In light of this morning's breaking news about the nurse who has contracted the Ebola virus
from the Dallas patient who died earlier this week, I thought I would post what I recently learned about the protocol at UAMS.
UAMS infectious disease doctors and staff already have experience dealing with patients who for one reason or another are in isolation. With a nuclear power plant just up the Arkansas River, they are trained to equipped to deal with patients exposed to radiation, for example. Staff must also contend with antibiotic-resistant germs, and protective gear is worn not just to protect the medical professionals, UAMS infectious disease specialist Dr. Keyur Vyas told
Friday, but other patients.
Vyas and RN Rachel Hicks
demonstrated for the Times
on Friday how personnel who, in the highly unlikely case anyone suspected of being infected with the virus comes to UAMS' ER or clinic, will suit up. Gloves, a hair covering, an M95 mask with a breathing valve, a plastic wrap around face shield and a non-woven Tyvek suit go on first. Another set of gloves and a plastic surgical gown that goes over the Tyvek suit, and shoe protection, completes the layering, necessary to keep those treating the patient from coming in contact with the patient's bodily fluids, including droplets from coughs and sneezes, which like blood, sweat and other body fluids, are also infectious. As you might suspect, it's hot in the suit; Hicks was drenched in sweat after the short demonstration.
The way in which the gear is removed is extremely important, and it is this part of the protocol that may have been breached by the nurse in Dallas. (The nurse in Spain who has tested postive for Ebola believes she touched her nose with her gloved hand.) The exterior of the gown, gloves, suit, etc. — surfaces that may have come in contact with the virus — must not be touched. Ebola medical waste — including the disposable gear worn by the staff — is deemed dangerous enough that the federal government does not allow it to be transported, but must be incinerated on site or sealed off.
There is a new protocol for patients, as well. All who come to the ER are to inform the officer stationed at the entrance if within the past 21 days they have been to any of the sites in Africa where the Ebola outbreak is occurring. A sign at the entrance to the ER lists the sites patients will be questioned about — Republic of Congo, Liberia, Guinea, Nigeria, Senegal, Sierra Leone, (and, just penciled in, Dallas). If the answer is yes, the patient will be placed in a room and the infectious disease team will be summoned to further screen the patient. The screening will be "very individualized," Vyas said. If the patient has symptoms — fever, vomiting, stomach pain, bleeding — he'll be placed in isolation and have blood drawn for testing. If the blood test shows antibodies to Ebola, "supportive care" such as IV fluids will be administered. That is all that can be done.
Vyas said the case in Dallas added "urgency" to the hospital's updating of its protocols. But he said he is far more concerned with an infectious agent he knows will be in Arkansas — the influenza
virus — and urges everyone to get a shot.
UPDATE: Centers for Disease Control Director Tom Frieden said today that it's possible that there will be more cases of Ebola in Dallas. "This is because the health care workers who cared for this individual may have had a breach of the same nature," The Huffington Post quoted Frieden as saying.
The nurse who has been infected has been identified as Nina Pham.