10/2/14

Communicable Disease Prevention: Did the First Ebola Patient Diagnosed in the U.S. Slip Through the Cracks?


By on 12:36 PM

It was a matter of time before the first person infected with Ebola in Liberia entered the U.S. and was "misdiagnosed." Just one week ago, such a man walked into the emergency department (ED) at a hospital in Dallas complaining of fever and abdominal pain. If he had not been a visitor from Liberia, he would have received a number of differential diagnoses and there would have been no suspicion of an Ebola virus infection.

However, this specific hospital had a checklist in place to screen patients in light of the fact that over 7,000 people in West Africa have been infected with Ebola to date. The checklist is effectively designed; however, as is often the case when there is a breakdown in processes, the "message" that failed to be delivered to the appropriate personnel was the vital link to patient information (a visitor from Liberia which should immediately put the ED staff on alert) and instituting immediate isolation precautions versus sending a patient home.

For many years now, infection prevention and control experts have been stressing pandemic planning and the important role of the ED in identifying possible contagious diseases at the earliest possible stage of a patient's visit to the hospital. However, no matter how well a pandemic plan is written, human failure will more than likely occur as we have not yet mastered the skills critical to prevent these types of situations. While we have come a long way in reducing  healthcare associated infection rates (central line associated blood stream infections in the hospital setting), since pandemic situations are not an everyday occurrence, there isn't enough "practice to make perfect" or consistency with identifying and treating contagious diseases, particularly of this nature, as is evident by this latest breach in prevention.

This specific patient more than likely did not infect any passenger on any of his plane flights as he was not exhibiting signs and symptoms, according to the CDC. However, a system failure in the ED has resulted in an exposure and that is the concern surrounding the need for vigilant adherence to infection control processes.

The burning question is whether the World Health Organization and CDC is doing enough to prevent a pandemic. While an Ebola patient "is not infectious until they are exhibiting symptoms," the case in Dallas is a good example of exposure to people after he began to become physically ill. How is it possible to trace every person potentially exposed to his body fluids? Unconfirmed sources state that he was vomiting uncontrollably outside the apartment complex he was visiting. Should WHO and CDC have considered halting all travel into and out of West African nations that have been affected by this deadly illness, and how different is this to other rapidly spreading contagious illnesses such as SARS and H1N1?

There are many facets to the prevention of the spread of contagious diseases. For healthcare professionals, we need to concentrate on educating the staff members, particularly in the ED, to be on their guard at all times and not to be cavalier about this deadly virus remaining on Africa's soil and not spreading to other countries. Checklists are only as good as the people working with them and, once again, communication is key in stopping the spread of deadly infections.

Phenelle Segal of Infection Control Consulting Services provides infection prevention and control services to a variety of healthcare facilities and organizations including, but not limited, to hospitals and health systems, ambulatory surgery centers, physicians practices, dentists and nursing homes. Contact Phenelle Segal by clicking here.

Ebola Resources 
- Checklist for EMS from CDC (pdf)
- Checklist for ED from CDC (pdf)
- Factsheet: Interim Guidance for Specimen Collection, Transport, Testing, and Submission for Patients with Suspected Infection with Ebola Virus Disease from CDC (pdf)
- Evaluating Returned Travelers for EVD from CDC (pdf)

Phenelle Segal, RN, CIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.

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