About 70 hospital staffers cared for Ebola patient

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About 70 hospital staffers cared for Ebola patient
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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DALLAS (AP) - They drew his blood, put tubes down his throat and wiped up his diarrhea. They analyzed his urine and wiped saliva from his lips, even after he had lost consciousness.

About 70 staff members at Texas Health Presbyterian Hospital were involved in the care of Thomas Eric Duncan after he was hospitalized, including a nurse now being treated for the same Ebola virus that killed the Liberian man who was visiting Dallas, according to medical records his family provided to The Associated Press.

The size of the medical team reflects the hospital's intense effort to save Duncan's life, but it also suggests that many other people could have been exposed to the virus during Duncan's time in an isolation unit.

On Monday, the director of the Centers for Disease Control and Prevention said the infection of the nurse means the agency must broaden the pool of people getting close monitoring. Authorities have said they do not know how the nurse was infected, but they suspect some kind of breach in the hospital's protocol.

The medical records given to the AP offer clues, both to what happened and who was involved, but the hospital said the CDC does not have them.

A CDC spokeswoman said the agency reviewed the medical records with Duncan's care team and concluded that the documents were not helpful in identifying those who interacted directly with the patient.

"This is not something we can afford to experiment with. We need to get this right," said Ruth McDermott-Levy, who directs the Center for Global and Public Health in Villanova University's College of Nursing.

Until now, the CDC has been actively monitoring 48 people who might have had contact with Duncan after he fell ill with an infection but before he was put in isolation. The number included 10 people known to have contact and 38 who may have had contact, including people he was staying with and health care professionals who attended to him during an emergency room visit from which he was sent home. None is sick.

The CDC has not yet established a firm number of health care workers who had contact with Duncan.

"If this one individual was infected - and we don't know how - within the isolation unit, then it is possible that other individuals could have been infected as well," said Dr. Tom Frieden, director of the CDC. "We do not today have a number of such exposed people or potentially exposed health care workers. It's a relatively large number, we think in the end."

Caregivers who began treating Duncan after he tested positive for Ebola were following a "self-monitoring regimen" in which they were instructed to take their temperatures regularly and report any symptoms. But they were not considered at high risk.

Typically, the nurses, doctors and technicians caring for a contagious patient in isolation would be treating other people as well and going home to their families after decontaminating themselves. The hospital has refused to answer questions about their specific duties.

The 1,400-plus pages of medical records show that nurses, doctors and other hospital employees wore face shields, double gowns, protective footwear and even hazmat suits to avoid touching any of Duncan's bodily fluids. Ebola spreads through direct contact with those fluids, usually blood, feces and vomit. The virus has also been detected in urine, semen and breast milk, and it may be in saliva and tears.

CDC officials said there were chinks in that protection at Texas Presbyterian, but they have not identified them and are investigating.

"Patient had large, extremely watery diarrhea," a nurse wrote in a report filed the day Duncan tested positive.

Another nurse noted that Duncan's urine was "darker in color with noted blood streaks."

It was unclear from the records released to the AP how many of the approximately 70 individuals involved in Duncan's care had direct contact with his body or fluids.

Dr. Aileen Marty, a World Health Organization doctor who recently returned to Florida International University after a month fighting Ebola in Nigeria, said no amount of protection is going to help if hospital workers do not put on and take off their protective layers carefully.

"The first thing in caring for someone with Ebola is to do everything in your power to never become a victim," she said.

And tracking all contacts, even within the medical setting, is complicated.

Generally, the first step in locating care providers for isolated infected patients is a personnel log on the door, "that should have everyone going in and out, signing in and out," said Dr. Lisa Esolen, Geisinger Health System's Medical Director of Health Services and Infection Prevention and Control. Medical records indicate the Dallas hospital had a log.

On the day before Duncan died, records indicate that at least nine caregivers entered and exited the room.

A spokesman for Texas Health Resources, the hospital's parent company, said the CDC probably has a log from the room door that would list everyone who got close to Duncan.

Dr. Christopher Ohl, who heads Wake Forest Baptist Medical Center's infectious-disease department and has worked with the CDC in the past, said the expanding monitoring "is an abundance of caution that's probably beyond what needs to be done" because medical caregivers will notice if they're getting a fever, and they're not contagious until that point.

"You start to know when you get those body aches and headaches, most people know that," he said. "It's not like you're surprised by it. Most people can figure out what to do when that happens."

___

Associated Press writers Maud Beelman and Jamie Stengle contributed to this report.

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