There are four hospitals in the United States with special isolation wings to treat highly infectious patients. George Risi runs one of them.
Risi is an infectious disease specialist at St. Patrick's Hospital in Missoula, Montana. In 2007, his hospital became the support facility for the nearby Rocky Mountain Laboratories, a federal lab that does work with certain rare and contagious diseases. If anyone got sick at the Rocky Mountain Labs, they could go to St. Patrick's.
So far, the other three hospitals with these isolation wings are the three facilities that have treated Americans who contracted Ebola abroad: Emory, the University of Nebraska, and the National Institutes of Health. Risi's hospital has not had a patient yet, but his hospital could be a natural choice in the future.
I spoke with Risi on Thursday about how his hospital's isolation unit was built, what makes it different from other hospital facilities, and why he thinks any American hospital could handle an Ebola patient.
Sarah Kliff: Tell me a little bit about when your isolation unit was built and what that entailed.
George Risi: Our hospital is the support hospital for the Rocky Mountain Labs, which deals with high hazard, infectious diseases and its part of the National Institute of Allergies and Infectious Diseases campus out here.
When we were asked to be the support facility, we looked at the other models like the stand alone unit at Emory. The problem with that model is that its expensive to maintain a unit that's stand alone unit if it won't be used regularly.
For those kinds of reasons, we went ahead and retrofitted rooms in our intensive care unit to provide that kind of support. That allows us to have full access to the pharmacy and also see other patients in those rooms. We use these rooms all the time as regular ICU rooms.
SK: What makes these rooms different from typical ICU rooms? What makes them isolation units?
GR: The difference is there is special air handling. 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. The HEPA filters connect to duct work that goes up to the top of the roof of the hospital and is discharged 8 feet above the roof.
Nothing gets through two sets of HEPA filters but, if it did, anything would be dispersed and all of these viruses are killed by ultraviolet light.
We put in anterooms, which are the entrance rooms with two sets of doors. Also all the surfaces are smooth and readily cleanable without a lot of cracks and crevices where blood and bodily fluids could stay. But a lot of this has really become standard. Most hospitals have some rooms with anterooms. The Dallas hospital, I'm sure has something quite similar.
SK: What kind of protective gear do you keep on hand for people who might have to work with a highly contagious disease at some point?
GR: The gear depends on the stage of illness and which disease. For someone with tuberculosis, we would use N95 masks [which filter out air particles]. Those are the ones that are appropriate for isolation of an airborne isolation. We'd also be gowning and gloving depending on the nature of the disease.
SK: I'm curious about the larger suits that we saw Emory doctors wear when they escorted Kent Brantley out of an ambulance. Is that something that your hospital, or others, keep on hand?
GR: We certainly have a supply of them on hand and would probably put in a big order to get more if someone were admitted with a highly contagious disease. Right now, we have enough to manage somebody for several days.
SK: Has your hospital done any work to prepare for the possibility of treating an Ebola patient?
Ever since the Rocky Mountain Labs has had us as their support hospital, we've had a training program. Every six months or so we have a workshop and also do periodic drilling.
Its true that these are exotic diseases but, in a way, they're not that exotic at all. If you trust your protective gear and if you use it appropriately, the risk of getting infected is minimal and that's no different from other diseases. The key is not to become excited or overwhelmed if you're asked to care for a patient like this.
SK: One challenge some hospitals have talked about is what to do with the waste from Ebola patients and how to dispose of that. Does your hospital have a plan?
GR: We're in the process of re-evaluating that. We have an autoclave on site, which is what you use to sterilize surgical items but from what we've heard from Emory about the volume, we may need to get more. That's something we're working through right now.
SK: Are there are things you've learned from hospitals like Emory that have seen Ebola patients that are helping you prepare right now?
GR: I think we've learned a lot about the importance of keeping moral up and the importance of emphasizing the ways that the disease can and can't be spread. A lot of this is leading from the front, such that the physicians who need to be involved will be willing and able to see an Ebola patient if that happens. That was part of the reason of my going to Sierra Leone with Kate Hurley, who is the head nurse of the isolation unit. We wanted to get over the fear factor.
This is something we've been talking about for years, how you handle this kind of patient, so its not new to us. The possibility is a little more real with the patient now in Dallas.
SK: What's different about treating Ebola in Sierra Leone, compared to the type of facility you work in in Montana?
GR: It's a very different situation over there in a country that is trying to emerge from decades of civil war, poverty and a stressed health care system.
There are limits in terms of the medical support and the sheer numbers. At our hospital, the average daily census was 90 patients. This is equatorial Africa, so you could spend maybe three and a half hours in one of the protective suits before you had to come out and rehydrate.
We were very limited in what we could do. We didn't have access to blood products, or investigational drugs. It was really just IV hydration, that was kind of all we could provide. Despite that, we did save more people than we lost. Our mortality rate was 40 to 45 percent, which means 55 to 60 percent of our people survived and are immune. Some of them actually helped us manage our patients after they survived and became immune. They were able to help clean up and bring food, things like that.