Microscope image of an Ebola virus.

‘Suspect’ Ebola cases spawn confusion over hospital handling

Some staff misunderstand screening process in ER, Fraser Health official says

A Fraser Health official is denying claims from nurses that another suspect Ebola case was mishandled at Surrey Memorial Hospital Wednesday, putting staff and patients at risk if the deadly virus had actually been present.

According to nurses, the patient was in contact with many staff and other patients before being isolated for further assessment and ultimately ruled out as an Ebola case.

But Dr. Elizabeth Brodkin, Fraser’s executive medical director for infection prevention and control, insists there have been no breaches of protocol in the handling of patients initially feared to have Ebola and says there’s some confusion among staff.

“There’s enormous anxiety about this,” Brodkin said.

“A lot of what is feeding the anxiety is misunderstanding about how the virus actually works as well as what a suspect case is and what we would do when we found one.”

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A patient who arrives at a Fraser hospital with a fever and who recently travelled from West Africa is to be flagged by ER triage staff, immediately taken to an isolation room in the ER and questioned further by staff wearing protective gear.

But Brodkin said that patient isn’t yet considered a “suspect patient” until the secondary questioning and assessment fails to eliminate Ebola.

Only then would the patient be taken to the high-acuity unit in Surrey Memorial Hospital’s new critical care tower, which has advanced infection control safeguards, to await the results of a blood test.

Some staff incorrectly assume the initial flagging of the patient at triage means they should immediately go to the critical care tower, Brodkin said.

“Fever and travel to West Africa by itself does not mean you’re a suspect patient,” Brodkin said. “Those are the initial screening questions. That’s the starting point.”

She said about half a dozen patients have been flagged for further assessment but only one so far in Fraser has been deemed a suspect patient and taken to the high-acuity unit at SMH. That patient was ruled out as an Ebola victim within 12 hours.

Feverish arrivals from West Africa are much more likely to have symptoms from other causes – like malaria or the flu – than Ebola.

Brodkin was asked whether staff or other patients might be exposed if an Ebola victim arrives at a busy ER and isn’t triaged and isolated for some time.

“Casual contact in an emergency waiting room is not a risky encounter,” she said, noting the disease is not airborne but transmitted only by blood and bodily fluids and “not very contagious” in the early stages.

Patients aren’t flagged for assessment if they travelled by air from other areas of the world, despite growing concern that some airline passengers may have been exposed on flights with Ebola carriers.

“You’re talking about very casual contact. You have to work at it to catch the Ebola virus,” Brodkin said.

Fear and confusion about the disease may spike further as flu season arrives and more people are flagged for assessment, Brodkin said, but added the odds of a real Ebola case in B.C. remain extremely small.

“We have seen suspect cases. We’re going to see more suspect cases. But we will probably never see a real case.”

The B.C. Nurses Union on Tuesday accused B.C. health authorities of being unprepared to deal with Ebola cases and urged immediate action to adequately protect health care workers.

The province responded with a review of protocols and a pledge of stepped-up training of front-line staff.

One issue for nurses is what type of respirator mask is appropriate.

The BCNU has pushed for a fit-tested N95 type of mask that Fraser Health so far says isn’t necessary because Ebola isn’t airborne like tuberculosis or measles.

Vancouver Coastal Health has now agreed to use of the N95 masks and BCNU president Gayle Duteil wants Fraser to do the same.

“Our nurses see what people are wearing down in the States while caring for Ebola patients and insist on an N95 mask, as opposed to a basic surgical mask you may see people wearing walking on the streets of Vancouver,” Duteil said. “That’s just unacceptable.”

Brodkin said a mask is needed but it’s much more critical to use a face shield protecting the eyes and other parts of the face from infectious fluid droplets.

North American anxiety about the disease outbreak that has killed thousands in West Africa soared after a patient arrived in Texas with the virus and later died.

Two nurses there subsequently tested positive for the virus although it’s unclear how they were was exposed.

The BCNU has warned nurses to treat suspected or confirmed Ebola patients only if they’re properly equipped and trained and has outlined to them the WorkSafeBC procedure for refusing unsafe work if managers fail to address concerns.

WorksSafe BC is investigating one complaint from a health care worker at a Vancouver Island hospital.

A spokesperson said WorkSafeBC will review Ebola response plans from health authorities and will inspect hospitals as needed to ensure compliance.

Brodkin said she’s not aware of any Fraser Health nurses refusing to treat possible Ebola cases.

“I have seen nothing but professionalism and the very best care delivered by the nurses and the physicians who were involved.”