through direct contact with bodily fluids, much as HIV/AIDS is spread, rather than through airborne droplets, like tuberculosis.
“The way it’s feeling to the public is that it’s spread like TB or like smallpox, which was very easy to get,” but the direct contact is much more difficult, Roberson said.
At this point, the Hoboken hospital is requiring staff to use masks, although the respirators are available.
Roberson said the increasingly amplified message from the CDC has gained the attention of emergency department workers, and made them more aware of how they put on and take off protective equipment like gloves and gowns.
“My staff is saying, ‘Help me get educated,’ and I’m saying, ‘Wonderful,’ ” Roberson said, adding that the Hoboken emergency department has provided additional training this week, including information for employees who work with laboratory blood samples.
Roberson said the most important step for every emergency department is doing mock drills, which allow the hospital to learn where staff members need training or equipment. “We did a mock drill this afternoon and found we learned the importance of having an anteroom” -- a small room where staff members put on and remove their protective equipment. Since the ED lacked this room, the hospital engineering department built a temporary anteroom within four hours.
Hoboken staff members also are meeting with community organizations to publicize the message of how people contract Ebola and that residents who’ve visited West Africa should contact healthcare providers immediately if they exhibit cold-like symptoms.
HPAE policy and political director Jeanne Otersen said that each hospital should develop healthcare teams with additional training on how to handle potential Ebola cases, in addition to the state establishing a single hospital for confirmed cases.
“We want to work with the Department of Health, we want to work with hospitals, but we think there’s more work to be done,” she said.
She said a staff member of one hospital called her asking how to handle blood samples, since the hospital hadn’t clearly communicated safety procedures. She declined to name the hospital, saying that she wanted didn’t want to “cast aspersions.”
“This is the chance for every hospital to reexamine every assumption, every protective system, everything we’re doing,” Otersen said, adding that the union is working to ensure that workers have the knowledge they need to protect themselves and their patients. In addition, workers’ pay should be protected in case they need to take a leave due to potential Ebola exposure, she said.
A state Department of Health spokeswoman noted that the CDC continues to offer new information about Ebola to healthcare providers, and that the state has been updating local, health, hospital, and other healthcare officials.
Darryl Alexander, health and safety director for the American Federation of Teachers -- of which the HPAE is an affiliate -- said the CDC should revisit all of its guidelines in the wake of the Dallas nurse’s infection.
“We’d like to see the healthcare facilities and the CDC operate on a more precautionary principle,” including considering the possibility that Ebola can be spread by airborne droplets, Alexander said.
HPAE health and safety consultant Jonathan Rosen said the concerns about hospital preparedness are rooted in cuts to public health investment made over the past two decades.
“We’re really not prepared nationally and in New Jersey to really provide the type of protections to the patients and the healthcare workers who care for them,” Rosen said, adding that at both the federal and state levels, concerns are heightened by viruses like the H1N1 flu or SARS, but preparation fades before the next crisis.
It’s a message shared by the state’s other nurses union, JNESO. Executive Director Douglas Placa said hospitals must do more to ensure that his union’s members are ready.
“I’m hopeful that the employers where we’re at would provide the training for this,” said Placa, whose union represents workers at six New Jersey hospitals, including Hoboken.