May-June 2015 | Health

How Bethesda’s NIH Prepared for Its First Ebola Patient, Nina Pham

The behind-the-scenes story

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In the second week of August, Dr. David Henderson, deputy director for clinical care at the Clinical Center, called Phillips to his office to talk about preparing the SCSU for an Ebola patient. From that point on, they held an early-morning meeting every day to discuss potential facility changes. Phillips also attended daily meetings with other staff members and fielded requests from nurses, housekeepers and other departments. Then she headed back to her deputies and planned modifications.


Director Donna M. Phillips (left) of the Division of Facilities, Operations and Maintenance reviews plans with colleagues Donald Edwards (middle) and Michael McClain. Phillips oversees the roughly 400 employees who manage all NIH facilities and handles an average of 250 trouble calls per day. Photo by Hilary Schwab.

One concern expressed by clinicians was that Ebola patients can produce up to 5 liters of vomit and diarrhea per day. Staff had to consider how to safely transfer waste without splashing or spilling it. In August 2014, Phillips and her team installed two new autoclave machines in the SCSU. The pressure chambers are used to sterilize infectious materials with steam. Previously, clinicians would have to transport waste to autoclaves elsewhere in the Clinical Center, or in nearby Building 14A on campus. The project required 3,000 feet of piping, welded ductwork, electrical conduits and two new exhaust fans.

In early September, Phillips worked with a contractor to design a special funnel that would slowly drain fluids from a continuous dialysis machine into a waste bag designed to be placed in an autoclave machine. “It was incredibly cool, and it speaks to the way that nobody stepped away from a challenge throughout this whole process,” Lee says.

Staff also made several modifications to equipment. For example, the standard short and squat trash cans in the SCSU were replaced with taller models that nurses could reach more easily. Another change involved personal protective equipment (PPE). Workers had noticed that the ties securing the back of their shrouds were too long. Staff began cutting them before donning the protective gear, leaving only about a quarter inch of material to eliminate the risk of dangling.

Lee, who started at NIH 25 years ago, says her job was to “channel her inner Eeyore,” or to constantly imagine worst-case scenarios in order to take measures to prevent them. In early September, Lee staged a daylong drill that simulated what it would be like to care for an Ebola patient. A nurse served as the “patient,” and health care workers donned full protective gear. “We spent an afternoon putting together the pieces into one long stream of care, and watching for what happened at the junctures in the process,” Lee says.

Lee noticed that there was a vulnerable moment when the trash cart was transferred from the patient’s room to the autoclave machine down the hall. “It was just one step, but if you didn’t do it precisely right, there was a chance for contamination,” she says.

To address the issue, Phillips and her team built lighter, more maneuverable autoclave transport carts that could be pushed directly into the autoclave machines, eliminating the need for a nurse to lift a bag of waste from the cart and place it into the machine.

“Honestly, I don’t know if Donna Phillips slept for a month,” says Maureen Gormley, the Clinical Center’s chief operating officer.

ON SEPT. 28,  the team got a trial run. An American physician who had been exposed to the virus via a needlestick injury while volunteering in Sierra Leone arrived at the SCSU for observation. Thus began daily 3 p.m. “huddles,” or meetings, to review policies and procedures. Dozens of people filled a large conference room in the SCSU, which became standing room only as everyone from nurses to engineers crowded in for the hourlong meetings.

“I’m talking about medical staff, individuals from the office of the director, different groups within nursing, materials management, epidemiology, housekeeping, engineers, lab medicine—everyone,” says Debbie Gutierrez, senior nurse manager for the SCSU.


Debbie Gutierrez, senior nurse manager of the Special Clinical Studies Unit, was concerned for the safety of her staff. “It’s like when your teenager goes away to college—you worry about them,” she says. Photo by Hilary Schwab.

Gutierrez says clinicians spoke openly about their concerns. “I was constantly worrying about my staff, and worrying about the patient,” Gutierrez says. “It’s like when your teenager goes away to college—you worry about them. You wonder if they are eating properly, getting enough sleep or going to class on time. Being able to talk with my peers in the daily huddles helped a great deal. We shared concerns we normally wouldn’t share—little things like, ‘The staff needs more water.’ ”

After the patient was declared Ebola-free and discharged on Oct. 7, the team started preparing for what they all viewed as inevitable, especially after they learned in early October that two Dallas nurses had been exposed to Ebola while caring for a patient there. “We were completely fixated on what was going on in Dallas,” Lee says. “We had a feeling we’d likely be called upon to help, and we were excited and privileged to provide care to one of our own—to someone who risked her life caring for others.”

EARLY IN THE MORNING of Oct. 15, NIH staff learned that they would, indeed, be called upon to help: Nurse Nina Pham would arrive late the next day. Pham had contracted Ebola at Texas Health Presbyterian Hospital while caring for Thomas Duncan, a Liberian man who died of the disease at the hospital.

Immediately, weekend plans were postponed. Baby sitters were scheduled, and families were prepared. On Oct. 16, a Thursday, Collins sent an email to all NIH employees, letting them know that Pham was on her way to Bethesda.

To ease the fears of a workforce worried about exposure to the deadly virus, Palmore posted a 12-page white paper with information about Ebola on NIH’s public website, and spoke at two town hall meetings for staff. “There was some anxiety and fear about Ebola, especially among the nonclinical staff,” Palmore says.

According to an NIH newsletter, one staff member at a town-hall style question-and-answer session asked why Pham was being moved from Texas to NIH. “We are a biomedical research institution,” Dr. Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, said in response, according to the newsletter. “Very little research has been done on these patients due to the cataclysmal nature of treating them. We have almost a moral responsibility to step to the plate on this.”

For Justin Cohen, chief of communications at the Clinical Center, the morning of Wednesday, Oct. 15, brought an onslaught of phone calls and emails from the news media, medical professional societies and the general public.

Cohen had come to NIH from the Environmental Protection Agency in 2013, and had hired new team members shortly after arriving. Though staff members had covered events such as Hurricane Sandy and handled media relations for organizations including the U.S. Marine Corps in their previous jobs, the six team members had never confronted a major event like this together.

In addition to responding to incoming media requests, Cohen and his team spent Oct. 15 and 16 preparing photos and footage for reporters who wanted to illustrate what the SCSU looked like inside, how clinicians put on and take off protective gear, and what the Ebola virus looks like under a microscope. That meant working around the schedules of the SCSU clinicians. “We couldn’t just barge into the SCSU while our experts prepped it for a patient,” Cohen says. “The SCSU is an extremely sensitive space. It was a delicate dance: With no time to spare, the communications team was scrambling to create materials media worldwide would clamor for—and yet somehow not interfere with the Clinical Center’s obvious top priority, which is providing the best patient care possible.”

Team members also spent most of Oct. 15 and 16 making the rounds of the long line of satellite trucks parked in front of the Clinical Center, running wiring, suggesting spots to do stand-ups, and guiding reporters to the cafeteria and restrooms. Several communications staffers from other parts of the NIH campus volunteered to help. Cohen stationed them by entrance points to the campus and the Clinical Center.

In order to provide privacy for Pham when she arrived, all news trucks were asked to leave the campus by 8 p.m. on Oct. 16, and not return until 5 a.m. the next day. It was then, Cohen says, that preparing for Pham’s arrival gave way to waiting.