Updated 11:44 a.m.
Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, confirms that Ebola patient Nina Pham, whose family lives in Fort Worth, is being transferred to the National Institutes of Health Hospital in Bethesda, Md. The biocontainment hospital is one of four in the nation.
Updated 7:37 a.m.
Texas Health Presbyterian Hospital this morning sent out a point-by-point statement about allegations of sloppy procedures made Wednesday by the union National Nurses United. Here is the hospital’s statement in full:
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“National Nurses United recently made allegations regarding the protocols and equipment in place during Thomas Eric Duncan’s treatment at Texas Health Presbyterian Hospital Dallas. The assertions do not reflect actual facts learned from the medical record and interactions with clinical caregivers. Our hospital followed the Centers for Disease Control (CDC) guidelines and sought additional guidance and clarity.
The following are facts about procedures and protocols in place during Mr. Duncan’s treatment:
• When Mr. Duncan returned to the Emergency Department (ED), he arrived via EMS. He was moved directly to a private room and placed in isolation. THD staff wore the appropriate personal protective equipment (PPE) as recommended by the CDC at the time.
• Regarding the ED tube delivery system utilized during Mr. Duncan’s initial visit, all specimens were placed into closed specimens bags and placed inside a plastic carrier that travel through a pneumatic system. At no time did Mr. Duncan’s specimens leak or spill – either from their bag or their carrier – into the tube system.
• During Mr. Duncan’s second visit, the tube system was not used at all. His specimens were triple-bagged, placed in a container, and placed into a closed transport container and hand-carried to the lab utilizing the buddy system. Additionally, while Mr. Duncan was in the MICU, all lab specimens were hand-carried and sealed per protocol. Routine labs were done in his room via wireless equipment.
• Nurses who interacted with Mr. Duncan wore PPE consistent with the CDC guidelines. Staff had shoe covers, face shields were required, and an N-95 mask was optional – again, consistent with the CDC guidelines at the time.
• When the CDC issued updates, as they did with leg covers, we followed their guidelines.
• When the CDC recommended that nurses wear isolation suits, the nurses raised questions and concerns about the fact that the skin on their neck was exposed. The CDC recommended that they pinch and tape the necks of the gown. Because our nurses continued to be concerned, particularly about removing the tape, we ordered hoods.
• Protective gear followed governing the CDC guidelines at the time.
• The CDC classified risk/exposure levels. Nurses who were classified as “no known exposure” or “no risk” were allowed to treat other patients per the CDC guidance.
• Per the CDC guidelines, patients who may have been exposed were always housed or isolated per the CDC guidance.
• Regarding hazardous waste, the hospital went above and beyond the CDC recommendations. Waste was well-contained in accordance with standards, and it was located in safe and containable locations.
• Admittedly, when we received Tyvek suits, some were too large. We have since received smaller sizes, but it is possible that nurses used tape to cinch the suits for a better fit.
According to an employee satisfaction survey by Press Ganey, Texas Health Dallas is in the top one percent in the country when it comes to employee engagement and partnership. We support the tireless and selfless dedication of our nurses and physicians, and we hope these facts clarify inaccuracies recently reported in the media.”
A Dallas nurse who is the second to be diagnosed with Ebola took a commercial flight to Dallas/Fort Worth Airport the day before she tested positive, heightening anxiety far beyond Dallas about the potential spread of the disease.
The new diagnosis came amid harsh criticism of Texas Health Presbyterian Hospital Dallas for procedures said to have been used in the care of the original Ebola patient, Thomas Eric Duncan. He died at the hospital Oct. 8.
Since then, two workers who cared for him — nurses Nina Pham, 26, and Amber Vinson, 29 — have tested positive for the lethal virus.
Vinson, of Dallas, tested positive around midnight and by Wednesday afternoon was being transferred from Presbyterian to Emory University Hospital in Atlanta at the request of the Centers for Disease Control and Prevention and Arlington-based Texas Health Resources, Presbyterian’s parent company. She arrived at Emory on Wednesday evening, and her condition was unknown.
Pham was reported to be in good condition Wednesday, Presbyterian said.
On Monday, Vinson flew on Frontier Airlines Flight 1143 from Cleveland to DFW, according to the CDC. Dr. Thomas Frieden, the agency’s director, said that the 132 passengers on the flight are at “low risk” for contracting Ebola but that the agency nonetheless is trying to reach all of them.
Late Wednesday, the Eagle Mountain-Saginaw school district alerted parents that a parent of one of its students was on the plane. The parent is in the military, stationed at Naval Air Station Joint Reserve Base Fort Worth, the district said.
“Upon advisement from the military, and as a precautionary measure, the family will be isolated for 21 days,” according to a statement on the district’s website.
“No members of this local family are exhibiting any symptoms and are being isolated purely as a precautionary measure. Since no member of the family has presented any symptoms, there is nothing to indicate that the disease has or will be spread,” the statement continued.
The new Ebola diagnosis prompted both President Barack Obama and Gov. Rick Perry to cancel travel plans. Obama had planned a fundraising trip to New Jersey and Connecticut, while Perry was in Europe.
