CDC head criticized for blaming 'protocol breach' as nurse gets Ebola

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CDC head criticized for blaming 'protocol breach' as nurse gets Ebola
DALLAS, TX - OCTOBER 15: Emergency vehicles escort an ambulance on the tarmac at Love Field Airport October 15, 2014. The ambulance had reportedly delivered Amber Vinson, a health care worker, to an air ambulance. According to reports, Vinson, had contracted the Ebola virus and had taken a commercial Frontier Airlines flight from Cleveland, Ohio to Dallas, Texas, a day before become symptomatic. (Photo by Stewart F. House/Getty Images)
Amber Joy Vinson, 2nd Dallas nurse with Ebola, traveled to Ohio to visit family, plan wedding http://t.co/AfQQEcnh4h http://t.co/YP5oI0j9Iv
WASHINGTON, DC - OCTOBER 17: Paige Victoria, 23, of Cleveland, Ohio, and Jeff Hulbert of Annapolis, Maryland, (obscured in back) hold up signs in front of the White House on October 17, 2014 in Washington, D.C. Hulbert is protesting the entry of Ebola into the country through air travel. 'There should be a temporary travel ban on visitors from infected regions until medical infrastructure can get up to speed,' said Hulbert. (Photo by Allison Shelley/Getty Images)
Jeff Hulbert from Annapolis, Maryland, dressed in a protective suit and mask holds a poster demanding for a halt of all flights from West Africa,as he protests outside the White House in Washington, DC on October 16, 2014. Top US health officials faced a grilling Thursday by lawmakers infuriated over the nation's fumbling response to the Ebola outbreak, as the Obama administration scrambles to contain the disease's spread. Centers for Disease Control (CDC) director Thomas Frieden has become the most prominent target of the criticism, which has mounted as it emerged that a second Texas health care worker infected with the deadly disease was allowed to board a commercial flight despite reporting a low-grade fever. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
Twilette Miller, a nurse arriving from Dayton, Ohio, and concerned about Ebola reports, wears a precautionary surgical mask at Dulles International Airport October 16, 2014, in Sterling, Virginia, outside Washington, DC. Some schools in Ohio and Texas closed Thursday amid fears that students or staff had been exposed to a nurse who had Ebola infection during an airline flight. The US Centers for Disease Control has reached out to 132 people who were on the same October 13 flight as Amber Vinson, but said there was an extremely low risk that anyone was infected. AFP PHOTO/Paul J. Richards (Photo credit should read PAUL J. RICHARDS/AFP/Getty Images)
DALLAS, TX - OCTOBER 15: An air ambulance carrying Amber Vinson takes off from Love Field Airport October 15, 2014. According to reports, Vinson, a healthcare worker, had contracted the Ebola virus and had taken a commercial Frontier Airlines flight from Cleveland, Ohio to Dallas, Texas, a day before become symptomatic. (Photo by Stewart F. House/Getty Images)
WASHINGTON, DC - OCTOBER 16: White House Press Secretary Josh Earnest takes questions from the media during his daily briefing in the Brady Briefing Room, October 16, 2014 in Washington, DC. Secretary Earnest spoke about the two health care workers who were infected with the Ebola virus in Texas. (Photo by Mark Wilson/Getty Images)
This 2010 photo provided by tcu360.com, the yearbook of Texas Christian University, shows Nina Pham, 26, who became the first person to contract the disease within the United States. Records show that Pham and other health care workers wore protective gear, including gowns, gloves, masks and face shields and sometimes full-body suits when caring for Thomas Eric Duncan. (AP Photo/Courtesy of tcu360.com)

Nina Pham (Instagram)

