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As Anxiety Increases, Agency Scrambles to Address Concerns of Health Workers

Since a Liberian man tested positive for Ebola in Dallas a week ago and officials announced on Monday that a nurse in Spain had been infected by the virus there, calls have been pouring into the Centers for Disease Control and Prevention from doctors and nurses wanting help in protecting themselves and their employees from the disease. Associations of infection specialists, hospital care managers and other health providers are also calling.

“Before Dallas, we had about 15 calls a day from clinicians,” said Abbigail Tumpey, an agency spokeswoman. “After Dallas, it’s been about 150 calls a day, just into the C.D.C. information line.”

Many want training on protection strategies, so the agency has scheduled two nationwide conference calls — one this week for public health agencies and another next week for hospitals and clinicians.

But despite some calls for provision in the United States of the “moon suits” Ebola workers in Africa wear, the C.D.C. has not changed its recommendations on what gear health care workers should use.

Because Ebola is transmitted only by contact with bodily fluids, the agency recommends that workers wear gloves, waterproof gowns, face masks and goggles or comparable eye protection. In cases involving a lot of blood or other fluids, extra protection like shoe covers may be advised. But the C.D.C. is not recommending hazardous-material suits.

“We’re saying that we don’t think the extra is necessary,” Ms. Tumpey said. “However, if facilities want to use it, they need to train their staff in appropriate use.”

If doctors and nurses do not know how to put this gear on, and especially how to take it off once they’ve been in contact with a patient who has Ebola, the danger of infection could be greater, not less, experts say.

Some hospitals are already going beyond the C.D.C. recommendations in providing protective gear for their staff members and offering additional training.

At Johns Hopkins Hospital in Baltimore, where many doctors and nurses have experience treating patients during infectious disease outbreaks, the plan is to give workers caring for an Ebola patient long gloves taped to the gown, foot and leg covers, and a hooded air purifier that covers the head and neck, said Dr. Lisa Maragakis, the director of hospital epidemiology and infection control. The air purifier is usually used for airborne diseases, but Hopkins’s plans include it because it “can offer one-stop shopping for covering the head, neck and mucous membranes,” she said.

Staff members would follow the buddy system used in Africa: A colleague would watch the doctor or nurse remove protective gear to make sure it was done correctly.

Dr. Thomas Kirsch, an associate professor of emergency medicine at Johns Hopkins, said “scientifically, what the C.D.C. says is probably true, but because of the fatality and concern of people, then those are not appropriate standards.”

The recent cases have only heightened the concern. “Our nurses are going crazy, the doctors too,” he said. “Everyone’s worrying about the level of protection.”

But at Doctors Hospital in Columbus, Ohio, standard precautions are considered adequate, said Dr. John Casey, an emergency physician. “The basic rule is ‘If it’s wet and you didn’t make it, don’t touch it,’ ” he said. “Essentially, that is protection against Ebola. It doesn’t really take much more than that.”

Dr. Casey said that hospital workers wear more protective gear when entering the rooms of patients with bed bugs than they would for an Ebola case. “For the most part, the biggest precaution we can take is asking people about travel history if they have symptoms,” he said.

But National Nurses United, the country’s largest union and professional association of nurses, contended that hospitals were not doing enough. It said that in a survey of more than 1,600 of its members, 75 percent said their hospitals had not informed them of a policy for dealing with Ebola patients.

“There’s discussion around, ‘Oh you don’t want to create hysteria and panic,’ ” said Bonnie Castillo, director of the organization’s registered nurse response network, which sends nurses to disaster sites. “But the way you prevent panic is to be prepared.”

She said the American Hospital Association should require all hospitals to provide hazardous-material suits and hands-on training.

In a statement, Dr. Ken Anderson, chief operating officer of the hospital association’s research arm, said the organization was urging hospitals to “meet the latest C.D.C. guidance and best practices to protect health care workers.”

Some hospitals, including in New York City, are running drills in which people pretending to be patients with Ebola symptoms enter the hospital. Hospital staff members, unaware that these are fictional patients, then go through the process of diagnosing, admitting and planning treatment, protecting themselves and other patients in the process.

Last week, in Louisville, Ky., one of the 96 hospitals run by Catholic Health Initiatives, a nonprofit health system, conducted such a drill with a patient posing as a worker returning from Africa. Aaron Williams, the system’s national director of infection prevention, said that for months now, the group’s hospitals had been prepared with hazardous-material suits and air purifiers.

While the C.D.C. will be having conference calls to give advice to agencies, hospitals and clinicians, it is running training sessions in Anniston, Ala., for doctors and nurses heading to West Africa to care for Ebola patients, including hands-on practice in donning and removing layers of gowns and masks, and disinfecting themselves with chlorine solution with each layer. To show how bodily fluids can splash and spread, the simulations have used chocolate syrup, Ms. Tumpey said.

Sheri Fink contributed reporting.

A version of this article appears in print on  , Section A, Page 13 of the New York edition with the headline: As Anxiety Increases, U.S. Agency Scrambles to Address Health Workers’ Concerns. Order Reprints | Today’s Paper | Subscribe

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