11:22 PM EBOLA LAPSES PERSISTED FOR DAYS AT DALLAS HOSPITAL, MEDICAL RECORDS SHOW | |
The medical records of Thomas Eric Duncan, given to the Associated Press by his family, provide a window of the span of exposure to the hospital's workers in the early days of Duncan's treatment. The records show that because of a lag in implementing preventative measures or because of insufficient measures, multiple hospital staffers were put at risk. The hospital's protective protocol was "insufficient," said Dr. Joseph McCormick of the University of Texas School of Public Health, who was part of the CDC team that investigated the first recorded Ebola outbreak in 1976. "The gear was inadequate. The procedures in the room were inadequate." The Centers for Disease Control and Prevention had previously pointed to lapses by the hospital in the initial days after Duncan arrived at the hospital, and the records show heightened protective measures as his illness advanced. The records show Nina Pham, the first Texas nurse to be diagnosed with Ebola, first encountered the patient after he was moved to intensive care at 4:40 p.m. on Sept. 29, more than 30 hours after he came to the ER. Nearly 27 hours later, Amber Joy Vinson, a second nurse who contracted the disease, first appears in Duncan's charts. Because doctors and nurses are focused on logging the patient's care, they may not always note their own safeguards in the medical records. In Pham's first entry, she makes no mention of protective gear. When she logs again the following morning, she specifically mentions wearing a double gown, face shield and protective footwear, equipment she mentions again in later entries. In the first apparent mention of Vinson -- identified by just her first name in another nurse's notes -- she is said to have worn personal protection, including a hazardous-materials suit and face shield. It's unclear whether those initial interactions with Duncan represent the time at which a breakdown in protection led to the infections, or whether such lapses persisted during the remainder of the patient's 11-day stay. At least 70 workers are named in the records as being involved with Duncan's care in that period. Dr. Tom Frieden, the CDC director, told lawmakers during a congressional hearing Thursday that he did not know how the nurses got infected, only that "possible causes" had been identified. In comments a day earlier, he gave a clue: "For the first several days of the patient's stay, before he was diagnosed, we see a lot of variability in the use of personal protective equipment." Because Ebola has an incubation period of up to 21 days, those who cared for Duncan at the start of his second hospital stay will not be considered safe from infection until Monday. Those with him at the time of his death will not emerge from monitoring until Oct. 30. Duncan first arrived at Presbyterian on Sept. 25 but was sent home. When he returned by ambulance at 10:07 a.m. on Sept. 28, he was sicker and probably more contagious. Staff noted immediately upon his intake that he had recently arrived from Liberia. Five minutes later, a nurse notes that he is in a room and had "put on airborne precautions." Nine minutes after that, Duncan is seen by a doctor who writes that Ebola is a possibility and notes that he "followed strict CDC protocol" by being "masked, fully gowned and gloved" when treating Duncan.
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