Breaking ranks with the US Centers for Disease Control and Prevention's Director Thomas Frieden, 3 doctors at 2 of the nation's 4 bio containment care facilities and a fourth at a military hospital said allowing community hospitals to care for patients with Ebola and similar pathogens is too risky. They call for creating a new system of regional facilities fully equipped and staffed with workers trained to safely handle such cases.
Breaking ranks with the US Centers for Disease Control and Prevention’s Director Thomas Frieden, three federal doctors at two of the nation’s four biocontainment care facilities and a fourth physician at a military hospital said allowing community hospitals to care for patients with Ebola and similar pathogens is too risky.
They call for creating a new system of regional facilities fully equipped and staffed with workers trained to safely handle such cases
“Caring for patients with filovirus and arenavirus infections in a conventional setting presents enormous challenges,” they wrote in an article published online today in the Annals of Internal Medicine.
The authors are Mark Kortepeter, MD MPH, Philip Smith, MD, Angela Hewlett MD and Theodore Cieslak.
Kortepeter is associate dean for research at the National Institutes of Health Clinical Center federally designated high-level containment care (HLCC) facility located in Bethesda, MD.
Coauthors Smith and Hewlett work at the Division of Infectious Diseases Biocontainment Unit at the University of Nebraska Medical Center in Omaha, NE. Cieslak works at San Antonio Military Medical Center, Fort Sam Houston, TX.
“Lapses inevitably occur in infection control routines in conventional medical settings, but once a patient enters the facility, there is no margin for error,” the colleagues said. While as a practical matter, all hospitals need some training in isolating patients who may have these lethal infections, the level of preparedness—both in training and equipment—required to meet HLCC standards is simply impractical for most community facilities to attain.
“It is impossible to completely engineer out human error, eliminate the risk for sharps or needlestick injury, or prevent inadvertent contact contamination,” in conventional settings, they wrote.
Such mistakes have apparently happened in Dallas, TX.
The CDC and local officials are currently investigating how two nurses who cared for deceased Ebola victim Thomas Eric Duncan at Texas Presbyterian Hospital came to be infected themselves. One nurse is now a patient at that hospital and the second has been transferred to the US Army Medical Research Institute of Infectious Diseases (USAMRID) HLCC at Emory University Hospital in Atlanta, GA.
“The serious nature of filoviral and arenaviral infections, their rarity and unfamiliarity to clinicians in developed settings, the lack of effective treatment and vaccines, their propensity to infect health care staff, and the infection control challenges they present argue for, in our opinion, specialized containment and treatment facilities,” they wrote. The 4 existing biocontainment facilties have a total of 19 beds.
Though Ebola patients or those with other deadly pathogens may first present at community hospitals or other facilities, the authors argue for creating a “network of strategically located regional referral centers” tied to biohazard labs or airport quarantine facilities. These patients could be transfered there, they said.
The position of the Obama administration, reiterated in a speech the president made last night, is that with proper training, community hospitals can handle Ebola patients.
In a disclaimer in the article the authors said the views expressed “do not reflect the official policy of the Department of the Army, the Department of Defense , or the US government.”