Minnesota nurses push for better Ebola gear

The Minnesota Nurses Association called on hospitals to provide "the highest level of protective equipment, such as hazardous material suits," for staff treating Ebola patients — the latest symptom of anxiety and second-guessing among hospital workers after a Texas nurse became infected while treating a patient with the deadly virus.

"We go into the community, into the grocery stores," said Linda Hamilton, president of the nurses' union. "If we get sick, people are going to get it from us." Full-body hazmat suits with respirators would be a substantial step beyond the gowns, gloves, masks and face shields currently stocked by Twin Cities hospitals and recommended by federal authorities. The resolution received a unanimous vote at the association's annual meeting, after an informal survey found only two of the 150 nurses on hand felt adequately trained and prepared to treat Ebola patients.

The worst Ebola outbreak on record has afflicted more than 8,000 people in west Africa and caused more than 4,000 deaths. Five Americans infected while in Africa have been treated in biocontainment facilities at Emory Healthcare in Atlanta and Nebraska Medical Center in Omaha.

Another American was diagnosed with the infection — and died last week — after returning from Africa to Dallas, and one of his nurses was infected despite wearing the federally recommended protective gear.

The nation's top disease-fighting agency acknowledged Tuesday that federal health experts failed to do all they should have done to protect the nurse from the Ebola virus.

Agency Director Tom Frieden outlined a series of steps designed to stop the spread of the disease in the U.S., including increased training for health care workers and changes at the Texas hospital where the virus was diagnosed to minimize the risk of more infections.

A total of 76 people at the hospital might have had exposure to Thomas Eric Duncan, and all of them are being monitored for fever and other symptoms daily, Frieden said.

Also Tuesday, doctors from Emory and Nebraska conducted a teleconference with more than 5,500 hospital and health care leaders, discussing everything from the conditions set by trash haulers who remove potentially Ebola-contaminated debris to the restrictions from water quality officials before flushing an infected patient's urine. Such measures are somewhat extreme, considering that the Ebola virus doesn't survive well outside the body, said Dr. Bruce Ribner, director of Emory's Serious Communicable Disease Unit. "This is not a very hardy virus."

Emory's Dr. Alexander Isakov said the federal recommendations for protective gear are sufficient and that he has worn the basic gown and gloves on many occasions when assessing patients whose symptoms and travel history suggest an Ebola risk.

However, the hospital has used full bodysuits and so-called PAPR (powered air purifying) respirators for its paramedics, doctors and nurses caring for its actual Ebola patients, because they had experienced fogging when wearing goggles and face shields, and also had the risk of wiping sweat from their foreheads with contaminated gloves.

"It just turned out to be more practical to have our provider wear the hooded PAPRs for comfort and convenience while taking care of these critically ill patients," Ribner said.

Health officials believe the chance of an Ebola case surfacing in Minnesota is remote, despite the Twin Cities' large population of people from the West African nation of Liberia, which has been the epicenter of the current outbreak.

But hospitals throughout Minnesota have been adding protective equipment, designating isolation rooms for patients suspected of Ebola infections, and conducting drills to test their readiness for any cases.

At least three Minnesota hospitals have reported seeing suspected Ebola cases, but all the patients turned out to have had other illnesses, such as malaria.

"We're ready today if it happens," said Kasey Paulus, director for quality and patient safety at Methodist Hospital in St. Louis Park.

Drills have tested the readiness of the Methodist ER to identify patients at risk of Ebola infections based on their symptoms and recent travel history, and to move them into isolation for further evaluation.

Next, Paulus said, the hospital will be testing how to safely move any actual Ebola patients to intensive care for treatment. The hospital is currently following the CDC guidance for the protective equipment its staff needs to wear around suspected Ebola patients.

Television images of the Emory caregivers in full protective gear and using respirators, however, have contributed to mixed messages.

Those images concerned caregivers at Regions Hospital in St. Paul, for example, where leaders opted to provide staff with full bodysuits instead of gowns.

Hamilton said Minnesota nurses should receive the same protections if that's what doctors at Emory and the CDC in Atlanta are wearing when they see Ebola patients. "When the CDC goes into those rooms, that's what they're wearing," she said. "And they're the experts!"

The Nebraska Medical Center had its own procedures for protective gear as well, such as requiring caregivers to wear two sets of gloves that were duct-taped at the wrist, and then a third layer of gloves over that. "Whatever form of personal protective equipment," Ribner said, "it is critically important to do proper training and completion of donning and doffing."

Hamilton agreed that procedures are critical, but said she still hopes for better protective gear for nurses. It's no small matter, she noted, because full bodysuits are bulky and poorly insulated and create a barrier between nurses and patients.

"They're hot, they're sticky, they're uncomfortable," she said, "but at the same time they're safe."

Jeremy Olson • 612-673-7744