Q&A: How are Minnesota hospitals adjusting their Ebola prep?

Blood samples
Rochelle Zarzar shows the type of plastic blood tubes that would be used to transport suspected Ebola specimens to the laboratory at Hennepin County Medical Center.
Lorna Benson / MPR News

Minnesota hospitals continue to review their Ebola preparedness plans after Wednesday's news that a second Texas health care worker is being treated for the deadly virus.

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Investigators have not pinpointed how the two Texas nurses contracted Ebola from a patient in their care. But during a news briefing Wednesday the director of the CDC said the highest risk period to hospital staff was likely during the first several days of patient treatment.

How are Minnesota hospitals adjusting their Ebola preparations in light of the news?

What concerns CDC investigators about the first few days of care for the first Ebola patient, Thomas Eric Duncan?

Duncan returned to Texas Presbyterian Hospital on Sept. 28 after being sent home from the hospital's emergency department a few days earlier. When he was finally admitted, he was very ill and very infectious.

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The two health care workers who gotten sick so far worked during those early days of his care and had extensive contact with the patient when he was vomiting and secreting other bodily fluids.

According to the CDC, the Texas hospital had a variety of personal protective gear. Having different types of gear can make it harder to remember how to put it on correctly. The CDC also observed that hospital staff were adding extra layers and taping parts of the protective gear. That can make it harder to take it all off, which can raise the risk of contamination.

What's the takeaway for Minnesota hospitals?

The simple message to hospitals everywhere is that a lot of different types of personal protective equipment can be effective, but only if staff members are really familiar with that equipment — and if they've practiced donning and doffing the gear multiple times.

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Are hospitals doing that? Are they having their staff members practice with the gear?

Well, it's been a confusing few days for hospitals. Initially many were convinced that they had all the safety equipment they needed. But these cases in Texas have made some of them re-evaluate their personal protective equipment.

For example, Children's Hospitals and Clinics of Minnesota has ordered a few different types of full-body hazmat-style suits. The idea is to see whether these suits are easier to use and if front-line workers feel safer using them. But if staff members decide to switch to these coverall suits, they will have to invest more training time to learning how to properly remove them. These are not simple decisions to make.

What are other hospitals saying about their preparations?

It's tough to say. Over and over, hospitals have said that their key Ebola experts are in meetings or are conducting drills and exercises this week.

They've also been trying to keep up with CDC briefings. Yesterday, more than 6,200 health care workers across the country called in to the CDC's briefing. Like the rest of us, they're seeking more information and more guidance on the diesase.

Dr. Peter Bornstein, medical epidemiologist at HealthEast, said hospitals throughout Minnesota are in what he calls "a deep-learning dive."

He said preparing for a possible Ebola case has put a strain of time and money on health care systems.

"We're already pretty lean organizations, and so now, when we have to learn all of a sudden this very new type of process, it's pretty stressful," he said. "So a lot of people are very concerned. You hear the nurses are very concerned. Physicians are very concerned. Everybody is very concerned."

Is there anything that can be read into the decision to move one of the sick Texas health care workers to Emory University Hospital in Atlanta? Is it possible that hospitals here could hand off Ebola patients if they don't feel prepared to care for them?

That is possible. It's not clear yet if some of these more experienced centers will be willing to receive additional Ebola patients going forward. The CDC says it is in conversations about that possibility.

But there's no getting around the fact that, at a minimum, every hospital has to be prepared to safely isolate and diagnose Ebola, if a patient walks through its doors with fever symptoms and recent travel to places where Ebola has broken out or possible exposure to someone with the disease.

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