Lax guidelines led to Ebola spread in Dallas

Infection control experts blame lax federal guidelines for the spread of Ebola to two Dallas healthcare workers who cared for the country's first Ebola patient, the New York Times reports.

The Centers for Disease Control and Prevention (CDC) issued new guidelines Tuesday that will include sending rapid response teams to any U.S. hospital with a confirmed case of the deadly virus. The stricter guidelines now include full-body suits that cover the head and neck, supervision of the risky process when taking off protective gear and the use of hand disinfectant as each item is removed.

The new guidelines aren't as strict but are more in line with procedures that Doctors Without Borders has followed for the past 10 years while treating Ebola in Africa, according to the Times.

The earlier guidelines were "absolutely irresponsible and dead wrong," said Sean G. Kaufman, who oversaw infection control at Emory University Hospital in Atlanta while it treated the two American healthcare workers who came down with Ebola while working with patients in Liberia.

Kaufman told the publication he was glad the CDC changed the protocol, but that it is too late since so many of the caregivers at the Texas Health Presbyterian Hospital in Dallas have been exposed to the virus and one of the healthcare workers boarded a plane with a low-grade fever the evening before she arrived at the hospital for care.

The nurse called the CDC before she boarded the plane but said officials didn't tell her she couldn't fly, Reuters reported. The plane is now out of service for cleaning, and two pilots and four flight attendants were put on a 21-day paid leave of absence as a precaution, according to the news outlet. Several nurses from the Cleveland Clinic and the Metro Health System, both based in Cleveland, were on board the flight returning from a conference in Texas and have also been put on paid leave.

The World Health Organization describes the Ebola outbreak as the worst in 40 years and reports that more than 4,000 people have died. The virus causes fever, bleeding, vomiting and diarrhea, and spreads through contact with bodily fluids.

Nurses at Texas Presbyterian complained this week that the hospital didn't provide training or follow proper protocols after confirmation that the first Ebola patient, Thomas Eric Duncan, had the virus and healthcare workers were subsequently exposed to Ebola. Duncan sought treatment at the hospital but was initially sent home with antibiotics.

The hospital is reviewing the complaints, but Daniel Varga, M.D., the chief clinical officer for Texas Health Resources, which includes the Dallas hospital, said in written testimony prepared for a congressional hearing today that "we did not correctly diagnose his symptoms of those of Ebola. We are deeply sorry."

Meanwhile, infection control experts say Ebola patients should receive treatment at one of four specialized regional centers--Emory University Hospital's Infectious Disease Unit, St. Patrick Hospital in Missoula, Montana; Nebraska Medical Center in Omaha; and the National Institutes of Health in Bethesda, Maryland--and not at local hospitals.

"Is it really realistic to think that all the hospitals across the country that don't have the best infection control programs on earth are going to be able to throw a switch and have the best infection control programs on earth" if an Ebola case shows up?" William Jarvis, former chief of the division that monitors hospitals' infection control practices at the CDC told USA Today. "The care of these patients should be at … specialized regional centers."

And nurses say that the missteps at the Dallas hospital underscore the fact that most U.S. hospitals aren't prepared to deal with rare infections. "We've been lied to in terms of the preparation of the hospitals," RoseAnn DeMoro, executive director of National Nurses United, told US. News & World Report. "What happened in Dallas can happen anywhere."

Indeed, about one in 25 hospital patients acquired an infection during their hospital stay in 2011, FierceHealthcare previously reported. In 2011, patients acquired more than 720,000 infections in hospitals. About 75,000 of those infected died, according to the CDC.

"There is very little discipline in a lot of hospitals around infection control," Leah Binder, president of the Leapfrog Group, which tracks hospital quality, told USA Today. "If an Ebola patient walks into a hospital that has a high rate of infection for other (illnesses) … they are going to be woefully unprepared for an infection with so little room for error."

To learn more:
- read the New York Times article
- here are the new CDC guidelines
- see Reuter's coverage
- here's the written testimony (.pdf)
- read the first USA Today story and the second one  
- check out U.S. News & World Report's coverage

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