The Texas nurse who contracted Ebola while caring for a dying Liberian man repeatedly visited his room from the day he was admitted to the intensive care unit until the day before he died, medical records show.

Nurse Nina Pham and other health-care workers wore protective gear, including gowns, gloves, masks and face shields — and sometimes full-body suits — when caring for Thomas Eric Duncan, but the 26-year-old Pham became the first person to contract the disease within the United States.

U.S. health officials on Monday urged hospitals to "think Ebola" and launched a review of procedures for treating infected patients, while the World Health Organization called the outbreak "the most severe, acute health emergency seen in modern times."

Pham's family told WFAA-TV in Dallas on Monday that she was the health care worker with Ebola. A rector at her family's church, Hung Le, told The Associated Press that Pham's mother told him Pham has the virus.

70 hospital staff cared for Ebola victim

Pham was among about 70 hospital staffers who were involved in Duncan's care after he was hospitalized, according to the records.


Centers for Disease Control and Prevention Director Tom Frieden said he would not be surprised if another Texas hospital worker becomes ill. (The Associated Press)

The Texas Christian University nursing school graduate was monitoring her own temperature and went to the hospital Friday night as soon as she discovered she was running a low fever. She is in isolation and in stable condition, health officials said.

By Monday evening, she had received a transfusion of plasma from Kent Brantly, a Texas doctor who survived the virus, according to her pastor and the non-profit medical mission group Samaritan's Purse. Brantly, an aid worker in Liberia, was flown back to the U.S. and treated with the experimental drug ZMapp at Emory University Hospital in Atlanta. Another American doctor who contracted Ebola in Liberia, Phil Sacra, received two blood transfusions from Brantly as part of a treatment program at the Nebraska Medical Center that allowed him to recover from the virus.

Public-health authorities have since intensified their monitoring of other Dallas hospital workers who cared for Duncan.

Centers for Disease Control and Prevention Director Tom Frieden said he would not be surprised if another hospital worker who cared for Duncan becomes ill because Ebola patients become more contagious as the disease progresses. Pham's name appears frequently throughout the hundreds of pages of documents in Duncan's medical records, provided to The Associated Press by his family. They show she was in his room Oct. 7, the day before he died.

Progress reports note he had loose, watery stool and nurses had difficulty inserting a needle at one point. Pham's notes also describe nurses going in and out of Duncan's room wearing protective gear to treat him and to mop the floor with bleach.

She also notes how she and other nurses were ensuring Duncan's "privacy and comfort," and providing "emotional support."

Nature of protocol breach unknown

Frieden has said a breach of protocol led to the nurse's infection, but officials are not sure what went wrong. Pham has not been able to point to any specific breach.

The CDC now is monitoring all hospital workers who treated Duncan and planned to "double down" on training and outreach on how to safely treat Ebola patients, Frieden said.


This 2010 photo shows Nina Pham, 26, who became the first person to contract Ebola within the United States. (Courtesey of Press)

A CDC spokeswoman said the agency reviewed the medical records with Duncan's care team and concluded that the documents were not helpful in identifying those who interacted directly with the patient.

"This is not something we can afford to experiment with. We need to get this right," said Ruth McDermott-Levy, who directs the Center for Global and Public Health in Villanova University's College of Nursing.

Health officials have relied on a "self-monitoring" system when it comes to U.S. health-care workers who care for isolated Ebola patients and wear recommended protective equipment. They expect workers to report any potential exposures to the virus and watch themselves for symptoms.

Besides the workers, health officials continue to track 48 people who were in contact before Duncan was admitted to the hospital and placed in isolation. They are monitoring one person the nurse was in contact with while she was in an infectious state.

None has exhibited symptoms, Frieden said.

The case involving Pham raised questions about assurances by American health officials that the disease will be contained and that any U.S. hospital should be able to treat it.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases was asked on ABC's Good Morning America if federal health authorities should consider requiring that Ebola patients be sent only to highly specialized "containment" hospitals.

"That is something that should be seriously considered," Fauci said.

Duncan, who arrived in the U.S. from Liberia Sept. 20, first sought medical care for fever and abdominal pain Sept. 25. He told a nurse he had travelled from Africa, but he was sent home. He returned Sept. 28 and was placed in isolation because of suspected Ebola.

CDC investigating protective gear removal

Among the things the CDC will investigate is how the workers took off protective gear, because removing it incorrectly can lead to contamination. Investigators will also look at dialysis and intubation — the insertion of a breathing tube in a patient's airway. Both procedures have the potential to spread the virus.

Fauci said on CNN that the CDC is examining procedures like dialysis to see if they "heighten greatly" the risk of health care workers contracting Ebola. He suggested that in cases where the patient has deteriorated to the point where he or she cannot be saved, such high-risk procedures should not be done.


A hazmat worker finishes up cleaning outside an apartment building of a Texas health care worker who has tested positive for Ebola and is in stable condition. (LM Otero/Associated Press)

Every emergency room needs to be prepared to take action because no one can control where an Ebola patient might show up, said Dr. Dennis Maki, University of Wisconsin-Madison infectious disease specialist and former head of hospital infection control.

However, only large hospitals such as those affiliated with major universities truly have the equipment and manpower to deal with Ebola correctly, Maki said.

Health-care workers treating Ebola patients are among the most vulnerable, even when wearing protective gear.

More than 370 health care workers in West Africa have fallen ill or died since the epidemic began earlier this year.

Ebola has killed more than 4,000 people, mostly in the West African countries of Liberia, Sierra Leone and Guinea, according to WHO figures published last week.

The virus spreads through close contact with a symptomatic person's bodily fluids, such as blood, sweat, vomit, feces, urine, saliva or semen.


  • A previous version of this story stated that nurse Nina Pham was in the patient's room the day before he died on Oct. 13. In fact, she was in the room on Oct. 7, before the patient's death the next day.
    Oct 14, 2014 11:54 AM ET