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US releases revised Ebola gear guidelines

October 21, 2014

ATLANTA (AP) — Federal health officials on Monday issued new guidelines to promote head-to-toe protection for health workers treating Ebola patients.

Officials have been scrambling to come up with new advice since two Dallas nurses became infected while caring for the first person diagnosed with the virus in the United States.

The new guidelines set a firmer standard, calling for full-body garb and hoods that protect worker’s necks; setting rigorous rules for removal of equipment and disinfection of gloved hands; and calling for a “site manager” to supervise the putting on and taking off of equipment.

They also say health workers who may be involved in an Ebola patient’s care should repeatedly practice and demonstrate proficiency in donning and removing gear — before ever being allowed near a patient.

And they ask hospitals to establish designated areas for putting on and taking off equipment, whether it’s a room adjacent to an Ebola patient’s room or a hallway area cordoned off with a plastic sheet.

Nurses’ groups and other hospital workers had pressed the federal Centers for Disease Control and Prevention for the new guidance, saying the old advice was confusing and inadequate, and workers felt unprepared.

It’s not clear exactly how or when the two nurses at Texas Health Presbyterian Hospital became infected. Hospital officials have said they were following CDC guidance while caring for Thomas Eric Duncan, who had traveled to Dallas from his native Liberia, one of the West African countries hit hardest by the Ebola outbreak which has killed more than 4,500 people.

“The bottom line is the guidelines didn’t work for that hospital,” said CDC director, Dr. Tom Frieden, in announcing the revision.

He said the latest advice offers an “extra margin of safety” and is better suited to U.S. hospitals where more high-risk procedures may be used. Earlier CDC guidelines had been based on treatment of Ebola patients in Africa, which sometimes has occurred in medical tents. That advice also allowed hospitals some flexibility with wearing protective garb when dealing with a suspected — not confirmed — case of Ebola.

The CDC cannot require hospitals to follow the guidance; it’s merely official advice. But these are the rules hospitals are following as they face the possibility of encountering patients with a deadly infectious disease that a few months ago had never been seen in the U.S.

Duncan was the first person diagnosed with Ebola in the U.S. The Liberian came down with Ebola symptoms last month, a few days after arriving in Dallas from Liberia.

Duncan went to Texas Health Presbyterian Hospital on Sept. 25 but was not tested for, or diagnosed with, Ebola. He was admitted a few days later, and died Oct. 8.

Duncan’s case led to the monitoring of about 50 people who came in contact with him before his second trip to the hospital, and dozens of health care workers who cared for him after his admission.

Some good news this week: The 50 in the initial contact group have passed a 21-day observation period and no longer are deemed at risk for coming down with the dreaded disease.

Youngor Jallah spent the past three weeks confined to her small apartment with her children and boyfriend, fearing they had contracted the deadly Ebola virus from Duncan, who was her mother’s fiance.

But with the household emerging symptom-free from the incubation period, Jallah’s family members are now trying to resume their lives - replacing the personal belongings incinerated in a cleanup at her mother’s home, and overcoming the stigma of the Ebola scare that has gripped Dallas.

On Monday, Jallah beamed as she sent her children back to school with clearance from the Dallas County health department tucked into their backpacks. Her mother emerged from her own confinement and started looking for a new place to live.

“We were sitting here traumatized,” Jallah told The Associated Press on Monday. “We just thank God we never came down with the virus.”

There are now about 120 people in Texas being monitored for symptoms, with their wait period ending Nov. 7, said Dallas Mayor Mike Rawlings. He said the number may fluctuate.

There are also about 140 people being monitored in Ohio because of contact or potential contact with nurse Amber Vinson, Ohio officials said. Vinson, who cared for Duncan in Texas, flew from Dallas to Cleveland on Oct. 10 and flew back Oct. 13.

An Ebola patient who was being treated in Atlanta since early September was released from Emory University Hospital on Sunday after he was determined to be free of the virus and no threat to the public. Hospital and health officials never released his name, in keeping with his family’s wish for privacy.

Health officials said they were relieved as the monitoring period ended for many, and after a cruise ship scare ended with the boat returning to port in Texas and a lab worker on board testing negative for the virus.

After Duncan was diagnosed with Ebola, Jallah’s mother, Louise Troh; Troh’s 13-year-old son; Duncan’s nephew, and a family friend were ordered by a Dallas court to stay inside the apartment among Duncan’s used linens. Five days later they were evacuated to a four-bedroom home in an isolated corner of a 13-acre (5.2-acre) gated property owned by the Roman Catholic Diocese of Dallas, southwest of downtown.

Except for a few plastic bins filled with personal documents, photographs, trophies and a Bible, the apartment was stripped down to the carpeting and the contents were incinerated.

The city of Dallas announced Monday it is coordinating with a local church and donors to provide Jallah’s mother, Louise Troh, with funds to pay for six months of housing. Once she chooses a location, nonprofits will assist the family with furniture, linens and other household items, the city said.