DALLAS, TX - OCTOBER 12: A man dressed in protective hazmat clothing walks towards an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
Twilette Miller, a nurse arriving from Dayton, Ohio, and concerned about Ebola reports, wears a precautionary surgical mask at Dulles International Airport October 16, 2014, in Sterling, Virginia, outside Washington, DC. Some schools in Ohio and Texas closed Thursday amid fears that students or staff had been exposed to a nurse who had Ebola infection during an airline flight. The US Centers for Disease Control has reached out to 132 people who were on the same October 13 flight as Amber Vinson, but said there was an extremely low risk that anyone was infected. AFP PHOTO/Paul J. Richards (Photo credit should read PAUL J. RICHARDS/AFP/Getty Images)
Passengers at Frontier gate at Hopkins now wearing masks http://t.co/kBn0hhZhQZ
This is Amber Vinson, the #ebola patient that flew from #CLE to #Texas after visiting #Akron http://t.co/wBoZM9Hvr1 http://t.co/RGSvcA6l3Q
Family confirms, #Dallas nurse Nina Pham is 2nd patient with #Ebola... #PrayersforNina http://t.co/dTXi5SPZVW http://t.co/u4slPTn6US
#NinaPham identified as Dallas nurse with #Ebola http://t.co/3p3AFlxp42 http://t.co/L4Ho8zSHuM
DALLAS, TX - OCTOBER 12: Workers with hazmat company CG Environmental Cleaning Guys prepare a tarp to block the view of media as they prepare to enter an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A man dressed in protective hazmat clothing leaves after treating the front porch and sidewalk of an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: No trespassing signs and warning tape mark the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Dallas police setup a barrier after a hazmat vehicle entered the alley behind the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A man dressed in protective hazmat clothing walks towards an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A Dallas police officer sets up a barrier after a hazmat vehicle entered the alley behind the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A man dressed in protective hazmat clothing treats the front porch of an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Two workers with hazmat company CG Environmental Cleaning Guys stand in the alley behind an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A man dressed in protective hazmat clothing treats the sidewalk in front of an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A worker with hazmat company CG Environmental Cleaning Guys hangs a tarp blocking view of the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Brad Smith with the hazmat company CG Environmental Cleaning Guys talks with the media outside of an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: G.C. Williford, Battalion Chief for the Dallas Fire Department, talks with fire department personell outside an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Police officers stand near a barrel containing waste material (L) that was removed from the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Police officers stand outside an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Brad Smith with the hazmat company CG Environmental Cleaning Guys talks with the media outside of an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A Dallas police officer responds to media questions as hazmat company CG Environmental Cleaning Guys begins setup at the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Brad Smith (C) with hazmat company CG Environmental Cleaning Guys directs an employee outside of the apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Volunteers pass out flyers for the Dallas County Health and Human Services department near an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A barrel containing waste material that was removed from the apartment where a second person diagnosed with the Ebola virus resides sits on the lawn on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: G.C. Williford, Battalion Chief for the Dallas Fire Department, enters an apartment where a second person has been diagnosed with the Ebola virus on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A barrel containing waste material that was removed from the apartment where a second person diagnosed with the Ebola virus resides stis on the lawn on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A woman passes out flyers for the Dallas County Health and Human Services department near an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: Volunteers pass out flyers for the Dallas County Health and Human Services department near an apartment where a second person diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
DALLAS, TX - OCTOBER 12: A barrel labeled with biohazardous waste sits in front of an apartment where a second person has diagnosed with the Ebola virus resides on October 12, 2014 in Dallas, Texas. A female nurse working at Texas Heath Presbyterian Hospital, the same facility that treated Thomas Eric Duncan, has tested positive for the virus. (Photo by Mike Stone/Getty Images)
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By JULIE STEENHUYSEN

(Reuters) -- Some healthcare experts are bristling at the assertion by a top U.S. health official that a "protocol breach" caused a Dallas nurse to be infected with Ebola while caring for a dying patient, saying the case instead shows how far the nation's hospitals are from adequately training staff to deal with the deadly virus.

Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, made the declaration on Sunday at a news conference and called for an investigation into how the unidentified nurse became infected while caring for Liberian national Thomas Eric Duncan, the first Ebola patient diagnosed in the United States. Duncan died last week at Texas Health Presbyterian Hospital.

Healthcare and infection control experts said that hospital staff need to be coached through the stages of treating an Ebola patient, making sure they have the right safety equipment and know how to use it properly to prevent infection.

It was not immediately clear whether the Texas hospital prepared its staff with simulation drills before admitting Duncan, but a recent survey of nurses nationwide suggests few have been briefed on Ebola preparations. Officials at the hospital did not respond to requests for comment.

