If it’s anything like those in most U.S. hospitals, the isolation room at Texas Health Presbyterian Hospital in Dallas is bare-bones and nondescript.
But the room could make all the difference in the fight against the Ebola virus.
Thomas Eric Duncan, the Liberian patient diagnosed with Ebola earlier this week, is now being treated in one such isolation room at the hospital — one converted from an intensive care unit, officials said.
Typically, an isolation room holds only the essentials: the patient’s bed, machines that monitor blood oxygen and blood pressure, and other vital equipment.
The patient lies in what’s called the “hot room.” Health care workers enter through a side room called the “warm room,” where they put on protective equipment before entering the hot room. The gear typically includes a surgical hat, a respirator mask, a surgical gown, a face shield and surgical boot covers.
Entry is limited to only a few doctors and nurses. Once they enter the hot room and tend to the patient, they exit back through the warm room, where they peel away the protective equipment. They put the contaminated clothing in yellow trash bags labeled “biohazard.” The material is sterilized and incinerated.
Isolation rooms for Ebola patients use ventilation systems that generate negative pressure. That means air can flow into the room but not escape it.
Experts said that such isolation rooms and protective equipment are important — but that staff training and preparation are critical.
Preparation
Training and preparation, as well as the use of experimental drugs, were key to caring for three American health care workers with Ebola who were recently transferred from West Africa to the U.S. They were taken to special biocontainment units in Omaha, Neb., and at Emory University Hospital in Atlanta — two of four units in the country designed for treating patients with extremely infectious diseases.
At the Nebraska Biocontainment Patient Care Unit in Omaha, nursing director Shelly Schwedhelm said that her team had 48 hours’ notice to prepare for the arrival last month of Dr. Rick Sacra, who contracted Ebola in Liberia.
More important, “we had been preparing for an event like this for the better part of nine years,” she said. “We’re always ready to deal with a patient. But when I got that call, I made sure we had all the supplies we’d need.”
Schwedhelm said her team of 40 nurses, infectious disease and intensive care doctors received “intensive training” to deal with Ebola patients.
Sacra was released from the hospital last week. Staff members who treated him are still being closely monitored and will continue to have their temperature taken every day until Oct. 15. That marks 21 days after the patient’s release and the full incubation period for the virus.
Schwedhelm said that health care workers must be properly trained to deal with Ebola. “One of the things I am worried about with Ebola is that staff [must] practice, practice, practice putting on and taking off the personal protective equipment,” she said.
She said that strict attention must be paid to the exact order in which the protective equipment is removed. “If you don’t pay attention to that order, you could contaminate yourself,” she said. “I hope the people in Dallas are really focused on that.”
Officials at Texas Health Presbyterian in Dallas didn’t respond to requests for information about their isolation rooms.
Wider net
But at most U.S. hospitals, “the equipment and structure of those isolation rooms is already set up to deal with a communicable disease like Ebola,” said Dr. Cristie Columbus, assistant medical director of infection control and prevention at Baylor University Medical Center.
Baylor has the type of isolation rooms found in most U.S. hospitals. Columbus said the rooms are routinely used for patients with tuberculosis and other infectious diseases.
In Baylor’s emergency room, John Garrett, medical director of emergency management, spent Thursday preparing his staff in case an Ebola patient arrives at the ER.
“Everyone is on high alert,” he said. “We know that a possible contact of the case could walk through our doors.”
Garrett said that his team has already been trained on how to deal with a suspected Ebola case, but that they are constantly retraining.
“We’ve been screening everyone for Ebola since Aug. 4,” he said. “We screen by asking them if they have traveled to West Africa, had contact with an Ebola case and had any symptoms of Ebola.”
Patients who answer “yes” to those questions must immediately wear a face mask before entering a nearby isolation room.
Since this week’s Ebola diagnosis in Dallas, Garrett said the screening questions have been changed. “We’re casting an ever wider net. Now we ask, ‘Have you been to any country in Africa?’”
Baylor’s 81-bed emergency room has eight isolation rooms. Following CDC guidelines, two of those rooms have been kept empty, ready for patients with suspected Ebola to walk through the door.
“I just did a night shift, and staff and patients are concerned,” said Amy Wilkins, nursing manager in the emergency room. “But we are telling everyone: ‘Be diligent. This is not the time to skip a step.’”
Dr. Seema Yasmin, a former epidemiologist with the Centers for Disease Control and Prevention, is a physician and a professor at the University of Texas at Dallas. Follow her on Twitter at @DoctorYasmin.
