Hopkins picked to create Ebola training tool

The Baltimore Sun
What new role will John Hopkins play to help keep doctors and nurses free of Ebola?

Federal health regulators picked Johns Hopkins Medicine on Friday to lead development of a Web-based tool to train doctors, nurses and other health care workers on the protocols they should follow when treating patients with, or at risk of contracting, Ebola.

The Centers for Disease Control and Prevention announced that the Johns Hopkins Armstrong Institute for Patient Safety and Quality, known for its push for basic protocols to prevent medical errors, would head a 40-member team of hospitals and professional organizations in the effort.

The website, expected to launch next week, will give users a step-by-step guide on how to put on and remove protective gear and how to ensure that safe practices are followed throughout the process. The protocols are government-approved.

Many in the health community have complained they have not been trained adequately to deal with Ebola cases after two nurses at a Dallas hospital contracted the disease while caring for an infected Liberian man. The patient, Thomas Eric Duncan, died of Ebola on Oct. 8.

One of the nurses, Nina Pham, was declared free of the virus and released from the National Institutes of Health Clinical Center in Bethesda on Friday. The other nurse, Amber Vinson, is being treated at Emory University Hospital in Atlanta. "Tests no longer detect virus in her blood," the hospital said.

After meeting with — and getting a hug from — President Barack Obama at the White House, Pham flew out of Baltimore-Washington International Thurgood Marshall Airport for Dallas on a private medical charter Friday evening, according to a source familiar with the arrangements but not authorized to discuss them.

The CDC and Hopkins officials hope the training tool will help health care workers like Pham avoid contracting the deadly virus even as they treat new cases such as the New York doctor who tested positive for Ebola after returning recently from treating patients in Guinea.

Dr. Peter Pronovost, head of the Armstrong Institute, hopes the website will help resource-strapped medical institutions offer their workers training they may feel they are not equipped to provide. He also believes it could save lives.

"One of the best defenses against Ebola is training," said Pronovost, who has pushed simple protocols for using central-line catheters to cut hospital-acquired infections significantly and save lives. His checklist has virtually eliminated bloodstream infections where it was implemented.

Hopkins officials said taking off and putting on protective gear might seem simple, but small missteps can lead to passing on the disease. In developing the online courses, which will be available through iTunes U and the CDC website, they looked for potential mistakes that could cause contamination. They tested the procedures in a simulation room.

The infection of the nurses was ascribed by the CDC to a "protocol breach" in donning or removing their protective gear.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, described Pham, 26, as "an extraordinarily courageous and lovely person" and "a devoted nurse."

"She has no virus in her," Fauci said. "She feels well."

Before the start of the news conference Friday, Pham stood with NIH doctors and staff and her mother and sister, smiling and wearing a black suit with a turquoise shirt at the NIH facility. She then read a statement and did not take any questions.

"I feel fortunate and blessed to be standing here today," Pham said. "I would first and foremost like to thank God, my family and friends. Throughout this ordeal, I have put my trust in God and my medical team. I am on my way back to recovery, even as I reflect on how many others have not been so fortunate."

The current Ebola outbreak in the West African nations of Liberia, Guinea and Sierra Leone has killed thousands of people.

At his daily news briefing, White House press secretary Josh Earnest said the president's decision to greet Pham was "an opportunity, first of all, to thank her for her service."

"She was doing the work that many nurses do on a daily basis, and she did so even though it did put her at some risk," Earnest said.

Pham did not undergo any additional medical testing before greeting and hugging the president, Earnest said, noting that she had been shown to be free of the virus on five separate occasions before being released.

Obama, he said, was "not at all concerned" that he might come under risk of contracting Ebola by hugging Pham.

At the news conference in Bethesda, Pham said she looked forward to returning to Texas and to a normal life with her dog, Bentley. The King Charles spaniel was quarantined after Pham was diagnosed. He tested negative for Ebola but is still in his 21-day incubation period until the end of the month, according to Texas officials.

Fauci said that doctors and staff at the NIH did not administer any experimental drugs to Pham.

Patients infected with the Ebola virus require a large number of staffers to provide around-the-clock care. At the NIH, that was about 27 people — doctors, nurses, support staff — for one patient for a week, said Dr. John Gallin, director of the NIH Clinical Center.

Amber Vinson, 29, the other nurse who became stricken with Ebola at the Dallas hospital, "is making good progress in her treatment," Emory University Hospital in Atlanta said in a statement Friday.

Vinson, who was transferred to Emory for treatment last week, remains in the hospital's Serious Communicable Diseases Unit "for continued supportive care."

"We do not have a discharge date at this time," the statement said.

Another person infected with the disease, NBC freelance cameraman Ashoka Mukpo, also was declared Ebola-free earlier this week. He contracted Ebola in Liberia and was treated at Nebraska Medical Center in Omaha.

Meanwhile, New York got its first test this week when a doctor who had been treating Ebola patients in the West African nation of Guinea tested positive for the virus after returning to the city and presenting himself at a hospital with a fever of 100.3 degrees.

After the confusion and missteps that surrounded the first U.S. Ebola diagnoses in Dallas last month, public health officials in New York were ready.

The physician, Craig Allen Spencer, was whisked into isolation, his fiancee and friends were placed into quarantine, and his apartment immediately decontaminated by a biohazard crew.

New York and New Jersey also announced mandatory quarantines for anyone traveling from three West African nations who had direct contact with an Ebola patient, including health care workers.

"This is too serious a situation to leave it to the honor system of compliance," said New York Gov. Andrew M. Cuomo.

City officials said weeks of drills and lessons after the Dallas cases helped ensure a rapid response there, from the moment Spencer called the aid group Doctors Without Borders on Thursday morning to report that he had a fever.

New York Mayor Bill De Blasio and Dr. Mary Bassett, the city's health commissioner, assured New Yorkers that Spencer did not become symptomatic until Thursday morning and that he was not contagious during his outings earlier in the week.

"This was a doctor," Cuomo said. "He was taking his temperature twice a day. He knew he was only contagious if he was symptomatic."

Baltimore Sun reporter Kevin Rector, Tribune newspapers and Reuters contributed to this article.

andrea.walker@baltsun.com

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