On Tuesday, National Nurses United (NNU) released a statement criticizing disease protocols at Texas Health Presbyterian in Dallas — the same hospital where Thomas Eric Duncan died of Ebola and where two of Duncan’s nurses, Nina Pham and Amber Vinson, contracted the disease.
This outbreak, according to Dr. Tom Friedman, head of the Centers for Disease Control and Prevention, resulted from a breach in protocol and could have been prevented.
Friedman’s statement infuriated nurses from Texas Health Presbyterian, according to the union, prompting RNs to contact the NNU in order to anonymously call attention to the hospital’s inept training and general preparation regarding Ebola protocol. Union officials read the nurses’ statement on Tuesday, outlining the alleged flaws and absence of procedures on the day Duncan was admitted to the emergency room with severe symptoms.
Union officials reported that Duncan was admitted “under the suspicion from him and his family members that he may have [had] Ebola.” Despite this, “Mr. Duncan was left for several hours, not in isolation, [but] in an area where other patients were present.” When a nurse arrived and realized Duncan was among other patients, acording to the statement, she demanded he be moved to isolation; hospital authorities, however, rebutted her request.
When hospital authorities finally recognized the danger of Duncan’s condition, “no one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn. … There was no training,” RoseAnn DeMoro, NNU’s executive director, said.
“Initial nurses who interacted with Mr. Duncan … wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields,” DeMoro said in the statement. “Some supervisors said that even the N-95 masks were not necessary.”
Given Duncan’s reported condition—“he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids” — the nurses’ personal protective equipment was not in compliance with CDC regulations.
Nurses interacting with Duncan should have had gloves sealed around their wrists and no exposed skin. Nurses picked up on this and, according to the statement, expressed concern for their bare necks.
How did hospital authorities’ respond? According to Deborah Burger, union co-president, nurses “were told to use medical tape and had to use four to five pieces of medical tape wound around their neck,” a seemingly elementary solution to a serious problem.
NNU addressed the tape issue specifically in their statement Tuesday, pointing out how, unlike CDC regulations require, the tape is not impermeable due to its seams, and because nurses were asked to apply and remove the tape themselves, there was no sanitary containment.
One would hope that nurses who had interacted with Duncan without proper protective equipment would at least be told to stay away from patients and other hospital staff not suffering from Ebola. But hospital officials allegedly “allowed nurses who had interacted with Mr. Duncan to … continue normal patient care duties [with] other patients.”
Not only, then, was hospital staff allegedly contaminating other areas and potentially other patrons of the hospital, but nurses were also left unaware of how to properly clean up after them. Nurses reported that “there was no one to pick up hazardous waste as it piled up to the ceiling,” and that there were “no policies in cleaning or bleaching the premises without housekeeping services.”
From the moment Duncan arrived at Texas Presbyterian Health to hours after his death, hospital staff did not know how to properly and sanitarily handle the situation. In each of these cases, the proper protocol was unknown to workers.
DeMoro addresses this in an interview with CBS News. “Were protocols breached?” she asked hypothetically. “There were no protocols. ”
In their statement on Tuesday, NNU stated that “there was no advance preparedness on what to do with the patient, there was no protocol, there was no system.”
If these allegations are true, it’s easy to understand why Texas Presbyterian nurses received CDC head Dr. Tom Friedman’s words with such disdain. The CDC has alleged that at the Dallas hospital staff failed to follow proper protocols, but those protocols don’t even exist. The blame for the infections can’t be placed on a work staff that was forced to improvise over a deadly disease.
An internal email obtained by Politico’s Mike Elk (a former staff writer at In These Times) sent to union members by DeMoro on October 12, however, may raise some concern about the NNU’s concern for factual accuracy versus positioning themselves strongly in the public debate around Ebola. Elk reports:
DeMoro told union members not to address how Ebola “infects, mutates, etc.” DeMoro said that was “a slippery slope and we do not want to get dragged into a factual dispute when we have a much larger agenda. … Our strength is patient advocacy and disease containment. If you speak inside of that parameter, we win. Speak of our families, of your job and the consequences in exposing others, especially the more physically vulnerable. Speak as a nurse. It is your strength; it will win us this battle. We need to be cognizant that we are bargaining for health and safety in the press.
Still, if Texas Presbyterian nurses’ claims prove correct, hospitals’ lack of proper protocol and equipment may prove to blame for recent Ebola missteps rather than errors by rank-and-file nurses.