Health care workers monitored after Ebola case in Dallas

Federal health officials on Monday urged the nation's hospitals to "think Ebola" and keep vigilant watch for symptoms of the disease in any patients who have traveled from the three West African nations that have seen the greatest number of infections, reports AP.
Health authorities also intensified their monitoring of Dallas hospital workers who cared for a man who died of Ebola. Their stepped-up efforts came a day after a nurse was tested positive for the virus.
The nurse, who was wearing protective gear when she took care of Thomas Eric Duncan, became the first person to contract the disease within the United States. Duncan, who traveled from Liberia to visit family, did not get sick until he arrived here. He died Wednesday.
Centers for Disease Control and Prevention Director Tom Frieden said he would not be surprised if another hospital worker who cared for Duncan becomes ill because Ebola patients become more contagious as the disease progresses. He said the CDC is now monitoring all hospital workers who treated Duncan.
The case raised questions about assurances by American health officials that the disease will be contained and that any U.S. hospital should be able to treat it.
Frieden has said a breach of protocol led the worker to become infected, but officials are not sure what occurred. The nurse, who has not been identified, has not been able to point to any breach.
President Barack Obama asked the CDC to quickly investigate the incident.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases was asked on ABC's "Good Morning America" if federal health authorities should consider requiring that Ebola patients be sent only to highly specialized "containment" hospitals.
"That is something that should be seriously considered," Fauci said.
Dallas police barred entry to the nurse's apartment complex Sunday. Officers also knocked on doors, made automated phone calls and passed out fliers to notify people within a four-block radius about the situation, although authorities assured residents the risk was confined to those who have had close contact with the two Ebola patients.
The nurse wore a gown, gloves, mask and face shield while she cared for Duncan during his second visit to Texas Health Presbyterian Hospital, said Dr. Daniel Varga of Texas Health Resources, which runs the hospital.
Duncan, who arrived in the U.S. from Liberia Sept. 20, first sought medical care for fever and abdominal pain Sept. 25. He told a nurse he had traveled from Africa, but he was sent home. He returned Sept. 28 and was placed in isolation because of suspected Ebola.
Liberia is one of the three West African countries most affected by the Ebola epidemic, which has killed more than 4,000 people, according to World Health Organization figures. The others are Sierra Leone and Guinea.
The health care worker reported a fever Friday night as part of a self-monitoring regimen required by the CDC, Varga said.
Another person described as a "close contact" of the health worker has been proactively placed in isolation, he added. The hospital said its emergency department is diverting ambulances to other hospitals, though is still accepting walk-in patients.
"We knew a second case could be a reality, and we've been preparing for this possibility," said Dr. David Lakey, commissioner of the Texas Department of State Health Services.
Among the things the CDC will investigate is how the workers took off protective gear, because removing it incorrectly can lead to contamination. Investigators will also look at dialysis and intubation — the insertion of a breathing tube in a patient's airway. Both procedures have the potential to spread the virus.
Fauci said on CNN that the CDC is examining procedures like dialysis to see if they "heighten greatly" the risk of health care workers contracting Ebola. He suggested that in cases where the patient has deteriorated to the point where he or she cannot be saved, such high-risk procedures should not be done.
Every emergency room needs to be prepared to isolate and take infection control precautions, because no one can control where an Ebola patient might show up, said Dr. Dennis Maki, University of Wisconsin-Madison infectious disease specialist and former head of hospital infection control.
However, only large hospitals such as those affiliated with major universities truly have the equipment and manpower to deal with Ebola correctly, Maki said.
Health care workers treating Ebola patients are among the most vulnerable, even when wearing protective gear.
Nurses at many hospitals "are alarmed at the inadequate preparation they see," says a statement from Rose Ann DeMoro, executive director of the National Nurses United union.
A Spanish nurse assistant who helped care for two patients is the first health care worker infected outside West Africa in this outbreak. More than 370 health care workers in West Africa have fallen ill or died since the epidemic began earlier this year.
Officials said they were told there may be a pet in the Texas health care worker's apartment, and have a plan to care for the animal. They do not believe the pet has signs of having contracted Ebola. A dog belonging to the Spanish nurse was euthanized, drawing thousands of complaints.
Ebola spreads through close contact with a symptomatic person's bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen. Those fluids must have an entry point, such as a cut or scrape, or if someone touches the nose, mouth or eyes with contaminated hands or gets splashed.