Health & Medicine

Kentucky hospitals changing procedures after Ebola problems in Dallas

Kentucky health officials are learning from the mistakes made by the Dallas hospital coping with the country's first Ebola case.

"It has certainly raised some concerns and we are looking back at a lot of our practices and we are making some changes," said Dr. Derek Forster, UK HealthCare epidemiologist and medical director for infection prevention and control.

"What has happened has really heightened the concern that maybe our health care system wasn't as prepared as the CDC (Centers For Disease Control) thought it was," said Dr. Mark Dougherty, epidemiologist for Baptist Health.

Two nurses who treated the country's first Ebola patient, Thomas Eric Duncan, have tested positive for the disease. Duncan was treated at Texas Health Presbyterian Hospital in Dallas.

Officials from National Nurses United, a union, are raising concerns about the lack of proper protective equipment and training and education about Ebola.

There have been no reported cases of Ebola in Kentucky.

Ebola is not an airborne illness, like tuberculosis. It can be passed along only through contact with body fluids.

In Dallas, nurses claim protective equipment left skin exposed to such fluids and that they were not properly trained on how to take off the equipment.

The CDC's minimum requirement had been a gown, gloves and goggles.

But, following concerns raised in Dallas, Forster said UKHealthCare will be requiring anyone dealing with a potentially Ebola-infected patient to wear a full protective suit covering the entire body. Dougherty said Baptist Health Lexington is also adopting more stringent requirements for protective gear.

At both UK and Baptist Health, staff members are practicing putting on and taking off protective gear.

Properly taking off the protective suits and gloves can take 30 minutes, Dougherty said.

Both Baptist Health and UK have asked for volunteers willing to work with Ebola patients, and those staff members will get additional training.

Dougherty said the Dallas case, where some 70 hospital workers were involved in the care of a single patient, shows a need to minimize the number of people caring for an infected patient.

UK and Baptist Health are also focusing on prevention in the emergency rooms. Dougherty said a "decoy" patient was sent through the ER at Baptist Health without the staff's knowledge to test the hospital's readiness to deal with a real case. He said the staff followed the appropriate protocols and that other test runs are in the works.

The UK hospital has one of the longest wait times in the country and is frequently overcrowded, requiring patient beds to line the hallways. Steps are being taken to ensure patients are not infected in the emergency room, said Kim Blanton, UK HealthCare Enterprise Director for Infection Prevention & Control/Safety. Every patient coming into the ER is being asked about his travel history. If patients have recently traveled to one of the most infected countries, such as Liberia, Sierra Leone or Guinea, they will immediately be taken to an isolation room, Blanton said.

"The minute they tell us they have that history of travel we are not even asking them for symptoms," she said. Blanton said UK has several isolation rooms available near the ER, and there are also isolation rooms throughout the hospital. The isolation rooms are equipped with negative air pressure that helps reduce cross-contamination.

Dr. Kraig Humbaugh, the state's epidemiologist, said because Ebola is not an airborne illness, an "isolation space" doesn't need to have negative air pressure. It can be a private room with a private bath. Any hospital in the state should be able to provide that, along with proper protective equipment for their staff, he said.

Humbaugh said the state is sending frequent updates to health departments, medical organizations and infection control officers at hospitals to encourage providers to ask about travel to countries with Ebola outbreaks.

Fayette County Health Commissioner Dr. Rice Leach said because he has been receiving more and more calls from health professionals with questions, he is planning a seminar on Ebola.

Leach said there is no need to panic.

If you haven't traveled to a country with an outbreak, he said, "the chances of you having Ebola are slim to none."

It is a good sign that health officials are seeing what is happening in other places and looking to improve their plans, Leach said.

"This thing is a fluid situation," he said. "It's been 100 years since the United States has had to deal with something like this."

The latest news out of Dallas has raised the level of awareness among the public, Humbaugh said. But, he said, hospitals, health departments and other medical professionals have been involved in preparing for Ebola for months.

Dr. Stephanie Mayfield, the state commissioner of public health, said the fact that one of the nurses infected in Dallas flew to Cleveland does not affect how Kentucky is reacting.

Public health officials, she said, are already on full alert. "We understand that people may heighten concern," she said. But, she said, whether a case is in Texas or Ohio, "we all need to be prepared. We still need to have that same level of concern and that same heightened level of preparedness."

In the long term, Dougherty said he's not sure that smaller hospitals have the capacity to handle Ebola cases. Texas Presbyterian was an established teaching hospital, he said, and there were lots of mistakes made.

He said "centers of excellence" with particular expertise and experience treating Ebola may need to be established.

David McArthur, spokesman for KentuckyOne Health, said the hospital chain that operates St. Joseph and St. Joseph East in Lexington is monitoring the Ebola situation and is prepared: "KentuckyOne Health has an extremely effective infection-control team and well-trained staff across all of our facilities."