Updated Ebola guidelines in effect in Pittsburgh region

Updated guidelines from the U.S. Centers for Disease Control and Prevention for treating patients with the Ebola virus neither surprise nor burden local hospitals, local officials say.

“I think what we’re seeing is that the CDC is catching up with what we were doing, or already were planning to do,” said Robert J. Keenan, a thoracic surgeon who serves as chief quality officer at Allegheny General and West Penn hospitals.

“If a patient with Ebola shows up at one of our [Allegheny Health Network] facilities, we have plans in place on how to deal with it internally,” Dr. Keenan said, noting minimal cost for supplies necessary to meet the guidelines. “We have confidence we can handle it safely and provide good care to the patient and protect our caregivers for whatever length of time is required.”

But a recent commentary published in the Annals of Internal Medicine argues that “it is impossible to completely engineer out human error, eliminate the risk for sharps or needlestick injury, or prevent inadvertent contact contamination,” at hospitals that lack high-level biocontainment care units. None exists in the region.

“The training policies, procedures and logistics necessary for the provision of such care are significant, cannot be assumed to be optimally in place well in advance of actual need and must be continually reinforced through repetitious training,” states the journal’s commentary, “Caring for Patients with Ebola: A challenge in Any Care Facility,” published Oct. 16.

The only facilities fully prepared to treat people with Ebola infections, it says, are the nation’s four high-level biocontainment care facilities. They include Emory University Hospital in Atlanta, where infected Dallas nurse Amber Vinson was transferred for treatment; and the Nebraska Medical Center in Omaha, where patients with Ebola have been treated successfully without further transmission. The National Institutes of Health Clinical Center, Bethesda, Md., is treating Dallas nurse Nina Pham.

A fourth facility exists at Rocky Mountain Laboratories in Hamilton, Mont.

Transferring patients with Ebola to these facilities represents “the preferred strategy,” the commentary states.

But the CDC and Dr. Keenan acknowledge the potential for patients with Ebola to walk through the doors of any hospital, as happened when Thomas Eric Duncan entered Texas Presbyterian Hospital Dallas with the virus that caused his death on Oct. 8.

That scenario, with Ms. Vinson and fellow nurse Nina Pham contracting the infections during his care, inspired the new guidelines to limit the risk of medical-staff exposure to the infected person’s bodily fluids.

CDC guidelines call for staff to be trained rigorously to don and remove personal protective equipment. All skin should be covered. The necks of the Dallas nurses were uncovered.

A third provision requires trained medical personnel to monitor the medical procedures, including the process of putting on or taking off protective gear.

The so-called buddy system would help spot and correct procedural mistakes. Such a system already is being implemented at AHN hospitals, Dr. Keenan said.

Other guidelines would limit the use of such sharps as syringes and avoid aerosol medical treatments, among many other provisions.

UPMC is reviewing CDC guidelines with the goal of implementing them “for the safety of our staff, patients and visitors,” Tami Minnier, UPMC’s chief quality officer, said in a prepared statement.