A breach in safety protocol at a Dallas Hospital has caused a female healthcare worker to become infected with Ebola after having extensive contact with Ebola patient Thomas Eric Duncan.
The development — the first known case of the deadly disease transmitted in the United States — stunned health officials who had not included the woman in the group of 48 people being monitored for the disease because she was thought to be of low risk for infection because she had worn protective equipment while caring for Duncan.
But the woman developed symptoms Friday, and preliminary diagnostic tests came back positive late Saturday — a reminder of the risk that nurses, doctors and other hospital workers face treating Ebola patients. More than 400 healthcare workers, the vast majority in West Africa, have contracted Ebola. Fifty-eight percent of those have died, according to the most recent report from the World Health Organization.
Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said the CDC still must confirm the diagnosis, but that there was little doubt that there had been a failure of the supposedly rigid precautions that health workers are to take when caring for patients with the highly contagious disease.
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“We don’t know what occurred in the care of [Duncan], but at some point, it was a breach in protocol and that breach in protocol resulted in this infection,” Frieden said in a briefing Sunday. “If this individual was exposed, which they were, it is possible that other individuals were exposed,” Frieden said.
All healthcare workers who treated Duncan are now being monitored for possible infection. Previously, those monitored included family members and others who had come into contact with Duncan before he was hospitalized Sept. 28. Four family members are being checked twice a day and are being guarded to ensure they remain isolated. The 21-day incubation period for most of the 48 ends on Oct. 19.
Meanwhile, a Boston Globe report said a man who recently visited Liberia is being assessed at Beth Israel Deaconess Medical Center in Boston for a possible Ebola infection. The report said that the man, whom officials have not identified, was hospitalized late Sunday afternoon after he complained of headache and muscle aches.
As the epidemic has swept the West African nations of Liberia, Guinea and Sierra Leone, healthcare workers, unaware that they were treating people with the disease, are thought to have played a role in its spread. Texas officials said only one person is believed to have had contact with the new Dallas patient after she began to show symptoms. That person will now be monitored for 21 days.
The CDC now is recommending that the Dallas hospital, Texas Health Presbyterian, keep the number of workers treating possible Ebola patients to an “absolute minimum,” Frieden said. The agency also wants the hospital to provide a full-time infection control officer to ensure that safety measures are followed with Ebola patients.
The hospital announced Sunday that its emergency department had stopped until further notice accepting patients brought by ambulance “because of limitations in staffed capacity,” a step known as “diversion.”
“While we are on diversion we are also using this time to further expand the margin of safety by triple-checking our full compliance with updated CDC guidelines,” the hospital said. “We are also continuing to monitor all staff who had some relation to Mr. Duncan’s care even if they are not assumed to be at significant risk of infection.”
The infected woman sought care immediately after her symptoms developed and was placed in isolation at the hospital, Frieden said.
Frieden said the worker had extensive contact on multiple occasions with Duncan during his care, but currently had a low level of the virus.
The CDC is recommending that the hospital perform only “essential procedures” on Ebola patients to limit workers’ possible exposure to the virus. Under that guideline, Duncan would not have received the kidney dialysis and respiratory intubation treatments.
Officials will also examine whether the infection occurred during the removal of the worker’s protective equipment. The full-body suits, gloves and masks worn by Ebola caregivers are designed to protect them from infected body fluids, which spread the disease.
But removing the gear is a “major potential area of risk,” Frieden said.
A nursing assistant in Madrid, Spain, who became infected after treating Ebola patients, has suggested her infection might stem from hand-to-face touching as she removed her protective equipment. Spanish authorities are monitoring 16 people who came in contact with the nursing assistant who is critical condition.
Kathy Vetter and Judy Wiley of the Fort Worth Star-Telegram contributed to this report.