Friday, October 17, 2014

Dallas Nurse Risks Her Job at Hospital (New York Times--October 17, 2014)

Controls Poor in Dallas, Nurse Says

DALLAS — A nurse who observed and participated in the care of Ebola patients at Texas Health Presbyterian Hospital spoke out publicly on Thursday about what she characterized as inadequate training and infection control there.
The nurse, Briana Aguirre, 30, who has worked at the hospital for three years, said in an interview that when Thomas Eric Duncan arrived at the emergency room on Sept. 28, it took at least three hours to place him in isolation, despite suspicions that he had contracted the deadly virus. Mr. Duncan had visited the emergency room three days earlier with a fever and other symptoms, as well as a history of recent travel from West Africa, but was sent home with antibiotics after being misdiagnosed.
Ms. Aguirre described a confused and chaotic scene when he returned. “A lot of questions unanswered, staff not knowing exactly what to do, mishandling things,” she said.
The doctor handling the case, whom Ms. Aguirre would not name, waited hours to call the Centers for Disease Control and Prevention for guidance, she said.
Briana Aguirre, a nurse at Texas Health Presbyterian Hospital in Dallas, spoke of inadequate protocols for dealing with Ebola. Credit Cooper Neill for The New York Times
“I know he spent a multitude of hours in an area where anyone could be walking up and down the hall,” Ms. Aguirre said of Mr. Duncan. “He was in a room with a closed door, but the same staff that was caring for him was caring for other people at that time and it stayed that way anywhere from three to five hours.”
She said that up to seven patients may have been in the emergency room with Mr. Duncan. Eventually, she said, the other patients were removed from the area and the emergency room became Mr. Duncan’s isolation unit for two days.

More Ebola Coverage

Ms. Aguirre, who lauded the general quality of care at the hospital, said she had come forward because she had lost confidence in her employer and feared that fellow nurses and other staff had been put at risk. She is one of several nurses who anonymously released a statement on Tuesday night that made similar claims.
“I’m not alone in my feeling that someone needs to know what has been happening inside those doors,” she said.
On Thursday night, the hospital issued a statement saying that when Mr. Duncan arrived at the emergency room, “he was moved directly to a private room with a negative air pressure and placed in isolation,” and that the hospital’s infection control coordinator “was properly notified in a timely manner of the initial diagnosis.” It said it had followed C.D.C. guidelines in effect at the time.
Ms. Aguirre also helped care for her fellow nurse, Nina Pham, for several days after Ms. Pham contracted the virus while treating Mr. Duncan. Ms. Aguirre is one of more than 70 health care workers being monitored because they helped treat Ebola patients. She said that she has been instructed to take her temperature twice a day and that she receives a daily call asking if she has symptoms.
Ms. Aguirre said she and other nurses were “horrified” at the protocols used to care for Ms. Pham. She said they received instruction only once about the proper use of personal protective equipment — gloves, masks, gowns, hoods and shields — before entering Ms. Pham’s room, and then were shown how to remove the potentially contaminated gear while in the room. The garb left a triangle of skin exposed on the front of her neck.
“The very first time I was being instructed to put the stuff on I immediately voiced my concerns,” Ms. Aguirre said. “Why would I be wearing two pairs of gloves, three pairs of bootees, have my entire body covered in plastic, have two hoods on and have an area so close to my mouth and my nose exposed? And they said, ‘We know, we’ve addressed it and basically our verdict on that at this time is we’re taping that area closed.’ ”

She said the hospital had offered a single, voluntary session on treating Ebola patients a month or two before Mr. Duncan’s arrival. “There were some fliers stuck up in our break room saying they were having a seminar to discuss some facts about Ebola,” Ms. Aguirre said. “I didn’t go. I had a friend who said it was good information, very interesting, but it was not hands-on. It was just a lecture.”

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