INFECTIONS ARE RAMPANT

Hospitals and, especially, nursing homes are not always safe when it comes to infections. In fact, there have been documented cases of otherwise healthy people being admitted for various procedures and becoming sick. These illnesses are called hospital‑based infections. It isn’t the norm, but it’s more common than anyone really wants to believe.

In a recent Daily News article, Carolyn Herzig, of the Columbia University School of Nursing, explained that “Infections are a leading cause of deaths and complications for nursing home residents and, with the exception of tuberculosis, we found a significant increase in infection rates across the board.” Her team analyzed data submitted by nursing homes to the US Centers for Medicare and Medicaid Services between 2006 and 2010. They found rising rates of pneumonia, urinary tract infections, viral hepatitis, sepsis, wound infections, and multiple drug‑resistant bacterial infections. Herzig believes, “Unless we can improve infection prevention and control in nursing homes, this problem is only going to get worse as the baby boomers age and people are able to live longer with increasingly complex, chronic diseases.”

To a slightly lesser degree, this goes for hospitals as well.

Usually younger, otherwise healthy people do not get sick in hospitals. While anyone admitted to a hospital could contract a health‑care‑associated infection, some groups are definitely more at risk than others, such as the very young and the very old. Those with chronic medical conditions like diabetes and those with immune deficiencies are also at risk.

TAKING RESPONSIBILITY… OR NOT

Following Thomas Duncan’s death, the CDC sent an alert to hospitals all over the country warning that: “Every hospital should ensure that it can detect a patient with Ebola.” While a perfectly reasonable statement, it didn’t outline a national policy for exactly how this should be accomplished. More importantly, it didn’t mandate national guidelines for every hospital when it comes to staff education and training, protective gear requirements, and isolation room procedures. Even procedures as basic as how to put on and take off hazardous material suits are different based on the brand.

The issue with all of this is that hospitals are so decentralized that they are, apparently, not required to listen to the CDC. A spokesman for the National Nurses United union, Charles Idelson revealed that few hospitals have provided adequate education for their employees. Idelson says most are simply pointing nurses to information on their websites, or linking to CDC information.

One of the main issues with this is that despite the recent onslaught of coverage in the media over Ebola, it truly is seen as a third‑world issue, and US hospitals are generally more inclined to put their resources into areas where they know for sure a condition exists because it’s common to the population or the region. Think influenza in the wintertime in the Northeast.

Most hospitals already have systems in place for dealing with influenza outbreaks. They rely on these systems in the treatment of all highly contagious diseases, few if any of which have the death rate that Ebola has. As Dr. David Klocke, chief medical officer for Regional Health hospitals in South Dakota, explains, “We really are in general very well prepared to deal with dangerous microorganisms anyway.”

Some might take the above statement as comforting, but I look at it and wonder if there’s an aspect of arrogance in it. Is Dr. Klocke saying that his medical center can handle a community‑wide Ebola outbreak? Given the circumstances, it would be a miracle if even the CDC could do so.

Going forward, we must do what can be done. Hospitals should be more vigilant about having nationally standardized practices in place for treating Ebola, and build a stockpile of materials that would make their efforts more successful.

WHOSE RESPONSIBILITY?

In the case of Texas Presbyterian, National Nurses United believes that procedures and protocols were definitely ignored or followed incorrectly. Although human error occurred, they feel that poor planning and mismanagement are the culprits that put the nurses who were infected at risk.

Management disagrees. A spokesperson for the hospital, Wendell Watson, made a statement that “Patient and employee safety is our greatest priority, and we take compliance very seriously” and that the hospital would “review and respond to any concerns raised by our nurses and all employees.”

The Centers for Disease Control and Prevention stated that some breach of protocol probably sickened Nurses Pham and Vinson. National Nurse United claimed that protocols were either non‑existent or were changed constantly after Thomas Duncan was admitted. Further investigation reveals other alarming allegations of protocol breaches, most by the hospital.

Ms. Pham was reportedly there from the beginning of his illness and treated Duncan throughout the course of his battle in the hospital’s intensive care unit. Reportedly, “Duncan’s medical records make numerous mentions of protective gear worn by hospital staff, and Pham herself notes wearing the gear in visits to Duncan’s room. But there is no indication in the records of her first encounter with Duncan, on September 29, that Pham donned any protective gear.”

How is that possible? How could Ebola not have been suspected as the cause of illness for a Liberian national who had traveled from Liberia shortly before ending up in that Texas emergency room?

According to National Nurses United, nurses from Texas Presbyterian have alleged that Duncan’s “lab samples were allowed to travel through the hospital’s pneumatic tubes, possibly risking contaminating of the specimen‑delivery system [and] that hazardous waste was allowed to pile up to the ceiling.”

TIP

There are no community‑wide Ebola outbreaks here at present, and we can, under strong leadership, become capable of containing the disease in West Africa while protecting home territory. It will take a lot of humanitarian aid and tough, but logical, decision making.

It apparently wasn’t for several days that protective gear, including shoe coverings, had been mandated for use in Duncan’s care–that apparently there were a number of loose protocols and “recommendations” but very few essential hospital mandates.

Finally, several days into the ordeal, one of the nurses noted: “RN entered room in Tyvek suits, triple gloves, triple boots, and respirator cap in place.” But what about all those days before? What kind of protections and precautions had been in place? The documentation is sparse.

It has been rumored that the staff at the hospital has been threatened with firings for speaking to the press, so it’s hard to know if the public at large will ever know the real truth about how Duncan’s care had been managed or mismanaged.

So who’s at fault?

The medical staff may have committed errors in the donning and doffing of protective gear, if it was given to them in the first place. I have put on and taken off these outfits myself, and believe me when I tell you that there is a learning curve. A wrong move could easily mean contamination. Humans aren’t perfect, and mistakes happen, but I believe in my heart that nurses are heroes and the heart and soul of the field of health care. I have seen what they do day in and day out, and I will admit to you, as a physician, that I couldn’t do it.

The hospital has a burden of blame to bear, as it was clearly unprepared for dealing with the Ebola patient. It didn’t have the equipment, the advanced training, and the policies in place that would have made the unit an effective team. To put it simply, the hospital was in over its head.

The blame falls, therefore, where the buck stops, and that’s at the very top of our medical administration. Our top health officials have told us so often that we have nothing to worry about. We expect that we are up for any challenge because we are told that lie daily. I hoped that the high technology and vast resources in the United States would trump human error, disorganization, and yes, arrogance.

I was wrong. There are, indeed, circumstance for which we are unprepared, and woefully so. Our medical directors at the national level have failed to make us ready for the challenge of a deadly and contagious disease like Ebola. They have put considerations that may be political into an arena that should be apolitical. They have forgotten their duty to preserve the health of US citizens.

Yet, if any nation can rise to the challenge, we can. There are no community‑wide Ebola outbreaks here at present, and we can, under strong leadership, become capable of containing the disease in West Africa while protecting home territory. It will take a lot of humanitarian aid and tough, but logical, decision making.