Did safety protocols fail nurse infected with Ebola?

Nina Pham, a 26-year-old nurse, is the first person to become infected by Ebola on US soil.

But with strict guidelines on how health workers can protect themselves while caring for victims of Ebola virus disease (EVD), questions are now being asked about how she was infected. Were protocols breached or did they fail?

The virus isn't as easily transmitted as some, as we discussed in our briefing on the outbreak.

"Something went wrong, and we need to find out why and what," Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN.

The US Centers for Disease Control and Prevention (CDC), which has been at the forefront of the fight against the latest outbreak, has launched an investigation into safety practices at Texas Health Presbyterian Hospital in Dallas where Pham works and is now in isolation.

Dr Thomas R. Frieden, the director of the CDC, says Pham's case has prompted the agency to “substantially” rethink how it approaches infection control for health officials.

Scientific American has a good rundown of the issues.

The source of Pham's infection is clear: She cared for Thomas Duncan after he entered the isolation ward at the hospital on September 30. (Duncan caught the virus in Liberia but did not become sick until after he traveled to Dallas.) What is unclear is how Pham became infected even though she was wearing protective gear.

The CDC has strict guidelines (pdf) on the minimum protection requirements – gloves, goggles, a gown and a mask or respirator – and Pham complied, as all Duncan's nurses did.

But simply covering up is not enough to prevent spread of the virus. In addition to ensuring that no skin is exposed, health care workers must exercise extreme caution while with the isolated patient—to avoid needle pricks and other accidental routes of contamination. And perhaps the most challenging link in the chain is the exiting procedure. After leaving the isolation area a healthcare worker must be fastidious in properly removing each potentially contaminated item safely. "Health care workers need to be meticulous," says Jeff Duchin, a professor of infectious diseases at the University of Washington School of Medicine and chief of communicable disease and epidemiology for Public Health—Seattle and King County, who spoke with Scientific American about infection control. "The potential to expose yourself is real."

Now the CDC is monitoring the healthcare workers caring for Pham and has set up a buddy system to ensure all of the safety steps are followed and to see how they can improve procedures.

Pham was reported to be in good condition as of Wednesday evening, Dallas time, and her hospital remains optimistic about her recovery.

  1. https://beta.cosmosmagazine.com/life-sciences/ebola-no-quick-solutions
  2. http://www.cdc.gov/vhf/ebola/pdf/ppe-poster.pdf
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