One U.S. Hospital's Strategy For Stopping Ebola's Advance

Oct 8, 2014
Originally published on October 8, 2014 12:22 pm

Dr. Jack Ross is used to seeing potentially lethal viruses, and he is used to putting patients into isolation. Still, Ebola is different.

"I think, for any hospital today, Ebola represents one step higher than anything else, if we had to do it," says Ross, who directs infection control for Hartford Healthcare's five hospitals in Connecticut.

On a tour of Hartford Hospital, Ross explains how his Ebola control plan would affect various parts of the facility — from the emergency room, to the intensive care unit, to the floors of rooms where patients stay.

"This would be an area that we would close off with plastic sheeting," Ross says. "Right here, we'd have a security officer, because you want to restrict visitors. You want to have a log of who goes in, who goes out."

In Connecticut, the idea of taking care of an Ebola patient is still just theoretical; one of the reasons that public health officials are confident that American hospitals could contain an outbreak in the U.S. is because facilities in every state can accommodate the isolation and sanitation measures that are needed to keep the virus from spreading.

The best place to put someone who falls ill, for instance, is at the end of a hall in a room with its own bathroom, anteroom and entrance. "The rest of the floor is safe," Ross says. "I limit the amount of traffic. I'm able to do the care there."

Ross and his team are preparing in other ways, too. With the help of the Centers for Disease Control and Prevention, he has made a specific list of questions that doctors and nurses will ask incoming patients about symptoms and travel. He has inventoried the supplies they would need to treat an Ebola patient.

Ross says he understands the general public's concern when it comes to Ebola; the symptoms and severity of the illness are frightening. But he also says this: Ebola might frighten the general public, but the virus doesn't threaten the public.

"This is not something that will become established in the local general American population," Ross says. Why not? In the United States, a strong medical infrastructure should allow health workers to relatively quickly diagnose the infection, trace contacts, isolate patients with symptoms and offer them the needed intravenous fluids and other supportive treatment. And, in comparison to, say, the flu or measles, the Ebola virus is not spread through the air and is not very contagious. The people at risk of catching Ebola are people who have been in close, unprotected contact with someone who is sick with active symptoms of the disease.

"The risk here in America from an imported case would be to health care workers in a hospital environment," Ross says.

Indeed, so far, the only known case of Ebola that has been transmitted outside of a West African country is a nurse in Spain who fell ill after caring for two missionaries who contracted the disease in Africa and eventually died. While anyone in close physical contact with a symptomatic patient is at some risk, the evidence suggests that the people most likely to be exposed to the virus from these isolated cases are family members and health care workers.

For that reason, Ross says hospital workers have to be painstakingly vigilant. That begins with the triage questions nurses and doctors ask patients coming into the emergency room, and at various other times throughout their treatment.

According to protocol, if a patient is diagnosed with Ebola, health care workers treating that patient need to wear a face mask or goggles, and they also need a buddy with them as they put on and take off their protective clothing. All of that is to make sure they don't come into any contact with the infected patient's body fluids.

The gear used to care for an Ebola patient — the goggles, the clothing, the bed linens — then becomes contaminated waste that has to be treated and sterilized in much the same way as tools being prepared for use in an operating room. Just how that's accomplished will be determined on a case-by-case basis, governed by the CDC and the federal Department of Transportation.

After decades of work in the field of infectious disease, Ross feels prepared. Still, he says, he expects to be nervous if and when he treats a person with Ebola.

"My heart may be pounding, my palms may be sweating," he says. "I think it's only a natural human response that we would have heightened awareness and some nervousness as we go through this."

Ross says he'd be concerned about any caregiver treating Ebola who wasn't at least a little nervous, too.


This story is part of an NPR collaboration with Kaiser Health News and WNPR.

Copyright 2017 WNPR News. To see more, visit WNPR News.

STEVE INSKEEP, HOST:

Health care facilities in this country want to be ready to avoid a nightmare situation that has evolved in Spain. As we’ve reported on this program, in Spain, a nurse treating a patient for Ebola contracted the virus herself. And that brings renewed attention to concerns for the safety of health care workers. Jeff Cohen of member station WNPR visited one hospital in Hartford, Connecticut to see how it’s preparing.

JEFF COHEN, BYLINE: Jack Ross is the director of infection control for Hartford Healthcare’s five hospitals, including this one, Hartford Hospital. He says doctors are used to seeing potentially lethal viruses, and they’re used to putting patients into isolation. Still, Ebola is different.

JACK ROSS: This would be an area that we would close off with plastic sheeting right here. We’d have a security officer here because you want to restrict visitors. You want to have a log of who goes in, who goes out.

COHEN: He’s giving me the tour of the hospital’s setup. From the ER to the ICU to patient floors, all of which could be put to use should Ebola make its way here. If it does, Ross says he and his team are prepared. It’s a long checklist, and here are three things that are on it. He's made a specific list of questions doctors and nurses will ask incoming patients about symptoms and travel. He's inventoried the supplies they would need to treat an Ebola patient. And he’s figured out the best place to put someone who falls ill, ideally at the end of a hall in a room with its own bathroom, anteroom and entrance.

ROSS: The rest of the floor is safe. I limit the amount of traffic. I’m able to do the care there. I managed my waste stream for the two to three, four weeks the person’s going to be here.

COHEN: This is the most intensive isolation you could come across at Hartford Hospital?

ROSS: It is. It is. I think for any hospital today, Ebola represents one step higher than anything else, if we had to do it.

COHEN: Ross says he understands the concern of the general public when it comes to Ebola. Compared to something like the flu, it’s relatively unknown and scary. But he also says this. Ebola might frighten the general public, but it doesn't threaten it.

ROSS: What people need to understand with this - this is not something that will become established in the local, general American population. The risk here in America from an imported case would be to health care workers in a hospital environment.

COHEN: So he and his staff have to be painstakingly vigilant. That begins with the triage questions nurses and doctors asked incoming patients when they arrive at the emergency room and at various other times throughout their treatment.

ROSS: Have you traveled to Liberia, Nigeria, Sierra Leone, Congo, Guinea…

COHEN: If a patient is diagnosed, health care workers treating an Ebola patient needed to wear a face mask or goggles. And they also need a buddy with them as they put on and take off their protective clothing. All of that is to make sure that they don't come into any contact with bodily fluids. And there's the question of what to do with the contaminated waste, everything from those goggles, to bed linens, to medical equipment. Before they leave the hospital, they all have to be treated and sterilized in much the same way as tools being prepared for use in the operating room. The method the hospital uses to kill the virus will determine how and when the waste is transported. That’s a case-by-case determination governed by the CDC and the Federal Department of Transportation. So Ross’s decades of work in infectious disease and daily work dealing with people in isolation have taught him how to prepare. But even with all of those precautions, he says he’s human, too.

ROSS: The first time I see somebody with this, I am going to be nervous. My heart may be pounding. My palms may be sweating because I'm going to be very deliberate in what I do and how I move.

COHEN: And Ross says he’d be concerned about any caregiver treating Ebola who wasn't nervous too. For NPR News, I’m Jeff Cohen in Hartford.

INSKEEP: His story’s part of a reporting partnership between NPR, WNPR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.