“All of us are going to be shocked if no more Ebola cases turn up in the U.S.,” says Craig Wilson, MD, director of UAB Sparkman Center for Global Health. “And when someone does go into a facility sick, at that point, the potential exposure point is all healthcare workers.”

With several nurses catching the virus in Texas after caring for an Ebola-stricken man who had travelled from West Africa, hospitals are on full alert.

Three of Birmingham’s hospitals — Trinity Medical Center, Brookwood Medical Center, and Princeton Baptist Medical Center— released statements that although the likelihood of receiving a confirmed Ebola patient remains very low, they have prepared for possible cases. The hospitals are conducting drills or posting protocols related to the identification, isolation, testing and treatment of an Ebola patient, along with the appropriate use of personal protective equipment (PPE).

“Staying up with CDC [Centers of Disease Control] guidelines is a work in progress,” says Danne Howard with the Alabama Hospital Association (AlaHA). “Basically, we keep communications going multiple times a day on information as it comes from the CDC.”

In October, following the investigation into how the nurses in Texas contracted the disease, the CDC made a major change to the protocol on PPE. No skin at all can be exposed.

In the CDC trainings in Anniston for healthcare workers heading to Africa, this more restrictive requirement adds a new layer of vigilance to wearing the suits. “For instance, the piece of cloth between the goggle and the face came loose on one man during training and exposed skin. His colleague noticed, and that person had to leave and take off their equipment,” says Jason McDonald, a Public Affairs Specialist with the CDC. This can be a 20 minute endeavor, because removing the potentially contaminated suit requires meticulous care. “It takes two people to don and doff the suits so one can watch the other,” McDonald says.

To remove the suits, the healthcare workers remove their first of two pairs of gloves. They wash their hands while still wearing the second pair. Then, literally almost head to toe, they remove the suit piece-by piece. “They start with the apron, then wash their gloved hands again, then remove their gown and wash again, and that process follows every piece they’re wearing,” McDonald says. The person must also endeavor to remove each item without touching the outside of it, where any splatter of contagious material might have landed. “It’s almost ritualistic,” adds McDonald.

But the annoyance with the suits isn’t the time spent donning and doffing. “What we often hear is it’s hot,” McDonald says, adding that in some places in West Africa, they have to step out of the suits every 45 minutes to cool off. “You really have to appreciate the people who go and do this,” he says.

The CDC trains the suited-up healthcare workers to perform tasks most common in a medical setting, including taking blood, cleaning up vomit or feces, and disposing of a diseased body. All while being watched for any breaches. They must also learn to handle equipment problems, like fogged up goggles, without contamination.

Some of Alabama’s infectious disease equipment needed to protect against Ebola came to hospitals last year during the H1N1 outbreak that reached epidemic levels in America. “We have PPE kits through federal grants, like M95 masks, and some of that is still within guidelines,” AlaHA’s Howard says. Their website at alaha.org has a page dedicated to Ebola information for healthcare workers, including a link to an hour-long update on Ebola by State Health Officer Don Williamson, MD, given on October 21. They’re planning a webinar especially for nurses to air before the end of the year.

The Alabama Department of Public Health also posts recommendations on Ebola for healthcare providers at adph.org/ebola, including PPE guidance and an emergency medical services toolkit. On October 1, they conducted a continuing medical education satellite program and live webcast on Ebola preparedness for physicians, nurses, infection control practitioners, hospital administrators, and other healthcare providers. The program is available at http://www.adph.org/ALPHTN/index.asp?id=6792&dev=true.

UAB’s Wilson says healthcare workers need to stay vigilant and the public needs some perspective. The normal protocols in healthcare facilities in this country, such as washing with soap, wearing gloves and utilizing isolation, could take care of 80 percent of transmissions. He adds that around 4,900 people have died from Ebola since it reared up last December. “If want to be worried about something in America, then remember that we’re coming into flu season, and 35,000 in the U.S. died from flu last year.”