Today more than one news outlet is asking whether the USA health community is ready for Ebola. What has triggered this, of course, is the second case of Ebola in the Dallas area, the case of the nurse who was caring for the patient. The CDC said that there was a protocol error, and they were correct. This protocol error says that the answer to the question being asked is that no we are not ready for Ebola. Having said that, I would like to unpack that statement and the CDC statement.
Various news outlets are saying that the CDC is blaming the victim by saying that there was a protocol error. As a member of the healthcare community, and a person trained in microbiology (among other disciplines), let me say that to say that there was a protocol error is not to blame the victim. That type of terminology is only applicable when applied to the victim of a crime, and is most certainly not applicable to a healthcare investigation. All that a protocol error means is that some step was not properly followed. The next step is to investigate why that step were not followed. Were the nurse to have been a trained researcher, then the cause would probably have been carelessness. Since the nurse was not a trained researcher, the cause is probably inadequate training.
Before you blame the hospital, restrain yourself. Most hospital clinical and laboratory personnel are trained in up to Bio Safety Level 2 protocols with many making it to Bio Safety Level 3 protocols. Even so, in 2007 there were only 1,356 Bio Safety Level 3 protocol facilities in the USA. The laboratory in which I work is a Bio Safety Level 2 facility.
But, Ebola requires Bio Safety Level 4 protocols be followed. In 2007, there were only 15 facilities in the USA that were geared to regularly handle bacteria and viruses that are of that level of danger. Nine of those facilities were government facilities. This means that almost none of the physicians, nurses, and clinical laboratory scientists in the USA are trained in Bio Safety Level 4 protocols. Our hospitals are not truly set up to handle Bio Safety Level 4 patients. Most of all, those who come into contact with the patient are not trained in how to properly follow that protocol. With Bio-Safety Level 3, you “gown up” and that is usually sufficient. But, Bio Safety Level 4 protocols require not simply that you “gown up,” but that you put on the protective clothing in a certain order so that when you remove them in a reverse order, there is almost no chance of your being accidentally contaminated.
It is that protocol that was probably breached. Given that only 15 facilities in the USA (back in 2007) knew how to properly follow those protocols, it should not be surprising that a local nurse was not experienced in the protocol. Of course, some will say that CDC personnel should have been on hand and taken over the care of the patient. There is just one problem. Current law does not simply allow Federal personnel to walk into a private facility to take over, particularly in Texas. More than that, CDC personnel are researchers who do not currently practice in a hospital. Even if they had gone there, they would not have been able to function as nurses in a hospital whose procedures and protocols they did not know.
Sadly, the news media will probably be more concerned with finding blame than with realizing the complexity of the problem that is being faced. The common USA attitude, that if anything goes wrong someone must be to blame, is the least helpful attitude that we could have at this time. We cannot afford to have top hospital administrators or top researchers or top government administrators being forced to resign in order to satisfy the American mistaken penchant of declaring that heads must roll even when the situation is so outside of what one can normally expect that it is unfair to blame someone in charge.
p align=”justify”>More than that, by that type of reasoning, the heads of every nursing and laboratory program must resign because they did not teach us how to handle Bio Safety Level 4 procedures and be practiced in them. Should I mention that if we were to be trained in every possible procedure and protocol the cost of nursing and laboratory training would rise into the stratosphere (as would our wages)? Yes, it is true that we may now need to be trained in those procedures. But, that is beginning to happen now.