By Julie Steenhuysen
CHICAGO (Reuters) - When Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), visited Ebola-stricken sites in West Africa last August, he was dressed in a full protective bodysuit and ventilator.
That level of protection was far greater than the basic gear the CDC initially recommended for U.S. hospital workers, which at minimum included a gown, a single pair of gloves, a mask and face shield.
After a second nurse at Texas Health Presbyterian Hospital in Dallas fell ill with Ebola after caring for a dying Liberian patient, the CDC this week beefed up its recommendations for personal protective equipment to include hooded full-body suits that cover the neck, more frequent hand washing and a supervisor who oversees the removal of infected gear, steps experts said should have been done long ago.
"The frightening truth is that we cannot guarantee the safety of our healthcare workers on the front lines of response," U.S. Representative Michael Burgess of Texas said on Thursday at a congressional hearing focussed on missteps in the Ebola response on American soil. Burgess brandished a picture of Frieden in full protective garb in Africa.
Frieden responded that the type of protection varied from one Ebola setting to the next. But the issue of how well nurses and doctors are protected against the virus has become a flashpoint as the United States now handles its first cases of the disease that has already killed nearly 4,500 people in Sierra Leone, Guinea and Liberia.
"Most U.S. hospitals will tell you they are following CDC protocols, but CDC protocols are evolving," said Dr. Dan Kelly, an infectious disease doctor based at University of California, San Francisco, who is currently in Sierra Leone.
Frieden said on Wednesday that unfamiliarity and inconsistent use of protective gear may have contributed to the infection of the two Dallas nurses, Nina Pham and Amber Vinson, who cared for Thomas Eric Duncan through bouts of extreme vomiting and diarrhoea.
When a CDC team arrived in Dallas, they noticed some hospital workers were putting on three or four layers of gloves and apparel "in the belief that this would be more protective," Frieden said on Wednesday.
But adding more layers makes it "much harder to take them off," increasing the risk of contamination, he said.
Dr. Daniel Varga, chief clinical officer and a senior vice president for the hospital's parent company, Texas Health Resources, defended its use of protective gear at the hearing, saying both nurses "were using full protective measures under CDC protocols." But he acknowledged that hospital staff had not been trained to handle Ebola patients.
Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, has given training on Ebola preparedness at five U.S. hospitals in the past few weeks. He believes the CDC's protocols were inadequate.
Macgregor-Skinner instructs healthcare workers to wear a protective suit, rubber boots that can be decontaminated, two pairs of gloves, head covering, a mask and a face shield or goggles.
Several U.S. medical centres have adopted policies that exceed CDC's guidelines for protective gear based on standards set by the World Health Organisation and protocols developed by Emory University in Atlanta and the Nebraska Medical Center in Omaha, which have successfully treated Ebola patients airlifted from Africa to their high-security biocontainment units.
"We are going higher than what the CDC has said," said Dr. Marc Napp, deputy chief medical officer at Mount Sinai Health System in New York. "We have been really grappling with this for two-and-a-half months."
For example, when Mount Sinai admitted a suspected Ebola patient in August, one of the hospital's infectious disease physicians who does research on Ebola "insisted on going to his lab" and getting his impermeable hooded Tyvek suit.
That set a model for all hospital staff. Mount Sinai is bringing in experts to train them on the proper way to put on and take off the suits.
Luke Chen, an infection prevention expert at Duke University Medical Center in North Carolina said the hospital is designating a specific group of experienced staff to treat Ebola using full-length Tyvek suits.
"We know the patient requires basically 24/7 care. You don't want to be looking down at your shoe or checking your pant leg," to see if your protective gear is intact, Chen said.
Ensuring nurses remain confident while dealing with what can be a terrifying disease is essential, experts said.
When Macgregor-Skinner was in Port Harcourt, Nigeria, an Ebola patient vomited on a nurse he was training.
"She was very upset and reacted by wanting to remove her (protective gear) right away. I had to hug and hold so she didn't, and so now I was also covered in vomit," he said.
Once she calmed down, they went through the slow process of decontaminating and removing her protective clothing, using the buddy system, a strategy now recommended by the CDC.
"She never became a patient."
(Reporting by Julie Steenhuysen; Additional reporting by Terry Wade in Dallas; Editing by Michele Gershberg and Jonathan Oatis)