How SLO County hospitals are preparing for Ebola

Twin Cities Community Hospital in Templeton.
Twin Cities Community Hospital in Templeton. dmiddlecamp@thetribunenews.com

In light of a second confirmed case of an American contracting Ebola in the United States, San Luis Obispo County health providers are ramping up preparations for how they would treat a potential patient, including running weekly drills and training workers in proper use of protective gear.

Local hospital officials said they are following guidelines from the Centers for Disease Control and Prevention, which issued an advisory to all U.S. hospitals Monday detailing the correct procedures for treating an Ebola patient. The advisory also features a checklist for hospitals to use for correct procedure.

On Tuesday, the CDC announced that it would send out a special “response team” to assist in treatment at any hospital in the United States that reported an Ebola patient.

Ann McDowell, epidemiologist with the San Luis Obispo County Department of Public Health, said the county has been working closely with local hospitals and first responders — EMTs, firefighters and police — to ensure that all are prepared to recognize a patient with Ebola-like symptoms, which include fever and chills.

The county has held several “tabletop discussions,” or meetings with representatives from local hospitals, with a public health official leading them through a scenario in which a patient enters the hospital with symptoms that could be indicators of Ebola, McDowell said.

The exercises test how workers respond at each “trigger point” when a potential Ebola case should be recognized, from asking about travel history to recognizing symptoms, she said.

Because the disease is highly infectious once an individual comes in contact with an infected person’s bodily fluids, health workers must be extremely diligent when dealing with a potential patient. The New York Times reports an Ebola patient can have 10 billion viral particles in one-fifth of a teaspoon of blood at the height of the illness, compared with 50,000 to 100,000 particles in an untreated HIV patient or 5 million to 20 million in someone with untreated hepatitis C.

Some California hospitals have expressed concerns that they don’t have enough resources to properly respond to an Ebola case and have said that they have received conflicting messages from federal, state and local agencies on procedure.

In a letter to U.S. Sen. Barbara Boxer, D-Calif., on Tuesday, California Hospital Association President and CEO C. Duane Dauner wrote that in a survey of member hospitals, about one-third reported problems implementing the CDC’s guidelines, although 90 percent reported that they received sufficient guidance from the CDC and federal authorities regarding direct patient care issues.

McDowell said she is highly confident that local hospitals — using the CDC resources — could treat a patient with the infectious disease today without incident.

“I would say (our level of preparation is) a nine or a 10,” McDowell said. “I would hesitate to say 10, because there is always something to do better, but we are working with our community partners, and we are working with our first responders extensively, so I do feel we are very well prepared.”

Workers at Twin Cities Community Hospital have run both theoretical and physical drills weekly on the proper way to identify, isolate, test and treat an Ebola patient, said Trish Bartel, director of business development. Chief Nursing Officer Carol Howland and Infectious Diseases Director Jeannette Tosh are in charge of those preparations, Bartel said.

Besides holding its own meetings with health workers, Twin Cities has run an emergency-room drill in which a mock patient leads responders through the identification and isolation process, she said. The most recent drill was held Friday.

“If you truly follow all of the CDC guidelines and use everything properly, the likelihood of (contracting Ebola) is very low,” Bartel said.

She said if a patient were to show Ebola-like symptoms at the hospital with a travel history that indicated a risk for the disease, the patient would be confined to one of the hospital’s containment rooms that use negative air pressure to allow air to flow into but not out of the room. This helps to prevent the spread of contagions.

The hospital also recently formed a stat team of health workers who are on call 24/7 in the event an Ebola case presents itself at Twin Cities, Bartel said.

These workers are specially trained in the CDC method of isolation and treatment for Ebola patients, including how to properly use personal protective equipment to prevent the spread of the disease to health workers — a major concern considering that two health workers tested positive for Ebola after treating a now-deceased patient this month at Texas Health Presbyterian Hospital Dallas.

Twin Cities stores its personal protective equipment, which consists of masks, head and foot coverings, robes, gloves and other equipment, on site. Bartel did not know how many of each piece are on hand at the hospital.

Some experts question the ability of smaller regional medical centers to effectively treat and contain an Ebola patient.

“I don’t think every hospital has the facilities or the wherewithal, or for that matter the desire, to care for Ebola patients,” said Stephen Morse, a professor of epidemiology at Columbia University’s Mailman School of Public Health in a recent New York Times article on the spread of the disease.

But Bartel said she is highly confident that Twin Cities could safely contain and treat a patient.

“I would rank us at a nine for preparation,” she said. “We’ve been working very hard.”

At Sierra Vista Regional Medical Center in San Luis Obispo, which is a fellow Tenet Healthcare hospital, similar measures have been taken to prepare for a possible Ebola patient.

The hospital has conducted drills for workers as recently as Tuesday morning that include learning how to properly put on and use protective gear and how to prevent transmission of the disease to health care workers, hospital spokesman Ron Yukelson said.

In the event of an infected patient, the hospital would limit the number of staff members who treat the patient to a minimum, but all workers who could possibly be exposed to the patient are being trained in proper procedure, Yukelson said.

The staff also has been required to take an online course to provide education on Ebola.

In addition, Sierra Vista has developed and circulated a policy, “Management of Patient with Suspected or Confirmed Ebola,” that outlines site-specific procedures for Sierra Vista workers; it has placed signs throughout the hospital asking patients and visitors to inform workers whether they have or know anyone who has recently traveled to Africa; and it has added a series of screening questions used by all admittance personnel to determine whether a patient has been exposed to the virus.

“Sierra Vista is taking this situation very seriously,” Yukelson said. “Our focus will be to ensure that we can quickly identify a patient with Ebola, or suspected Ebola, protect all our staff, physicians, patients and visitors so they can safely care for the patient, and respond in a calm and coordinated fashion.”

Megan Maloney, director of marketing and communications for Dignity Health hospitals — which include Arroyo Grande Community Hospital, French Hospital Medical Center in San Luis Obispo and Marian Regional Medical Center in Santa Maria — would not answer specific questions on how the hospitals are preparing for possible Ebola patients. Instead, she issued a general statement:

“Every day, Dignity Health treats and successfully manages dangerous forms of infectious diseases. Our hospitals maintain designated rooms for isolating patients which would be used for patients with Ebola. Dignity Health remains in contact with local and state authorities, as well as the Centers for Disease Control and Prevention, in order to provide

up-to-date information and recommendations as they are released.

“In addition, hospital infection control specialists are communicating with all health care workers, including the medical staff, to ensure processes are in place for identifying, isolating and treating any potential cases that may present to our hospitals and clinics.”

McDowell said county and local hospitals are taking the possibility of a case very seriously.

“It is important to know that we live in a world where you can get to any place in 24 hours,” she said. “So is it possible someone (with Ebola symptoms) could come here? Yes. Is it likely? No — but we are preparing in any case.”