Guidelines under review

ATLANTA - Revised guidance for health care workers treating Ebola patients will include using protective gear "with no skin showing," a top federal health official said Sunday, and the Pentagon announced it was forming a team to assist medical staff in the U.S., if needed.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, said those caring for an Ebola patient in Dallas were vulnerable because some of their skin was exposed.

The Centers for Disease Control and Prevention is working on revisions to safety protocols. Earlier ones, he said, were based on a World Health Organization model in which care was given in more remote places, often outdoors, and without intensive training for health workers.

"So there were parts about that protocol that left vulnerability, parts of the skin that were open," Fauci said.

The CDC guidance was expected as early as Saturday, but its release has been pushed back while it continues to go through review by experts and government officials.

Health officials had previously allowed hospitals some flexibility to use available covering when dealing with suspected Ebola patients. The new guidelines are expected to set a firmer standard: calling for full-body suits and hoods that protect worker's necks, setting rigorous rules for removal of equipment and disinfection of hands, and calling for a "site manager" to supervise the putting on and taking off of equipment.

The guidelines are also expected to require a "buddy system," in which workers check each other as they come in and go out, according to an official who was familiar with the guidelines but not authorized to discuss them before their release.

Hospital workers also will be expected to exhaustively practice getting in and out of the equipment, the official said.

Said Fauci: "Very clearly, when you go into a hospital, have to intubate somebody, have all of the body fluids, you've got to be completely covered. So that's going to be one of the things ... to be complete covering with no skin showing whatsoever."

The American Nurses Association and other groups have called for better guidance that sets clearer standards on what kind of equipment, how to put it on and how to take it off.

On Sunday the Pentagon announced that Defense Secretary Chuck Hagel had ordered the formation of a 30-person support team from across the services to assist civilian medical professionals in the U.S. if needed to treat Ebola. So far, three cases have been confirmed in the U.S.

The team was to be formed by Northern Command's Commander, Gen. Chuck Jacoby, and was to consist of 20 critical care nurses, five doctors trained in infectious disease and five trainers in infectious disease protocols. Once formed, the team would undergo up to a week of specialized training in infection control and personal protective equipment at Fort Sam Houston in San Antonio, Texas, then remain in "prepare to deploy" status for 30 days.

The team would not be sent to West Africa or other overseas location, and would "be called upon domestically only if deemed prudent by our public health professionals," Pentagon press secretary Rear Adm. John Kirby said in a statement Sunday.

Ebola's incubation period is 21 days, and Fauci noted that mark was being reached Sunday for Texas Health Presbyterian Hospital workers who first treated Duncan.

"The ones now today that are going to be 'off the hook' are the ones that saw him initially in the emergency room," said Fauci, representing the Obama administration as he appeared on five Sunday news shows.

Duncan was seen at the hospital on Sept. 26 and sent home with antibiotics. He returned by ambulance and was admitted Sept. 28, and died of Ebola Oct. 8.

Judge Clay Jenkins, the chief executive of Dallas County, called the 75 health workers who cared for Duncan "hometown health care heroes," and said they had signed agreements with the state's public health commissioner to stay off public transportation.

He said if any other health workers test positive for Ebola, a plan is in place that includes the following protocols:

-All intake will be done at Texas Health Presbyterian Hospital.

-Ambulances have been instructed to bring anyone with a history of West Africa travel and a fever to that hospital.

-Those found to be infected will be transferred by air ambulance to one of three national health centers set up to handle very risky germs, or by ground ambulance to the University of Texas Medical Branch at Galveston, which has the capability of disposing of the "copious waste" that Ebola cases generate.

-If a large number of cases surface, a triage unit at another, undisclosed location will be set up in the next 24 hours, with isolation units.

Fauci appeared on ABC's "This Week," NBC's "Meet the Press," ''Fox News Sunday," CNN's "State of the Union" and CBS' "Face the Nation." Jenkins was on ABC.