Only 6 Percent of U.S. Hospitals Are Equipped to Handle Ebola

Don’t let the hazmat suit fool you. Most U.S. hospitals aren’t totally prepared to take on Ebola patients. (Photo: Markus Schreiber/AP Photo)

Texas Health Presbyterian Hospital in Dallas has come under fire for failing to properly handle the first Ebola case to arrive stateside. But a new survey by the Association for Professionals in Infection Control and Epidemiology (APIC) suggests that the majority of U.S. hospitals are similarly ill-prepared to receive Ebola patients.

From Oct. 10 to Oct. 15, APIC asked 1,039 infection prevention personnel at U.S. hospitals this question: How prepared is your facility to receive a patient with the Ebola virus? Only 6 percent thought their hospital was well-equipped to tackle such a case, even though 81 percent had initiated Ebola training for their staff. Five percent said their facility wasn’t prepared at all.

A big part of the problem: a shortage of staff focused on warding off infection. Among the hospitals surveyed, 51 percent had just one infection prevention expert on staff or none at all. Forty-two percent had only two to five infection preventionists.

Related: How Plasma Transfusions From Survivors Fight Ebola

It’s hard to say exactly how many infection preventionists the average U.S. hospital should employ, since more than the number of inpatient beds needs to be considered, said Linda Greene, RN, an infection preventionist at Highland Hospital in Rochester, N.Y., and a former board member of APIC. The administration should also evaluate things like critical-care capacity and the number of clinics — for example, dialysis facilities — that are associated with the hospital. “You really have to do a thorough assessment of where the needs are,” she said. “And for many hospitals, that evaluation has not necessarily been done.”

What exactly does an infection preventionist do? The job description is exactly what you’d expect: helps to prevent and control the spread of infectious diseases through surveillance, investigation of cases and outbreaks, staff training, and development of infection-control policies. (Many are registered nurses or have a master’s degree in public health.)

In an ideal situation, “they are the feet-on-the-ground individuals, doing in-the-moment teaching, answering questions about disease transmission or different types of organisms,” Greene said. “They’re doing a continual scan of what’s coming in — what types of patients, microbiology reports, infections.” Unfortunately, mandatory reporting of infectious-disease data means preventionists are often “tied to their desks” instead of educating the hospital’s staff about infection control and implementing disease-prevention strategies, said Greene.

Related: Should the Ebola Quarantine Be Longer Than 21 Days?

In a small hospital, a single infection preventionist may be adequate, said Greene, but “the majority of respondents [to the survey] really feel that they don’t have the resources necessary.” This is due not only to inadequate funding, but also a lack of appreciation for infection preventionists’ role in the hospital. “When there is not an immediate threat, like the Ebola outbreak, and your infection rates are very good, [people don’t realize] that those rates are good because someone is working to prevent infections,” Greene told Yahoo Health. “The infection preventionist is underappreciated until something goes wrong.”

In other words, when things are running smoothly, hospitals may not understand the necessity of infection experts, so they staff only one or two. But when a crisis strikes, they suddenly find themselves grossly underprepared. “The most important thing we’ve learned from the Dallas experience is how important planning is and how important surge capacity is,” Greene said. Translation: Hospitals should consider the worst-case scenarios — say, a sudden Ebola outbreak — when deciding how many infection prevention experts to bring on board, not the number they’d need when infectious diseases are well under control.

A shortage of preventionists not only leaves a hospital ill-equipped to handle the crisis at hand, but also it may also mean more run-of-the-mill infections are neglected. “We’re really worried about that — about superbugs, like CRE and clostridium difficile,” said Greene. “These can have devastating consequences. People die from these diseases.” As Ebola readiness takes precedence, these infections may take the backburner, permitting an uptick in their rates. “It’s kind of like taking your eye off the ball,” she said.

The smarter solution: Instead of racing to combat outbreaks only when they happen, hospitals should already have safety practices in place so they’re prepared when the next crisis strikes. That means conducting drills, training staff on how to properly put on and remove protective gear, and educating nurses about worrisome symptoms to watch for. Bellevue Hospital in New York City, where the doctor who recently contracted Ebola is being treated, has been praised for preemptively training nurses to ask symptomatic people about international travel, for example, and setting up an Ebola isolation unit even before the patient arrived. 

When asked about their facilities’ Ebola-readiness inadequacies, the preventionists’ primary areas of concern were waste management/removal and personal protective gear to shield health care workers from infection. That may be because, thus far, facilities have found themselves medically prepared — i.e. able to treat the Ebola patient — but logistically crippled.

“When you’re planning for something, the question is, ‘How do we care for patients?’” said Greene. “Then it becomes, ‘Oh my gosh, we can’t just throw the waste in the regular trash. How do you get that waste outside the room? Where are we going to house our patients? What’s the traffic flow so that we’re not going back between a clean and dirty area?’ These are all logistical issues.”

Since the survey was conducted, the CDC has released new waste-management guidelines, which clearly outline protocol for dealing with Ebola-contaminated medical equipment. Any gowns, gloves, sheets, or other materials that may be contaminated are considered a Category A infectious substance — one that’s capable of killing people — so they have to be sterilized through autoclaving (a technique that uses pressurized steam) or incineration. Chemical methods of inactivating infectious agents haven’t been standardized.

The CDC has also recently released guidelines about protective gear, which they say should include a powered air-purifying or N95 respirator; a fluid-resistant or impermeable gown; two pairs of disposable gloves with extended cuffs; single-use or impermeable boot covers; and a disposable apron that extends from torso to midcalf if the patient has been vomiting or has diarrhea.

“It’s not just putting it on — it’s this idea of a buddy system, where a trained observer watches you put it on,” Greene told Yahoo Health. “Are there any gaps? Is all the skin covered? Can you move your arms?” During interactions with the patient, the observer also makes sure there are no “breaks in technique” or accidental encounters with bodily fluids, she said.

Although this new Ebola-prevention protocol may be daunting to hospitals, Greene thinks the current crisis has been positive in one respect: It reminds health care workers of the importance of safety, regardless of the presence of Ebola, and watching out for each other, which may be as simple as prompting a colleague to wash his or her hands. “Some hospitals have done that very well,” Greene said. “But I think we have a long way to go. This is a lesson learned, in terms of taking what we learned and applying it to our everyday practices. This is the time to really step up infection prevention. We must not only educate our health-care workers, but also educate the public.”