“We’re operating in a pretty dynamic environment right now,” White House spokesman Josh Earnest said, adding that the administration is addressing the situation in a “tenacious” manner.
A Perry spokesman released no details other than to say he was returning because of the Ebola situation.
In testimony prepared for a congressional hearing today, Daniel Varga, chief clinical officer at Texas Health Resources, admitted that the hospital “made mistakes” in its initial treatment of Duncan.
“We did not correctly diagnose his symptoms as those of Ebola. We are deeply sorry,” Varga said in written testimony filed with a House Energy and Commerce subcommittee.
“Also, in our effort to communicate to the public quickly and transparently, we inadvertently provided some information that was inaccurate and had to be corrected,” he said. “No doubt that was unsettling to a community that was already concerned and confused.”
Varga indicated that he would not attend the hearing in person. Frieden was also scheduled as a witness.
Union: Nurses say waste piled up
Vinson’s diagnosis came after a nurses union said it had been contacted by nurses at Texas Health Presbyterian who were concerned about how the hospital handled the first Ebola patient.
According to Deborah Burger of National Nurses United, nurses at the hospital had to use medical tape to secure openings in their flimsy garments and worried that their necks and heads were exposed as they cared for Duncan.
The nurses at Texas Health Presbyterian are not represented by Nurses United or any other union. RoseAnn DeMoro, executive director of Nurses United, said the information came from “several” nurses, but she declined to state how many.
She said that the organization vetted the claims and that the nurses cited were in a position to know what occurred. She did not specify whether they were among those caring for Duncan.
The nurses allege that his lab samples were allowed to travel through the hospital’s pneumatic tubes, possibly risking contamination of the delivery system, and that hazardous waste was allowed to pile up to the ceiling.
Hospital spokesman Wendell Watson did not respond to specific claims by the nurses but said the hospital has not received similar complaints.
“Patient and employee safety is our greatest priority, and we take compliance very seriously,” he said in a statement. He said the hospital will “review and respond to any concerns raised by our nurses and all employees.”
The nurses’ statement said they had to “interact with Mr. Duncan with whatever protective equipment was available,” even as he produced “a lot of contagious fluids.”
Duncan’s medical records underscore that concern. They also say that nurses treating Duncan were also caring for other patients and that, in the face of constantly shifting guidelines, they were allowed to follow whichever ones they chose.
Frieden confirmed Wednesday that a wide variety of protective gear was used in the first few days, including two and three layers of protective gear and gloves, which in fact are harder to remove safely.
When Ebola was suspected but unconfirmed, a doctor wrote that use of disposable shoe covers should also be considered. At that point, by all protocols, shoe covers should have been mandatory to prevent anyone from tracking contagious bodily fluids around the hospital.
A few days later, entries in the hospital charts suggest that protection was improving.
DeMoro and Burger said the nurses claimed they had been warned by the hospital not to speak to reporters or they would be fired.
The Associated Press has tried since last week to contact dozens of individuals involved in Duncan’s care. Those who responded to reporters’ inquiries have been unwilling to speak.
David R. Wright, deputy regional administrator for the U.S. Centers for Medicare and Medicaid Services, which monitors patient safety and has the authority to withhold federal funding, said his agency will want all the information the nurses provided.
“We can’t talk about whether we’re going to investigate or not, but we’d be interested in hearing that information,” he said.
CDC officials did not respond to requests for comment.
Duncan first sought care at the hospital’s emergency room late on Sept. 25 and was sent home the next morning. He was rushed back by ambulance Sept. 28.
Decontamination started early
Dallas County Judge Clay Jenkins said early Wednesday that Vinson was isolated and being tested within 90 minutes of learning that she had a fever.
She lives alone and has no pets — Pham’s Cavalier King Charles Spaniel, Bentley, is being cared for in isolation.
Dallas Fire-Rescue workers started decontamination at Vinson’s apartment before 7 a.m., and workers went door to door at the complex at Skillman Street and Village Bend Drive, informing tenants that a resident had tested positive for Ebola.
Dallas Mayor Mike Rawlings said another positive result was not unexpected, but the CDC appeared to be scrambling to seal holes in Ebola treatment procedures, sending a team of 16 people to monitor and help at the hospital.
“We are not fearful. It may get worse before it gets better, but it will get better,” Rawlings said.
The second CDC team includes experts in infection control, Ebola control, lab science, personal protective equipment, hospital epidemiology and workplace safety, the fact sheet says.
The team is looking into what protective equipment is being used; what medical procedures were done that may have exposed the healthcare workers; decontamination for workers; and ensuring oversight of infection control.
The total number of people being monitored for Ebola symptoms, including contacts or possible contacts with both Pham and Duncan, was at 125 before Vinson’s diagnosis.
That number includes an employee of the Alcon medical company in Fort Worth who had direct contact with Pham, according to the state public health department.
Staff writers Monica Nagy and Andrea Ahles contributed to this report, which includes material from The Associated Press.