“We want to restore what’s lost but more than that, we want to give her a running start on her new life,” said Troh’s pastor, George Mason of Wilshire Baptist Church in Dallas.

___

Schmall reported from Dallas. Associated Press writers Jamie Stengle, Nomaan Merchant and Marilynn Marchione in Dallas contributed to this report.

Health officials released new guidelines Monday for how health workers should gear up to treat Ebola patients.

The federal Centers for Disease Control and Prevention released the long-anticipated updates Monday evening. Health workers have been pushing for new standards since two Dallas hospital nurses were diagnosed with the disease this month after treating an Ebola patient.

The guidelines call for face shields, hoods, boot covers and other garb that leave no part of the body exposed. They also call for a trained monitor to supervise the donning and doffing of protective wear. And they call for repeated training and practice.

The CDC guidance was expected as early as Saturday, but its release has been pushed back while it continues to go through review by experts and government officials.

Health workers had been pushing for the guidance since the nurses at Texas Health Presbyterian Hospital in Dallas were infected. They had treated an Ebola-infected patient named Thomas Eric Duncan — the first person diagnosed with the virus in the U.S.

Exactly how the two nurses were infected is not clear, said CDC Director Dr. Tom Frieden during a Monday night teleconference with reporters.

“We may never know exactly how that happened, but the bottom line is, the guidelines didn’t work for that hospital,” Frieden said.

The new guidelines include:

—Use of protective garments, hoods, face shields, double gloves, face masks or respirators and other protective equipment to cover every square inch of a health worker’s body.

—A call for health workers who may be involved in an Ebola patient’s care to practice repeatedly and demonstrate proficiency in donning and doffing gear before ever being allowed near a patient.

—Placement of a trained hospital employee to supervise all aspects of care in an Ebola patient’s room and watch that all health workers put on and take off gear correctly.

Duncan’s infection and subsequent death led to the monitoring of about 50 people who came in contact with him before he entered the hospital and dozens of health care workers who cared for him after his admission.

Some good news this week: The 50 in the initial contact group have passed a 21-day observation period and no longer are deemed at risk for coming down with the dreaded disease.

Youngor Jallah spent the past three weeks confined to her small apartment with her children and boyfriend, fearing they had contracted the deadly Ebola virus from her mother’s fiance.

But with the household emerging symptom-free from the incubation period, Jallah’s family members are now trying to resume their lives — replacing the personal belongings incinerated in a cleanup at her mother’s home, and overcoming the stigma of the Ebola scare that has gripped Dallas.

On Monday, Jallah beamed as she sent her children back to school with clearance from the Dallas County health department tucked into their backpacks. Her mother emerged from her own confinement and started looking for a new place to live.

“We were sitting here traumatized,” Jallah told The Associated Press on Monday. “We just thank God we never came down with the virus.”

Jallah’s fiance, Thomas Eric Duncan, died Oct. 8.

Health officials said Monday about 50 people have passed the incubation period safely. Others who are still being monitored include health care workers who treated Duncan as well as those who cared for two nurses who had treated Duncan and also became infected.

There are now about 120 people in Texas being monitored for symptoms, with their wait period ending Nov. 7, said Dallas Mayor Mike Rawlings. He said the number may fluctuate.

There are also about 140 people being monitored in Ohio because of contact or potential contact with nurse Amber Vinson, Ohio officials said. Vinson, who cared for Duncan in Texas, flew from Dallas to Cleveland on Oct. 10 and flew back Oct. 13.

An Ebola patient who was being treated in Atlanta since early September was released from Emory University Hospital on Sunday after he was determined to be free of the virus and no threat to the public. Hospital and health officials never released his name, in keeping with his family’s wish for privacy.

Health officials said they were relieved as the monitoring period ended for many, and after a cruise ship scare ended with the boat returning to port in Texas and a lab worker on board testing negative for the virus.

After Duncan was diagnosed with Ebola, Troh, her 13-year-old son, Duncan’s nephew and a family friend were ordered by a Dallas court to stay inside the apartment among Duncan’s used linens. Five days later they were evacuated to a four-bedroom home in a gated property owned by the Roman Catholic Diocese of Dallas, southwest of downtown.

Except for a few plastic bins filled with personal documents, photographs, trophies and a Bible, the apartment was stripped down to the carpeting and the contents were incinerated.

The city of Dallas announced Monday it is coordinating with a local church and donors to provide Jallah’s mother, Louise Troh, with funds to pay for six months of housing. Once she chooses a location, nonprofits will assist the family with furniture, linens and other household items, the city said.

“We want to restore what’s lost but more than that, we want to give her a running start on her new life,” said Troh’s pastor, George Mason of Wilshire Baptist Church in Dallas.

While health workers cleared Jallah of having Ebola, the disease’s stigma lingers — including among fellow Liberians, she said.

“If they see me at the store, they run away,” she said.

___

Schmall reported from Dallas. Associated Press writers Jamie Stengle, Nomaan Merchant and Marilynn Marchione in Dallas contributed to this report.

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