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3 US hospitals stopped Ebola from spreading. Why didn't Texas?

A possible Ebola patient (who later tested negative) arrives at Texas Presbyterian Hospital in Dallas.
A possible Ebola patient (who later tested negative) arrives at Texas Presbyterian Hospital in Dallas.
Joe Raedle/Getty Images

There's something unique about the three hospitals that have so far successfully treated Ebola patients — something that's different from Texas Presbyterian Hospital in Dallas, where a patient died and one worker treating him became infected.

Emory, the University of Nebraska, and the National Institutes of Health have all received and successfully discharged Ebola patients. These three hospitals are among just four in the nation with specialized biocontamination units. These are units that have existed for years, with the sole purpose of handling patients with deadly, infectious dieases like SARS or Ebola.

While biocontamination units look similar to a standard hospital room, they usually have specialized air circulation systems to remove disease particles from the facility. And, perhaps more importantly, they're staffed by doctors who have spent years training, preparing and thinking about how to stop dangerous infections from spreading. 

"Ever since [2007] we've had a training program," says George Risi, who runs the country's fourth biocontainment unit, at St. Patrick's Hospital in Montana. His is the only unit that hasn't yet treated an Ebola patient, but his staff has spent years preparing for that moment. Every six months, they "do a workshop and also have periodic drilling."

This isn't true of Texas Presbyterian. Like most American hospitals, it doesn't have a biocontamination unit. It hasn't spent years running through the drills of how to treat an Ebola patient. It began receiving additional training from the CDC, director Tom Frieden told reporters Sunday, only this week.

"The care of Ebola can be done safely but its hard to do it safely," Frieden said in his Sunday press conference. "Even an innocent slip up can result in contamination."

What's different about biocontamination units is their training

isolation unit

One of Emory University's isolation units (Emory University)

I got to talk to Risi earlier this month, and he told me about all the things that make their biocontamination rooms different from typical hospital rooms. Some if it is technology.

"Each of those three rooms has negative pressure: the air is drawn in from the hallway and then goes out through a series of high efficiency particulate air [HEPA] filters," he says. "The HEPA filters connect to duct work that goes up to the top of the roof of the hospital and is discharged eight feet above the roof."

But more than the physical structure of the units, Risi really thinks it comes down to the extensive training. His staff has, for seven years now, run periodic drills about how they would treat these patients. The Nebraska hospital that successfully treated one Ebola patient — and is currently caring for the infected NBC cameraman — has been preparing for a patient like this since 2005.

These hospitals are in close contact with each other, sharing information about how to best handle tricky situations. Risi, for example, has talked to experts at Emory about the best way to dispose of waste from Ebola patients.

In Montana, Risi and his head nurse even went to Sierra Leone this summer to become more familiar with the disease — and shake off some of the scare factor around it. At his hospital, treating an Ebola patient is "something we've been talking about for years, how you handle this kind of patient. Its not new to us."

The CDC thinks that the problem in Texas comes down to the ability to follow protocol and better training. "There's a need to enhance the training to make sure the protocols are followed," he said. "We know the protocols work."

"The necessity of doing this right 100 percent of the time does require... a very intensive training process," Frieden continued.

CDC: All hospitals need to be prepared

Frieden fielded one question on Sunday morning: should all Ebola patients be cared for at these four, specialized biocontamination units?

He said that his agency will "absolutely be looking at" the "safest way to provide care" — and this could be one option.

But he also addressed one challenging point here: most Americans don't live near a biocontamination unit. An Ebola patient is more likely to turn up at the emergency department of a hospital without the specialized training. And, even if patients are ultimately transferred to a better-prepared facility, there is still some amount of time where patients will interact with their local providers.

"We can't let any hospital let its guard down," Frieden says. "A patient, who had exposure and maybe didn't have an awareness. We do want hospitals to have the ability to rapidly consider, isolate and diagnose someone who may have Ebola."