Some experts also question the CDC's assertion that any U.S. hospital should be prepared to treat an Ebola patient as the outbreak ravaging West Africa begins to spread globally. Given the level of training required to do the job safely, U.S. health authorities should consider designating a hospital in each region as the go-to facility for Ebola, they said.

"You don't scapegoat and blame when you have a disease outbreak," said Bonnie Castillo, a registered nurse and a disaster relief expert at National Nurses United, which serves as both a union and a professional association for U.S. nurses. "We have a system failure. That is what we have to correct."

More than 4,000 people have died in the worst Ebola outbreak on record that began in West Africa in March.

In recent months, the CDC has published detailed guidelines on how to handle various aspects of Ebola, from lab specimens and infectious waste to the proper use of protective equipment.

How that information gets communicated to frontline workers, however, varies widely, Castillo said.

In many cases, hospitals "post something on a bulletin board referring workers and nurses to the CDC guidelines. That is not how you drill and practice and become expert," she said.

CDC spokesman Tom Skinner said the agency is still investigating the case of the Dallas nurse, but stressed that "meticulous adherence to protocols" is critical in handling Ebola. "One slight slip can result in someone becoming infected."

Skinner said the CDC is going to step up its education and training efforts on how to triage and handle patients, and may consider designating specific hospitals in each region as an Ebola treatment facility.

"We've been doing a lot over the past few months, but clearly there is more to do," he said. "The notion of possibly transporting patients diagnosed with Ebola to these hospitals is not something that is out of the question and is something we may look into."

Ebola Due To 'Breach In Protocol'

LEGAL RECOURSE

Dr. Gavin Macgregor-Skinner, an expert on public health preparedness at Pennsylvania State University, also disagreed with the talk of a breach of protocol, saying it just puts the onus on the nurse.

"I think that is just wrong," said Macgregor-Skinner, who helped the Nigerian government train healthcare workers when a traveler from Liberia touched off an outbreak of Ebola this past summer.

"We haven't provided them with a national training program. We haven't provided them with the necessary experts that have actually worked in hospitals with Ebola," he added in reference to U.S. hospital staff.

Legal experts said the Dallas nurse may be entitled to compensation if the hospital carries workers' compensation insurance. If it doesn't, she would have the right to sue the hospital for damages under Texas law, said Jay Harvey, a lawyer in Austin, Texas.

Her ability to show that the hospital was negligent by, for example, not providing proper training, would be key to winning such a suit, Harvey said.

Sean Kaufman, president of Behavioral-Based Improvement Solutions in Atlanta, helped train healthcare staff at a special isolation unit at Atlanta's Emory University which treated U.S. aid workers Dr. Kent Brantly and Nancy Writebol, the first two Ebola patients to be treated on U.S. soil.

He would observe the nurses and doctors as they cared for patients and keep detailed notes when someone would accidentally touch their sleeve or mask with an infected glove.

He then helped coach them through the process of carefully removing their infected gear. Facilities caring for Ebola patients are encouraged to use a buddy system so that colleagues are watching each other to make sure they don't take risks.

"Doctors and nurses get lost in patient care. They do things that put themselves at risk because their lens is patient-driven," Kaufman said. In Dallas, "I suspect no one was watching to make sure the people who were taking care of the patients were taking care of themselves," he said.

CDC and Texas health officials said the nurse who became infected had been wearing the recommended personal protective gear for Ebola, which consists of gloves, a gown, a mask, and a shield to protect the eyes from possible splatters from the patient.

According to experts, that gear offers the minimum level of protection. When an Ebola patient enters the latter stages of the disease, as Duncan did, they become so-called fluid producers, Kaufman said.

"Towards of end of the illness, the virus is trying to live and thrive. It's trying to get out of the person's body. It's producing massive amounts of fluid," he said.

At that point, caregivers need to add more layers of protective gear, such as double gloves and a respirator or a full bodysuit. Those kinds of decisions need to be made by managers who are constantly assessing the risk to healthcare workers, Kaufman said.

Macgregor-Skinner said all U.S. hospitals must be ready to identify and isolate an Ebola patient, but should also be able to turn to a regional facility that is better prepared to receive them.

"Every hospital can then prevent the spread of Ebola, but not every hospital in the U.S. can admit a patient in the hospital for long-term care," he said.

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