WHO warns of Ebola health care risks
A prominent World Health Organization adviser has warned that more Ebola cases can be expected among medical staff - even in developed countries with modern health care systems.
Professor Peter Piot said he was not surprised that a Spanish nurse had contracted the disease.
The nurse, Teresa Romero, is the first person known to have contracted the deadly virus outside West Africa.
She treated two Spanish missionaries who died of Ebola in Madrid.
Ms Romero, a 40-year-old auxiliary nurse, had been part of a team of about 30 staff at the Carlos III hospital in Madrid looking after Manuel Garcia Viejo and Miguel Pajares when they were repatriated from Sierra Leone and Liberia respectively.
She remains in quarantine in the Spanish capital along with her husband and three other people.
A fifth person was admitted on Wednesday morning with a slight fever. She is said to be a friend of Ms Romero and, like her, an auxiliary nurse in the Carlos III Ebola care unit.
In all, more than 50 people in Spain are under observation.
Ms Romero told Spain's El Mundo's newspaper on Wednesday that she had followed the correct protocol and had "no idea" how she had become infected. She said she was feeling "a little better" but was very tired.
Officials say earlier she had twice gone into Mr Garcia Viejo's hospital room, first to treat him and later to disinfect the room after his death.
The BBC's Lucy Williamson in Madrid says hospital staff reported scenes of panic at work on Tuesday, with some people crying and others leaving the premises.
Spanish media say neighbours of the infected nurse have been calling emergency services, asking how to protect their children after sharing lifts and public spaces.
Promising "total transparency", Prime Minister Mariano Rajoy appealed for calm while at the same time urging vigilance.
"Let the professionals do their work. Spain's health system is one of the best in the world," he told parliament on Wednesday.
In another development, the woman's husband, Javier Limon, is reported to be fighting a court order to have their pet dog put down over fears that it could be carrying the disease. Animal rights groups have also criticised the move, saying there is no evidence that Ebola has been spread by dogs.
Some 3,400 people have died in the current Ebola outbreak with most of the deaths in Guinea, Sierra Leone and Liberia.
There have been nearly 7,500 confirmed Ebola infections worldwide, with officials saying the figure is likely to be much higher in reality.
The BBC's Imogen Foulkes in Geneva says that from the start of the epidemic, the World Health Organization (WHO) has emphasised the impoverished health care systems of the countries hardest hit: Liberia, Guinea, and Sierra Leone.
Its experts have insisted that modern hospitals with rigorous disease control measures would prevent infection - but our correspondent says the case of the Madrid nurse proves that is far more difficult than many thought.
Professor Piot, a world specialist in Ebola brought in by the WHO as a scientific adviser, warned that even the simplest movement, like rubbing your eyes, is a risk.
"The smallest mistake can be fatal," he said.
"For example, a very dangerous moment is when you come out of the isolation unit you take off your protective gear, you are full of sweat and so on."
Professor Piot said he was not surprised by the case of the nurse in Madrid and expected more cases in Europe and the US, although he did not expect to see the illness spread as rapidly as it has in Africa.
Many of those who have died of Ebola in West Africa have been health care workers.
Meanwhile the US military is stepping up its efforts to respond to the Ebola outbreak in Liberia, Sierra Leone and Guinea.
Liberia's ambassador to the US, Jeremiah Sulunteh, told the BBC more treatment centres and ambulances were desperately needed.
The International Monetary Fund (IMF) has warned of dire consequences for economies in the region if the virus continues to spread.
Ebola virus disease (EVD)
- Symptoms include high fever, bleeding and central nervous system damage
- Spread by body fluids, such as blood and saliva
- Fatality rate can reach 90% - but current outbreak has mortality rate of about 70%
- Incubation period is two to 21 days
- There is no proven vaccine or cure
- Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery
- Fruit bats, a delicacy for some West Africans, are considered to be virus's natural host
The European Commission has asked Spain to explain how Ms Romero could have become infected.
The hospital in Madrid is conducting an investigation.
Although medical staff did have two sets of overalls, gloves and goggles as part of the hospital's safety guidelines, some reports said that the protective clothing used did not have level-four biological security, which is fully waterproof and with independent breathing apparatus.
Protective Ebola suit×
The cap forms part of a protective hood covering the head and neck. It offers medical workers an added layer of protection, ensuring that they cannot touch any part of their face whilst in the treatment centre.
Goggles, or eye visors, are used to provide cover to the eyes, protecting them from splashes. The goggles are sprayed with an anti-fogging solution before being worn. On October 21, the US Centers for Disease Control and Prevention (CDC) announced stringent new guidelines for healthcare personnel who may be dealing with Ebola patients. In the new guidelines, health workers are advised to use a single use disposable full face shield as goggles may not provide complete skin coverage.
Covers the mouth to protect from sprays of blood or body fluids from patients. When wearing a respirator, the medical worker must tear this outer mask to allow the respirator through.
A respirator is worn to protect the wearer from a patient's coughs. According to guidelines from the medical charity Medecins Sans Frontieres (MSF), the respirator should be put on second, right after donning the overalls.
A surgical scrub suit, durable hospital clothing that absorbs liquid and is easily cleaned, is worn as a baselayer underneath the overalls. It is normally tucked into rubber boots to ensure no skin is exposed.
The overalls are placed on top of the scrubs. These suits are similar to hazardous material (hazmat) suits worn in toxic environments. The team member supervising the process should check that the equipment is not damaged.
A minimum two sets of gloves are required, covering the suit cuff. When putting on the gloves, care must be taken to ensure that no skin is exposed and that they are worn in such a way that any fluid on the sleeve will run off the suit and glove. Medical workers must change gloves between patients, performing thorough hand hygiene before donning a new pair. Heavy duty gloves are used whenever workers need to handle infectious waste.
A waterproof apron is placed on top of the overalls as a final layer of protective clothing.
Ebola health workers typically wear rubber boots, with the scrubs tucked into the footwear. If boots are unavailable, workers must wear closed, puncture and fluid-resistant shoes.