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Vol. LXVII, No. 3
January 30, 2015
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Ebola Patients Pose Unique Challenges to CC Nurses

On the front page...

Nurses who work on the special clinical studies unit include (from l) Leighann Ebenezer, Debbie Gutierrez, Melissa Hubbard, Kevin Barrett, Kim Adao and Kim Jeffries.
Nurses who work on the special clinical studies unit include (from l) Leighann Ebenezer, Debbie Gutierrez, Melissa Hubbard, Kevin Barrett, Kim Adao and Kim Jeffries.
They’re on the job 24 hours a day, 7 days a week. They take vital signs, blood and other samples, refill supplies, serve food, disinfect rooms and take out the trash—all while wearing a head-to-toe protective suit and two pairs of gloves.

They are the nurses who care for patients with Ebola or those who may have been exposed to the disease. They work at the Clinical Center’s special clinical studies unit (SCSU), a modern, high-tech facility that provides high-level isolation capabilities.

Caring for these patients presents a set of unique challenges, said nurse Melissa Hubbard, the unit’s clinical manager.

Anyone who enters the patient’s room must follow strict procedures for putting on—donning—and taking off—doffing—protective equipment that covers the whole body, she said. This equipment includes two pairs of gloves, two pairs of shoe covers, a Tyvek suit, disposable gown and a powered air-purifying respirator.

Continued...

“We can’t just run into the patient’s room and give them something,” she said. “It takes 10 minutes to put our protective equipment on.”

Before the nurses can enter, someone called a “WatSan” reads a step-by-step checklist that walks the nurses through the donning and doffing procedures. WatSan is short for water and sanitation. This can be a nurse, physician or laboratory worker trained in the special procedures for putting on and taking off the protective gear, she noted. The WatSan then inspects the protective equipment to verify that all areas of the body are covered.

The rules stipulate that two nurses must enter the patient’s room at a time, Hubbard said. One nurse performs patient care duties such as monitoring vital signs or collecting lab samples. The other watches for any breaches in the protective equipment and disinfects the room.

Monitoring an Ebola patient’s vital signs differs from monitoring those of other patients because the nurses frequently can’t use standard equipment, said nurse Meghan Schlosser. For instance, the nursing staff uses a stethoscope that broadcasts to a Bluetooth speaker to listen to a patient’s breath sounds. This is because the nurses can’t fit the ear pieces of a standard stethoscope past their protective head gear.

SCSU nurse Meghan Schlosser stands in one of the unit’s patient care rooms.

SCSU nurse Meghan Schlosser stands in one of the unit’s patient care rooms.

“We have to think outside the box,” said nurse Kevin Barrett. “We’re constantly tweaking how we care for patients and making sure that we’re providing the best possible care that we can.”

Hubbard added that the nurses can only wear their protective equipment for 2 hours at a time because it raises their body temperature 3-4 degrees F. They have to leave to rehydrate. After their 2 hours are up, two other nurses go into the room for 2 hours.

For SCSU nurses, work doesn’t end once they leave the patient’s room. Schlosser said the nurses coordinate closely with each other to make sure that everyone in the unit knows what they need to do. They also provide doctors and other health care specialists with information.

“We’re never off,” she added.

Access to the unit is restricted to essential personnel. As a result, SCSU nurses have more responsibilities than other nurses.

Within the unit, “The pharmacy department doesn’t fill medicines, the central hospital supply doesn’t refill supplies, the nutrition department doesn’t deliver food, the housekeeping staff doesn’t clean the room or empty the trash,” said Schlosser. “We don’t have the outside help.” Everything is delivered to the door of the unit, then the nurses take over.

Shown applauding during a press conference at NIH on Oct. 24 are nurses (back row, from l) Hubbard, Barrett, Schlosser, Anitra Fitzgerald-Monroe and Gutierrez. In front are (from l) CC director Dr. John Gallin, Cathy, Nina and Diana Pham and NIAID clinical director Dr. H. Clifford Lane.

Shown applauding during a press conference at NIH on Oct. 24 are nurses (back row, from l) Hubbard, Barrett, Schlosser, Anitra Fitzgerald-Monroe and Gutierrez. In front are (from l) CC director Dr. John Gallin, Cathy, Nina and Diana Pham and NIAID clinical director Dr. H. Clifford Lane.

Photos: Bill Branson, Kim Seigfreid

Barrett compared working in the unit to scuba diving.

“When I put on my equipment, everything looks murky—like I’m underwater,” he said.

For scuba divers, it’s not easy getting to the water’s surface. If something goes wrong, such as an equipment failure, “it’s really hard to ask for help,” Barrett said. Divers have to rely on their training and devise a plan to fix the problem on their own.

That’s what it’s like in the SCSU. So far, nothing has gone wrong. If something were to happen, the nurses know that they can trust each other’s ability to solve problems.

“Whatever happens has to be okay,” Barrett said. “We have to use what we’ve learned in training and apply it to new situations.”

Following isolation procedures was nothing new for the unit staff, Hubbard said.

“Our unit’s mission is to isolate and treat laboratory workers who were occupationally exposed to infectious diseases at federal research facilities,” she said. “We’ve prepared and trained in support of that mission for years.” In fact, the SCSU opened in 2010 to care for workers potentially exposed to pathogens at the BSL-4 laboratories at Ft. Detrick.

The majority of SCSU nurses have a background in critical care medicine. Hubbard said that experience helps them make decisions under pressure.

Schlosser’s attire is carefully designed to prevent transmission of pathogens such as Ebola.
Schlosser’s attire is carefully designed to prevent transmission of pathogens such as Ebola.

Caring for a patient coming from West Africa or elsewhere in the United States takes more resources than the 10-nurse staff could provide, she said. If a patient is unstable, 5 nurses work on a shift; if a patient is stable, 4 nurses handle the shift. The patient receives care around the clock.

To meet the need, the SCSU recruited volunteers from other units and trained them in the standard procedures of infection control. So far, Hubbard estimates that they’ve trained close to 70 volunteers.

“We trained nurses how to take care of patients while wearing protective equipment, collect laboratory samples, take out the trash and clean and disinfect the room,” she said. “In addition, we also had to make sure nurses were comfortable working in the unit and reassure them that they could go home at night to their families.”

Anitra Fitzgerald-Monroe, a nurse who volunteered to work on the unit, called the experience “totally different” from what she normally does because nurses “can’t leave the unit during their shifts.”

Typically, patients and nurses can step outside a patient’s room to make a phone call or pick up lunch in the cafeteria. The nurses in the SCSU can’t do those things. They have to stay in the unit and can’t leave until they take a shower.

And the challenges don’t end once they leave the unit. One nurse was uninvited to a party; another nurse’s babysitter quit. Barrett said these things are just “part of the job” and “you have to let it roll off your back.”

The experience has brought the unit closer together.

“You know that you can trust these people,” Schlosser said. “We have each other’s backs.”

Despite the challenges, the nursing staff has done “an extraordinary job,” said Hubbard. She credited the unit’s success to the nurses’ dedication to the job.

Concluded NIAID deputy clinical director Dr. Richard Davey, “The true heart and soul of the unit’s success in dealing with [Ebola admissions] have been the esprit and dedication of the nursing staff in pulling together an organized, multidisciplinary approach to delivering care in the safest and most efficient manner, always with utmost attention to the needs of the patient, the safety of the caregivers and consideration for the need to preserve the normal flow of routines elsewhere in the hospital.”


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