Ebola outbreak: How prepared are Canadian hospitals?

Thedeathofthe first patient to be diagnosed with Ebola in the U.S.and the case of theTexasnurse who contracted the virus from him haveinevitably turned the focus in Canada toCanadian hospitals and how prepared they are to containthe disease if it shows up here.

"I think it's very variable and it's hard to say," saidDr. Caroline Quach, the incoming president of the Association of Medical Microbiology and Infectious Disease Canada. "I thinksome are very prepared and others are still in theprocessof getting prepared."

"I think all hospitals are different because they were built at different periods of time. The older hospitals might not all have the isolation rooms that would be ideal," she said.

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Nurse Nina Pham became the first person to contract the disease within the United States while caring for Thomas Eric Duncan, who was infected in Liberia but later travelled to Dallas, where he died.Phamand other health-care workers wore protective gear, including gowns, gloves, masks and face shields and sometimes full-body suits when caring forDuncan.

Health officials in Dallas are still trying to determine how Phamcould have contracted the virusdespite allthe precautions taken. Buther case has sparked concerns about the readiness of hospitals across North America.

Questionsabout 'how prepared we really are'

"Theres a lot of questioning within thehealth-carecommunity about how prepared we really are," said Dr. BrettBelchetz, a Toronto emergency room doctor. "Probably not prepared enough."

On Tuesday, Canada'schief public health officer, Dr. Gregory Taylor, metwith the Council of Chief Medical Officers of Health. Helaterreleased a statement assuring Canadians thattheirhospitals "have strong infection control systemsand procedures in place designed to limit the spread of infection, protect health-careworkers, and provide the best care possible for the patient."

Canada, it said, has become better prepared because of its experience withpublic health diseases like SARS,H1N1andH5N1, As well, provincial and territorial health authorities have been provided with"Ebola specific guidance."

Post SARS, many hospitals in Canada built isolation rooms, or negative pressure rooms that are hermetically sealed, specificallyfor patients with communicable diseases.

But how ready would other hospitals be, such assmaller rural hospitals that do not have such facilities, for someone walking in with symptoms of Ebola?

Quach said it doesn't take a lot of high technology to turn a room into an isolation unit.The focus, she said, should be on having a single room, ideally with a bathroom attached, so the patient remains in that room.

"So you really dont need an isolationunit thats completely remote from the rest ofthe hospital," she said.

"Theres an ideal situation, and what youcan do if you dont have that ideal situation. Soin the absence of a negative pressure room, you would do itin a single room with the door closed,wearing the full protective equipment."

Even a negative pressure roomisn't a must because Ebola is not an airborne virus,said Dr. Joel Kettner, medical director for the Winnipeg-based International Centre for Infectious Diseases.

'No really fancy technology needed'

"There is noreally fancy technology needed to do this," he said. "Youdon'tneed even aspecialroom.You doneedspaceso you can isolate the person from otherpatientsbut for thisparticulartypeof infection the people at risk are people who have very direct and closecontactwith the patient."

That's why somefront-line health-care workers areexpressing concerns about the safety and readiness of Canadian hospitals.

We have the protective gear and we have receivedsome instruction on how to use it," said Beltchez, the Toronto emergency room doctor. "But if you were to ask have I had hands on drills, do I feelcomfortablethat I know how to put this gear on and use it with a patient and take it off in such a manner asto be utterly foolproof? No, I dont feel confident at all.

"I have not had the drills and I feel that were I to have an Ebolapatient in front of me that I was treating Id be very concerned about doing things correctly."

Similar sentiments have been expressed south of the border. In Atlanta,Centersfor Disease Control and Prevention director TomFriedensaid on Tuesday that he's been hearing "loud and clear" from health-care workers in the U.S. that they are worried and don't feel prepared to treat Ebola. That's why he saidthe CDC had created an Ebola response team that will travel anywhere in the country where Ebola is diagnosed within hours."

Linda Silas, president of the Canadian Federation of Nurse Unions, told CBC News that Canada needs to take an immediate risk assessment, looking at whois trained and who is not and which hospitals have the proper equipment.

"I have heard horror stories in the last week," she said.

"We have had about, what, 10 false alarms wherethe suits, the sleeves, were too short, the mask was not covering the full face. The screening wasn't doneproperly by the triage at the emergency. So those are all lessons learned and we have to move forward and move fast."

In hisstatement Tuesday, Taylorsaid public health officialsmust "improve our systems and preparedness" and discussed ways "to implement our guidance for how to properly use personal protective equipment in hospitals, and how we further strengthen them, in the unlikely event an Ebola case arrives in Canada."