Ebola Outbreak: How Safe Do U.S. Healthcare Professionals Feel?

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A student in the CDC’s infection control course learns how to properly put on and take off PPE. Image by the CDC

Ebola is a contagious and sometimes fatal disease that recently made its way to the United States.

Healthcare workers who take care of Ebola patients are required to wear special equipment to help keep them from getting sick… Unfortunately, however, some healthcare workers in the United States were diagnosed with Ebola after caring for patients – despite following the guidelines issued by the Centers for Disease Control and Prevention (CDC).

While the infected healthcare workers have recovered, concerns over identifying the correct personal protective equipment (PPE) and how to properly put it on (donning) and take it off (doffing) is essential in preventing the spread of disease.

To gain a better understanding of the concerns that healthcare workers have regarding Ebola, Decoded Science interviewed healthcare workers.

Of the twelve interviewees, there were seven nurses, three certified nursing assistants, one pediatric emergency technician, and one medical laboratory scientist – ranging from one  year of experience to 35+ years of experience in the medical field.

Ebola Safety Concerns

Despite CDC guidelines, a few healthcare workers came into contact with the Ebola virus while taking care of Ebola patients here in the United States and became ill. Although they did recover, many healthcare workers are frightened. We wanted to know what concerns healthcare workers would have, in the event of an Ebola patient at their healthcare facility.

Interviewees responded with concerns over inadequate personal protective equipment, lack of training and education, as well as being exposed and then not realizing it until after returning home or going out in public. Here are some of their responses:

One remarks, “I would be very concerned; so far they are saying just gown, gloves, and mask.  Let’s think this through; gowns stop at our knees and our entire back and neck is exposed, if a patient vomited while our backs were turned, or if fluids splashed on our pants below the knee, we would have been exposed. And let’s not forget the patients that cough in our faces.

“Not to mention if we step in something, we have now tracked it everywhere we have walked, including other patients’ rooms, whereever we stop on the way home (Kroger, Walmart, gas station), and most importantly home to our husbands and children! We are most definitely not ready to handle a patient with something as deadly and contagious as Ebola.”

The World Health Organization reports that the average case fatality rate is 50 percent. Image by the CDC.

Another health care professional tells us, “This is the most concerned I have been for my personal safety, and subsequently my family’s safety, in 20 years. My current concerns are the complete lack of education, training and personal protection. There is no plan in place at my current place of employment and we have not heard of any upcoming classes, or safety training. Personal protective equipment is inadequate!”

Another responded, “I am concerned that there is not a specific screening process currently in the Emergency Department (ED) I work in. We have been told to isolate patients who exhibit ‘symptoms’ and have been out of the country, but nothing has been added to our triage process or posted in the ED to notify patients of this information.

“In addition, we have been told to place patients in precautions, but I don’t feel that this is enough. I see people in Africa with what looks like a Hazmat suit on while we just have a simple isolation gown, mask, and single pair of gloves.”

Finally, we heard, “I have been trained to work in a level three lab. As you know, Ebola can only be handled in a level four lab. In the lab we are told that we will not receive specimens from suspect patients, but that they will be isolated and transferred to a Boston hospital. We are hoping to obtain a point of care instrument that will only do Ebola suspect specimens, otherwise we would have to decontaminate our main analyzers and delay care for other patients.

“Our concern is that we will be performing tests on patients that later are labeled as suspect and by then it is too late. We have simple PPE available, no N100s or impermeable gowns or hoods available.”

The Average American Hospital

The news showed that average American hospitals took care of Ebola patients; however, a few healthcare workers who came into contact with the Ebola virus became sick, despite following the CDC guidelines. Ebola is a contagious disease that has, on average, a 50 percent fatality rate. The outbreak of the Ebola virus in Africa is the largest in history – are our hospitals prepared if a serious outbreak took place here?

Decoded Science wanted to know how healthcare workers feel about this. Do they believe that their average hospital can care for patients with this level of disease? Among the healthcare workers Decoded Science interviewed, the consensus was that the average American hospital is not prepared to care for Ebola patients. Here are some of their responses:

Doctors assist each other with the donning of PPE before entering the Ebola treatment unit in Liberia. Image by the CDC.

“I do not feel that the average hospital can manage caring for Ebola. We have not had any training or in service. There needs to be a specialized unit for these patients. Most hospitals do not have the space or employees to provide that.”

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“Being a nurse I believe it is our duty to care for the sick, which includes Ebola patients. I think there should be specific isolation rooms in every hospital, which are equipped with negative pressure, specifically for Ebola patients. This may be an expense in the beginning, but would ensure the safety of the patient as well as nurse and would decrease transmission.”

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“After training in the State lab I can say for certain that the average hospital worker- nursing, lab, housekeeping, etc. are not prepared to work with a level 4 agent. Just the complexity of donning and doffing PPE is daunting and is very specific. Not many people are trained for this and the universal precautions.”

What’s Needed to Prevent Further Cases Among Healthcare Professionals?

The CDC has issued guidelines on personal protective equipment and on environmental precautions that are applicable to any healthcare setting, not just hospitals. The guidelines also state that each hospital is responsible for developing their own policies regarding monitoring healthcare workers who have potentially been exposed, as well as sick leave policies.

