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Maine Medical Tests Readiness to Handle Ebola Patients

PORTLAND, Maine - Officials at Maine Medical Center in Portland say they welcome the new federal CDC guidelines for Ebola, and say the hospital already exceeds many of the standards. Maine Med had a chance to test its preparedness earlier this month when a patient with possible Ebola symptoms came to its emergency room. On Wednesday morning, hospital staff gave reporters a glimpse of the protective suits and protocols they've put in place.

 

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Credit Patty Wight / MPBN
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MPBN
Maine Medical Center Epidemiologist Dr. August Valenti.

When it comes to protection against Ebola, the key word is "maximize." says Dr. August Valenti. He's the epidemiologist at Maine Med, and says the hospital exceeded federal CDC guidelines back in August when it first created an Ebola plan. In fact, he says, it still exceeds some of the CDCs expectations. "I think that they're catching up," he says.

Under the new guidelines, health care workers who treat Ebola patients must receive rigorous training on how to put on and take off protective equipment.  That equipment can't allow any skin to be exposed.  And a trained observer must watch staff follow these protocols. Maine Med employed the full-body protection when a patient with possible Ebola symptoms came to the hospital more than a week ago. 

It all starts with a one-piece Tyvek suit. Emergency Management Coordinator Brian Dougher slides his feet into the bright yellow suit made of strong synthetic fibers with built-in booties. He pulls gray patient socks with treads over the booties to ensure he won't slip and fall. He slides his arms into the sleeves and zips the suit up to his neck. The whole time, he's got a buddy watching him. This time it's John Swiger, from Maine Med's Safety Department.

"And basically I'm the spotter," Swiger says. "I'm keeping an eye to make sure everything is put on correctly, it's taped properly, there's no breaches in the suit, exposed skin, things of that nature."

Swiger makes sure that Dougher pulls the Tyvek suit over the wrists of his latex gloves to fully cover his skin. He helps Dougher double up with a pair of neoprene gloves. To seal it, Swiger uses a ubiquitous essential in most household tool kits - duct tape. "I always say more is better when it comes to duct tape," he says. "It's affordable."

Duct tape covers the zipper in the front of the Tyvek suit for good measure. It covers the gap between the suit and a full face hood that would otherwise expose Dougher's neck. This whole suit is Maine Med's base protective model that can be augmented through things like a longer face hood - or more duct tape.

The specifics of this protective equipment can vary from hospital to hospital. At Maine Med, the idea is to keep it as simple as possible, says Swiger. Hence, the one-piece suit and the use of equipment that's already in the hospital - from the gloves and socks to the respirator Dougher wears. "We want to keep the workflow as consistent as possible because that helps eliminate some of the errors," he says. "If it's familiar to them, they know how to do it."

And that buddy's job isn't over once the partner is suited up.  He or she puts on protective gear as well, and stands watch from a separate room, while the first partner tends to the patient.  When it's time to remove the suit, the buddy meticulously scrubs the partner's suit clean from head to toe, crease to crease, with an alcohol-based wipe, says nurse Gwen Rogers.  She leads the Department of Epidemiology and Infection Prevention at Maine Med.

"That is where the highest risk occurs for the health care worker," Rogers says. "And that is the concern of possibly where the two nurses in Dallas contaminated themselves. They weren't using the buddy system, they were also not using this level of protection."

The new CDC guidelines mean that Maine Med will now add a third observer to keep tabs on the buddies. The hospital is creating a designated isolation unit that can hold about four patients. Epidemiologist Dr. August Valenti says he's confident about the hospitals' Ebola plan, but there's more work to do. "We are still trying to decide how to manage the patient who calls, who is at risk," he says.

Before showing up at the hospital, Valenti wants these patients to call first. But the question is, how do you transport someone at risk for Ebola safely from their community to the hospital? That's a plan, says Valenti, they're still working on.