As hospitals across America prepare for the potential of handling Ebola cases, concerns are increasing regarding determining a uniform protocol for treating patients while securing the safety of medical staff. Given that two Dallas nurses, Nina Pham and Amber Vinson, contracted the virus in the course of their work, the Centers for Disease Control and Prevention (CDC) and the nation’s medical experts are anxious that hospitals establish guidelines for treating Ebola patients and effectively protecting doctors and nurses. This need has created certain controversies. For instance, medical facilities now face the dilemma of whether or not to forgo certain aggressive treatments for Ebola patients as a safeguard against exposing medical professionals to the virus.
Currently, there are no national guidelines for what procedures to use or to forgo in treating Ebola patients. There are conflicting practices at medical facilities nationwide, giving rise to ethical debates. Some facilities have opted to forgo cardiopulmonary resuscitation, which requires mouth-to-mouth contact with patients, and invasive surgical procedures, which put the several medical professionals necessarily involved in such a procedure at increased risk of contracting the virus. Proponents of this approach argue that such aggressive treatment would only be called for in patients for whom there is little chance of saving, and so pursuing such treatment is not worth the increased risk of spreading the virus. However, it is contrary to the instincts of most doctors to decline to do everything possible to intervene, and some argue that it is not certain what constitutes futile care. The CDC calls for keeping lab testing and medical procedures to a minimum, but states that decisions should be made by attending physicians in each particular case.
There is also some debate over whether just any hospital is prepared to carry out the necessary protocol. Ebola cases present particular challenges. For instance, there is the question of how to properly handle infectious waste, such as garments soiled with bodily fluids, from Ebola patients. Some hospitals have more experience dealing with infectious diseases and perform regular drills in how to handle biohazards. Tom Skinner, a spokesman for the CDC, has been quoted as saying the agency is “exploring further” the idea of making particular hospitals designated Ebola treatment units. Restricting Ebola treatment to the most prepared and well-trained facilities may help prevent the virus’ spread to medical professionals.
Proper training of nurses and medical staff, particularly with regard to the Ebola PPE (personal protective equipment) they wear when treating patients, is essential to ensuring the safety of those professionals and that all vital protocol is performed. It is necessary to have the right gear, from Ebola suits to protective hoods, to put such gear on in the right order, and to remove it properly. CDC Director Tom Frieden identified gear removal as a “major potential area for risk.” Extreme care must be taken to avoid contaminating regular clothing, eyes or mucous membranes. An official with direct knowledge of Nurse Pham’s case reported that there were “inconsistencies” in the type of personal protective gear Pham wore and with the process she used to put the gear on and remove it. Teresa Romero, a nurse’s aide who contracted Ebola while treating a patient in Spain, has said she received only 30 minutes of training in putting on protective gear, prompting her husband to publish a scathing letter and to call for the resignation of Madrid’s regional health minister. The World Health Organization advises that the dressing and undressing of protective wear should be supervised by another trained member of the medical team. A “buddy system,” in which a safety supervisor consistently monitors the worker from the time he or she puts the gear on until the time it is taken it off, has been effective in stopping other kinds of infection in hospitals.
Healthcare workers are the nation’s best defense in preventing the further spread of Ebola. Ensuring their safety from infection as they treat Ebola patients is paramount. For more information on the CDC’s current recommended Ebola protocol, visit their website.