HOSPITAL READINESS FOR A POSSIBLE EBOLA OUTBREAK
There isn’t a federal mandate on how Ebola should be handled; state and local guidelines still hold sway in these matters. The CDC reports: “Strict infection control is critical to stopping chains of transmission. Standard infection control practices in US health‑care facilities apply to the safe management of patients with Ebola, but must be adhered to rigorously and meticulously. Hospitals should have staff practice the procedures and practice using the protective garb in advance.”
But will hospitals follow the CDC’s recommendations? This remains to be seen. The outbreak of Ebola in the United States is not considered an epidemic at the time of this writing. Therefore, many hospitals, as indicated above, are relying on the resources already in place for treating infectious diseases. Some hospitals may believe that an Ebola outbreak could never happen in the United States. This amounts to administrators and other professionals burying their proverbial heads in the sand.
However, some hospitals are beginning to see the wisdom in providing health‑care professionals with additional training, plus education on the proper use and care of protective gear, including hazmat suits and masks.
One of the main reasons for the spread of Ebola in Sierra Leone and elsewhere is that while there may be protective gear available, it doesn’t mean it’s being used properly. The climate conditions in West Africa are oppressively hot and humid, with temperatures reaching 100 degrees Fahrenheit. Sometimes excessive condensation makes masks difficult to breathe through. It has been reported that workers can only handle being in full‑body protective gear for just forty minutes before they become unbearably hot. Luckily, this is not an issue in the hospitals in developed nations where the climate can be controlled, but there are other factors at work. Take, for example, a typical emergency room interview between doctor and patient. Essentially, it amounts to the ticking off of a checklist of symptoms; rarely is a travel history taken from an ER patient. The staffers, often with heavy patient loads, try and push through the waiting patients to decide if admittance to the hospital is necessary. In many cases, patients who are admitted must wait hours on a gurney before a bed becomes available.
As Ebola is most commonly transmitted through direct contact with body fluids, or contact with contaminated objects, it’s not as easy to contract Ebola as it would be to catch a cold, primarily transmitted through the air.
Dr. Dino Rumoro, Rush UNI Medical Center’s emergency medicine chief, says he’s worked with worrisome diseases including AIDS, SARS, swine flu, and smallpox. As Ebola is most commonly transmitted through direct contact with body fluids, or contact with contaminated objects, it’s not as easy to contract Ebola as it would be to catch a cold, primarily transmitted through the air. Rumoro has said, “At least with Ebola we have a fighting chance because I know that it is coming from body fluids and I know if I wear my (protective) suit I’m safe and I know if I don’t stick myself with a needle or cut myself with a scalpel I’m safe.”
The truth is that we are still uncertain about Ebola transmission, at least that’s the opinion of the Center for Infectious Disease Research and Policy (CIDRAP). Dr. Rumoro is correct that bodily fluids are the most likely mode of transmission, but we all must realize that there is a lot we still don’t know about the disease.
There are more than 5,700 hospitals in the United States. However, CNN reports:
That may seem like enough high‑level centers that can handle Ebola safely, but there is one troubling statistic. There are only nineteen beds available total, if you add up all the beds in all four hospitals! The Nebraska Medical Center has the most beds, ten, while the others only have three each.
This is a real eye‑opener and leads to the question: how can just four hospitals spread across the nation accommodate any significant outbreak of Ebola or, really, any truly dangerous infectious disease? They can’t. That’s why hospitals need to take measures to get themselves ready. Bruce Ribner, MD, medical director of the infectious disease unit at Emory University Hospital in Atlanta, stated, “It’s not going to be possible, if this outbreak continues in West Africa, for a select number of institutions to care for patients.”
The CDC has issued a preparedness checklist for hospitals to evaluate whether their current systems will be adequate to fight an Ebola epidemic should it ever arise at their facilities. If a patient in a US hospital is suspected or known to have Ebola virus disease, health‑care teams should follow standard, contact, and droplet precautions, including the following basic recommendations:
• Isolate Ebola patients confirmed and suspected.
• Have health‑care workers treat Ebola patients while wearing protective gear, including gloves, gowns (fluid resistant or impermeable), eye protection (goggles or face shields), and facemasks, as well as double gloving, disposable shoe covers, and leg coverings.
• Do not permit visitors.
• Keep a log of everyone who comes in contact with the Ebola patient.
• Avoid aerosol‑generating procedures wherever possible. (Did you know that flushing a toilet produces aerosols?).
• Implement environmental infection control measures by sterilizing non‑disposable equipment and safely and carefully discard disposable hazardous waste.
As the old saying goes, “An ounce of prevention is worth a pound of cure.” Hospitals may find their cases of Ebola can be controlled if they follow the CDC’s recommendations and take proper precautions. Of course, there is always the possibility of human error, which means you need to be prepared beyond what hospitals may be able to offer.
NOW YOU KNOW…
Only four hospitals in the United States are fully equipped to handle and properly treat Ebola cases and only nineteen beds are available to treat all Ebola patients. While hospitals are upping their infectious diseases procedures and paying close attention to the particular demands of safe Ebola treatment, a great deal of improvement is needed. It’s essential for you to make sure your local hospital has a workable plan to handle an Ebola outbreak should one occur in your area.
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