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UPMC Presbyterian, AGH identified as spots for suspected Ebola patients

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Tribune-Review
Allegheny General Hospital, part of Allegheny Health Network, in Pittsburgh's North Side.
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Trib Total Media
The main entrance of UPMC Presbyterian in Oakland.

Sophisticated academic medical centers appear best prepared to treat Ebola patients in the United States since a Dallas hospital failed to keep the virus from infecting its staff, several doctors and public health scholars said Wednesday.

Critical mistakes at Texas Health Presbyterian Hospital set the facility apart from Emory University Hospital in Atlanta and University of Nebraska Medical Center in Omaha, which have cared for five Ebola survivors and prevented workers from contracting the disease, said Allegheny County Health Department director Karen Hacker.

She said medics in the county would rush patients to academic medical centers such as Allegheny General Hospital in the North Side or UPMC Presbyterian in Oakland for suspected Ebola infections.

The federal Centers for Disease Control and Prevention has said every hospital should be ready for Ebola patients. Even so, it reported the latest infected health care worker, Amber Vinson, would be flown from Dallas to Atlanta for treatment.

“Not every place is as ready as we'd like them to be to handle that,” said Jennifer Nuzzo, an epidemiologist at the UPMC Center for Health Security in Baltimore. She said top-notch academic medical centers probably have more resources and sharper experience than smaller community hospitals to protect workers from Ebola and prevent the virus from spreading.

Nuzzo described the 898-bed Dallas hospital as the first community-level facility in the country to handle Ebola. The hospital did not respond to a Tribune-Review inquiry.

“I think you want to have those patients in the highest-level facility you can, within reason,” said Dr. Robert Keenan, chief quality officer at Allegheny General and West Penn Hospital in Bloomfield. He called Ebola care “incredibly labor-intensive, incredibly supply-intensive.”

“You want to have the capability that the larger hospitals can offer,” said Keenan, who also advocates treatment at more advanced medical centers.

Clinicians said hospital workers are at especially high risk because they deal directly with bodily fluids and invasive procedures such as dialysis for Ebola patients.

Two of more than 100 people in touch with Thomas Eric Duncan, the Liberian who died of Ebola last week in Dallas, developed disease symptoms, the CDC said.

Nurses at the hospital worried about their risk when they cared for Duncan, said Deborah Burger, co-president of National Nurses United. Workers were concerned about flimsy garments and head and neck exposures.

“There was no advance preparedness on what to do with the patient. There was no protocol, there was no system,” the union said in a statement.

Registered nurses said Duncan was left for hours in an area with other patients, even when he and his family thought he might have Ebola, according to the union. His unsecured lab specimens traveled through a hospital tube system, and nurses who interacted with him went on to care for other patients, even though they had not been wearing proper protective gear, workers said in a statement

A hospital spokesman did not respond to specific claims by the nurses. He told The Associated Press that the hospital would answer workers' concerns, calling “patient and employee safety our greatest priority.”

Other observers heaped blame on the CDC for not dispatching a more thorough response to educate Dallas medical workers when doctors diagnosed Duncan. It's “extremely easy” for workers to contaminate themselves when they remove protective gear, said Phenelle Segal, president of Montgomery County-based Infection Control Consulting Services and a former infection prevention analyst for Pennsylvania's Patient Safety Authority.

“There was obviously a breach in practice, which is not the fault of the nurse. She got a bad rap for that. The hospital got a bad rap,” Segal said.

It would be ideal for Ebola patients to be treated in Omaha; Atlanta; Missoula, Mont.; and Bethesda, Md. — cities with top-tier biocontainment units, she said.

That does not mean big medical centers, including large teaching hospitals, would do better than smaller venues in stopping the spread, Segal said. Smaller hospitals with less bureaucracy can be swift at adapting their emergency procedures.

“Unfortunately, it takes a catastrophic event like this to have everybody on board and learn,” she said. “In defense of all hospitals, in defense of all health care personnel, we don't know how to deal with these situations until we have a specific event take place like this.”

The Associated Press contributed to this report. Adam Smeltz is a Trib Total Media staff writer. He can be reached at 412-380-5676 or [email protected].

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