Area health-care providers are ramping up infectious-disease protocols and employee training to ensure they are ready to respond to an unlikely but potential diagnosis in West Virginia — Ebola, the viral hemorrhagic fever wreaking havoc in several West African countries.
For local hospitals, such as Charleston Area Medical Center, Saint Francis and Thomas Memorial, that means screenings of every patient that include one important question: whether they’ve traveled recently to Liberia, Sierra Leone, Guinea or another West African country where outbreaks of the disease have been confirmed.
“Currently, patients are being screened at all points of entry in our facilities — inpatient and outpatient,” said Leslie Blackhurst, an infection control nurse for Saint Francis Hospital. “We actually ask the travel question first, regardless.”
Paige Johnson, spokeswoman for Thomas Health System, said Thomas and Saint Francis hospitals have established an active Ebola planning team to address the potential of an Ebola patient. The team is working on protocols for identification, isolation settings and strategies, placement, needed supplies and equipment, sanitation and cleaning needs and any additional treatment challenges that might occur.
“We’ll be having further training as a step-up from our normal isolation precautions,” said Sarah McClanahan, an infection control nurse at Thomas. “We’ll have ongoing training and education, because it’s definitely not something you can mention once and not mention again . . . we will have those additional trainings for the duration of this crisis.”
The two hospitals are following all protocols recommended by the state and in cooperation with the Centers for Disease Control and Prevention and the World Health Organization.
Additional medical staff training at the hospitals has incorporated the use of a “buddy system,” to create more accountability for the precautions used by workers, and has focused more on the proper use of Personal Protective Equipment, to avoid contamination.
The two health-care workers who tested positive for Ebola after treating Thomas Eric Duncan, the Liberian man who died of the disease last week at Texas Health Presbyterian Hospital Dallas, likely were exposed to the disease by improperly removing their PPE, officials said.
CAMC has been updating its protocols in the past several weeks, according to Terrie Lee, director of infection prevention and employee health for CAMC hospitals. She said nurses and other health-care workers have volunteered to be part of a treatment team for any potential case of Ebola, and all of CAMC’s hospitals are prepared for an initial patient intake, although ongoing care would be provided at one of the Charleston facilities, she said.
“If, as time goes on, we need additional folks to help beyond what we have with our initial volunteer staff, we would work toward that,” Lee said. “I’m reminded of 30 years ago, when we first started really dealing with HIV, and I was in the department then, also. There are similar reactions.
“When we first start caring for patients with a strange new disease that people are afraid of, after we’re able to demonstrate that we can give compassionate care to people who need us and that people can be protected during that interaction, it gives people confidence to bring others in the circle and help provide care.”
Both hospital systems are part of a task force formed earlier this month and coordinated by the Kanawha-Charleston Health Department. The task force includes representatives from CAMC, Thomas Health Systems, Highland Hospital, MedExpress, the Kanawha County Emergency Ambulance Authority, Kanawha County Office of Emergency Management, Putnam County Emergency Medical Services, the KCHD, the Putnam County Health Department and the Charleston Fire Department.
Dr. Rahul Gupta, chief health officer for the KCHD and the Putnam health department, said the goal of the task force is to elevate the response of every health-care provider who could come in contact with an infected person. The KCHD is the agency coordinating those efforts but, in the event of a case, it would serve another important function: The agency would be responsible for identifying those who had been in contact with the patient and quarantining them or asking them to monitor themselves for symptoms —- something the KCHD is working to develop.
“What we need to be prepared to do, on one hand, is isolate and quarantine people in their home,” Gupta said. “We ought to be able to separate them based on the varied levels of exposure among family members and friends. On the other hand, the first effort is to avoid a situation like with [Thomas Eric Duncan] developing, where an individual would be allowed to come into contact with multiple individuals before they are appropriately diagnosed.
“If you end up having a full 40 or 50 people who come into contact, the question becomes, how do you isolate them? How do you determine whether they need isolation or self-monitoring?” Gupta said.
Ebola can spread only through direct contact with an infected person’s blood or body fluids or by direct contact with objects contaminated by an infected person’s blood or body fluids or by infected animals, according to the CDC.
The second health-care worker diagnosed after contact with Duncan, Amber Vinson, was allowed to fly on commercial flights between Dallas and Cleveland, even after she reported a low-grade fever to the CDC before her return flight from Cleveland, according to The Associated Press. The CDC is now considering putting 76 health-care workers at Texas Health Presbyterian Hospital Dallas on the TSA’s no-fly list, according to CNN.
Yeager Airport, in Charleston, had its own concerns Wednesday, when a passenger on a Delta flight reported that three other passengers in adjacent seats might have been exposed to Ebola. The three were quarantined at the airport and Ebola was quickly ruled out, after it was found that none had traveled to West Africa or exhibited any symptoms. Gupta said the passengers had been discussing Ebola on the plane. He said he believes other passengers might have misunderstood their conversation and thought they had been exposed to the disease.
“Everybody responded, we isolated the passengers in question, we screened them to make sure they had no symptoms or travel history, but in the process, even though it turned out there was no suspected case, it did get everyone involved — local, state and federal,” Gupta said. “It gave us a better understanding of how significant this threat can be.”
Had they needed to transport anyone to the hospital, the KCEAA has been working to prepare for just such a scenario, said director Joe Lynch.
“We have taken an ambulance and are in the process of having it made up so that, if we did have to move patients, we could,” Lynch said. “From [Sept. 11], the state has issued us a regional response vehicle equipped with decontamination equipment and suits to protect our people. We have a small group of people who are trained in the event that, at some point, this might happen.”
Jerry Rhodes, director for the Center for Threat Preparedness at the Department of Health and Human Resources, said West Virginia already has in place “comprehensive and redundant” email and alert systems, to keep local health agencies informed of protocols for outbreaks and health emergencies, and that all 49 health departments in the state are receiving information from the CDC and WHO on the procedures for best addressing the threat.
Stan Mills, coordinator for threat preparedness at the Cabell-Huntington Health Department, and Michelle Trickett, regional epidemiologist at the Beckley-Raleigh County Health Department, said they have received additional preparation directives from the state.
“We have infectious-disease outbreaks every day in this country. That’s why we have epidemiology specialists at the state and local level. The best thing we can do is make sure we keep a level head and make sure we understand the particular incident we’re facing — its significance and severity — and look at how we’re going to manage that,” Rhodes said. “Managing that perspective is probably one of the most important things we do, and this is no different. This is a serious disease, but there are, thankfully, no cases in West Virginia and the likelihood of acquisition or transmission of the disease in this state is very, very low.”
The state has an epidemiology hotline that residents can call with questions about infectious diseases, at 1-800-423-127. The CDC also has an information hotline, focused on preparedness and emergency infections, at 404-639-0385.
Reach Lydia Nuzum at lydia.nuzum@wvgazette.com, 304-348-5189 or follow @lydianuzum on Twitter.