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» »Unlabelled » Questions Rise on Preparations at Hospitals to Deal With Ebola

Federal health officials have offered repeated assurances that most American hospitals can safely treat Ebola, but Emory University Hospital in Atlanta, which had years of preparation for just such a crisis, found out how hard that is while it cared for three Ebola patients.
As doctors and nurses there worked to keep desperately ill patients alive in August, the county threatened to disconnect Emory from sewer lines if Ebola wastes went down the drain. The company that hauled medical trash to the incinerator refused to take anything used on an Ebola patient unless it was sterilized first. Couriers would not drive the patients’ blood samples a few blocks away for testing at the Centers for Disease Control and Prevention. And pizza places would not deliver to staff members in any part of the hospital.
“It doesn’t matter how much you plan,” Dr. Bruce Ribner, an infectious disease specialist who directed the patients’ care, said in an interview. “You’re going to be wrong half the time.”
Emory solved its problems, but the challenges it faced could overwhelm a hospital with fewer resources. At Texas Health Presbyterian Hospital in Dallas, mistakes in treating a patient from Liberia — a delay in diagnosing the disease, and its spread to a health worker who had apparently taken all precautions — have raised questions about the general level of preparedness in hospitals around the country. Medical experts have begun to suggest that it might be better to transfer patients to designated centers with special expertise in treating Ebola.
Federal health officials are also beginning to consider that idea, though they emphasize that every hospital has to be able to diagnose the disease.
During a news conference this month, Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said: “Essentially, any hospital in the country can safely take care of Ebola. You need a private room with a private bathroom, and rigorous, meticulous training and materials to make sure that care is done safely so caregivers aren’t at risk.”
But on Sunday, after it was confirmed that a nurse in Dallas had been infected with Ebola, Dr. Frieden said his agency would consider whether patients should be transferred to specialty centers.
“We’re looking at different options for what will be the safest way to care for patients,” he said in an interview on Monday. But he declined to explain what those options were.
There are four biocontainment units around the country that have been equipped to isolate patients with dangerous infectious diseases: at Emory; the National Institutes of Health in Bethesda, Md.; Nebraska Medical Center in Omaha; and St. Patrick Hospital in Missoula, Mont. But other large hospitals around the country could also handle Ebola patients, Dr. Ribner said.
“I think the larger regional hospitals are where the care of these patients is going to have to be focused,” Dr. Ribner said, adding that there is a long tradition in medicine of transferring critically ill patients from smaller hospitals to larger ones better equipped to care for them.
source:-nytimes.com

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