ANALYSIS | Stricter Ebola protection for health workers advised by US

A local health worker checks the temperature of a person passing through the Newton checkpoint on the outskirts of Freetown, Sierra Leone

U.S. health officials will issue stricter Ebola guidelines to protect the nation’s medical workers after two caregivers were infected in Dallas while treating a patient who later died from the disease.
The recommendations follow sharp criticism by some in Congress of existing national safety protocols. They increase attention to covering every bit of skin, safely donning and removing protective wear, and properly disposing of infected medical waste.
“The original recommendations that we put out in August provided a lot of flexibility,” said Abbigail Tumpey, an associate director for communications science at the Atlanta- based Centers for Disease Control and Prevention, the agency that will release the new guidelines.
Hospitals “in the past wanted to adapt to what they have locally,” Tumpey said in an interview at CDC headquarters. “What we found in Dallas is that some of that adaptation could lead to potential confusion. These new recommendations are going to be much more specific.”
While greater protections are being sought for use in future cases, Texas health officials asked medical workers who treated Ebola patient Thomas Eric Duncan at Texas Health Presbyterian Hospital Dallas to limit their activity in public. The workers were asked to sign agreements saying they would avoid public transportation and public areas while they monitor their conditions for 21 days from their last possible exposure to Duncan, who died Oct. 8.
The new CDC guidelines are being prepared for release as President Barack Obama named former White House official Ron Klain to coordinate the U.S. response to Ebola amid rising public concern about his administration’s response. Klain, 53, a former chief of staff to Vice President Joe Biden, received the assignment after the CDC was sharply criticized at a congressional hearing over its handling of the first three Ebola cases to emerge in the U.S.
Representative Tim Murphy, a Pennsylvania Republican, said at the Oct. 16 hearing that trust in the administration is “waning as the American public loses confidence each day with demonstrated failures of the current strategy.”
Obama, though, said the appointment wasn’t made because CDC officials “haven’t been doing an outstanding job really working hard on this issue, but they also are responsible for a whole bunch of other stuff.”
Pedro Greer, a Miami doctor who won the Presidential Medal of Freedom in 2009 for treating the poor and teaches at Florida International University’s medical school, said Klain’s lack of background in public health isn’t necessarily a deficit for the job of a coordinator.
“You have all the scientists and experts at the CDC but what you need is a manager,” Greer said. “With all due respect, we scientists are not the best managers.”
Concerns about prevention protocols arose after National Nurses United, a labor union, said Texas Health Presbyterian supplied safety suits with exposed necks, and sent Duncan’s lab specimens through the system without being specially sealed. The group also said the hospital left Duncan for hours in an area with other patients.
Criticism of the CDC grew further after one of the nurses went to the hospital this week with a fever the day after taking an airline flight, and was found to be infected. The first nurse infected, Nina Pham, is in fair condition and “resting comfortably” in a National Institutes of Health facility in Maryland, after being transfered there from Dallas, NIH director Anthony Fauci said.
Amber Vinson, the second health-care worker infected in Dallas, has been moved to Emory University Hospital in Atlanta, which has a specialized isolation unit.
Vinson’s trip to Cleveland after Duncan died has touched off widespread precautions and efforts to contact and monitor those she may have been near.
Ohio officials have reached 87 state residents who were on the flights to or from Dallas with Vinson, or were at an Akron bridal shop she visited on Oct. 11, said Donna Skoda, assistant Summit County health commissioner. Twenty-nine people from six Ohio counties are being reviewed to determine the level of contact they had with Vinson, Skoda said in an interview.
Of that number, 12 are being actively monitored by having health officials check their temperature daily, and one has been quarantined, she said. Frontier Airlines has now taken off duty, with pay, the flight crews from both legs of Vinson’s trip, according to spokesman Todd Lemacher.
The newest CDC guidelines will contain specific recommendations, such as urging workers to cover all of their skin and use alcohol-based hand sanitizer on protective gloves. They also recommend a dressing room be set up outside medical- care areas, and that hospitals implement a “buddy system,” according to Tumpey.
The buddy system, where workers watch each other put on and take off protective equipment, has been used widely in Ebola outbreaks in Africa and is the standard for Doctors Without Borders, a global humanitarian group.
“It’s not necessarily something that has been implemented in the U.S. health care system,” Tumpey said. “We’ve suggested it in the past, but this is the first time we’ve said you have to have a buddy. There’s no wiggle room on this.”
Texas Health Presbyterian is investigating how they contracted the virus, said Daniel Varga, chief clinical officer for Texas Health Resources, which runs the hospital.
The CDC also is readying new guidelines for health-care workers performing medical procedures, such as dialysis and delivery of babies, on Ebola patients, Tumpey said.
Duncan received dialysis and respiratory intubation, two areas where a breach may have occurred and led to the caregivers’ infections, CDC Director Thomas Frieden said on Oct. 13. The new guidelines were developed after extensive interviews with health-care workers that had experience in caring for Ebola patients, according to Tumpey.
CDC officials also met with the National Institute of Occupational Safety and Health, the Occupational Safety and Health Administration, and the U.S. Department of Transportation, which oversees disposal of medical waste, to write the new protocol, she said.
In addition, the guidelines have been reviewed by groups including the American Hospital Association, and hospitals in Nebraska, Atlanta, and Bethesda, Maryland, that are currently caring for Ebola patients, she said.
As important a factor as the release of the new guidelines is the idea that health-care workers practice them until they’re highly skilled, said Tom Skinner, a CDC spokesman.
“The workers have to practice, practice, practice and practice some more,” he said. After the administration acknowledged lapses in handling the first U.S. cases, Obama said he’s mobilizing the federal government to contain any spread of the virus within the country’s borders. He said the key to stemming the outbreak is battling it in West Africa. More than 4,500 people have died from Ebola this year, mostly in Guinea, Liberia and Sierra Leone. Caroline Chen and John Lauerman, Bloomberg