With Sunday’s confirmation that an ICU nurse at a Dallas hospital that cared for a dying Ebola patient has tested positive for the deadly virus, President Obama ordered federal authorities to “take immediate additional steps to ensure hospitals and healthcare providers nationwide are prepared to follow protocols should they encounter an Ebola patient.”
That’s appropriate, as is the growing sense of urgency with regard to the level of readiness not just for the potential spread of Ebola but for other disease outbreaks.
This is not a time to panic. It is a time to get things right.
“Ebola is dangerous, and our No. 1 responsibility is to keep our people safe,” says Senator Elizabeth Warren, the Massachusetts Democrat who is a member of the Committee on Health, Education, Labor and Pensions. “But we want to be very careful that we are following the recommendations of the scientific community. We want to use best science here. That’s how we’ll keep ourselves safe. So for me, part of this is the reminder it is powerfully important to make long-term investments, particularly in medical research.”
Warren has not been shy about noting that “with all the spending cutbacks and all the pressure on the National Institute of Health, much of that research has been shelved.”
Warren is right; according to The Hill, “The sequester resulted in a $195 million cut that year to the National Centers for Emerging and Zoonotic Infectious Diseases, a CDC program that tries to prevent illness and death from infectious disease.”
Research is essential, but so too is basic preparedness.
The best way to determine if our hospitals are ready to respond is by asking a nurse. Or, to be more precise, nurses.
The answer, unfortunately, is that our hospitals are not up to speed.
Describing training and preparations as “woefully insufficient,” Castillo says, “We have to continue to sound the alarm. There is the potential for many more Dallases if hospitals are not mandated and do not commit to more vigorous standards. We see potential gaping holes for this to spread.”
Those gaps need to be closed. Resources must be made available to do the address real concerns, and budgets cannot be nickle-and-dimed by austerity-obsessed officials.
“The time to act is long overdue,” says RoseAnn DeMoro, the executive director of NNU, the nation’s largest nurses union.
NNU leaders have from the start of the Ebola outbreak in West Africa been outspoken regarding the need to provide immediate support for healthcare personnel in Liberia, Sierra Leone and other countries. The union has raised money and offered support for those initiatives.
At the same time, the union has focused attention on the need for greater preparation by US hospitals.
Weeks ago, NNU leaders and members began to sound the alarm—highlighting what Castillo described in September as “the critical need for planning, preparedness and protection at the highest level in hospitals throughout the nation.” And the union took action, launching a national survey of hospital preparedness.
So far, 2,000 registered nurses at more 750 facilities in forty-six states and the District of Columbia have weighed in, providing evidence of serious gaps in readiness.
• “76 percent of those surveyed say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola”
• “85 percent say their hospital has not provided education on Ebola with the ability for the nurses to interact and ask questions”
• “37 percent say their hospital has insufficient current supplies of eye protection (face shields or side shields with goggles) for daily use on their unit; 36 percent say there are insufficient supplies of fluid resistant/impermeable gowns in their hospital”
• “39 percent say their hospital does not have plans to equip isolation rooms with plastic covered mattresses and pillows and discard all linens after use; only 8 percent said they were aware their hospital does have such a plan in place.”
NNU leaders have also outlined a response agenda.
The “full emergency preparedness plan” they propose includes a call for:
• “Full training of hospital personnel, along with proper protocols and training materials for responding to outbreaks, with the ability for nurses to interact and ask questions.”
• “Adequate supplies of Hazmat suits and other personal protective equipment.”
• “Properly equipped isolation rooms to assure patient, visitor, and staff safety.”
• “Proper procedures for disposal of medical waste and linens after use.”
The emphasis on the need for rigorous training is echoed by other unions that have a major presence in the nation’s hospitals. Service Employees International Union occupational health and safety director Mark Catlin told Politico that even when medical facilities have protocols, “it’s not clear how well facilities implement them.”
This lack of clarity is the issue that must be addressed.
NNU’s DeMoro warns, “There is no standard short of optimal in protective equipment and hands-on-training that is acceptable.”