Ebola and Healthcare Worker 10/12/14

October 12th, 2014

A female healthcare worker at Texas Health Presbyterian Hospital Dallas who cared for the late Thomas Eric Duncan after he was admitted with Ebola on September 28 has preliminarily tested positive for the virus, the state health department announced today.

The patient, who has not yet been identified, is the second person after Duncan to be diagnosed with the deadly disease in the United States. Duncan died on October 8. CNN reports that the patient is a nurse, but that has not yet been confirmed.”We knew a second case could be a reality and we’ve been preparing for this possibility,” David Lakey, MD, commissioner of the Texas Department of State Health Services, said in a news release. On the evening of October 10, the healthcare worker reported having a low-grade fever in the course of a self-monitoring regimen prescribed by the Centers for Disease Control and Prevention (CDC) for caregivers of Ebola patients, according to accounts from the Texas health department and the hospital’s parent company, Texas Health Resources. The woman was immediately admitted to Texas Health Presbyterian and isolated. On Saturday night, the hospital learned that the patient tested positive for Ebola in a preliminary test conducted by a state health department laboratory in Austin. The CDC confirmed the positive test result later today. The patient’s condition was stable as of this morning.

At a news conference this morning, Dan Varga, MD, the chief clinical officer and senior executive vice president of Texas Health Resources, said that the healthcare worker worker had worn personal protective equipment (PPE) when caring for Duncan. A “close contact” of the healthcare worker has been placed in isolation as well, Dr. Varga said. Meanwhile, health officials are trying to identify other individuals who may have crossed paths with the patient and been exposed to the virus, which is only spread through direct contact with bodily fluids or contaminated objects.

Duncan, a native of Liberia, came to Dallas last month after coming into close contact with a woman dying of Ebola. He first visited Texas Health Presbyterian with a high fever and other Ebola symptoms on the evening of September 25. Duncan told an ED nurse that he had recently been in Africa, and this information was documented in the hospital’s electronic health record system, but it was “not fully communicated throughout the full team,” according to one Texas Health Resources official. As a result, the hospital missed an Ebola diagnosis and sent Duncan home that night, only to admit him in worse shape three days later.

“Breach in Protocol” Resulted in New Case, Said CDC Director

At a press conference today, CDC Director Tom Frieden, MD, MPH, said that the agency will investigate the yet undetermined “breach in protocol” that resulted in the newly diagnosed Ebola case. The infected female healthcare worker had had extensive contact with Duncan during his hospitalization, Dr. Frieden said, “That individual has not been able to identify a single breach.”

The CDC will take a close look at how the healthcare worker and others removed PPE after caring for Duncan at bedside, he said. Taking it off without coming into contact with contaminated materials “is critically important, and not easy to do.”

The CDC investigation also will focus on the kidney dialysis and intubation that Duncan underwent during his hospitalization. Dr. Frieden called them “high-risk procedures” that can spread infected material. He noted that he was unfamiliar with any other Ebola patients having been dialyzed or intubated. “Certainly it would be very unusual if it had happened before,” he said.

In general, hospitals should limit the number of procedures performed on Ebola patients in light of the infection risk, he said. If a patient is not experiencing diarrhea or vomiting, for example, clinicians might want to draw blood only once a day to check electrolytes as opposed to several times. Other key precautions, he said, are limiting the number of healthcare workers assigned to treat an Ebola patient, and assigning one clinician to oversee infection control for these cases.

Dr. Frieden said he was “deeply concerned” to hear about the healthcare worker testing positive for the Ebola virus, but reiterated his conviction that public health authorities would stop its spread in Dallas.

“It is possible that we will see additional cases in those who had contact with either of the 2 patients,” he said. “But there is no doubt we can break the links in the chain of transmission. We’ve done it before and we’ll do it here.”

However, success will require 100% compliance with protocols to rapidly diagnose and isolate patients with Ebola, identify and monitor contacts, and prevent the virus’ spread in healthcare facilities, he said. The Dallas situation “re-emphasize(s) how meticulous we have to be on every single aspect of the control measures.”

PLEASE REVIEW HOW TO PUT ON AND TAKE OFF PPE WITH YOUR STAFF AND MAKE THEM DEMONSTRATE

This pdf may be helpful, I have attached a few other documents you might find useful

Questions call Deb McMahan, MD