These guidelines are detailed and specific, resulting in the need for hospitals to provide training and education to their employees. So Decoded Science asked our interviewees, if your average American hospital is going to take care of Ebola patients, what would it take for healthcare workers to feel safe enough to care for the patients? Here’s what they told us:

“The average ICU nurse would need training on proper use of the adequate personal protective gear as well as frequent updates on disease process. I’m talking hazmat suits and the antiviral rinse afterward.  I do not believe my current hospital has these and I do not believe that they will, even in light of this current crisis. If nurses are going to care for Ebola patients they need to be properly informed and educated and protected!”

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“I do think it is okay for a nurse to take care of Ebola patients, but only if the hospitals are proactive with the training. The training should take place before they ever meet an Ebola patient. If I am already taking care of the patient before I know the proper PPE then I am possibly exposed.”

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“I am not a nurse but I have spent a lot of time in the ICU both professionally as an educator and personally with family members. I do not believe one nurse can adequately care for one Ebola patient, not only because of the severity of the disease but because there is so much time spent with PPE, waste management, supply management, decontamination processes, etc. it would take extensive level 4 training and a change in culture and thinking to care for these patients without spreading the disease. Specialized institutions have shown that they can successfully care for these patients because they have the appropriate mindset and training. I believe that the average hospital cannot without the risk of spreading the disease.”

 

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“For an ICU nurse, having a full protective suit (the CDC version) would make them feel more at ease about being protected. Opposed to the plastic gowns and masks currently provided. Also putting on and taking off a suit with another provider observing (to ensure it is being done properly) would make it less stressful. Second to PPE, having the proper education on Ebola is crucial to a healthcare provider. Knowing what it is and how it works is extremely important. If you know how a disease works then you can learn how to fight it. I feel like a nurse that is competent, cool, calm and collected then they would have no issue taking care of an Ebola patient. With that being said a nurse who is too afraid of becoming ill then I would suggest they not take care. Being too anxious leaves a lot of room for error. Caution would be my main focus.”

A scientist in a level 4 hazmat suit, works with the Ebola virus in a biosafety lab. Image by United States Army Medical Research Institute of Infectious Diseases

Ebola: Final thoughts from Healthcare Workers

When concluding the interviews, some of the healthcare workers left Decoded Science with final comments expressing concerns over their safety – and the safety of their family and friends – as well as their thoughts on how the CDC has handled the outbreak. Here’s what they said:

“I think the head of CDC should be fired for lack of action and blaming the first nurse for ‘breach of protocol’ when there was not proper protocol put into place to begin with.”

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“I think that the way the Dallas hospital has placed blame on the nurse who caught Ebola is wrong. In my honest opinion, she was probably doing what she was told, given improper PPE and the hospital will never have the employees back. It’s a sad situation.”

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“I believe that healthcare facilities should provide workers adequate paid training. If that involves sending a CDC trained employee to every hospital then so be it. Our healthcare workers need to be protected. Taking care of any patient is a risk. Someone has to do it. And we took our jobs knowing we could be in close contact with very sick patients. All we can do is to try to protect ourselves and others around us. Hand washing, proper isolation gear, educating people, providing quick diagnosis and treating the symptoms effectively.”

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“I feel for the nurse who called the CDC for information and was subsequently suspended. Because I asked questions about protocols and supplies and training, I was told I made my manager look bad and I should let management work things out and be patient. While I can understand this, I believe we are too slow in developing the best response possible with the resources we have and there needs to be more training and a sense of urgency to be prepared that currently is lacking.”

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“I would like to say that I think, being in the ER, I am more fearful because I’m on the front line. Our first admitting question now is -have you been out of the states in the last 6 months; have you been to or around anyone who has been to West Africa. It’s almost like we hold our breath until they answer that question. I do feel more confident with the way my hospital is handling the situation. There has been every form of education we can find, plus daily updates with CDC recommendations. It helps me feel more confident that if a child comes in with Ebola that I can do my best to help that child through the beginning process. As well as keep myself, co-workers, and family safe. With this whole situation I keep in mind this is what I signed up for. This is what I want to do. I want to help and do what I can to save/change lives.

Ebola is terrifying, but I’m not going to let it stop me from doing a job I love.”

Dedicated Ebola Hospitals in the U.S.

At the time of these interviews, it was not public knowledge that U.S officials and the CDC were working on dedicating certain hospitals to care for Ebola patients. On December 2, 2014, the Washington Post reported that U.S. officials have named 35 hospitals in the United States that are to care for Ebola patients.

State and hospital executives chose these hospitals and the CDC’s infection control team assessed them. These experts assessed these hospitals on having adequate staff, equipment, training, and resources to care for Ebola patients. Of these 35 hospitals, three hospitals have special isolation units, and have now cared for some of the Ebola patients in the U.S.

However, the average American hospital will need to stay updated on guidelines and training, should they have a patient come into their hospital with Ebola or suspected Ebola.

Ebola and Hospitals: Front-line Workers Worry About Their Safety

Healthcare workers are those who will be caring for you when you are feeling your worst. They expose themselves to various illnesses and diseases to do their job. They have expressed their concerns over safety, training and education, and their ability to do their job without infecting themselves or their family and friends. It is essential that we listen to the concerns of these front-line workers and act upon their concerns.

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