With concerns about Ebola rising in the U.S. after a man died in Texas, hospitals in rural Kentucky are among those updating procedures for screening and treating infected people, providing training for employees and checking their supplies of biohazard suits to prepare in case they get a patient with the deadly virus.
The risk of Ebola coming to rural Kentucky is low, officials said, and there have been no cases in the state.
Furthermore, hospital officials said most rural facilities don't have the specialized staff, space, equipment and money to care for an Ebola victim for an extended time.
However, Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, pointed out that it's not known where a patient might enter the health care system. That means it is important that every hospital be able to correctly screen, diagnose, isolate and stabilize someone with Ebola before transferring them to a larger facility.
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On Friday, the Mountain Advocate newspaper in Barbourville reported that an ambulance brought a woman to the Knox County Hospital who was concerned she'd been exposed to Ebola. The hospital closed off the emergency room before determining the woman had not been exposed, the paper reported.
More than 4,500 people have died this year in an area of West Africa during the worst Ebola outbreak in history. The disease came to the U.S. by way of an infected man from Liberia, one of the three hardest-hit countries. Two nurses in Dallas who were treating the man reportedly got the virus despite wearing protective gear.
That has gotten a lot of attention among health care workers in Kentucky.
"We're looking at what happened in Dallas to make sure it doesn't happen here," said Amy Tomlinson, public health preparedness manager for the 10-county Lake Cumberland District Health Department, which has its main office in Somerset.
Tomlinson said the health department is sending out information daily on dealing with Ebola through a coalition which includes all nine hospitals in the region, as well as nursing homes, ambulance services and emergency managers.
"Everyone here is very aware of the threat," she said.
Officials at several rural hospitals and health departments said they're closely following streams of information from the federal Centers for Disease Control and Prevention and the state Department for Public Health and gearing up to handle an Ebola patient.
For example, the 63-bed Manchester Memorial Hospital in Clay County has taken steps that included adding questions to the patient-screening process to help determine the risk of Ebola, reviewing isolation procedures, and taking stock of protective gear, said president Erika Skula and Stephen O'Neal, the chief clinical officer. Hospital staffers plan to take part soon in an exercise with the health department, emergency officials and others.
J.D. Miller, chief medical officer for Appalachian Regional Healthcare, said the hospital chain has done education for staff members, started asking people with fever or flu-like symptoms whether they've traveled from an Ebola hotspot, and done training on how to use protective suits.
Miller said ARH hospitals also have added hoods to the protective suits for workers. The CDC had not recommended that initially, but added that because of the exposures in Dallas, he said.
ARH has eight hospitals in Eastern Kentucky and two in southern West Virginia.
Dana Garrett, nursing services administrator at Taylor Regional Hospital in Campbellsville, said the facility has increased coordination between department directors, put new screening procedures in place in the emergency room and elsewhere, and checks frequently for updated guidance from the federal Centers for Disease Control and Prevention.
Joe Murrell, chief executive officer at the 25-bed Wayne County Hospital, and Sheila Hickey, the infection-control coordinator, said the hospital has updated screening questions, reviewed procedures and posted advisories on dealing with Ebola. The hospital also put a new battery in a piece of equipment used to make sure no contaminated air escapes an area where an Ebola patient would be treated.
But the hospital — in fact, most rural hospitals — don't have the resources to treat an Ebola patient for a long period, Murrell said. He said the protocol for hospitals would be to put an Ebola patient in isolation, then contact the local or state health department for guidance on whether to transfer the person.
Pikeville Medical Center is renovating an unused part of the 261-bed facility to create an isolation ward in case it needs to treat Ebola patients, said Walter E. May, president and chief executive officer. The hospital also is training an Ebola treatment team.
May said gearing up for the threat is an expensive challenge. For instance, the hospital now has only a few of the hundreds of hazardous-materials suits it would likely need to provide long-term care for Ebola patients, he said.
May said he doesn't think Kentucky — or the nation — is prepared for a large outbreak of Ebola. One issue is a lack of specialized-care facilities. But there also is a problem with conflicting information, May said.
One example: May said Pike-ville Medical officials took part in calls in recent days with two of the four U.S. hospitals with high-level containment units that have been used to treat Ebola patients, and heard differing recommendations on how many layers of gloves to use.
Kevin Kavanagh, a Somerset physician and board member of Health Watch USA, which promotes health care transparency, competition and patient advocacy, said health care providers may be doing all they know to do to prepare for Ebola, but that there are still unanswered questions.
Kavanagh said his understanding is that the CDC does not yet know how the Dallas nurses got infected despite wearing protective gear. Other questions include what plans hospitals have made to dispose of medical waste and the extent of knowledge about how the disease spreads, he said.
Kavanagh said the Dallas case also highlights concerns that healthcare facilities don't do an adequate job of controlling infectious organisms.