Improving procedures: Lessons from Texas hospital hit by Ebola outbreak

On Sept. 28, 2014, a middle-aged man presented at Presbyterian Hospital in Dallas, Texas, with a fever, abdominal pain and diarrhea. He informed his caregivers that he had just returned from a trip to Liberia, a country embroiled in the largest outbreak of Ebola virus in human history.

Within days the man was dead from organ failure, two nurses tested positive for Ebola virus infection and personnel from the Centers for Disease Control (CDC) were onsite overseeing quarantine and sterilization efforts.

What happened next should serve as a blueprint for healthcare facilities who may be forced to deal with a similar situation in the future, wrote CDC researcher Kristin Cummings, MD, and her co-authors of a recently published article in the Annals of Internal Medicine.

“After admission of the first patient with [Ebola virus infection], a multidisciplinary team from the CDC joined the hospital's infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and management of regulated medical waste,” they wrote. “Existing engineering and administrative controls were strengthened. The personal protective equipment ensemble (PPE) was standardized, [staff] were trained on donning and doffing of PPE, and a system of trained observers supervising PPE donning and doffing was implemented.”

The experiences of Cummings and her colleagues helped inform national policies for the care of Ebola patients as well as the protection of caregivers, including new PPE protocols, the creation of the CDC Ebola Response team and increased readiness on the part of hospitals in the event of an outbreak.

“At a community hospital caring for patients with [Ebola virus infection] and preparing for potential additional cases, we found that a systems approach that included engineering and administrative controls and PPE was critical to improving and ensuring workplace safety and health,” the authors wrote. “The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for [staff] to be prepared to safely care for patients with [Ebola virus infection].”